Association between the Different Phenotypes of Polycystic Ovary Syndrome and the Outcome in in Vitro Fertilization at Human Reproductive Center Paul et Chantal Biya-Yaoundé

Background: In Vitro Fertilization/Intracytoplasmic Sperm Injection (IVF/ICSI) represents the final step in the management of Polycystic Ovarian Syndrome (PCOS). Our objective was to study the association between PCOS phenotypes and IVF/ICSI results in women admitted to Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital (CHRACERH). Material and Method: We carried out a cohort study with historical-prospective data collection over a period of seven years (January 2016 to March 2023) at Chracerh. PCOS patients were subdivided into 4 subgroups A, B, C and D. Results: We recruited 128 patients including 64 PCOS patients divided into four phenotypes and 64 non-PCOS patients constituting the control group. Phenotype D without hyperandrogenism had used the lowest dose of gonadotropins, i.e. 1939.7 ± 454.3 IU, and had produced a greater quantity of estradiol on the day ovulation was triggered (6529.8 ± 4324.8 ng/ml). The average number of punctured follicles and mature oocytes were higher in the phenotype D group. Ovarian hyperstimulation syndrome (OHSS) occurred mainly in phenotype D (3/35), with an estimated prevalence of 2.3%. The fertilization rate seemed lower in the hyperandrogenic phenotypes A, B, C compared to the group without hyperandrogenism without significant difference (p = 0.461). The biological pregnancy rate and live birth rate were comparable between the different groups. Conclusion: Phenotype D used less dose of gonadotropins. Biological pregnancy and live birth rates were comparable between the different phenotypes.

Randomized controlled trial of Letrozole versus Clomiphene citrate for induction of ovulation in polycystic ovarian syndrome (PCOS): A Malaysian experience

Background: The purpose of this study was to compare the effectiveness of Letrozole versus Clomiphene citrate for ovulation induction in polycystic ovarian syndrome (PCOS) with infertility. Methods: This was a prospective randomized trial involving 150 women with PCOS attending the Infertility Clinic at three hospitals in Malaysia. During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (75 patients) or 100 mg Clomiphene citrate daily (75 patients) from the fifth until the ninth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The subjects were homogenously distributed. The difference between Letrozole and Clomiphene citrate for ovulation rate was 59 (78.7%) versus 40 (53.3%). Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of9.2 mm(SD ± 2.3) versus8.4 mm(SD ± 2.2) for patients taking Clomiphene citrate, and these differences were statistically significant

Hormonal Imbalance in Polycystic Ovarian Syndrome (Pcos) in Teaching Hospitals in Ekiti State, Nigeria

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women at reproductive age and the major cause of anovulatory infertility. The aim of this study is to determine hormonal imbalance in women with PCOS in teaching hospitals in Ekiti State, Nigeria. Samples of 110 females (50 freshly diagnosed PCOS subjects and 60 healthy subjects) between the ages of 25 - 45 years old were collected from Ekiti State University Teaching Hospital, Ado Ekiti and Federal Teaching Hospital, Ido Ekiti, Ekiti State, Nigeria. Serum Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Total Testosterone, Prolactin, Progesterone, Estradiol and Insulin were evaluated in subjects’ blood sample using Enzyme-Linked Immunosorbent assay (ELISA). Results obtained were subjected to statistical analysis (p < 0.05). The PCOS subjects showed significant increase (p < 0.05) in the concentrations of Total Testosterone, Insulin, LH, Estradiol and LH/FSH ratio, while FSH and progesterone concentrations showed significant decrease (p < 0.05) in comparison with the healthy control group. However, there was no significant difference in the concentration of Prolactin when compared with the healthy control group. Also, the PCOS subjects’ age at Menarche was significantly decreased (p > 0.05) when compared with the healthy control group. Hormonal values obtained in this study indicates hormonal imbalance in PCOS. Further investigation into novel helpful markers is required as it might help in achieving the therapeutical target in PCOS management research.

A novel herbal combination ameliorates ovarian dysfunction and regulates altered biochemical parameters in rats with letrozole-induced polycystic ovary syndrome

Objective:To investigate the potential activity of novel herbal combination and novel herbal formulation(syrup)in female Sprague Dawley rats with letrozole-induced polycystic ovary syndrome(PCOS).Methods:Forty-two rats were randomly divided into seven groups with six rats in each group.Group 1 received 0.5%carboxy methylcellulose orally for 37 days and served as the normal control group.Group 2 was orally administered with letrozole of 1 mg/kg for 21 days and served as the PCOS induction group without treatment.Group 3 to 7 were administered with letrozole of 1 mg/kg for 21 days orally to induce PCOS,and then respectively received clomiphene citrate at 1 mg/kg,100 and 200 mg/kg of novel herbal combination,200 mg/kg of novel herbal formulation(syrup),and 400 mg/kg of marketed formulation of Pushyanuga churna,once daily for 15 days.Effects of the novel herbal combination and its syrup formulation were evaluated on the hormonal profile,the levels of antioxidants,the lipid profile and on the ovarian morphology,using letrozole-induced PCOS model in rats.Results:Letrozole caused alterations in hormonal levels and lipid levels similar to PCOS and ovarian histology showed presence of ovarian cysts confirming the induction of PCOS in rats.On treatment with the novel herbal combination and its syrup formulation in PCOS-induced rats,the altered hormonal and lipid profiles showed significant recovery to normal levels.Ovarian histology confirmed the restoration of folliculogenesis in the PCOS-induced rats.The treatment with the syrup formulation of novel herbal combination was found to be more effective than novel herbal combination and showed better recovery in various parameters evaluated.The results of the study,however,suggested that treatment with novel herbal combination and its syrup formulation provided minimal protection against oxidative stress caused due to the induction of PCOS.Conclusions:The integrated approach for management of PCOS is to counterbalance the limitations associated with modern therapy.Both the novel herbal combination and the syrup formulation of novel herbal combination show efficacy in the management of PCOS in rats and restore folliculogenesis in the ovary.The syrup formulation of novel herbal combination is most effective in the management of PCOS and shows potential to be developed as an adjuvant therapeutic agent.

Automatic Diagnosis of Polycystic Ovarian Syndrome Using Wrapper Methodology with Deep Learning Techniques

One of the significant health issues affecting women that impacts their fertility and results in serious health concerns is Polycystic ovarian syndrome(PCOS).Consequently,timely screening of polycystic ovarian syndrome can help in the process of recovery.Finding a method to aid doctors in this procedure was crucial due to the difficulties in detecting this condition.This research aimed to determine whether it is possible to optimize the detection of PCOS utilizing Deep Learning algorithms and methodologies.Additionally,feature selection methods that produce the most important subset of features can speed up calculation and enhance the effectiveness of classifiers.In this research,the tri-stage wrapper method is used because it reduces the computation time.The proposed study for the Automatic diagnosis of PCOS contains preprocessing,data normalization,feature selection,and classification.A dataset with 39 characteristics,including metabolism,neuroimaging,hormones,and biochemical information for 541 subjects,was employed in this scenario.To start,this research pre-processed the information.Next for feature selection,a tri-stage wrapper method such as Mutual Information,ReliefF,Chi-Square,and Xvariance is used.Then,various classification methods are tested and trained.Deep learning techniques including convolutional neural network(CNN),multi-layer perceptron(MLP),Recurrent neural network(RNN),and Bi long short-term memory(Bi-LSTM)are utilized for categorization.The experimental finding demonstrates that with effective feature extraction process using tri stage wrapper method+CNN delivers the highest precision(97%),high accuracy(98.67%),and recall(89%)when compared with other machine learning algorithms.

Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome

BACKGROUND Insulin resistance(IR)was reported in most polycystic ovarian syndrome(PCOS)cases.Metformin,a biguanide drug,successfully reduced IR.Homeostatic Model Assessment for IR(HOMA-IR)and Doppler parameters assessed metformin's effectiveness.AIM To verify whether the area under the curve of the internal carotid artery(AUC-ICA)Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.METHODS An observational,cross-sectional study recruited 54 eligible PCOS women;the anthropometrics were as follows:age,body mass index(BMI),menstrual cycle days,biochemical serum cholesterol,low and high-density lipoprotein,sex hormone-binding globulin,fasting blood glucose,and HOMA-IR,hormonal testosterone,luteinizing hormone over follicle-stimulating hormone ratio,and ultrasonic pulsatility index(PI)and resistance index(RI),carotid artery intima-media thickness(CIMT)and(AUC-ICA)parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg;three times/day for 6 mo.In addition,AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.RESULTS Metformin caused a progressive reduction in BMI,menstrual cycle days,biochemical hormonal,and Doppler parameters(CIMT,PI,RI,and AUC-ICA).AUC-ICA correlated strongly to all PCOS parameters.AUC-ICA correlated inversely with treatment time(r=-0.98,P<0.001)and positively with HOMA-IR(r=0.98,P<0.0001).Via the best subset regression model,the AUC-ICA had the highest predictive value for HOMA-IR.CONCLUSION AUC-ICA preceded PI,RI,and CIMT with a strong,meaningful correlation to all PCOS parameters,making it a reliable marker for the assessment of IR,especially during metformin therapy.Further studies are recommended to promote the application in practice.

Effect of Mitochondrial Function of Ovarian Granulosa Cells on In Vitro Fertilization and Embryo Transfer Outcomes in Obese Polycystic Ovary Syndrome Patients

Objective:To investigate the effect of abnormal ovarian granulosa cell metabolism on in vitro fertilization and embryo transfer(IVF-ET)outcomes in obese polycystic ovary syndrome(PCOS)patients.Methods:Patients with PCOS who met the study criteria were screened according to the inclusion criteria.A total of 32 patients with obese PCOS were recruited into the study group,and 39 patients with non-obese PCOS were recruited into the control group.The general data(age,body mass index,and years of infertility),insulin resistance index(HOMA-IR),follicle-stimulating hormone(FSH),luteinizing hormone(LH),granulosa cell mitochondrial function,and IVF-ET outcome of patients in the study group and control group were retrospectively analyzed.Results:The differences in age and years of infertility between the study group and the control group were insignificant(P>0.05),and the body mass index(BMI)of the study group and control group was 30.5±1.24 kg/m2 and 22.3±1.12 kg/m2,respectively,in which the difference was statistically significant(P<0.05);the HOMA-IR of the study group was significantly higher than that of the control group(P<0.05);the reactive oxygen species(ROS)in the study group was significantly higher than that in the control group(P<0.05),and the ATP content in the study group was significantly lower than that in the control group(P<0.05);comparing the FSH and LH levels between the two groups,the difference was not statistically significant(P>0.05);the rate of IVF-ET failure was significantly higher in the study group than in the control group.Conclusion:PCOS is a complex endocrine disorder,and obesity is one of the independent risk factors for the development of PCOS.

穴位埋线对两种肥胖类型PCOS患者生殖指标及炎症因子的影响

目的探究穴位埋线对两种肥胖类型PCOS患者炎性因子及生殖指标的影响。方法将2020年1月—2021年1月于山东中医药大学附属医院妇科门诊诊断为多囊卵巢综合征(肾虚痰湿证)肥胖患者63例作为研究对象。将患者按照不同肥胖类型分为均匀性肥胖组(A组,WC<80cm,n=33)和腹型肥胖组(B组,WC≥80,n=31)。两组均给予穴位埋线配合炔雌醇环丙孕酮治疗,对比3个月后两组的性激素(E_(2)、T、FSH、LH),炎症因子(TNF-α、hs-CRP、APN、IL-6),卵巢功能(卵巢体积、AMH、INHB),子宫内膜容受性(子宫内膜厚度、PI、RI),并统计治疗后患者的体质量、BMI、治疗后2个月排卵率、妊娠率。结果治疗后,均匀性肥胖组(A组)和腹型肥胖组(B)组T(0.74±0.07 VS 1.05±0.13)ng/mL,LH(10.43±1.07 VS 14.08±0.95)mIU/mL,IL-6(17.84±0.36 VS 21.06±1.34)ng/L,TNF-α(16.19±1.61 VS 19.95±0.95)ng/L,hs-CRP(4.75±0.35 VS 6.66±0.27)ng/L,卵巢体积(10.7±0.64 VS 11.31±0.62)cm^(3),PI(2.33±0.10 VS 2.55±0.13),RI(0.62±0.04 VS 0.74±0.03),体质量(63.83±2.87 VS 69.47±3.29)kg,BMI(24.23±1.46 VS 26.35±1.31)kg/m^(2)均显著降低(P<0.05),且均匀性肥胖组(A组)降低明显(P<0.05)。均匀性肥胖组(A组)和腹型肥胖组(B)组APN(57.15±3.6 VS 48.16±1.52)pg/L,FSH(7.24±0.86 VS 6.66±0.81)mIU/mL,E_(2)(98.75±4.63 VS 70.19±23.61)pg/mL,子宫内膜厚度(8.95±0.22 VS 8.29±0.29)cm,AMH(8.60±0.54 VS 7.56±0.55)ng/dL均显著提高(P<0.05),且A组(均匀性肥胖组)提高明显(P<0.05)。A组(均匀性肥胖组)的排卵率为80%,高于B组(腹型肥胖组)的40%(χ^(2)=10.00,P=0.000)。A组(腹型肥胖)的妊娠率60%,高于B组(腹型肥胖组)的33.3%(χ^(2)=4.29,P=0.04)。结论穴位埋线联合炔雌醇环丙孕酮能够改善PCOS(肾虚痰湿证)肥胖患者的性激素、卵巢功能、子宫内膜容受性,其机制可能与改善机体炎症状态相关。均匀性肥胖组改善更明显。提示,穴位埋线治疗均匀性肥胖PCOS效果更好,临床应针对腹型肥胖PCOS患者特点,采取更精准的治疗措施。

黄体期长方案与拮抗剂方案在首次拮抗剂失败后PCOS患者中的应用比较

目的探讨首次拮抗剂治疗失败的多囊卵巢综合征(PCOS)患者再次超促排卵时分别采用黄体期长方案和拮抗剂方案诱导排卵的临床效果及妊娠结局的优劣。方法检索首次采用拮抗剂方案行IVF/ICSI-ET助孕失败后再次超促排卵的PCOS患者163例,根据第二次超促排卵方案,分为黄体期长方案组(共95例)和拮抗剂方案组(共68例)。回顾性分析比较两组患者的基础临床资料、临床及实验室指标及妊娠结局。结果①两组患者的基础临床指标除了LH,其他指标差异均无统计学意义。②黄体期长方案组患者自身超排卵对比,促性腺激素(Gn)启动剂量、Gn总天数、Gn总使用量、hCG注射日雌二醇(E_(2))值、获卵数、卵子成熟率、2PN受精数、2PN卵裂数、囊胚形成率、优质囊胚形成率显著高于首次拮抗剂周期(P<0.05)。拮抗剂方案组患者自身超排卵对比也观察到类似改善。③两组第二次超促排卵周期比较,黄体期长方案组Gn总天数、总用量、总费用较高(P<0.05),而hCG注射日E_(2)及LH水平、卵子成熟率显著低于拮抗剂方案(P<0.05),但两组间获卵数、2PN受精数、2PN卵裂数、囊胚形成率、OHSS率差异无统计学意义。④两组第二次超促排卵新鲜移植周期比较,黄体期长方案新鲜移植率、种植率、临床妊娠率及活产率略高,但差异无统计学意义。首次解冻周期的妊娠结局比较,拮抗剂组的生化妊娠率、临床妊娠率高于黄体期长方案组(P<0.05),但着床率、活产率、新生儿胎龄及出生体质量差异无统计学意义。结论对于首次拮抗剂方案治疗失败的患者,适当增加Gn启动剂量及用量,两种方案均能获得满意的妊娠结局。相较于黄体期长方案,再次使用拮抗剂方案保持了其优势,包括治疗周期短、成本低、患者依从性好。

血清PGC-1α水平与PCOS患者体外受精-胚胎移植妊娠结局的关系

目的探析血清过氧化物酶体增殖物激活受体γ共激活因子1α(PGC-1α)水平与多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)妊娠结局的关系。方法选取2021年1月至2022年12月于广西壮族自治区妇幼保健院接受IVF-ET治疗的99例PCOS患者作为研究对象,依据患者妊娠结局分为妊娠组(n=49)和未妊娠组(n=50)。收集并比较所有患者基线资料以及性激素、血清PGC-1α水平等。采用Logistic回归分析影响PCOS患者IVF-ET妊娠结局的危险因素;采用受试者工作特征(ROC)曲线评估血清PGC-1α水平对PCOS患者IVF-ET妊娠结局的预测价值。结果99例PCOS患者中有49例妊娠成功,妊娠成功率为49.49%。未妊娠组血清甘油三酯(TG)、睾酮(T)水平均高于妊娠组,且血清PGC-1α水平低于妊娠组,差异具有统计学意义(P<0.05)。Logistic回归分析显示,血清T、TG水平高是PCOS患者IVF-ET治疗后妊娠结局的危险因素(OR>1,P<0.05),PGC-1α水平高是PCOS患者IVF-ET治疗后妊娠结局的保护因素(OR<1,P<0.05)。绘制ROC曲线显示,血清PGC-1α水平预测PCOS患者IVF-ET妊娠结局的曲线下面积(AUC)为0.752(95%CI:0.654~0.850,P<0.05),具有一定的预测价值。当血清PGC-1α的Cut-off值为0.485 ng/mL时,预测PCOS患者IVF-ET妊娠结局的灵敏度和特异度分别为76%、67%。结论血清PGC-1α水平与PCOS患者IVF-ET妊娠结局有关,且当其水平达0.485 ng/mL时,妊娠失败风险明显增加,具有一定的预测价值,未来或可将其作为预测IVF-ET妊娠结局的辅助指标。

健脾温肾调周法结合松烟墨宝贴敷疗法治疗脾肾阳虚证型PCOS的临床价值

目的:评价健脾温肾调周法结合松烟墨宝贴敷疗法治疗脾肾阳虚证型多囊卵巢综合征(polycystic ovarian syndrome,PCOS)的临床价值。方法:选择2021年10月—2022年9月百色市人民医院诊治的60例脾肾阳虚证型PCOS患者作为研究对象,采用随机数表法将其分为治疗组和对照组,各30例。对照组给予炔雌醇环丙孕酮治疗,治疗组给予健脾温肾调周法结合松烟墨宝贴敷疗法治疗。比较两组性激素、治疗效果、不良反应及中医症状积分。结果:对照组治疗前后促卵泡激素(follicle-stimulating hormone,FSH)水平比较,差异无统计学意义(P>0.05);而对照组治疗前后黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E_(2))、睾酮(testosterone,T)水平比较,差异有统计学意义(P<0.05);治疗组治疗前后性激素水平比较,差异有统计学意义(P<0.05);治疗组治疗后FSH、LH、E_(2)、T水平改善较对照组明显,差异有统计学意义(P<0.05)。治疗组治疗总有效率为90.00%,与对照组的66.67%相比偏高,差异有统计学意义(P<0.05)。治疗组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。对照组治疗前后腰部酸软、畏寒、性欲低、体重增长、小便清长、大便稀软症状积分比较,差异无统计学意义(P>0.05);而月经紊乱、汗毛重症状积分比较,差异有统计学意义(P<0.05)。治疗组治疗前后中医症状积分比较,差异有统计学意义(P<0.05)。治疗组治疗后中医症状积分降低较对照组明显,差异有统计学意义(P<0.05)。结论:脾肾阳虚证型PCOS患者采用健脾温肾调周法结合松烟墨宝贴敷疗法治疗,能改善性激素水平,提高治疗效果,降低不良反应发生率,降低中医症候积分。

The Use of <i>Kigelia africana</i>in the Management of Polycystic Ovary Syndrome (PCOS)

This paper reports the beneficial effect of twice daily ingestion (a table spoonful) of dried Kigelia africana fruit powder in the management of Polycystic Ovary Syndrome (PCOS) in two patients. Both patients had the classical triad of Amenorrhoea, acne and hirsutism. The two were 25 years old and 22 years old spinsters respectively. The ultrasonography was suggestive only in the latter;unfortunately there were no facilities to do the confirmatory serum enzymes assay. The use of herbal preparation restored the menstrual flow in both of them as well as leading to significant reduction in the acne but there was no noticeable effect on the hirsutism. There was no observable side effect associated with the use of the powder. These preliminary data thus suggest that Kigelia africana fruit powder may be beneficial for cases of PCOS especially in the developing countries where the new generation oral contraceptives, presently being used for the condition, may not be readily available.

拮抗剂方案中HCG扳机日直径16~18 mm卵泡比例对PCOS患者IVF-ET结局的影响

目的探讨拮抗剂方案中人绒毛膜促性腺激素(HCG)扳机日直径16~18 mm卵泡比例对接受拮抗剂方案的多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2016年1月至2021年12月于南京医科大学附属妇产医院行IVF-ET助孕的PCOS患者的临床资料。根据HCG扳机日双侧卵巢直径16~18 mm卵泡比例以三分位法将患者分为三组,该比例<0.43为A组(262例),0.43~0.56为B组(267例),≥0.56为C组(247例)。比较三组一般临床资料、超促排卵周期情况、胚胎发育情况、体外受精周期后首次冻融胚胎移植(FET)情况以及妊娠、围产期结局。结果B组基础促黄体生成素(LH)、基础LH与基础促卵泡激素(FSH)比值显著高于A组和C组,差异有统计学意义(P<0.05)。A组促性腺激素(Gn)使用总量高于B组和C组,HCG扳机日雌二醇(E_(2))水平低于B组、C组,差异有统计学意义(P<0.05)。B组和C组获卵数、2原核(PN)数、卵裂数、囊胚形成数以及可移植胚胎数高于A组,差异有统计学意义(P<0.05)。C组囊胚形成率高于A组和B组,高评分囊胚率高于B组,差异有统计学意义(P<0.05)。三组移植胚胎数、移植胚胎天数、内膜准备方案及内膜厚度比较差异无统计学意义(P>0.05)。三组胚胎着床率、生化妊娠率、临床妊娠率、流产率、活产率、妊娠期糖尿病发生率及妊娠期高血压发生率等比较差异无统计学意义(P>0.05)。结论在拮抗剂方案中,HCG扳机日直径16~18 mm卵泡比例可反映卵母细胞发育潜能,当该比例≥0.56时可获得较好的获卵数、2PN数、卵裂数、囊胚形成数以及可移植胚胎数,在一定程度上可作为PCOS患者HCG扳机时机的参考指标,但该比例并不影响后续首次FET的妊娠结局。

滋肾育胎丸联合优思明对PCOS不孕症患者子宫内膜容受性、内分泌指标及妊娠结局的影响

目的 分析滋肾育胎丸联合优思明对多囊卵巢综合征(PCOS)不孕症患者子宫内膜容受性、内分泌指标及妊娠结局的影响。方法 将80例PCOS不孕症患者均分为对照组和观察组,对照采用优思明治疗,观察组采用滋肾育胎丸联合优思明治疗,两组均治疗3个月;收集患者的临床资料,比较两组患者入院及治疗后的临床疗效、子宫内膜容受性[血流搏动指数(PI)、阻力指数(RI)、子宫内膜血管指数(VI)、血流指数(FI)]、内分泌指标[睾酮(T)、促黄体生成素(LH)、促卵泡刺激素(FSH)、雌二醇(E2)、垂体泌乳素(PRL)、空腹胰岛素(FIN)、空腹血糖(FPG)]、血管内皮生长因子(VEGF)、妊娠结局及不良反应发生率。结果 观察组临床有效率高于对照组(P<0.05);治疗后,两组患者子宫内膜厚度、A型子宫内膜率、VI、FI、E2水平均上升,PI、RI、子宫内膜多层率、T、LH、FSH、PRL、FIN、FPG、VEGF均下降(P<0.05),且观察组子宫内膜厚度、A型子宫内膜率、VI、FI、E2高于对照组(P<0.05),观察组PI、RI、子宫内膜多层率、T、LH、FSH、PRL、FIN、FPG、VEGF低于对照组(P<0.05);观察组活产率、妊娠率高于对照组,流产率低于对照组(P<0.05);两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 滋肾育胎丸联合优思明治疗PCOS不孕症患者效果优于单一优思明治疗,可改善患者子宫内膜容受性、内分泌指标,并提高患者的妊娠率及活产率,安全性较好。

地屈孕酮联合吡格列酮治疗PCOS疗效及对患者胰岛素抵抗、卵巢功能及性激素影响

目的:探究地屈孕酮联合吡格列酮治疗多囊卵巢综合征(PCOS)疗效及对患者胰岛素抵抗、卵巢功能及血清AMH、FSH水平的影响。方法:选取2020年9月-2023年5月本院收治的PCOS患者147例,随机数字表法分为对照组(n=73)和观察组(n=74),均在月经周期第5天开始服用地屈孕酮治疗,观察组加用吡格列酮治疗;治疗3个月后比较两组临床疗效,治疗前后空腹血糖(FPG)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、卵泡个数、卵巢体积、抗苗勒激素(AMH)、卵泡刺激素(FSH)、睾酮(T)和促黄体生成素(LH)水平的变化情况和不良反应发生情况。结果:治疗后观察组总有效率(96.0%)高于对照组(84.9%),观察组与对照组FPG、FINS、HOMA-IR(2.14±0.49、3.19±0.97)、卵泡个数(7.11±0.76个、11.19±1.24个)、卵巢体积(23.18±3.04ml、31.51±4.13ml)、AMH(20.96±4.52pmol/L、28.75±5.64pmol/L)、FSH(5.19±0.51mIU/ml、5.56±0.63mIU/ml)、T(40.76±5.38nmol/L、51.65±6.24nmol/L)、LH(3.27±0.83mIU/ml、5.54±1.01mIU/ml)水平均低于治疗前,且观察组均低于对照组(均P<0.05);两组不良反应发生率(9.5%、6.5%)无差异(P>0.05)。结论:地屈孕酮联合吡格列酮治疗PCOS疗效提高,可纠正患者胰岛素抵抗,改善卵巢功能,降低血清AMH和性激素水平,且安全性较好。

PCOS不孕症患者糖脂代谢变化及其与子宫内膜容受性的关系

目的探讨多囊卵巢综合征(PCOS)不孕症患者糖脂代谢变化及其与子宫内膜容受性的关系。方法选取2021年3月至2022年10月商丘市妇幼保健院接收的136例PCOS不孕症患者作为疾病组,同时选取在商丘市妇幼保健院体检并明确因男性因素不孕的健康女性136例作为健康组。检测两组糖脂代谢指标[空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)]和子宫螺旋动脉搏动指数(PI)、阻力指数(RI)及子宫内膜厚度(Em)并比较。采用Pearson法分析PCOS不孕症患者糖脂代谢变化与子宫螺旋动脉PI、RI、Em的相关性。另根据疾病组患者子宫内膜容受性将其分为子宫内膜容受性良好组和不良组,比较两组患者糖脂代谢变化,并采用多因素logistic回归分析PCOS不孕症患者糖脂代谢变化对子宫内膜容受性的影响。结果疾病组FBG、FINS、TC、TG、LDL-C、HOMA-IR和子宫螺旋动脉PI、RI均高于健康组(P<0.05),HDL-C水平和Em均低于健康组(P<0.05);Pearson分析结果显示,PCOS不孕症患者FBG、FINS、TC、TG、LDL-C、HOMA-IR与PI、RI均呈正相关(P<0.05),与Em呈负相关(P<0.05);HDL-C水平与PI、RI均呈负相关(P<0.05),与Em呈正相关(P<0.05);子宫内膜容受性不良组FBG、FINS、TC、TG、LDL-C、HOMA-IR和子宫螺旋动脉PI、RI均高于良好组(P<0.05),HDL-C水平和Em均低于良好组(P<0.05);多因素logistic回归分析结果显示FBG、FINS、HOMA-IR、TC、TG、LDL-C、HDL-C均是PCOS不孕症患者子宫内膜容受性不良的影响因素(P<0.05)。结论PCOS不孕症患者FBG、FINS、TC、TG、LDL-C水平和HOMA-IR均升高,HDL-C水平降低,且均与子宫螺旋动脉PI、RI、Em相关联,糖脂代谢紊乱是PCOS不孕症患者子宫内膜容受性不良的影响因素。

滋阴补阳方序贯法联合西药治疗PCOS效果及对卵巢储备功能影响

目的:探究滋阴补阳方序贯法联合西药治疗多囊卵巢综合征(PCOS)效果及对卵巢储备功能的影响。方法:选取2021年8月-2022年10月本院收治的PCOS患者126例,简单随机(抽签法)分为西药组和中西联合组各63例,两组均采取西药治疗,中西联合组联合滋阴补阳方序贯法治疗。比较两组临床疗效,中医症状积分、卵巢储备指标、卵巢及卵泡指标变化及不良反应,持续随访1年,记录排卵及妊娠情况。结果:治疗后,中西联合组总有效率(93.7%)高于西药组(81.0%),两组中医症状各积分均降低且中西联合组低于西药组,两组卵泡刺激素、黄体生成素/卵泡刺激素、抑制素B、抗苗勒管激素均降低且中西联合组低于西药组,两组卵巢体积、AFC均下降且中西联合组(5.18±0.84mm、8.63±1.27个)低于西药组(5.83±0.57mm、10.45±1.82个)(均P<0.05)。治疗期间不良反应发生率中西联合组(4.8%)与西药组(1.6%)无差异(P=0.310);随访1年内,中西联合组排卵率(88.9%)和妊娠率(39.7%)均高于西药组(71.4%、22.2%)(均P<0.05)。结论:滋阴补阳方序贯法结合西药治疗PCOS提高了患者临床症状和卵巢储备功能改善程度,提高了治疗后排卵和妊娠率,用药安全性良好。

赋能理论联合叙事护理对PCOS伴不孕患者病耻感及情绪应对方式的影响

目的探讨赋能理论联合叙事护理对多囊卵巢综合征(PCOS)伴不孕患者病耻感及情绪应对方式的影响。方法回顾性收集2021年10月至2023年2月郑州大学第一附属医院妇科接受赋能理论护理的80例PCOS伴不孕患者纳入观察组。另选取同期接受赋能理论联合叙事护理的80例PCOS伴不孕患者纳入对照组。比较护理前后患者病耻感[采用女性不孕症患者羞辱感量表(ISS)评价]、情绪应对方式[采用简易应对方式问卷(SCSQ)评价]、护理满意度(自制护理满意度调查问卷调查)。结果两组护理前病耻感、情绪应对方式水平差异无统计学意义(P>0.05);护理后观察组患者病耻感水平比对照组低,积极情绪应对方式评分比对照组高,消积应对评分比对照组低,护理总满意率比对照组高(P<0.05)。结论赋能理论联合叙事护理可减轻PCOS伴不孕患者病耻感,促进患者采取积极情绪应对方式,提高患者对于护理的满意度。

育龄期PCOS患者血清TSH水平与性激素的相关性研究

目的探讨甲状腺功能正常的育龄期多囊卵巢综合征(PCOS)患者促甲状腺激素(TSH)水平对性激素的影响及其相关性。方法选取2019年12月—2023年5月于苏州大学附属第一医院就诊的151例甲状腺功能正常的育龄期PCOS患者作为研究对象,以TSH水平二等分组,对两组患者血清甲状腺激素指标[TSH、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]及性激素指标[卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)、泌乳素(PRL)、孕酮(Pg)、雌二醇(E2)和脱氢表雄酮硫酸酯(DHEAS)]水平进行分析;再根据BMI将PCOS患者分为正常BMI组(n=91)和高BMI组(n=60),比较两组患者血清甲状腺激素及性激素水平。结果①TSH低值组与TSH高值组血清甲状腺激素和性激素指标水平差异无统计学意义(P>0.05);Pearson相关性分析结果显示,TSH与PRL呈正相关性(P<0.05),与性激素指标无相关性(P>0.05);②高BMI组FT4和FSH水平低于正常BMI组,TSH、T和Pg水平高于正常BMI组,差异有统计学意义(P<0.05);两组血清FT3、LH、LH/FSH、PRL、DHEAS、E2水平差异无统计学意义(P>0.05);Pearson相关性分析结果显示,两组血清TSH与LH/FSH,T及Pg无显著相关性(P>0.05);③无论是正常BMI还是高BMI的PCOS患者,正常范围内的TSH水平高低不影响FT3、FT4及性激素指标水平(P>0.05)。结论正常范围内的TSH水平与性激素水平无关。即使性激素水平在正常范围内,育龄期PCOS患者应常规筛查血清TSH及其他甲状腺激素水平,及时发现可能存在的甲状腺功能异常并及时进行相应干预,降低对生殖和内分泌紊乱的影响。

中医辨证结合中西医治疗PCOS疗效及对患者性激素、脂代谢和卵巢的影响

目的:探讨中医辨证结合中西医治疗多囊卵巢综合征(PCOS)疗效及对性激素、脂代谢和卵巢的影响。方法:选择本院2022年5月-2023年5月收治的PCOS患者90例,随机数字表法分为两组各45例,西医组常规西药治疗,中西医组在西医组治疗基础上采用基于中医辨证的中药治疗,对比两组临床疗效、性激素水平、脂代谢指标、卵巢情况。结果:中西医组临床治疗总有效率(88.9%)高于西医组(68.9%);治疗后两组促卵泡激素(FSH)、睾酮(T)、黄体生成素(LH)、卵泡数目、卵巢体积、总胆固醇(TC)、甘油三酯(TG)、空腹胰岛素(FINS)水平均降低,且中西医组FSH(4.79±0.68 mU/ml)、T(2.46±1.14 ng/ml)、LH(11.29±1.47 ng/ml)水平低于西医组(5.22±1.09 mU/ml、3.24±1.23 ng/ml、13.44±2.36 ng/ml),卵泡数目(7.21±1.25个)、卵巢体积(8.54±1.35 cm^(3))低于西医组(9.46±1.49个、10.21±1.62 cm^(3)),TC、TG、FINS水平低于西医组(均P<0.05)。结论:中医辨证结合中西医治疗PCOS可提升临床疗效,进一步改善患者性激素、脂代谢水平和卵巢功能。