Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: closed (28 April 2023) | Viewed by 21772

Special Issue Editors

Endocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania
Interests: androgen receptor; adipose tissue; hyperinsulinism; hirsutisme
Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115 Iasi, Romania
Interests: clinical endocrinology; osteoporosis; metabolism; metabolic diseases; bone; autoimmunity; body composition; cancer cells; internal medicine; fracture
Endocrinology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
Interests: obesity surgery; infertility and polycystic ovary syndrome; neuro-endocrine and pituitary tumors

Special Issue Information

Dear Colleagues,

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age; it is characterized by chronic anovulation, hyperandrogenism and polycystic ovaries on ultrasound imaging. Even if there is evidence for a genetic component of the disorder, other causes (e.g., prenatal triggers) are considered among the possible factors that may induce the development of PCOS. Several animal models have been developed in an attempt to understand the potential mechanisms involved in the development of this syndrome.

Although it has been over 80 years since the first description, the pathophysiology and etiology of PCOS is still a subject of debate. Despite the new data regarding the genetic background and androgen physiology, the “fight” between ovarian hyperandrogenism and hyperinsulinism hypotheses continues. There are also gaps regarding the diagnostic criteria and curative treatment.

Therefore, we think it is necessary to analyze and discuss the important unsolved issues in PCOS.

This Special Issue welcomes submissions of both original research and review articles dealing with PCOS. We invite all researchers and clinicians involved in the diagnosis and treatment of PCOS to submit articles presenting the results of their research.

Dr. Cristina Preda
Prof. Dr. Dumitru Branisteanu
Prof. Dr. Simona Fica
Guest Editors

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Keywords

  • anovulation
  • hirsutism
  • infertility
  • obesity 
  • insulin resistance

Published Papers (8 papers)

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Research

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18 pages, 1261 KiB  
Article
Polycystic Ovary Syndrome and Gut Microbiota: Phenotype Matters
by Larisa Suturina, Natalia Belkova, Ilia Igumnov, Ludmila Lazareva, Irina Danusevich, Iana Nadeliaeva, Leonid Sholokhov, Maria Rashidova, Lilia Belenkaya, Aleksey Belskikh, Eldar Sharifulin, Kseniia Ievleva, Natalia Babaeva, Irina Egorova, Madinabonu Salimova, Mikhail Kuzmin, Daria Tiumentseva, Elizaveta Klimenko, Tuyana Sidorova and Alina Atalyan
Life 2023, 13(1), 7; https://doi.org/10.3390/life13010007 - 20 Dec 2022
Cited by 1 | Viewed by 1582
Abstract
Abnormalities in gut microbiota diversity are considered important mechanisms in metabolic disorders in polycystic ovarian syndrome (PCOS). However, the data on the association of these disorders with the PCOS phenotype remain controversial. The objectives of this study were to estimate the alpha diversity [...] Read more.
Abnormalities in gut microbiota diversity are considered important mechanisms in metabolic disorders in polycystic ovarian syndrome (PCOS). However, the data on the association of these disorders with the PCOS phenotype remain controversial. The objectives of this study were to estimate the alpha diversity of the gut microbiota of healthy women and PCOS patients depending on phenotype. The study participants (184 premenopausal women: 63 with PCOS, 121 without PCOS) were recruited during the annual employment assessment in the Irkutsk Region and the Buryat Republic (Russia) in 2016–2019. For PCOS diagnosis, we used the Rotterdam (2003) criteria and definitions of PCOS phenotypes. Five indexes of alpha diversity (ASV, Shannon, Simpson, Chao, and ACE) were estimated for the gut microbiota in all participants using amplicon metasequencing. As a result, two out of five alpha diversity indexes showed a statistical difference between the non-PCOS and PCOS groups. We did not find a significant difference in the alpha diversity of gut microbiota in the subgroups of women with hyperandrogenic PCOS phenotypes vs non-androgenic phenotype D and the group of women with the presence of only one of the PCOS criteria. Nevertheless, “classic” PCOS phenotypes demonstrated the most significant decrease in alpha diversity compared with healthy women without any signs of PCOS. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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Review

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17 pages, 466 KiB  
Review
Is There Still a Place for Surgery in Patients with PCOS? A Review
by Luigi Della Corte, Dominga Boccia, Mario Palumbo, Antonio Mercorio, Carlo Ronsini, Giuseppe Bifulco and Pierluigi Giampaolino
Life 2023, 13(6), 1270; https://doi.org/10.3390/life13061270 - 28 May 2023
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Abstract
Objective: The surgical management of polycystic ovary syndrome (PCOS) represents an unclear option compared to medical therapy, and it is necessary to deepen the role of minimally invasive surgery, represented by laparoscopic ovarian drilling (LOD) and transvaginal hydrolaparoscopy (THL), for the treatment of [...] Read more.
Objective: The surgical management of polycystic ovary syndrome (PCOS) represents an unclear option compared to medical therapy, and it is necessary to deepen the role of minimally invasive surgery, represented by laparoscopic ovarian drilling (LOD) and transvaginal hydrolaparoscopy (THL), for the treatment of PCOS in infertile women resistant to drug therapy and to establish its success in terms of ovulation and pregnancy rates. Methods: A search was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and the Cochrane Library) from 1994 to October 2022 in order to evaluate the role of surgery in patients with PCOS resistant to pharmacological treatment. Only original scientific articles in English were included. Results: Seventeen studies were analyzed in this review. In all analyzed studies, more than 50% of the population underwent spontaneous ovulation after surgical treatment without great differences between the two surgical techniques (LOD and THL). More than 40% of patients delivered, with a higher rate after LOD, although eight ectopic pregnancies and sixty-three miscarriages were reported. A lower risk of adhesion formation after THL has been reported. No clear data regarding the effect of surgery on the regularization of the menstrual cycle has been described. A reduction in LH and AMH serum levels as well as the LH/FSH ratio compared to preoperative levels for both surgical techniques has been described. Conclusions: Despite the scarcity and heterogeneity of data, surgical therapy could be considered an effective and safe approach in the management of PCOS patients with resistance to pharmacological treatment who desire to become pregnant. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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17 pages, 459 KiB  
Review
Effects of Dehydroepiandrosterone (DHEA) Supplementation on Ovarian Cumulus Cells following In Vitro Fertilization (IVF)/Intra-Cytoplasmic Sperm Injection (ICSI) Treatment—A Systematic Review
by Woon Shu Yuan, Muhammad Azrai Abu, Mohd Faizal Ahmad, Marjanu Hikmah Elias and Abdul Kadir Abdul Karim
Life 2023, 13(6), 1237; https://doi.org/10.3390/life13061237 - 24 May 2023
Viewed by 3031
Abstract
Despite many studies exploring the effects of DHEA supplementation, its application in IVF procedure continues to be a subject of debate owing to the inconsistent findings and the lack of rigorously designed, large-scale, randomized trials. Our review aims to explore the effectiveness of [...] Read more.
Despite many studies exploring the effects of DHEA supplementation, its application in IVF procedure continues to be a subject of debate owing to the inconsistent findings and the lack of rigorously designed, large-scale, randomized trials. Our review aims to explore the effectiveness of DHEA supplementation in ovarian cumulus cells following IVF/ICSI treatment. We conducted a literature search of Pub-Med, Ovid MEDLINE, and SCOPUS (inception to June 2022) for all relevant articles, including the keywords of “dehydroepiandrosterone/DHEA”, “oocyte”, and “cumulus cells”. From the preliminary search, 69 publications were identified, and following a thorough screening process, seven studies were ultimately incorporated into the final review. Four hundred twenty-four women were enrolled in these studies, with DHEA supplementation being administered exclusively to women exhibiting poor ovarian response/diminished ovarian reserve or belonging to an older age demographic. The intervention in the studies was DHEA 75–90 mg daily for at least 8–12 weeks. The only randomized controlled trial showed no difference in clinical or cumulus cell-related outcomes between the control and treatment groups. However, the remaining six studies (two cohorts, four case-controls) showed significant beneficial effects of DHEA in cumulus cell-related outcomes compared to the group (older age or POR/DOR) without DHEA supplementation. All studies revealed no significant difference in stimulation and pregnancy outcomes. Our review concludes that DHEA supplementation did show beneficial effect on ovarian cumulus cells in improving oocyte quality for women of advanced age or with poor ovarian responders. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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35 pages, 1701 KiB  
Review
Pathophysiological Effects of Contemporary Lifestyle on Evolutionary-Conserved Survival Mechanisms in Polycystic Ovary Syndrome
by Jim Parker
Life 2023, 13(4), 1056; https://doi.org/10.3390/life13041056 - 20 Apr 2023
Cited by 3 | Viewed by 2998
Abstract
Polycystic ovary syndrome (PCOS) is increasingly being characterized as an evolutionary mismatch disorder that presents with a complex mixture of metabolic and endocrine symptoms. The Evolutionary Model proposes that PCOS arises from a collection of inherited polymorphisms that have been consistently demonstrated in [...] Read more.
Polycystic ovary syndrome (PCOS) is increasingly being characterized as an evolutionary mismatch disorder that presents with a complex mixture of metabolic and endocrine symptoms. The Evolutionary Model proposes that PCOS arises from a collection of inherited polymorphisms that have been consistently demonstrated in a variety of ethnic groups and races. In utero developmental programming of susceptible genomic variants are thought to predispose the offspring to develop PCOS. Postnatal exposure to lifestyle and environmental risk factors results in epigenetic activation of developmentally programmed genes and disturbance of the hallmarks of health. The resulting pathophysiological changes represent the consequences of poor-quality diet, sedentary behaviour, endocrine disrupting chemicals, stress, circadian disruption, and other lifestyle factors. Emerging evidence suggests that lifestyle-induced gastrointestinal dysbiosis plays a central role in the pathogenesis of PCOS. Lifestyle and environmental exposures initiate changes that result in disturbance of the gastrointestinal microbiome (dysbiosis), immune dysregulation (chronic inflammation), altered metabolism (insulin resistance), endocrine and reproductive imbalance (hyperandrogenism), and central nervous system dysfunction (neuroendocrine and autonomic nervous system). PCOS can be a progressive metabolic condition that leads to obesity, gestational diabetes, type two diabetes, metabolic-associated fatty liver disease, metabolic syndrome, cardiovascular disease, and cancer. This review explores the mechanisms that underpin the evolutionary mismatch between ancient survival pathways and contemporary lifestyle factors involved in the pathogenesis and pathophysiology of PCOS. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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17 pages, 1007 KiB  
Review
Androgen-Induced Cardiovascular Risk in Polycystic Ovary Syndrome: The Role of T Lymphocytes
by Mohadetheh Moulana
Life 2023, 13(4), 1010; https://doi.org/10.3390/life13041010 - 14 Apr 2023
Cited by 2 | Viewed by 1570
Abstract
An estimated 15–20% of reproductive-age women are affected by polycystic ovary syndrome (PCOS). PCOS is associated with substantial metabolic and cardiovascular long-term consequences. In young women with PCOS, several cardiovascular risk factors may be found, including chronic inflammation, high blood pressure, and elevated [...] Read more.
An estimated 15–20% of reproductive-age women are affected by polycystic ovary syndrome (PCOS). PCOS is associated with substantial metabolic and cardiovascular long-term consequences. In young women with PCOS, several cardiovascular risk factors may be found, including chronic inflammation, high blood pressure, and elevated leukocytes. These women are at an increased risk of cardiovascular diseases (CVD), not only during the reproductive years, but also with aging and menopause; therefore, the early prevention and treatment of future cardiovascular adverse effects are necessary. The fundamental characteristic of PCOS is hyperandrogenemia, which is associated with increased pro-inflammatory cytokines and T lymphocytes. Whether these factors play a role in the pathophysiology of hypertension, a risk factor of CVD, due to PCOS is not well established. This review will briefly discuss how a modest increase in androgens in females is linked to the development of hypertension through pro-inflammatory cytokines and T lymphocyte subsets and the promotion of renal injury. Moreover, it reveals a few existing research gaps in this area, including the lack of specific therapy directed at androgen-induced inflammation and immune activation, thus emphasizing the necessity to explore the systemic inflammation in women with PCOS to halt the inevitable inflammatory process targeting the underlying abnormalities of CVD. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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16 pages, 1129 KiB  
Review
Assessment of Eating Disorders and Eating Behavior to Improve Treatment Outcomes in Women with Polycystic Ovary Syndrome
by Tea Shehu Kolnikaj, Rok Herman, Andrej Janež and Mojca Jensterle
Life 2022, 12(11), 1906; https://doi.org/10.3390/life12111906 - 16 Nov 2022
Cited by 2 | Viewed by 3146
Abstract
The essential role of the frequent coexistence of mental disorders and polycystic ovary syndrome (PCOS) is being increasingly recognized in the management of PCOS patients since it influences the success of weight loss interventions. Patients frequently experience disrupted eating behaviors, evidenced by the [...] Read more.
The essential role of the frequent coexistence of mental disorders and polycystic ovary syndrome (PCOS) is being increasingly recognized in the management of PCOS patients since it influences the success of weight loss interventions. Patients frequently experience disrupted eating behaviors, evidenced by the high prevalence of eating disorders in this population. Therefore, assessment and potential modification of eating disorders and eating-related behavior might be especially relevant to improve obesity treatment outcomes in this population, which remains the most efficient causal treatment in PCOS patients with high metabolic risk. Following a literature overview on common eating disorders and eating behaviors in PCOS, the aim of this review was to explore the prevalence and underlying mechanisms behind those occurrences. Understanding the clinical relevance of those associations and the addition of the assessments of eating disorders as well as eating phenotypes, eating chronotypes, and eating content as essential determinants of eating behavior could aid in the successful management of women with PCOS. In addition, the review also covers the potential of using eating disorders and eating behavior as a tool for the personalization of obesity treatment in PCOS. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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18 pages, 1722 KiB  
Review
Roles of microRNAs in Regulating Apoptosis in the Pathogenesis of Endometriosis
by Izyan Nabila Ahmad Azam, Norhazlina Abdul Wahab, Mohd Helmy Mokhtar, Mohamad Nasir Shafiee and Norfilza Mohd Mokhtar
Life 2022, 12(9), 1321; https://doi.org/10.3390/life12091321 - 26 Aug 2022
Cited by 6 | Viewed by 1917
Abstract
Endometriosis is a gynecologic disorder characterized by the presence of endometrial tissues outside the uterine cavity affecting reproductive-aged women. Previous studies have shown that microRNAs and their target mRNAs are expressed differently in endometriosis, suggesting that this molecule may play a role in [...] Read more.
Endometriosis is a gynecologic disorder characterized by the presence of endometrial tissues outside the uterine cavity affecting reproductive-aged women. Previous studies have shown that microRNAs and their target mRNAs are expressed differently in endometriosis, suggesting that this molecule may play a role in the development and persistence of endometriotic lesions. microRNA (miRNA), a small non-coding RNA fragment, regulates cellular functions such as cell proliferation, differentiation, and apoptosis by the post-transcriptional modulation of gene expression. In this review, we focused on the dysregulated miRNAs in women with endometriosis and their roles in the regulation of apoptosis. The dysregulated miRNAs and their target genes in this pathophysiology were highlighted. Circulating miRNAs as potential biomarkers for the diagnosis of endometriosis have also been identified. As shown by various studies, miRNAs were reported to be a potent regulator of gene expression in endometriosis; thus, identifying the dysregulated miRNAs and their target genes could help discover new therapeutic targets for treating this disease. The goal of this review is to draw attention to the functions that miRNAs play in the pathophysiology of endometriosis, particularly those that govern cell death. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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18 pages, 1396 KiB  
Systematic Review
Polycystic Ovary Syndrome and Endocrine Disruptors (Bisphenols, Parabens, and Triclosan)—A Systematic Review
by Tinkara Srnovršnik, Irma Virant-Klun and Bojana Pinter
Life 2023, 13(1), 138; https://doi.org/10.3390/life13010138 - 04 Jan 2023
Cited by 8 | Viewed by 4514
Abstract
Exposure to endocrine disrupting chemicals (EDCs) can result in alterations of the female reproductive system, including polycystic ovary syndrome (PCOS). The aim of this review was to summarize the knowledge about the association of EDCs (bisphenols, parabens, and triclosan) with PCOS. We conducted [...] Read more.
Exposure to endocrine disrupting chemicals (EDCs) can result in alterations of the female reproductive system, including polycystic ovary syndrome (PCOS). The aim of this review was to summarize the knowledge about the association of EDCs (bisphenols, parabens, and triclosan) with PCOS. We conducted an electronic literature search using PubMed for studies published between January 2007 and October 2022 on EDCs related to PCOS, and evaluated the association of PCOS with bisphenols, parabens and triclosan in 15 articles. Most studies revealed significantly higher plasma, urinary or follicular fluid levels of bisphenol A (BPA) in women with PCOS, and some showed a positive correlation of BPA with insulin resistance, polycystic morphology on ultrasound, hepatic steatosis, bilirubin levels, as well as free androgen index, androstenedione and testosterone serum levels, and markers of low-grade chronic inflammation. There was a negative correlation of BPA with markers of ovarian reserve, sex hormone binding globulin and vitamin D–binding protein. Parabens and triclosan have been studied in only one study each, with no significant associations with PCOS observed. Our review revealed an association of BPA with PCOS and negative effects of BPA on human ovaries; more research is needed to assess the potential associations of parabens and triclosan with PCOS. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome: Current Knowledge and Future Perspectives)
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