Polycystic Ovary Syndrome-Related Infertility Based on the Theory of“Liver and Kidney Homology”

Polycystic ovary syndrome(PCOS)is an endocrine disorder caused by hypothalamic-pituitary-ovarian(HPO)axis dysfunction.In the field of gynecology and reproduction,PCOS has emerged as both a research hot spot and a challenging area of study.According to Chinese medicine,this disease is related to kidney deficiency,phlegm and dampness obstruction,blood stasis and interconnection,Chong pulse impassability,the lack of Ren pulse,and the loss of uterine nourishment,all of which affect the normal development and maturation of eggs as well as the duration at which menstrual blood stores.In this paper,based on the theoretical basis of“liver collects blood,regulates the flow of qi,and is the master of drainage,”we explore the rationality of the treatment of this disease from the perspective of“liver and kidney have the same origin”and the development of PCOS-related infertility in relation to dysfunctional internal organs.We also explore the feasibility of treatment from the perspective of“liver and kidney homology,”expand the ideas for treatment,as well as develop and innovate the application of organ identification in PCOS in relation to infertility.

Clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome

Objective:To study the clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome (PCOS) and evaluate the the rate of ovulation and pregnancy.Method:Selecting 100 infertility patients with obesity-type PCOS, then they were randomly divided into control group (n=80) and observation group (n=80). The control group patients were given metformin+ under the diaphragm by stasis soup, the observation group were given metformin + exenatide + point thread-embedding, they were treated 3 months. Before and after treatment, we observed the changes of body mass index (BMI), waist-to-hipratio (WHR), fasting plasma glucose (FBG), 2-hour postprandial blood glucose (2hPBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma insulin (FINS), follicule-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, estrogen (E2), and testosterone (T). At last, we assessed the rate of ovulation and pregnancy.Results: After the treatment, the FBG, 2hPBG, TC, LDL-C, TG, BMI, WHR, HOMA-IR, FINS, LH, LH/FSH, E2, and T were lower than before treatment in both groups, and the difference had statistical significance, and the observation group were lower than control group, and the difference had statistical significance;the HDL-C and FSH were higher than before treatment in both groups, and the difference had statistical significance, and the observation group were higher than control group, and the difference had statistical significance. The rate of ovulation and pregnancy in the observation group were higher than control group, and the difference had statistical significance.Conclusions:Under the diaphragm by stasis soup combinated with point thread-embedding can improve the metabolize of carbohydrate and lipid, and the abnormity of sex hormones, through this process, the rate of ovulation and pregnancy can be raised.

Probiotics supplementation for management of type Ⅱ diabetes risk factors in adults with polycystic ovarian syndrome: a meta-analysis of randomized clinical trial

This meta-analysis of randomized controlled trials aimed to evaluate the effects of probiotic supplementation on glucose homeostasis in patients with polycystic ovary syndrome(PCOS).The meta-analysis was performed in accordance with the Cochrane Handbook guidelines and relevant the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement criteria.Of 825 identified reports,11 randomized clinical trials were included in the meta-analysis.An analysis of pooled extracted data revealed that supplementation with probiotics significantly decreased fasting blood glucose(FBG,n=7;standardized mean difference(SMD)=−0.40;95%confidence interval(CI):−2.02,−0.02;P=0.04)and insulin levels(n=6;SMD=−0.57;95%CI:−0.89,−0.25;P=0.0004)and the homeostatic model assessment of insulin resistance(n=7;SMD=−0.64;95%CI:−0.96,−0.31;P=0.0001)while increasing the quantitative insulin sensitivity check index(QUICKI,n=5;SMD=0.58;95%CI:0.08,1.09;P=0.02)in patients with PCOS.The FBG-reducing effect decreased as the baseline body mass index(BMI)and mean age of the participants increased.Indeed,a greater number of bacterial species and a higher bacterial dose were shown to reduce QUICKI effectively.The systematic review indicated that probiotic supplementation may help to control glucose homeostasis in adults with polycystic ovarian syndrome.

Correlation between IL-1β,IL-1Ra gene polymorphism and occurrence of polycystic ovary syndrome infertility

Objective:To explore the relationship between IL-1β.IL-1Ra gene polymorphism and the occurrence of polycystic ovary syndrome(PCOS) infertility.Methods:A total of 59 PCOS infertility cases visiling the reproductive center of our hospital from Mar.2010 to Mar.2012 and 56 healthy women were selected.ELISA method was used lor the detection of IL-1β.IL-1Ra lewis,and the levels of serum supersensitivity C reaction protein(US-CRP).insulin(FINS),follieule-stimulating hormone(FSH) and fasting blood—glucose(FRG) were detected.PCR analysis technology was adopted to detect the gene polymorphism of the.511 site of IL-1βand the second introne of IL- 1Ra.Results:The levels of IL-1β.IL-1Ra.US-CRP.FINS and FBG in blood scrum of patients in PCOS group were significantly higher than those in control group(P【0.05 or P【0.01).The level of FSH in PCOS group was significantly lower than that in control group(P【0.05).The genotypic frequency of T/T.the 511 site of IL-1βin PCOS group was 42.37%.significantly higher than 1250%in control group 【P【0.01).The frequency of T allele was also significantly higher than that in control group(P【0.01).The genotypic frequency ofⅠ/Ⅴ.the second introne of IL-1Ra in PCOS group was 20.34%,signicianlly higher than 3.57%in control group(P【0.05).The frequency of V allele in PCOS group was significantly higher than that in control group(P【0.05).Conclusions: T allele of the 511 site of IL-1βgene and V allele of the second inlrone of IL-1Ra gene might be the genetic basis of the rising of IL-1β.IL-1Ra and US-CRP levels in blood serum of PCOS patients,and are associated with the infertility occurrence of PCOS patients.

Exploring new treatment options for polycystic ovary syndrome: Review of a novel antidiabetic agent SGLT2 inhibitor

Polycystic ovary syndrome(PCOS)is the most common endocrinopathy in women of reproductive age associated with long-term metabolic and cardiovascular consequences.A plethora of symptoms and their severity differentiate on an individual level,giving the syndrome numerous phenotypes.Due to menstrual cycle abnormalities,women suffer from irregular menstrual bleeding,difficulty in conception,and infertility.Furthermore,the risk of pregnancy complications such as gestational diabetes mellitus,hypertensive disorders of pregnancy,and preterm birth are higher in women with PCOS than in the general population.Often,women with PCOS have comorbidities such as dyslipidemia,obesity,glucose intolerance or diabetes type 2,non-alcoholic fatty liver disease,and metabolic syndrome,which all influence the treatment plan.Historic insulinsensitizing agents,although good for some of the metabolic derangements,do not offer long-term cardiovascular benefits;therefore,new treatment options are of paramount importance.Sodium-glucose co-transporter-2(SGLT-2)inhibitors,a new class of antidiabetic agents with beneficial cardiovascular,bodyweight,and antihyperglycemic effects,although not approved for the treatment of PCOS,might be an attractive therapeutic addition in the PCOS armamentarium.Namely,recent studies with SGLT-2 inhibitors showed promising improvements in anthropometric parameters and body composition in patients with PCOS.It is important to further explore the SGLT-2 inhibitors potential as an early therapeutic option because of the PCOS-related risk of metabolic,reproductive,and psychological consequences.

Management strategy of infertility in polycystic ovary syndrome

Polycystic ovary syndrome(PCOS)is the most common endocrine and metabolic disease in women of reproductive age.PCOS is characterized by ovulatory disruption,which can lead to infertility.Patients with PCOS are also more likely to have poor pregnancy outcomes.For obese women,lifestyle interventions are recommended first,which have general health benefits.For women who have difficulty changing their lifestyle,drugs for the treatment of obesity or bariatric surgery could be considered.Clomiphene citrate is the first-line medication after weight loss that has been utilized in the past.Letrozole is supplanting clomiphene as the best option for ovulation induction for now,particularly in patients with PCOS.Metformin can improve ovulation and pregnancy rates;however,it has minimal effects in terms of raising live birth rates.Second-line therapies include gonadotropins and laparoscopic ovary drilling.In vitro fertilization can be utilized as a third-line treatment for patients with PCOS who have failed ovulation induction therapy or have other infertility factors.In summary,to achieve fertility,patients with PCOS require standardized individualized therapy.

Higher risk of type 2 diabetes in young women with polycystic ovary syndrome: A 10-year retrospective cohort study

BACKGROUND Polycystic ovary syndrome(PCOS)is a common disorder in women of reproductive age.Over the last few decades,research studies have revealed that PCOS is strongly associated with metabolic disorders,including metabolic syndrome,obesity,insulin resistance and prediabetes.Clinical observation has shown that women with PCOS are expected to have an increased risk of developing type 2 diabetes(T2DM)in the future.AIM To assess the hazard ratio(HR)of T2DM between women with/without PCOS.METHODS This population-based,retrospective cohort study evaluated data retrieved from the National Health Insurance Research Database.The subjects were women with PCOS(n=2545)identified on the basis of diagnosis,testing,or treatment codes,and women without PCOS as controls(n=2545).The HR of T2DM between women with or without PCOS was the main outcome measure analyzed.RESULTS Our study found that, during a 10-year follow-up period, the overall incidence of T2DM was 6.25per 1000 person-years in the PCOS group compared with 1.49 in the control group. Afteradjustment for potential confounding variables, the overall incidence of T2DM was higher in thePCOS group vs the control group (HR = 5.13, 95%CI: 3.51-7.48, P < 0.0001). The risk of developingT2DM subsequent to PCOS decreased with increasing diagnosis age: the adjusted HR was 10.4 inthe 18–24-year age group, 5.28 in the 25-29-year age group, and 4.06 in the 29-34-year age group.However, no such significant association was noted in women older than 35 years.CONCLUSIONThese findings highlight the importance of prompting a more aggressive treatment to preventdiabetes in women diagnosed with PCOS at a young age, and, in contrast, the lessened importanceof this type of intervention in women diagnosed with PCOS at a late reproductive age.

Endometrial Thickness as a Predictor of Endometrial Hyperplasia in Infertile Patients with Polycystic Ovary Syndrome

Background: Women with polycystic ovary syndrome (PCOS) are at higher risk of developing endometrial hyperplasia (EH). This study determined the prevalence of EH among women with infertility due to PCOS and assessed the predictive value of endometrial thickness (ET) measurement by trans-vaginal scan (TVS). Study Type & Population: This was a prospective study on infertile women with and without PCOS in which clinical data, hormonal profile, ET and endometrial biopsy (EB) for histopathological examination were collected. Methods: Thirty-seven women with PCOS and 23 women without PCOS presenting with infertility and/or abnormal uterine bleeding underwent TVS, hysteroscopy, laparoscopy and EB. Results: The overall prevalence of EH was 23.3 % while in PCOS group: 18.3 %. The mean ET (14.8 mm) was significantly higher in patients with EH (t = -2.74, P value = 0.009). The lower value of ET among women with EH was 10 mm. A cut-off point of 9.5 mm was set. An ET of >9.5 mm had 92.9% sensitivity and 51.85% specificity for the presence of EH. Women with ET ≥ 9.5 mm were 1.28 times more at risk of EH than women with ET 9.5 mm. Women with oligomenorrhea and irregular cycles were 5.5 and 13.7 times more at risk of EH compared to those with regular cycles, respectively. ET was positively correlated with insulin resistance (r = 0.439, P = 0.007). Conclusion: ET ≥ 9.5 mm predicts EH in infertile women with PCOS, with a high degree of sensitivity and a moderate degree of specificity. In PCOS patients with oligomenorrhea or irregular cycles, the risk of EH is higher than women with regular cycles.

Use of metformin during pregnancy for women with polycystic ovary syndrome

Objective: The purpose of this article is to review the literature assessing foetal and maternal pregnancy outcomes in women with PCOS who used metformin during pregnancy. Study Design: A literature search was conducted using MEDLINE, with analysis of 25 studies that recorded neonatal and maternal outcomes in women who used metformin during pregnancy. The outcomes assessed in this review include congenital deformities, miscarriages, preterm labour, gestational diabetes (GDM) and pregnancy induced hypertension (PIH). Results: We found that the use of metformin throughout pregnancy correlated with decreased rates of preterm labour, GDM and PIH. Conflicting evidence exists over whether metformin use during pregnancy reduced miscarriage rates. The use of metformin during pregnancy did not increase teratogenicity risks. Conclusion: The use of metformin throughout pregnancy is associated with decreased rates of preterm labour, GDM, and PIH. However, more randomised controls involving larger numbers of participants are required for more definitive results.

The Effect of Insulin Resistance on In-Vitro Fertilization-Embryo Transfer in Women without Polycystic Ovary Syndrome

Purpose: Insulin resistance (IR) plays an important role in the pathogenesis of polycystic ovary syndrome (PCOS);therefore, insulin-sensitizing agents are widely used to improve IR in women with PCOS. However, whether IR in patients without PCOS should be treated remains uncertain. This study aims to clarify whether IR in patients without PCOS affects the outcomes of in-vitro fertilization-embryo transfer (IVF-ET) and pregnancy. Methods: Between January 2011 and December 2013, we retrospectively reviewed the medical records of 116 non-PCOS patients who underwent the first IVF–ET cycle. IR was calculated using the homeostasis model assessment (HOMA) index [HOMA-IR = (insulin × glucose)/405]. A HOMA index of >2.5 was used to indicate IR. Based on the HOMA index calculation, 28 patients were IR(+) and 88 patients had normal insulin sensitivity. We retrospectively compared the response with controlled ovarian hyperstimulation, retrieved oocytes number, fertilization rates, pregnancy rate, live birth rates, and gestational diabetes mellitus (GDM) incidence. Results: There were no significant differences in human menopausal gonadotropin administration, peak estradiol, retrieved oocyte number, fertilized embryo number, good quality embryo number, implantation rate, clinical pregnancy rate, miscarriage rate, delivery rate, or ovarian hyperstimulation syndrome and GDM incidences between the groups. Conclusion: IR in non-PCOS patients has no effect on IVF-ET outcomes or perinatal prognosis.

Mental Health Status Assessment in Polycystic Ovarian Syndrome Infertility Patients: A Pilot Study

Polycystic ovary syndrome（PCOS） is a major endocrine disorder afflicting women of reproductive age. Women with PCOS are more likely to suffer from mental health disturbances than healthy women. The ＂infertility＂ suffered by PCOS patients would also lead to mental health disturbances. Symptom Checklist 90（SCL-90） and questionnaire which includes patients＇ socio-economic and demographic data were used to assess the mental health status of PCOS（n=103） and non-PCOS（n=110） infertile patients. Logistic regression analysis and t-tests were used for comparative analysis. The data demonstrated that scores of depression, interpersonal sensitivity, obsessive-compulsive, and hostility symptoms in PCOS infertile patients were significantly higher than those in the non-PCOS infertile patients（P〈0.05）. Logistic regression analysis revealed that acne had negative effect on mental health status（P〈0.05）. Secondary infertile PCOS patients were more easily to suffer from somatization, interpersonal sensitivity, obsessive-compulsive, anxiety, hostility and paranoid ideation symptoms than the primary infertile PCOS patients（P〈0.05）. The results suggested that the PCOS patients especially the secondary infertile PCOS patients had obvious mental health disturbances. The acne might play an importance role in the occurrence of mental health disturbances in PCOS patients. PCOS related symptoms may be risk factors of mental health status in PCOS patients with infertility. More attention should be paid to the PCOS infertile patients, and mental health therapy should be considered if necessary.

Assessing and treating insulin resistance in women with polycystic ovarian syndrome

Polycystic ovarian syndrome(PCOS) is a highly prevalent hormonal and metabolic disorder among reproductive aged women worldwide.Women with PCOS have widely varying phenotypes and seek medical care for differing reasons.In addition to concern for menstrual cycle function,ovulation,hirsutism and acne,many PCOS women have abnormal glucose metabolism.While diabetes mellitus and impaired glucose tolerance are easily diagnosed,the diagnosis of and concern for insulin resistance as a precursor disorder is underappreciated.Insulin resistance may be the first important marker of metabolic disease in PCOS women at risk for metabolic syndrome and coronary artery disease.

Polycystic ovary syndrome and type 2 diabetes mellitus:A state-ofthe-art review

Polycystic ovary syndrome(PCOS)often coexists with a wide spectrum of dysglycemic conditions,ranging from impaired glucose tolerance to type 2 diabetes mellitus(T2D),which occur to a greater extent compared to healthy body mass index-matched women.This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities,such as insulin resistance.However,due to methodological flaws in the available studies and the multifaceted nature of the syndrome,there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated.The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS,the unique pathophysiological mechanisms underlying the progression of dysglycemia,the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population,as well as T2D risk after transition to menopause.Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided.Specifically,adoption of a healthy lifestyle with adherence to improved dietary patterns,such the Mediterranean diet,avoidance of consumption of endocrine-disrupting foods and beverages,regular exercise,and the effect of certain medications,such as metformin and glucagon-like peptide 1 receptor agonists,are discussed.Furthermore,the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.

Integrative techniques using acupuncture,Chinese herbal medicine,diet,and supplements for polycystic ovary syndrome:a case report

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.

Endocrine Indices of PCOS in Women with Polycystic Ovaries but without Diagnostic Features of PCOS: A Study of an Infertility Clinic Population

Background: The presence of polycystic ovarian morphology (PCO) without the other characteristics of the polycystic ovarian syndrome (PCOS) is insufficient for the diagnosis of PCOS and there is little justification for follow up in endocrine clinics for women with PCO morphology alone. A few studies have been reported regarding the endocrine features of asymptomatic women with PCO with conflicting data about endocrine profiling. The aim of this study was to assess whether women with PCO, but who have no symptoms of PCOS differ, endocrinologically, from women with normal ovaries.?Methods: We analysed the results of ultrasound and endocrine investigations in 576 consecutive women who attended the infertility clinic between 1993 and 1995 at the Reproductive Medicine Unit of St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK. Results: Three hundred and twenty eight women had PCO and 248 had normal ovaries. Among the 328 women with PCO, 169 (51.5%) had PCOS according to Rotterdam criteria. The remaining women with PCO had no symptoms of the syndrome (n = 159);they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism. However, these women had higher timed LH [median (IQR) 5.3 (4.2) IU/l vs 4.8 (3.4) IU/l, respectively;p = 0.044] and testosterone [2.0 (0.8) nmol/l vs 1.8 (0.8), respectively;p = 0.009] compared with women with normal ovaries (although by definition within the normal range). There was no difference in BMI or FSH between the two groups. Among the 169 women with PCOS, 45.0% (n = 76) were anovulatory without hyperandrogenism, 34.3% (n = 58) fulfilled the NIH criteria and 20.7% (n = 35) were ovulatory with hyperandrogenism. The proportion of hyperandrogenism among anovulatory women with PCO is 43.3% (58 out of 134).?Conclusions: Women with PCO, but no symptoms of the syndrome, differ endocrinologically compared with women with normal ovaries: they had higher timed LH and testosterone (although by definition within the normal range). These data suggest that despite the lack of symptoms of PCOS, women presenting to an infertility clinic with PCO represent a milder phenotype of those with overt PCOS, but fall on the same spectrum.

Polycystic Ovary Syndrome (PCOS) and Fertility

The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.

Polycystic Ovarian Syndrome and Female Infertility

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, associated with chronic anovulation and hyperandrogenism. The cause of PCOS is multi-factorial and the mechanism is still unclear. A number of complications are closely related with PCOS such as infertility, hairy and obesity. Approximately up to one-third of females with PCOs have issues with infertility. Obesity is an independent factor which exacerbates infertility in PCOS, reduces the efficacy of infertility treatment and provokes a greater risk of miscarriage. Preconception counseling and guidelines play an initial major role in infertility treatment. The option of the most appropriate treatment depends upon various factors such as age, tubal patency, quality of sperm, experience, and duration of previous treatments and the level of anxiety of the couple. Tubal patency test and semen analysis are mandatory to decide the suitable treatment. Treatment modalities have two measures—non-pharmacological and the pharmacological. Oral clomiphene citrate remains the first line treatment to trigger ovulation. Gonadotrophin and laparoscopic ovarian drilling (LOD) surgery are the other treatment option. In vitro fertilization (IVF) and embryo transfer are the third line treatment and IVF remains the first option in the patient with diagnosed and established bilateral tubal occlusion and/or concentration of recovered motile sperm less than or equal to 5 million. Here, etiology, pathophysiology and molecular mechanisms of PCOS are reviewed, and perspectives are given for further research. The recent development, treatment, and diagnosis of PCOS are also highlighted. The summary will be of guiding significance in the prevention and treatment of PCOS.

Clinical effectiveness of the various approaches for infertility treatment in women with PCOS and hyperprolactinemia

【Objective】To evaluate the clinical efficiency of different treatments cancellation and infertility in women with PCOS and hyperprolactinemia.【Method】We performed retrospective analysis of 502consecutive case histories during 5 years of reproductive results of treatment of women is with anovulatory infertility,caused by different factors.Aim of the study was to determine the efficiency of conservative and surgical treatment.【Result】Differentiated application of conservative medical therapy allows to attain the effect of proceeding in a fertile function in 33,8%of patients.It is found that surgical induction of ovulation by ovarian laparoscopic partial degradation is an option in the management of female infertility associated with PCOS,especially as a second-line treatment after the failure of clomiphene citrate treatment,enhancing the efficiency of complex infertility treatment to 40%.【Conclusions】It is feasible to develop an algorithm differentiated use of infertility treatments in women with PCOS and hyperprolactinemia.

Association of sleep characteristics and night shift work with self-reported diagnosis of polycystic ovary syndrome:a questionnaire-based cross-sectional study

Objective:To examine the association between sleep characteristics and night shift work and the risk of polycystic ovary syndrome(PCOS)in Chinese women and to investigate their relationship with infertility in PCOS.Methods:From March 21,2021 to April 31,2021,3927 Chinese women with or without PCOS were recruited online.All participants completed WeChat-based electronic questionnaires.Sleep characteristics were measured using the Pittsburgh sleep quality index.Results:A total of 2871 women were included in the final analysis.Sleep duration(odds ratio[OR],0.857;95%confidence interval[CI],0.763-0.963),sleep midpoint(OR,1.142;95%CI,1.049-1.244),sleep disturbance(OR,1.320;95%CI,0.957-1.146),daytime dysfunction(OR,1.136;95%CI,1.030-1.253),and night shift work(OR,1.628;95%CI,1.264-2.097)were associated with a higher risk of PCOS.After adjusting for confounders,including age,body mass index,smoking status,and coffee and tea drinking status,sleep disturbance(OR,1.314;95%CI,1.111-1.555),daytime dysfunction(OR,1.143;95%CI,1.034-1.264),and night shift work(OR,1.800;95%CI,1.388-2.333)remained associated.In addition,sleep disturbance(OR,1.887;95%CI,1.400-2.542)and subjective sleep quality(OR,1.299;95%CI,1.037-1.627)were associated with infertility in women with PCOS,and sleep disturbance(OR,1.750;95%CI,1.281-2.390)remained significant after adjusting for confounders.Conclusions:Sleep disturbance,daytime dysfunction,and night shift work are significantly associated with PCOS.Screening for sleep disturbances and providing appropriate treatment could be potential strategies for managing PCOS and its long-term complications.

Gestational Diabetes and Infertility

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications which affect the mother and offspring. In addition to adverse perinatal outcomes, it may lead to permanent health problems for the mother, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), while increasing the risk of future obesity, CVD, T2DM and GDM in the child. Approximately 15% of women seek fertility treatment. Over the last decade, it has come to attention that patients with an infertility history are more prone to having GDM during their pregnancies, and this review examines the relationship between GDM and infertility. The elevated estrogen, progesterone, leptin, placental lactogen and growth hormone are the main reasons for increased insulin resistance during pregnancy. Despite some confounding factors in the mechanism of GDM in patients with an infertility history, infertility treatment increases the risk, according to numerous studies. The obesity epidemic and associated disorders have become a significant public health concern worldwide. Lifestyle modification for weight loss before pregnancy is encouraged, but there is no strong evidence for improvement in perinatal results. GDM, infertility and infertility treatment have a potential risk of alteration in the embryo’s environment and cause epigenetic reprogramming, which may be inherited to the next generation. The fertility treatment impacts the patient’s and offspring’s health. Patients should be informed about the risks so that they consent and get involved in the decision. Infertility treatment may be accepted as a reason for high-risk pregnancy, and patients can be screened for GDM in early pregnancy.