Gynecological Endocrinology最新文献

The aim of this analysis is to assess the effect of obesity on reproductive hormones in Chineses patients with polycystic ovarian syndrome (PCOS). Seven databases were searched. The Newcastle-Ottawa Scale (NOS) assessed the quality of included studies. A meta-analysis was performed using random-effects model. The means and standard deviations of the outcomes were synthesized as standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs). A total of 23 studies involving 4554 patients with PCOS were included. No significant differences in follicle-stimulating hormone (FSH) (p = 0.51), estradiol (E2) (p = 0.48), and prolactin (PRL) (p = 0.46) levels were found between obese and nonobese PCOS patients. However, obese PCOS patients had significantly lower levels of luteinizing hormone (LH) (p < 0.00001), LH/FSH (p = 0.001), progesterone (P) (p = 0.009), and anti-mullerian hormone (AMH) (p = 0.001). Conversely, they exhibited significantly higher testosterone (T) (p = 0.001) levels. Obese PCOS patients exhibited lower levels of LH, LH/FSH, P, and AMH, but higher T levels compared to nonobese PCOS patients, and no significant difference were observed in FSH, E2, and PRL levels in PCOS patients with and without obesity.

Objective: Observational studies have suggested associations between premature ovarian insufficiency (POI) and immunological abnormalities or dyslipidemia, but causal evidence remains unestablished.

Methods: We conducted a two-sample Mendelian randomization (MR) study to evaluate causal relationships of POI with immune cell traits (CD4+ regulatory T cell [Treg], and its subtype CD39 + CD4+ Treg, CD33 expression) and lipid metabolism markers (low-density lipoprotein [LDL] and intermediate-density lipoprotein [IDL] subfractions). Genetic instruments were derived from three independent sources: immune cell data from 3,757 Sardinians, lipid traits from 21,559 Europeans, and POI cases (N = 655) with population-matched controls (N = 267,780) from FinnGen R12. Primary causal estimates were generated using inverse-variance weighted regression, complemented by sensitivity analyses (MR-Egger, MR-PRESSO).

Results: CD39+ Treg subpopulations showed robust protection against POI in proportional analyses: secreting (%CD4 Treg: OR = 0.889, p = 0.015), activated (%CD4 Treg: OR = 0.881, p = 0.021). CD39+ resting Treg absolute count was significant (OR = 0.861, p = 0.027), while CD39 expression on activated/secreting Treg reduced risk (OR = 0.917-0.904, p < 0.05). Elevated CD33 expression on 9 of 12 myeloid cell subsets (e.g. granulocytic myeloid-derived suppressor Cells, CD33+ monocytes), and plasma CD33 protein (OR = 0.877, p = 0.030) were inversely associated with POI risk. Dyslipidemia traits demonstrated causal associations: total cholesterol (OR = 1.328, p = 0.028), large LDL-free cholesterol (OR = 1.28, p = 0.030), and IDL components-total cholesterol, free cholesterol, phospholipids, particle concentration, and total lipids (OR = 1.287-1.345, all p < 0.05).

Dyslipidemia traits demonstrated causal associations: Total cholesterol (OR = 1.328, p = 0.028), large LDL-free cholesterol (OR = 1.28, p = 0.030), and IDL components-total cholesterol, free cholesterol, phospholipids, particle concentration, and total lipids (OR = 1.287-1.345, all p < 0.05).

Conclusions: This study establishes POI as an immunometabolic disorder driven by Tregs deficiency, CD33-mediated protection, and lipid dysregulation, advocating targeted therapies for ovarian protection.

Aims: A systematic review and meta-analysis were performed to determine the association of metabolic syndrome (METS) in women with and without overactive bladder (OAB).

Methods: PRISMA guidelines were followed and the protocol was registered at PROSPERO (CRD42024606398). We searched PubMed, Embase, Cochrane Library, and LILACS databases to obtain relevant articles for studies reporting METS outcomes related to OAB published through October 2024. A meta-analysis was performed of available studies using random effect models. Results are reported as mean difference (MD), standardized MD (SMD), or odds ratio (OR) and their 95% confidence interval (CI). Heterogeneity was described with the I² statistic. The quality of studies was assessed using the Newcastle-Ottawa Scale.

Results: Of the 108 non-duplicated retrieved citations, after successive selection, four case-control studies with low or moderate risk of bias reported information about the association of METS in women assessed with the 8-item OAB Symptom Bother Scale. OAB patients displayed higher body mass index (BMI, MD: 3.27, 95% CI: 2.12, 4.43), waist circumference (MD: 7.96, 95% CI: 4.41, 11.52), fasting blood glucose (SMD: 1.26, 95% CI: 0.18, 2.34), triglycerides (SMD: 0.24, 95% CI: 0.01, 0.47), and LDL-cholesterol (SMD: 0.30, 95%CI: 0.06, 0.54) levels. In addition to low HDL-cholesterol levels (SMD: -0.40, 95% CI: -0.74, -0.06) compared to the control group. There were no significant differences in circulating total cholesterol levels and rates of hypertension, hysterectomy, postmenopausal status, and constipation in women with and without OAB.

Conclusion: Women with OAB display associations with age, BMI, waist circumference, and METS factors.

Background: This study aims to explore the value of anti-Müllerian hormone (AMH) in combination with angiopoietin-like protein 8 (ANGPTL8) in evaluating the ovarian function of infertile patients.

Methods: A total of 213 infertile patients who sought treatment in our hospital from January 2023 to July 2024 were included. Transvaginal color Doppler ultrasound assessed antral follicle count and ovarian reserve. Patients were divided into a0 control group (116 cases with normal ovarian reserve) and a research group (97 cases with decreased ovarian reserve). Serum levels of AMH, ANGPTL8, and sex hormones were measured for all patients, and results were compared between groups to analyze the combined assessment's value.

Results: In the control group, AMH levels were (4.44±2.36) ng/ml, ANGPTL8 (17.81±7.79) ng/ml, and estradiol (E2) (37.21±17.78) pg/ml. In the research group, AMH was (0.64±0.61) ng/ml, ANGPTL8 (12.04±5.04) ng/ml, and E2 (32.80±10.10) pg/ml. The research group showed significantly lower AMH, ANGPTL8, and E2 levels (P<0.05) and higher FSH and LH levels (P<0.001). The combined AMH and ANGPTL8 assessment demonstrated a sensitivity of 94.0%, specificity of 95.9%, and an area under the curve of 0.988.

Conclusion: The combined assessment of AMH and ANGPTL8 holds significant value in evaluating ovarian function in infertile patients.

The aim of this study was to compare pregnancy, obstetrical outcomes and number of visits between patients undergoing frozen embryo transfer in artificial vs modified natural cycle. A total of 1207 frozen single embryo transfer cycles performed in 2022 were retrospectively studied. Patients older than 40, with recurrent implantation failure, and recurrent pregnancy loss were excluded. Patients were divided according to their age, BMI, AMH, and type of embryo transfer protocol. Patients in the modified natural cycle group were followed by ultrasound until triggering criteria met, then HCG trigger was scheduled, and the embryo transferred 7 days later. In the artificial cycle group, patients received estrogen supplementation after downregulation, and when the endometrium reached a thickness ≥ 7 mm an embryo transfer was scheduled following intramuscular progesterone administration for 5 days. A total of 649 patients were included in the study. A higher percentage of patients in the artificial cycle group had an initial positive B-hCG test result. The modified natural group had significantly better clinical pregnancy and live birth rates, mainly due to the significantly higher miscarriage rate observed in the artificial cycle group. There was no difference in the mean endometrial thickness between both groups. The number of visits was higher in the m-NC group. Patients with a m-NC protocol had a lower risk of hypertensive disorders of pregnancy (HDP), but a higher risk of gestational diabetes, though the results were non-significant. In conclusion embryo transfer in m-NC yielded a higher live birth rate, more frequent clinic visits, and lower chances of miscarriage.

To date, there remains a paucity of prospective studies examining the association between premature ovarian insufficiency (POI) and cardiovascular diseases (CVD). The objective of this study was to investigate the potential association between POI and CVD utilizing the method of Mendelian randomization (MR). MR analyses utilized summary statistics from the most extensive genome-wide association studies (GWAS) on POI and CVD extracted from European ancestry cohorts and the FinnGen biobank. The inverse variance-weighted (IVW) method was the primary MR analysis technique. Supplementary analyses were performed using MR-Robust Adjusted Profile Score (MR-RAPS). Cochran's Q statistic, MR-Egger, and weighted median MR models were employed to further assess heterogeneity and horizontal pleiotropy. Causal effects of POI on coronary heart disease (odds ratio [OR] = 1.048, 95% confidence interval [CI]: 1.006-1.091; p = 0.023)] and ischemic stroke (OR = 1.010, 95% CI: 1.000-1.020; p = 0.0498) were found. However, we did not observe a significant correlation between POI and hypertension (OR = 0.999, 95% CI: 0.994-1.004, p = 0.691), heart failure (OR = 1.009, 95% CI: 0.999-1.020, p = 0.0725), atrial fibrillation (OR = 0.995, 95% CI: 0.986-1.004, p = 0.3035), and myocardial infarction (OR = 1.002, 95% CI: 0.991-1.013, p = 0.7061). POI was causally associated with coronary heart disease and ischemic stroke, with no apparent impact on hypertension, heart failure, atrial fibrillation, or myocardial infarction. The causal relationship between POI and CVD underscores the imperative for proactive cardiovascular risk management in individuals with POI.

Background: A prolonged release combined oral contraceptive (COC) pill, containing 2 mg dienogest (DNG)/0.02 mg ethinylestradiol (EE) in a 24 + 4 daily dosing regimen has recently been approved in Europe.

Objective: To determine if this COC impacts coagulation and fibrinolytic factors in comparison to an immediate release COC containing 3 mg drospirenone (DRSP)/0.02 mg EE.

Method: Forty-four patients received the novel product, and forty-seven the comparator (immediate release formulation) during nine complete cycles. Coagulation and fibrinolytic parameters were evaluated: activated protein C resistance ratio, Antithrombin III (AT III), C-reactive protein, Factor VII, Factor VIII, and D-Dimer.

Results: Compared to baseline, at the end of the study both groups displayed significantly higher mean values for AT III: 1.06 mg/mL (standard deviation [SD], 95% CI, 0.98-1.15) for the DNG/EE formulation and 1.04 mg/mL (SD 95% CI, 0.96-1.12) for the comparator (p = 0.0006 and p = 0.0009, respectively). D-dimer showed a non-significant slight reduction in the DNG/EE group, from 276.62 ng/mL (SD, 95% CI, 228.92-334.26) before treatment to 243.98 ng/mL (SD, 95% CI, 192.45-309.31) ng/mL after treatment. Contrarily, the comparator displayed a non-significant rise in D-dimer values from 246.46 ng/mL (SD, 95% CI, 205.44-295.66) ng/mL to 275.30 ng/mL (SD, 95% CI 219.21-345.75; p = 0.4520). All other parameters showed no significant differences before and after the treatment for both groups.

Conclusion: The COC 2 mg DNG/0.02 mg EE was not associated with any meaningful changes in the analyzed coagulation and fibrinolytic parameters indicating that a prolonged release formulation does not impact on these factors.

Clinical trial registry: EudraCT: 2019-0018-77-97.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder associated with chronic low-grade inflammation of the ovary. Sodium glucose co-transporter 2 (SGLT2) inhibitors are a class of antidiabetic drugs that can reduce the weight and hyperglycemia of type 2 diabetes patients. Dapagliflozin is a highly selective, orally active and reversible inhibitor of the human SGLT2. However, the role of dapagliflozin in regulating PCOS remains unclear.

Methods: In this study, 24 six-week-old female Sprague Dawley (SD) rats were randomly divided into control, letrozole, and letrozole + dapagliflozin groups. PCOS model rats were produced by gavage administration of letrozole for 21 days. The intervention was conducted after the gavage administration of dapagliflozin for 14 days to evaluate the estrous cycle and ovarian imaging changes of the rats in each group. We observed changes in the weight, ovarian weight, and ovarian morphology of the rats in each group. Pathological changes in the ovaries were examined by H&E staining, changes in ovarian tissue cell apoptosis were identified using TdT-mediated dUTP Nick-End Labeling (TUNEL) staining, and changes in inflammation-related factors were detected using immunohistochemistry and Western blotting analysis. Network pharmacology was used to predict the inflammatory targets and pathways affected by dapagliflozin in treating PCOS, and the potential interactions between dapagliflozin and inflammation-related target proteins were evaluated through molecular docking.

Results: Our results demonstrated that dapagliflozin treatment significantly improved PCOS symptoms, recovered ovarian morphology and physiological functions, and reduced the apoptosis of ovarian cells after drug intervention. Dapagliflozin treatment also reduced the levels of pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α, indicating its anti-inflammatory properties. Furthermore, network pharmacology identified 26 intersecting target genes relevant to inflammation in PCOS, with subsequent molecular docking simulations revealing strong binding affinities of dapagliflozin to key targets, including AKT1 and TP53.

Conclusions: These findings suggest that dapagliflozin exerts beneficial effects on PCOS by ameliorating ovarian dysfunction and reducing inflammation. Dapagliflozin represents a promising therapeutic candidate for managing PCOS, warranting further clinical investigation to explore its full potential in treating this multifaceted disorder.

Background: There is no strong evidence demonstrating whether or not aerobic exercise in conjunction with resistance exercise improves metabolic diabetes markers in postmenopausal women.

Objective: To evaluate the effect of aerobic exercise and resistance training on metabolic markers in postmenopausal women with type 2 diabetes mellitus (T2DM) by means of a systematic review and meta-analysis.

Methods: The searches were completed using EMBASE, MEDLINE/PubMed, Scopus and Web of Science databases. This study included non-blinded, single or double-blinded randomized control trials and postmenopausal women diagnosed with T2DM. The imposed intervention was aerobic exercise plus any training protocol to strengthen muscle groups for resistance intervention. The outcomes of interest were the blood glucose levels, insulin secretion, homeostasis model assessment-insulin resistance index (HOMA-IR) and glycated hemoglobin (HbA1c). Risk of Bias tools and GRADE were obligatory.

Results: Three studies were included (83 participants). Exercise intervention ranged between two to four days per week. Compared to the control group, in the group submitted to aerobic exercise + resistance training, no significant change was noted for HbA1c (subtotal = mean difference - 0.35 [95% CI: -0.85, 0.15], p = .17, and heterogeneity = 0%) (GRADE: very low), nevertheless, HOMA-IR index was significantly improved (subtotal = mean difference -0.52 [95% CI: -0.99, -0.05], p = .03, and heterogeneity = 0%) (GRADE: very low).

Conclusion: Despite the very low certainty found in the quality of evidences, our analysis showed that aerobic exercise along with strength exercise seems to improve some metabolic diabetes markers in postmenopausal women with T2DM. There is a need for further studies to support our preliminary findings.

Purpose: This study aimed to evaluate the short-term benefits of GnRHa therapy, with a specific focus on the first year of treatment, in girls diagnosed with idiopathic central precocious puberty (ICPP) after age 8, providing essential evidence to inform clinical decision-making.

Methods: Ninety-four female patients treated with GnRHa at Jiangsu Children's Medical Center from January 2018 to January 2021 were retrospectively reviewed. Patients were divided into two groups based on the age of treatment initiation: on or before age 8 (Group I) and over age 8 (Group II). Hormonal parameters, bone age (BA)/chronological age (CA) ratio, genital organ volume, predicted adult height (PAH), and body mass index (BMI) were assessed during the treatment period.

Results: Treatment with GnRHa in girls with ICPP, whether administered before or after age 8, effectively inhibited puberty, slowed BA maturation, and led to an increase in PAH. Group I exhibited significantly better PAH improvement than Group II, with 50% surpassing a 5 cm increase in PAH compared to 25.9% in Group II. No significant changes in BMI were observed following treatment.

Conclusions: The findings of the study support the knowledge that GnRHa treatment is effective in height gain in girls with precocious puberty, especially if started before the age of 8 years.