Polycystic Ovary Syndrome (PCOS) in Gynecologic Endocrinology

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 16977

Special Issue Editors


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Guest Editor
Department of Women’s Health, Institute of Rural Health in Lublin, Lublin, Poland
Interests: endocrine gynecology; reproductive endocrinology; endocrine diseases in pregnancy; infertility; menopause; antiaging medicine
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Guest Editor
Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
Interests: endometriosis; endometrial cancer; ovarian diseases; PCOS

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Guest Editor
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
Interests: oncological gynecology; ovarian cancer; vulvar cancer; endometriosis; PCOS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Polycystic ovarian syndrome (PCOS) is the most common reproductive endocrinology disorder and the first cause of infertility due to anovulation. Despite remarkable scientific efforts, PCOS is one of the most important dilemmas in reproductive medicine, as its etiopathogenesis is still largely unknown, and its environmental and genetic causative factors are still not defined. Many therapeutic strategies have been considered for inducing ovulation; however, in the case of patients with resistance to clomiphene citrate, there is no gold standard for management. Gonadotropins are not always successful and can cause adverse events such as multiple pregnancies, and ovulation induction has to be interrupted due to ovarian hyperstimulation syndrome risk on various occasions. Laparoscopy ovarian drilling (LOD) overcomes some of these limits and ensures more durable effects; however, some negative aspects, such as the risk of adhesion development or ovarian reserve damage, should not be underestimated. An ideal therapeutic strategy is yet to be identified, and the characteristics of the women who will better respond to each treatment and the main benefits and drawbacks for them are still unclear. The aim of this Special Issue is to describe the medical and surgical strategies used to overcome issues in cases of infertility treatment failure in women with PCOS.

Prof. Dr. Iwona Bojar
Dr. Pierluigi Giampaolino
Dr. Luigi Della Corte
Guest Editors

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Keywords

  • PCOS
  • infertility
  • ovarian drilling
  • clomiphene citrate resistance

Published Papers (5 papers)

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Research

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14 pages, 2242 KiB  
Article
Anxiety and Depression in Women with Polycystic Ovary Syndrome
by Paweł Dybciak, Ewa Humeniuk, Dorota Raczkiewicz, Jan Krakowiak, Artur Wdowiak and Iwona Bojar
Medicina 2022, 58(7), 942; https://doi.org/10.3390/medicina58070942 - 16 Jul 2022
Cited by 11 | Viewed by 5995
Abstract
Background and Objectives: Mental health disorders are often the consequence of hormonal disorders such as those accompanying polycystic ovary syndrome (PCOS), where changes in appearance and having to deal with a number of other problems occur due to this illness. The objective [...] Read more.
Background and Objectives: Mental health disorders are often the consequence of hormonal disorders such as those accompanying polycystic ovary syndrome (PCOS), where changes in appearance and having to deal with a number of other problems occur due to this illness. The objective of this study was to determine the prevalence and severity of anxiety and depression symptoms, the level of ego-resiliency, and the ways that women with PCOS cope with stress compared to healthy women in order to determine the influence of socio-demographic characteristics in relation to levels of anxiety and depression with ego-resiliency and stress-coping methods. Materials and Methods: The study was conducted in Poland in 2021 and included 230 women with PCOS and 199 healthy controls aged 20–40 years old. The hospital anxiety and depression scale (HADs), ego-resiliency scale, as well as the MINI-COPE inventory were used. Results: The women with PCOS had higher levels of anxiety and depression and poorer ego-resiliency in comparison to the healthy women. The women with PCOS used passive stress-coping strategies significantly more commonly than the healthy women. Living in rural areas, having a lower level of education and being childless increased anxiety levels. Similarly, being over 30, living in a rural area, having a lower level of education, being childless, and being obese increased depression levels in the women with PCOS. A low level of ego-resiliency and passive stress-coping strategies are predictors of high levels of anxiety and depression in women with PCOS. Conclusions: Women with PCOS should be checked for anxiety and depression. They should also be checked to see whether they have the resources to cope with chronic stress in order to optimize therapeutic interventions. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS) in Gynecologic Endocrinology)
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10 pages, 1189 KiB  
Article
Kisspeptin Variations in Patients with Polycystic Ovary Syndrome—A Prospective Case Control Study
by Mona Akad, Răzvan Socolov, Cristina Furnică, Roxana Covali, Catalina Daniela Stan, Eduard Crauciuc and Ioana Pavaleanu
Medicina 2022, 58(6), 776; https://doi.org/10.3390/medicina58060776 - 8 Jun 2022
Cited by 5 | Viewed by 2287
Abstract
Background and objectives: Kisspeptin, also named metastin, showed important roles in initiating the secretion of gonadotropin-releasing hormone (GnRH) and is an essential factor in the development of polycystic ovaries syndrome (PCOS). Several research studies noticed associations between kisspeptin levels and patients with [...] Read more.
Background and objectives: Kisspeptin, also named metastin, showed important roles in initiating the secretion of gonadotropin-releasing hormone (GnRH) and is an essential factor in the development of polycystic ovaries syndrome (PCOS). Several research studies noticed associations between kisspeptin levels and patients with anovulatory cycles due to PCOS with an increased LH/FSH ratio. The aim of our study was to bring scientific evidence regarding the correlation between high kisspeptin and luteinizing hormone values in subfertile women due to PCOS. Materials and Methods: A prospective case-control study was conducted in “Elena Doamna” Hospital of Obstetrics and Gynecology between 4 January 2021 and 1 March 2022. All patients agreed to participate in our study, had ages between 18 and 45 years old, and had a body mass index between 18.5 and 30 kg/m2. The study group consisted of subfertile patients with PCOS and menstrual disturbances, including amenorrhea or oligomenorrhea. The control group consisted of healthy patients with ovulatory cycles and no other reproductive or endocrinology pathologies. During the follicular phase of their menstrual cycle, patients had blood samples taken with the dosage of kisspeptin, LH, FSH, estradiol, insulin, glycemic levels, testosterone, and prolactin. Pelvic ultrasounds and clinical examinations were performed as well. Results: Significant differences were observed in kisspeptin, LH, FSH, and estradiol levels between patients with PCOS and the control group. After the univariate analysis, PCOS was significantly associated with increased kisspeptin, increased LH, and decreased FSH. There was no significant association between PCOS, estradiol, prolactin, and insulin. Conclusions: kisspeptin serum values are higher in subfertile PCOS patients, supporting the hypothesis that an over-stimulation of the KISS1 system might cause the hyper-stimulation of the HPG-axis. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS) in Gynecologic Endocrinology)
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11 pages, 906 KiB  
Article
Quantitative Changes in White Blood Cells: Correlation with the Hallmarks of Polycystic Ovary Syndrome
by Abdulrahman H. Almaeen, Abdulrahman Abdulwahab Alduraywish, Mudasar Nabi, Naveed Nazir Shah, Rahiman Shaik and Bilal Ahmad Tantry
Medicina 2022, 58(4), 535; https://doi.org/10.3390/medicina58040535 - 12 Apr 2022
Cited by 7 | Viewed by 2860
Abstract
Background and Objectives: In women of reproductive age, leukocytosis is a risk factor that bridges low-grade chronic inflammation (metabolic inflammation), metabolic changes, and polycystic ovary syndrome (PCOS) and is a potential early predictor of PCOS. This study aims to explore the predictive role [...] Read more.
Background and Objectives: In women of reproductive age, leukocytosis is a risk factor that bridges low-grade chronic inflammation (metabolic inflammation), metabolic changes, and polycystic ovary syndrome (PCOS) and is a potential early predictor of PCOS. This study aims to explore the predictive role of quantitative changes in white blood cells (WBCs) and neutrophils in PCOS-associated metabolic changes. Materials and Methods: A total number of 176 blood samples were obtained from age-matched women of the reproductive period, comprising 88 PCOS cases and 88 healthy controls. Hematological, metabolic, and anthropometric indices and ultrasonic assessment were recorded. Results: Elevated levels of luteinizing hormone, testosterone, and lipid parameters except HDL-C levels, and the prevalence of metabolic syndrome in PCOS were statistically significant (p < 0.001). The neutrophil count and neutrophil–lymphocyte ratio (NLR) in PCOS patients were significantly higher (p < 0.001) than their counterparts. The predictive ability of the neutrophil count and neutrophil–lymphocyte ratio (NLR) for PCOS, and possibly its associating subclinical inflammation at optimum cut-off values for the neutrophil count and NLR of >46.62% (sensitivity 94.32% and specificity 74.42%) and >1.23 (sensitivity 71.59% and specificity 100%), respectively. With regard to the areas under the curve (AUC) and Youden indices, they constituted 0.922 and 0.697 for neutrophil count and 0.926 and 0.716 for NLR, respectively. The comparative ROC z-statistic value was 2.222 and a p = 0.026. The multiple linear regression analysis revealed no significant influence for hormonal and metabolic independent variables on the neutrophil count in PCOS cases, but, as can be expected, revealed a significant negative relationship with the other components of WBCs. Conclusion: In conclusion, relative neutrophilia and elevated NLR are potential cost-effective, sensitive, and specific predictors of PCOS that may also shed light on the mechanism of chronic low-grade inflammation that is characteristic of the disease. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS) in Gynecologic Endocrinology)
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10 pages, 302 KiB  
Article
Poor Ovarian Response to Gonadotrophins in PCOS Women after Laparoscopic Ovarian Drilling
by Tanja Burnik Papler, Martin Stimpfel, Brina Kovacik and Eda Vrtacnik Bokal
Medicina 2022, 58(2), 147; https://doi.org/10.3390/medicina58020147 - 19 Jan 2022
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Abstract
Background and Objectives: Polycystic ovary syndrome (PCOS) is a major cause of anovulatory infertility, and ovulation induction is the first-line treatment. If this fails, laparoscopic ovarian drilling (LOD) is used to induce mono-ovulations. There have been implications, that LOD can cause destruction of [...] Read more.
Background and Objectives: Polycystic ovary syndrome (PCOS) is a major cause of anovulatory infertility, and ovulation induction is the first-line treatment. If this fails, laparoscopic ovarian drilling (LOD) is used to induce mono-ovulations. There have been implications, that LOD can cause destruction of ovarian tissue and therefore premature ovarian failure. Furthermore, unexpected poor ovarian response (POR) to gonadotrophins can occur in PCOS women after LOD. There have been reports about FSH receptor polymorphisms found in women with PCOS that are related to higher serum FSH levels and POR to gonadotrophins. Materials and Methods: In the present study, we retrospectively analyzed data of 144 infertile PCOS women that had LOD performed before IVF. Results: Thirty of included patients (20.8%) had POR (≤3 oocytes) to ovarian stimulation with gonadotrophins. Women with POR had significantly higher median levels of basal serum FSH (7.2 (interquartile range (IQR), 6.0–9.2) compared to women with normal ovarian response (6.0 (IQR, 5.0–7.4); p = 0.006). Furthermore, women with POR used a significantly higher median cumulative dose of gonadotrophins (1875 IU (IQR, 1312.5–2400) for ovarian stimulation compared to women with normal ovarian response (1600 IU (IQR, 1200–1800); p = 0.018). Conclusion: Infertile PCOS women who experience POR after LOD have significantly higher serum FSH levels compared to women with normal ovarian response after LOD. As these levels are still within the normal range, we speculate that LOD is not the cause of POR. We presume that women with PCOS and POR after LOD could have FSH-R genotypes associated with POR and higher serum FSH levels. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS) in Gynecologic Endocrinology)

Review

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10 pages, 318 KiB  
Review
Ovarian Drilling: Back to the Future
by Antonio Mercorio, Luigi Della Corte, Maria Chiara De Angelis, Cira Buonfantino, Carlo Ronsini, Giuseppe Bifulco and Pierluigi Giampaolino
Medicina 2022, 58(8), 1002; https://doi.org/10.3390/medicina58081002 - 27 Jul 2022
Cited by 4 | Viewed by 2927
Abstract
Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. The complex metabolic dysregulation at the base of this syndrome often renders infertility management challenging. Many pharmacological strategies have been applied for the induction of ovulation with a non-negligible rate of severe [...] Read more.
Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. The complex metabolic dysregulation at the base of this syndrome often renders infertility management challenging. Many pharmacological strategies have been applied for the induction of ovulation with a non-negligible rate of severe complications such as ovarian hyperstimulation syndrome and multiple pregnancies. Ovarian drilling (OD) is currently being adopted as a second-line treatment, to be performed in case of medical therapy. Laparoscopic ovarian drilling (LOD), the contemporary version of ovarian wedge resection, is considered effective for gonadotropins in terms of live birth rates, but without the risks of iatrogenic complications in gonadotropin therapy. Its endocrinal effects are longer lasting and, after the accomplishment of this procedure, ovarian responsiveness to successive ovulation induction agents is enhanced. Traditional LOD, however, is burdened by the potential risks of iatrogenic adhesions and decreased ovarian reserve and, therefore, should only be considered in selected cases. To overcome these limits, novel tailored and mini-invasive approaches, which are still waiting for wide acceptance, have been introduced, although their role is still not well-clarified and none of them have provided enough evidence in terms of efficacy and safety. Full article
(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS) in Gynecologic Endocrinology)
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