Search Results (73)

Polycystic ovary syndrome (PCOS) is a prevalent endocrinological condition among women of reproductive age, characterized by several well-known symptoms, including hyperandrogenism, anovulation, irregular menstrual cycles, and insulin resistance. In addition, women suffering from PCOS are also at an increased risk of developing several autoimmune diseases, including thyroid disorders, type 1 diabetes, and rheumatoid arthritis. Furthermore, an elevated prevalence of diverse autoantibodies is observed in women diagnosed with PCOS. These include antibodies specific to autoimmune diseases, e.g., anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and antinuclear antibodies (ANAs), as well as those that are non-specific, such as anti-malondialdehyde-modified human serum albumin (anti-HSA-MDA) or anti-α-crystallin. It appears that several mechanisms may be responsible for this phenomenon. PCOS has been observed to co-occur with autoimmune diseases, potentially attributable to shared genetic susceptibility or the presence of hormonal disorders resulting from autoimmune diseases. Moreover, PCOS is a chronic low-grade inflammatory disease that may contribute to immune dysfunction and subsequent overproduction of autoantibodies. A further intriguing aspect may be the yet-unknown role of autoantibodies in the pathogenesis of PCOS, considering PCOS as a disease with an autoimmune etiology. Full article

Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder characterized by a clinical and/or biochemical hyperandrogenism. In addition, PCOS is also associated with the presence of ovarian cysts, anovulation, and menstrual abnormalities such as oligomenorrhea or amenorrhea. The aetiology of the syndrome is multifactorial and heterogeneous due to the interaction of genetic, hormonal, metabolic, and environmental factors, as well as the different phenotypes and responses to treatments exhibited by the patients. Considering this complex interaction, it is essential to continue with the research focused on the mechanisms involved in the development and maintenance of the pathology. The alteration in the pulsatile secretion of the gonadotropin-releasing hormone (GnRH) is considered to be one of the main causes that contributes to its onset. In this review, we discuss recent evidence about the role of the rostral periventricular area of the third ventricle (RP3V), the arcuate nucleus (ARC), and the ventromedial nucleus of the hypothalamus (VMH), key hypothalamic regions that regulate GnRH secretion, in the development of PCOS. In addition, we analyse the clinical, metabolic, and endocrine factors that interact in the patients with PCOS, offering a multifactorial perspective to improve our understanding of this disorder. Full article

Background: The most common female endocrinopathy is polycystic ovary syndrome (PCOS), affecting 10–20% of women of reproductive age. It is associated with a wide range of hormonal and biochemical abnormalities and long-term metabolic and cardiovascular risks. It is characterized by infertility due to chronic anovulation, hyperandrogenism, polycystic ovarian morphology, and is often associated with insulin resistance (IR) and obesity. Hyperinsulinemia further increases androgen production and reduces sex hormone-binding globulin (SHBG) levels, thereby aggravating symptoms. In addition, vitamin D deficiency is often present in PCOS patients, and increasing evidence suggests that it may also be associated with insulin resistance and hyperandrogenism. Objective: This study aimed to evaluate the relationships between insulin resistance, vitamin D deficiency, body mass index (BMI), and androgen levels in women with PCOS. Method: A cross-sectional study was conducted in which data from 195 women diagnosed with PCOS and not yet receiving therapy at a gynecologic endocrinology unit of a university-based tertiary clinical center, between 2019 and 2024, were analyzed. The parameters recorded were age, body mass index (BMI), 25(OH) vitamin D levels, androgen hormone levels (testosterone, androstenedione), glucose-insulin responses during a 3-point oral glucose tolerance test (OGTT). Statistical analyses, including linear regression, Pearson, and Spearman correlation tests were used to assess associations between variables. Results: The mean age of the patients was 24.8 years (18–42), and the mean BMI was 30.6 kg/m² (17–51). Vitamin D deficiency was observed in 84.1% of patients, hyperandrogenism in 45.8%, and insulin resistance in 44.5%. A significant inverse correlation was found between BMI and vitamin D levels (r = −0.31, p =< 0.01) indicating that higher BMI is associated with lower vitamin D status. Similarly, BMI also showed a significant negative correlation with SHBG levels (r = –0.45, p < 0.01), suggesting that increasing body weight is linked to reduced SHBG concentrations. In addition, BMI was significantly positively correlated with 2 h insulin levels (r = 0.43, p =< 0.01) and with testosterone levels (r = 0.21, p = 0.01). These findings suggest that increased adiposity intensifies insulin resistance and is linked to both vitamin D deficiency and elevated androgen levels. Moreover, the combination of hyperinsulinemia and low vitamin D further disrupts hormonal balance by promoting ovarian androgen production and decreasing SHBG levels, thereby increasing the bioavailability of testosterone. A significant inverse correlation was found between vitamin D levels and 2 h insulin levels (r = −0.28, p =< 0.01), indicating that lower vitamin D status is associated with increased insulin resistance. Furthermore, 2 h insulin levels showed a significant positive correlation with testosterone levels (r = 0.32, p =< 0.01), suggesting that greater insulin resistance is linked to higher androgen production. Additionally, vitamin D levels were inversely correlated with testosterone (r = −0.18, p = 0.02), demonstrating that a lower vitamin D status may further contribute to the hyperandrogenic environment. Vitamin D levels also showed a significant positive correlation with SHBG concentrations (r = 0.29, p < 0.01), indicating that a higher vitamin D status may be associated with increased SHBG levels. In contrast, 2 h insulin levels were inversely correlated with SHBG (r = −0.43, p < 0.01), reflecting the suppressive effect of hyperinsulinemia on SHBG production. Conclusions: Insulin resistance, BMI, and vitamin D deficiency are closely related to each other and to the severity of PCOS, which is confirmed by the correlations with androgen levels. The revealed relationships draw attention to the special importance of vitamin D supplementation and the correction of carbohydrate metabolism in alleviating the symptoms of the disease and reducing long-term health risks. Full article

Infertility affects 17.5% of couples worldwide, and is notably caused in females by ovarian disorders that impact follicle development and oocyte maturation. Polycystic ovary syndrome (PCOS), affecting 8 to 13% of women of reproductive age, is a leading cause of anovulation and is characterized by arrested antral follicle development before the preovulatory stage. Reproductive issues of PCOS are often exacerbated in overweight or obese women. Obesity, which is increasingly prevalent worldwide, is also associated with anovulation, primarily due to defects in oocyte quality. Oocyte quality and competence depend on the proper activity of granulosa cells (GCs), which surround and support the oocyte. GCs produce key factors, such as 17β-estradiol, which regulate follicle growth and oocyte maturation. They also provide essential metabolic support for oocyte maturation and play a critical role in ovulation and fertilization. This review outlines the physiological role of GCs in follicle growth and maturation and explores recent advancements in understanding GCs’ molecular and physiological dysfunctions that contribute to infertility in PCOS and obesity. Improved knowledge of the endocrine mechanisms underlying follicular abnormalities in these conditions could help to predict oocyte competence and enhance assisted reproduction outcomes. Full article

Polycystic ovary syndrome (PCOS) is the expression of a complex alteration of the reproductive system. It is characterised by the increase in androgens, causing symptoms such as hirsutism, as well as infertility in many. This paper reviews whether Clomiphene Citrate, Letrozole and Inositol function better as monotherapy or combined therapy for anovulatory infertile PCOS patients. Ovulation and pregnancy rate were used as primary outcomes. PubMed and Scopus were the search engines of choice. Papers were excluded if patients were undertaking other fertility interventions, overlapping populations and non-RCT papers. It was found that co-prescribing Letrozole or Clomiphene Citrate alongside Metformin should be considered, Inositol should be examined as an alternative insulin sensitiser to Metformin and studies should be undertaken to identify the ideal dose and duration of Inositol therapy. Further large, well-designed, multi-centre studies should be conducted to solidify the claims of this review. Full article

Background: Obesity is a complicated, chronic condition that has a major impact on reproductive health, leading to infertility, anovulation, and poor pregnancy outcomes. It alters the hypothalamic–pituitary–ovarian (HPO) axis, promotes insulin resistance, and causes persistent low-grade inflammation, all of which result in hormonal abnormalities that compromise normal ovarian function. Because standard weight loss procedures frequently fail to provide significant and long-term reproductive benefits, bariatric surgery is becoming increasingly popular as a therapeutic option for obese women trying to conceive. However, continuous research is being conducted to determine the degree of its advantages and potential hazards to fertility and pregnancy outcomes. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and entered into the PROSPERO database. Comprehensive searches in the PubMed, Scopus, and Web of Science databases turned up relevant studies. Studies that examined the effects of bariatric surgery on female fertility, ovulatory function, pregnancy rates, and neonatal outcomes were considered. Methodological quality and risk of bias were evaluated using the Newcastle–Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias Tool for randomized controlled trials. Results: This review comprised 34 studies. More than 75% of the studies analyzed showed improvements in ovulatory function, monthly regularity, or spontaneous pregnancy after bariatric surgery. Post-surgical pregnancies are related to a lower incidence of gestational diabetes, hypertension, and macrosomia. However, several studies raised concerns about nutritional inadequacies and the possibility of small-for-gestational-age newborns, particularly following Roux-en-Y gastric bypass. Studies suggest delaying conception for 12 to 18 months after surgery to reduce nutritional hazards and improve pregnancy outcomes. Variability in study design, follow-up duration, and surgical methods reduces the generalizability of findings, emphasizing the importance of uniform research protocols. Conclusions: Bariatric surgery is a highly effective treatment for increasing fertility and pregnancy outcomes in obese women, particularly those with PCOS. However, rigorous preconception planning, postoperative nutritional monitoring, and multidisciplinary follow-up are required to reduce the related hazards. Future research should concentrate on long-term reproductive outcomes, standardizing fertility assessment criteria, and improving clinical guidelines for managing post-bariatric pregnancies. These findings support the incorporation of bariatric surgery into fertility treatment regimens for obese women, and they may shape future revisions to clinical guidelines on reproductive care following weight loss surgery. Full article

Obesity increases the risk of anovulation, insulin resistance, hyperandrogenism, and endometrial dysfunction, resulting in women with infertility and increasing preconceptional and pregnancy complications. Bariatric surgery has been described as the most effective intervention for obesity, with improved fertility outcomes. However, its invasive nature increases the potential of nutritional deficiencies and the need for a delayed conception post-surgery. On the other hand, pharmacological treatments such as glucagon-like-peptide 1 receptor agonists offer non-invasive alternatives with promising results in body weight, improving insulin sensitivity and restoring ovarian function. However, their use must be discontinued before conception due to potential fetal risks. Other available pharmacological treatment options encompass topiramate, phentermine, and Orlistat. The choice of treatment must be individualized considering cost-effectiveness, accessibility, obesity severity, reproductive goals, and associated risks within each patient. A multidisciplinary approach is essential to optimize metabolic and reproductive health in obesity and infertility. This review will examine the impact on metabolism when comparing surgical and pharmacological interventions for weight loss in women with infertility. Full article

In the early postpartum period, dairy cows undergo significant adaptations in Ca and lipid metabolism, immune function, and inflammatory processes. Concurrent exposure to endotoxins from the uterus, gastrointestinal tract, or mammary gland increases the risk of disease and reproductive problems. Metabolic and inflammatory imbalances during this phase can have both immediate and long-term effects on reproductive health. Associations between metabolic disorders and reproductive outcomes are often confounded by immune activation and systemic inflammation. However, optimal markers, thresholds, and durations for identifying maladaptation and predicting adverse health or reproductive outcomes remain unclear. This narrative review examines key physiological changes during the transition period, including hypocalcemia, lipid mobilization, immune activation, systemic inflammation, and uterine disease. We discuss how these events may affect the dominant follicle, corpus luteum, oocyte, and uterus, potentially leading to prolonged anovulation, reduced estrus expression, impaired response to synchronization protocols, lower progesterone concentrations, and compromised fertility. Understanding these mechanisms will support the development of strategies to monitor, prevent, and mitigate the impacts of transition-related maladaptation on reproductive performance. Such advancements can enhance the health and fertility of high-producing dairy cows. Full article

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among reproductive-aged women. It is characterized by hyperandrogenism, anovulation, and polycystic ovaries. Lifestyle changes are suggested as first-line interventions in managing PCOS. This systematic review aims to assess the scientific evidence regarding the role of lifestyle modifications (dietary changes, physical activity, and behavioral changes) in improving reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS. Dietary interventions such as foods with low glycemic index scores; caloric restrictions; high-fiber, omega three fatty acid-rich diets; ketogenic diets; Mediterranean diets; antioxidant-rich food; and anti-inflammatory diets improve insulin sensitivity and hormonal balance in women with PCOS. Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS. Further, behavioral and education modules can also be used to improve awareness, adherence, and the effectiveness of conventional treatment and to manage mental health issues related to PCOS. Collectively, lifestyle modifications not only improve the biochemical, hormonal, and anthropometric parameters in PCOS patients but also reduce the long-term risks of metabolic and cardiovascular diseases. Full article

Background: In this research, we retrospectively studied the influence of the IVF vs. the ICSI technique on embryo morphokinetics by means of a time-lapse incubator in fresh cycles. Methods: A total of 2645 treatment cycles resulting in ovum pick-up of 11,471 fertilized oocytes were included in the research from 2018 to 2022. The embryos were grouped according to IVF or ICSI. Embryonic development was monitored using a time-lapse incubator, and they were transferred on day 3 or 5. Results: The embryos in the ICSI group developed faster and had less fragmentation. However, fewer 2PNs were achieved and more embryos were discarded compared to IVF. When sibling oocytes treated with either IVF or ICSI were analyzed, we found that ICSI resulted in quicker development and higher KIDScores. Discussion: The anovulation and PCOS subgroups were the primary contributors to the high KIDScores in sibling oocytes, indicating that ICSI might have beneficial effects on oocyte factors, similar to the positive results it provides when male factors are involved. Conclusions: Women with PCOS undergoing IVF had better results when ICSI was used compared to spontaneous IVF. This study reveals that ICSI is superior to IVF in female factor infertility. Full article

The objective of this study was to evaluate four different automated activity monitoring (AAM) systems to identify anovulatory cows in early lactation. A total of 852 lactating Holstein cows (221 primiparous and 631 multiparous cows) from four commercial dairy herds were enrolled. On each farm, cows were equipped with a respective AAM system (SB: Smartbow; HT: Heatime; DP: Delpro; and CM: CowManager). Each cow was sampled three times within the voluntary waiting period (VWP) in a two-week interval to detect the blood progesterone (P4) concentration. Cows were classified based on the concentration of P4 as follows: (1) none of the three blood P4 concentrations exceeded 1.0 ng/mL (anovulatory); (2) at least one of the three blood P4 concentrations was above 1.0 ng/mL (ovulatory). Cows were classified based on estrus alerts as follows: (1) no estrus alert was detected by an AAM system from 7 to 60 DIM (anestrus); (2) at least one estrus alert was detected by an AAM system from 7 to 60 DIM (estrus). Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each AAM system for anovulatory cows [(SB: 77.6%; 26.8%; 89.3%; 36.7%; and 84.1%); (HT: 79.2%; 63.6%; 83.6%; 52.8%; and 88.9%); (DP: 47.2%; 78.8%; 41.5%; 19.5%; and 91.6%); (CM: 80.5%; 23.7%; 92.7%; 39.1%; and 85.3%)]. Full article

Obesity, which leads to metabolic dysregulation and body function impairment, emerges as one of the pressing health challenges worldwide. Excessive body fat deposits comprise a dynamic and biologically active organ possessing its own endocrine function. One of the mechanisms underlying the pathophysiology of obesity is low-grade systemic inflammation mediated by pro-inflammatory factors such as free fatty acids, lipopolysaccharides, adipokines (including leptin, resistin and visfatin) and cytokines (TNF-α, IL-1β, Il-6), which are secreted by adipose tissue. Together with obesity-induced insulin resistance and hyperandrogenism, the exacerbated immune response has a negative impact on the hypothalamic–pituitary–gonadal axis at all levels and directly affects reproduction. In women, it results in disrupted ovarian function, irregular menstrual cycles and anovulation, contributing to infertility. This review focuses on the abnormal intracellular communication, altered gene expression and signaling pathways activated in obesity, underscoring its multifactorial character and consequences at a molecular level. Extensive presentation of the complex interplay between adipokines, cytokines, immune cells and neurons may serve as a foundation for future studies in search of potential sites for more targeted treatment of reproductive disorders related to obesity. Full article

Polycystic ovary syndrome is a common endocrine disorder, characterized by hyperandrogenism and/or chronic oligo/anovulation, which leads to infertility. The aim of this systematic review and meta-analysis was to explore the efficacy of letrozole compared with clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome. The study protocol has been registered with PROSPERO (registration number CRD42022376611). The literature search included randomized clinical trials. We conducted our systematic literature search across three medical databases: MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Embase. The data synthesis employed a random effects model. Out of the 1994 articles screened, 25 studies fulfilled the inclusion criteria. The letrozole group exhibited a significant increase in endometrial thickness (mean difference = 1.70, confidence interval: 0.55–2.86; I² = 97%, p-value = 0.008). The odds of ovulation (odds ratio = 1.8, confidence interval: 1.21–2.69; I² = 51%, p-value = 0.010) and pregnancy (odds ratio = 1.96, confidence interval: 1.37–2.81; I² = 32%, p-value = 0.002) were significantly higher. The resistance index of the subendometrial arteries showed a significant decrease (mean difference = −0.15, confidence interval: −0.27 to −0.04; I² = 92%, p-value = 0.030). Women diagnosed with polycystic ovarian syndrome and treated with letrozole for ovulation induction had increased ovulation and pregnancy rates and increased endometrial thickness. The lower resistance index of subendometrial arteries can enhance intrauterine circulation, creating more favorable conditions for embryo implantation and development. Full article

Polycystic ovary syndrome (PCOS) is a leading cause of infertility, with an estimated worldwide prevalence between 5% and 15%. We conducted a case–control study with 121 PCOS patients and 155 controls to assess the association between coffee intake and the presence of having a diagnosis of PCOS in women in Murcia, Spain. The PCOS diagnosis was determined following Rotterdam criteria (the presence of two of the following three conditions: hyperandrogenism, oligo-anovulation, and/or polycystic ovarian morphology). Coffee consumption was assessed using a validated food frequency questionnaire. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression. Coffee consumption was categorized into never, less than one cup per day, one cup per day, and two or more cups per day. We found a significant inverse linear trend: the higher the coffee consumption, the lower the probability of having PCOS in multivariable analysis (p-trend = 0.034). Women who presented with PCOS were less likely to drink one cup of coffee compared to those who had never drunk coffee (OR = 0.313, 95% CI: 0.141–0.69). The consumption of at least one cup of coffee per day may be associated with a decrease in PCOS symptoms. Full article

Female fertility depends on the ovarian reserve of follicles, which is determined at birth. Primordial follicle development and oocyte maturation are regulated by multiple factors and pathways and classified into gonadotropin-independent and gonadotropin-dependent phases, according to the response to gonadotropins. Folliculogenesis has always been considered to be gonadotropin-dependent only from the antral stage, but evidence from the literature highlights the role of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) during early folliculogenesis with a potential role in the progression of the pool of primordial follicles. Hormonal and molecular pathway alterations during the very earliest stages of folliculogenesis may be the root cause of anovulation in polycystic ovary syndrome (PCOS) and in PCOS-like phenotypes related to antiepileptic treatment. Excessive induction of primordial follicle activation can also lead to premature ovarian insufficiency (POI), a condition characterized by menopause in women before 40 years of age. Future treatments aiming to suppress initial recruitment or prevent the growth of resting follicles could help in prolonging female fertility, especially in women with PCOS or POI. This review will briefly introduce the impact of gonadotropins on early folliculogenesis. We will discuss the influence of LH on ovarian reserve and its potential role in PCOS and POI infertility. Full article