Gynecological Endocrinology最新文献

Objectives: Polycystic Ovary Syndrome (PCOS) is a complex condition affecting approximately 1 in 10 women of reproductive age. However, limited data are available regarding the specific characteristics and needs of women with PCOS in Latin America. This consensus sought to evaluate the evidence-based practices for the management of PCOS for Latin American populations, consolidate regional insights, identify eventual gaps in implementation and identify key research opportunities.

Methods: Using the Delphi strategy, experts from various Latin American countries selected and reviewed a subset of recommendations from the 2023 International Evidence-Based Guideline (EBG) for the Assessment and Management of PCOS. Virtual and in-person meetings facilitated discussions on the selected recommendations, followed by voting rounds to achieve consensus.

Results: A total of 33 recommendations for PCOS diagnosis and treatment were evaluated. In the initial voting round, 25 recommendations achieved strong agreement (80%-100% support), while eight received less than 80% agreement. After further discussions on their relevance and potential to influence behavior change among health professionals and public health policies, the remaining recommendations achieved near-unanimous support in the second round.

Conclusions: This consensus underscored evidence-based practices for PCOS diagnosis and treatment deemed appropriate for the Latin American context. It also highlighted implementation barriers such as cost and accessibility, while identifying opportunities for research to improve PCOS management and address regional challenges. These findings aim to enhance clinical care and inform public health strategies tailored to the needs of Latin American women living with PCOS.

Objective: The aim of this study was to investigate the possible influence of a family history of PCOS on male reproductive health by comparing the spermiogram parameters of patients diagnosed with a first-degree relative with PCOS with those of a control group without such a family history.

Methods: This prospective study included 51 male participants aged 19-39 years, 25 of whom had a first-degree relative diagnosed with PCOS, while 26 formed the control group. Semen samples were collected and analyzed according to the World Health Organization (WHO) 2021 guidelines.

Results: In this study, the spermiogram results of 51 patients aged between 19 and 39 years with a mean age of 31.50 ± 4.80 years were analyzed. The median sperm concentration (0.6 vs. 11.1 million/ml; p = 0.024) was significantly lower in the study group and the median total progressive motile sperm concentration (3.7 vs. 3.0 million/ml; p = 0.010) was significantly lower in the control group. Comorbidities were more common in the study group, including hair loss (64%; p < 0.001) and gynecomastia (25%; p = 0.008). Robust regression analysis revealed that semen concentration was significantly higher in subjects with dyslipidemia (+95.973 million/ml; p < 0.001), as was sperm motility (+49.081 units; p < 0.001) and TPMSC (+74.028 million/ml; p < 0.001).

Conclusion: Men with family history of PCOS have distinct reproductive and metabolic features, including lower median sperm concentration and higher incidence of alopecia and gynecomastia. Dyslipidemia significantly predicted improved sperm concentration and motility.

Background: Adenomyosis is a uterine disorder causing menstruation-related symptoms such as dysmenorrhea, heavy menstrual bleeding (HMB) and dyspareunia. A long-term management of the disease is required. Hormonal drugs are the most used, including a variety of progestins, even though few data are available on their long-term use in adenomyosis.

Objective: To evaluate the long-term efficacy of different progestins, including progestin-only pills (POP), for the management of adenomyosis-related symptoms.

Methods: A total of 140 patients (18-45 years) with adenomyosis were treated with progestins for at least three years. The treatment groups included dienogest (2 mg, n = 71), levonorgestrel-releasing intrauterine device (52 mg, n = 25), desogestrel (75 mcg, n = 20), and drospirenone (4 mg, n = 24). Symptoms were assessed using the Visual Analogue Scale (VAS) for pain and the Pictorial Blood Assessment Chart (PBAC) method for bleeding.

Results: Dienogest significantly reduced dysmenorrhea, dyspareunia, and HMB, with efficacy maintained over three years in most patients. However, after the first year 49% of patients required a switch to other treatments due to side effects or contraception need. The levonorgestrel-releasing intrauterine device also effectively managed HMB and pain, with 15% of patients switching treatment due to side effects. Both drospirenone and desogestrel improved HMB and dysmenorrhea, but desogestrel had a higher discontinuation rate due to reduced long-term efficacy. Norethisterone acetate was used as a second-line treatment in cases of intolerance or inadequate response.

Conclusion: Progestins are effective for the long-term management of adenomyosis symptoms. The flexibility in switching between different progestins or routes of administration may help in optimizing outcomes.

Objective: While advances in allogeneic hematopoietic stem cell transplantation (allo-HSCT) have improved survival rates, the impact on reproductive function in Chinese female pediatric survivors remains underexplored. This study evaluated the incidence and factors influencing ovarian function impairment in these survivors.

Methods: A prospective study was conducted on 104 children who survived allo-HSCT between 2018 and 2021 at Beijing Children's Hospital. Data on hematologic disease, age, and ovarian function were collected. Statistical analyses assessed changes in sex hormone levels and identified factors linked to gonadal damage.

Results: Post-transplant, follicle-stimulating hormone levels rose significantly (p = 0.013 for girls ≥10 years old), while anti-Müllerian hormone levels decreased (p < 0.001). The incidence of premature ovarian insufficiency (POI) was 26.92% at 1 year, 47.44% at 2 years, and 70.18% at 3 years post-transplant. Risk factors for POI included transplantation age ≥10 years, weight >20 kg at transplantation, myeloablative conditioning, and total body irradiation (OR = 6.76, p = 0.005; OR = 6.63, p = 0.003; OR = 17, p = 0.017; OR = 15.03, p = 0.026). Only 3.85% of patients received ovarian function protection before transplantation. Among patients aged ≥12 years at follow-up, 86.36% developed POI, with 26.32% receiving oral estrogen replacement therapy.

Conclusions: Hypogonadal function significantly declines in pediatric patients after allo-HSCT. Fertility protection and hormone replacement therapy were rarely used.

Pregnant women with Polycystic ovary syndrome (PCOS) often experience exacerbated endocrine and metabolic dysfunction. While existing studies lack prospective data exist for Chinese populations. Our study aimed to characterize endocrine profiles in Chinese PCOS pregnancies using a prospective cohort. Ninety-one participants (33 PCOS, 58 non-PCOS) were enrolled. Endocrine and metabolic parameters were measured at three trimesters (12-16, 24-28, 32-36 weeks). Primary outcomes included total testosterone (T), sex hormone-binding globulin (SHBG), and free androgen index (FAI). Secondary outcomes covered fasting insulin (FINS), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), LDL, and HDL. Logistic regression models adjusted for confounders were used for group comparisons. Women with PCOS exhibited higher T and FAI levels compared to women without PCOS across all gestational windows, even after adjusting for factors including pre-pregnancy BMI. Women with PCOS exhibited elevated FINS levels and HOMA-IR at 12-16 weeks and 32-36 weeks of gestation. After adjustment for pre-pregnancy BMI, initial glucose metabolism differences were attenuated and no longer statistically significant. Women with PCOS displayed minor lipid metabolic differences in lipid metabolism. This study highlights complex metabolic changes in PCOS pregnancies, characterized by persistent hyperandrogenism and altered glucose metabolism. Pre-pregnancy BMI might emerge as the key driver of exacerbated glucose dysregulation.

To determine rates of fertilization, good-quality day 3 embryos, and blastocyst progression in sibling oocytes of the same patients undergoing piezo and calcium ionophore (CaI) activation. The retrospective cohort study included couples undergoing assisted reproductive treatment in 2023-2024 for primary infertility with a history of low fertilization rates (<30%), low blastulation rates (<20%), or male factor infertility such as teratozoospermia at the Izmir University of Economics Medical Point Hospital IVF Center. Sibling oocytes from each patient were randomly assigned to piezoelectric or CaI activation. The fertilization rate, number of degenerated embryos, number of abnormally fertilized eggs, number of day 3 grade 1 embryos, and blastocyst counts were compared among the sibling oocytes. In total, 1,105 MII sibling oocytes from 76 patients were included. Piezoelectric activation was applied to 575 MII oocytes, while CaI activation was applied to 530 MII oocytes. There was no significant difference between groups according to the activation method in the fertilization rate (piezo, 0.74% ± 0.22%; CaI, 0.68% ± 0.26%, p = 0.12), degeneration rate (piezo, 0.04% ± 0.13%; CaI, 0.02% ± 0.06%, p = 0.452), day 3 grade 1 embryo rate (piezo, 0.59% ± 0.33%; CaI, 0.54% ± 0.35%, p = 0.34), or blastocyst rate (piezo, 0.49% ± 0.33%; CaI, 0.43% ± 0.34%, p = 0.28) of sibling oocytes. Both piezoelectric and CaI activation yielded comparable results in terms of oocyte activation, with similar fertilization and blastulation rates.

This retrospective cohort study examined the association between first-trimester triglyceride-to-HDL cholesterol (TG/HDL-C) ratio and gestational diabetes mellitus (GDM) risk among 2,356 pregnant women from Shanghai General Hospital between October 2019, and June 2021. Using logistic regression and restricted cubic spline models, we found the TG/HDL-C ratio was an independent GDM predictor (OR:1.37, 95%CI:1.16-1.62, p<0.001), persisting after adjustment (aOR:1.65, 95%CI:1.27-2.13, p<0.001). Nonlinear dose-response relationships were observed (p-interaction<0.05), with stronger associations in women >35 years (OR:1.60, 95%CI:1.12-2.28) and those with BMI≥25kg/m² (OR:1.78, 95%CI:1.25-2.54). First-trimester TG/HDL-C ratio elevation significantly increases GDM risk, suggesting its potential for early risk stratification and targeted prevention.

Objective: The purpose of the study is to investigate therapeutic effects of metformin on improving PCOS and the underlying mechanism.

Methods: PCOS modeling and metformin treatment in rats was performed by subcutaneous injection of dehydroepiandrosterone (DHEA) daily, high-fat diet feeding, and intragastric administration of metformin for 21 consecutive days. PCOS modeling and metformin treatment in KGN cells was performed by DHEA treatment at a concentration of 10^-5mol/l for 48 h and metformin treatment (10^-7 M) for 24 h.

Results: After PCOS modeling, rats showed more weight gain, improved glucose tolerance, disrupted estrous cycles, characteristic polycystic ovary morphology, more apoptotic cells in the ovary with enhanced oxidative stress, and declined Nrf2 and HO-1 expressions. Metformin treatment effectively alleviated characteristic polycystic ovary morphology, prevented apoptosis and oxidative stress, and decreased Nrf2 and HO-1 expressions of PCOS rats. Similarly, metformin treatment reduced the apoptosis and oxidative stress in DHEA-treated KGN cells, but anti-apoptotic and antioxidant effects of metformin were partially reversed by Nrf2 knockdown in DHEA-treated KGN cells.

Conclusion: The findings of the study suggest that metformin protects ovarian granulosa cells against oxidative stress and apoptosis in the context of PCOS via activation of Nrf2-HO-1 pathway.