Gynecological Endocrinology最新文献

Purpose: To comprehensively compare and rank hormone therapy for patients with perimenopausal syndrome.

Methods: A comprehensive search was conducted on PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases from inception to August 20, 2024. The quality of the included randomized controlled trials (RCTs) were measured by the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was applied to grade the quality of evidence in this network meta-analysis. Network plots were depicted to show direct and indirect comparisons of hormone therapy for each outcome. The influences of different hormone therapy on the outcomes were illustrated via forest plots and league tables. Rank probabilities showed the ranking of different administration routes.

Results: Seven studies involving 704 perimenopausal syndrome patients were included. The rank probabilities suggested that oral estradiol (E₂₎ combined with medroxyprogesterone and general health guidance had the highest likelihood to be the optimal therapy for the severity of menopausal syndrome. General health guidance combined with oral E₂ was less likely to have a nausea and vomiting, and breast pain.

Conclusion: Oral E₂ and medroxyprogesterone or general health guidance combined with oral E₂ may be the effective and safe option for the management of perimenopausal syndrome.

Objective: To evaluate the effects of a combination of carnitines, L-arginine, L-cysteine and myo-inositol on metabolic and reproductive parameters in PCOS overweight/obese patients.

Methods: This was a retrospective study analyzing information of a group of PCOS (n = 25) overweight/obesity patients, not requiring hormonal treatment, selected from the database of the ambulatory clinic of the Gynecological Endocrinology Center at the University of Modena and Reggio Emilia, Modena, Italy. The hormonal profile, routine exams and insulin and C-peptide response to oral glucose tolerance test (OGTT) were evaluated before and after 12 weeks of a daily oral complementary treatment with L-carnitine (500 mg), acetyl-L-carnitine (250 mg), L-arginine (500 mg), L-cysteine (100 mg) and myo-inositol (1 gr). The hepatic insulin extraction index was also calculated.

Results: The mix of complementary substances significantly improved metabolic parameters, homeostatic model assessment for insulin resistance index values and gonadotropin plasma levels. Glucose, C-peptide and insulin response to OGTT was significantly reduced as well as the hepatic insulin extraction index.

Conclusion: The administration of a combination of carnitines, L-arginine, L-cysteine and myoinositol improved gonadotropin plasma levels and insulin sensitivity in overweight/obese PCOS patients and restored hepatic clearance of insulin as demonstrated by the decreased hepatic insulin extraction index.

Objective: This study aimed to determine the prevalence of vitamin D deficiency and its associated factors among women attending women's health clinics at a university medical center in Lebanon.

Methods: We retrospectively reviewed clinical and obstetric data, including 25-hydroxyvitamin D [25OHD] serum levels and vitamin D3 supplementation, from 873 healthy singleton pregnancies delivered between 2006 and 2017. Women with preexisting comorbidities or prior gestational complications were excluded. VDD was defined as a 25OHD serum level <20 ng/ml.

Results: At baseline, 63% of participants were vitamin D deficient. Poisson regression was used to identify independent predictors of deficiency. In early gestation, 25OHD levels varied significantly by age, pre-pregnancy BMI, parity, smoking status, and season of presentation (all p < 0.05). At late gestation, vitamin D levels were associated with pre-pregnancy BMI, hemoglobin status at delivery, and vitamin D status at early gestation. Women with 25OHD <20 ng/ml at late gestation were more likely to be anemic compared to those with levels ≥20 ng/ml (adjusted odds ratio 1.6; 95% CI: 1.1-2.5).

Conclusion: Vitamin D deficiency is highly prevalent among pregnant Lebanese women. Identified risk factors including higher BMI, younger age, multiparity, and anemia should prompt consideration of more aggressive vitamin D supplementation strategies for women planning pregnancy.

Synopsis: Vitamin D deficiency is quite prevalent among pregnant women in the Middle East. We aim to report the prevalence of Vitamin D deficiency and its associated predictors during pregnancy.

Objective: It has been established that male cigarette smoking has a negative effect on the semen quality and that it can induce DNA damage leading to worsening of reproductive outcomes. The aim of our large retrospective study is to determine the influence of male cigarette smoking on assisted reproduction, more specifically in IVF and ICSI outcomes.

Materials and methods: Our study included all consecutive infertile couples (with a nonsmoking female partner) having their first IVF/ICSI cycle. All patients had smoking assessment. Smokers were further classified into mild (1-10 cigarettes/day), moderate (11-20 cigarettes/day) or heavy smokers (>20 cigarettes/day). The primary outcome was live birth rates (LBR).

Results: The overall number of patients analyzed was 4004 and among them 433 (10.8%) were smokers. Baseline characteristics, such as female age and BMI differed significantly between nonsmokers and smokers. The crude analysis showed higher positive hCG and LBR in smokers (positive hCG 28.34% in nonsmokers vs 33.95% in smokers, p = 0.015; LBR 23.55% in nonsmokers vs 28.64% in smokers, p = 0.019) However after adjustment for relevant confounders (female age, BMI, cause of infertility, number of oocytes retrieved, insemination procedure, number of embryos transferred and day of embryo transfer) the smoking status was not significantly associated with fresh LBR (OR = 1.16, CI = 0.92-1.48; p = 0.2). The results were replicated after classification of smoking into mild/moderate/heavy [OR for nonsmokers (reference category) vs. mild vs. moderate vs. heavy= 1, 1.17, 1, 2.99; p = 0.18)].

Conclusion: Male smoking does not seem to impair live birth rates in patients undergoing IVF/ICSI treatment.

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.