BACKGROUND

Polycystic ovarian syndrome (PCOS) is a common gynecologic endocrine disorder affecting between 2.2% and 26% of the population. It is typically characterized by hirsutism and signs of ovulatory dysfunction. Hirsutism is defined as the presence of excess body or facial terminal hair growth in females, following a male-like pattern. It is diagnosed using visual assessment methods, such as the modified Ferriman–Gallwey (mFG) scoring system, and biochemical tests, including measurements of total testosterone (tT) and the free androgen index (FAI).

The general objective of the study is to identify the correlation of visual scoring with the biochemical evaluation of hirsutism. Specific objectives include (1) to describe the visual and biochemical scores of hirsutism in PCOS patients and (2) to determine a cutoff score for the visual scoring of hirsutism among Filipinos.

This is a cross-sectional study done in a tertiary hospital. Ethical approval was obtained for this study. Patients who satisfied the inclusion criteria were included in the study. Age, height, weight, body mass index (BMI), and OB score were noted. Visual scoring for hirsutism using the mFG scoring system was performed. Blood extraction was done for testosterone and sex hormone-binding globulin tests. FAI was then computed and correlated with the mFG scores.

A total of 52 patients were identified. A positive correlation is noted between the mFG with testosterone and FAI. A positive correlation was also noted between the BMI with testosterone and FAI. An mFG value of >4 is an acceptable cutoff for Filipinos.

The study showed as the mFG score increases, FAI and tT levels also increase. It was also noted that as BMI increases, the FAI and tT levels are also expected to increase. It can also be concluded that a lower mFG cutoff value, >4, is applicable for Filipinos.

This is a case of a 33-year-old, G3P3(3003) female patient with a clinical presentation of vaginal bleeding associated with on and off hypogastric pain. The patient was diagnosed and managed as a case of tubo-ovarian abscess and subsequently underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO). Microscopic sections of both ovaries, however, showed dual population of tumor cells composed of medium-sized, mononucleated cells admixed with multinucleated giant cells with marked pleomorphism, extensive hemorrhage and necrosis. Immunohistochemistry studies using beta-hCG was diagnostic of ovarian choriocarcinoma, favoring non-gestational in origin. Classification of non-gestational choriocarcinoma (NGOC) was established using diagnostic criteria for NGOC established by Saito et al., and Mangla et al. DNA analysis, however, remains to be the gold-standard for differentiating between gestational (GOC) and non-gestational (NGOC) etiology.

BACKGROUND AND OBJECTIVE

Polycystic ovarian syndrome (PCOS) is a complex disease associated with endometrial lesions. Local data on endometrial findings associated with PCOS are limited. This study aimed to determine the local prevalence and spectrum of endometrial findings and their association with clinical factors among Filipino women with PCOS.

This is a retrospective review of women aged 18–40 years old seen at a local tertiary hospital from January 2016 to December 2020 with ultrasound findings of polycystic ovaries based on Rotterdam criteria. The clinical data and ultrasound findings/impressions were reviewed. Histopathologic results when available were retrieved. Data were analyzed using descriptive statistics; abnormal endometrial findings were associated with clinical factors using binary logistic regression analysis.

A total of 177 women were included in the study, and 39 (22%) had abnormal endometrial findings by ultrasound including thickened endometrium (14.7%), polyp (5.1%), submucous myoma (1.1%), and malignancy (1.1%). Ultrasound findings that were significantly common with abnormal endometrium included thickening, nonuniform echogenicity, and the presence of vascularity. Irregular menses were more common in those with a normal endometrium, while heavy menses predominated in those with an abnormal endometrium, with statistically significant differences (CONCLUSION

Abnormal endometrial findings were relatively common among cases with polycystic ovaries, and most often, cases present with heavy menstrual bleeding. However, no predictable clinical factor can help identify PCOS patients with abnormal endometrial findings. Although malignancy was less common in the age group included in this study, the presence of abnormal sonographic findings would warrant further evaluation.

OBJECTIVE

To determine the threshold value for anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovarian syndrome (PCOS) in infertile Filipino women and to ascertain the correlation of AMH with age and body mass index of PCOS women.

A retrospective cross-sectional study was carried out on infertile Filipino women at the Center for Advanced Reproductive Medicine and Infertility from August 2015 to March 2020. The women were separated into the PCOS group and male factor infertility group. Serum AMH was analyzed with Access AMH chemiluminescent immunoassay by Beckman Coulter. The AMH threshold for the diagnosis of PCOS was computed using Youden’s index.

There were 585 women included in the study, 311 (53.16%) were diagnosed with PCOS by the Rotterdam criteria, while 274 (46.84%) were non PCOS women. Mean serum AMH for PCOS was 5.88 ± 3.37 (p < 0.01). A threshold value of serum AMH above 3.86 ng/ml was predictive of PCOS by Youden’s index with a sensitivity of 67.2%, specificity of 77.7%, and correct classification rate of 72.1%. There was a negative correlation of AMH level with increasing age in both PCOS and non – PCOS group but the PCOS group had a higher AMH level. There was no correlation noted with AMH and body mass index in both groups.

AMH levels were higher in the PCOS women compared to those without the diagnosis. AMH threshold level could support the diagnosis of PCOS in infertile Filipino women.

BACKGROUND

In-vitro maturation (IVM) is utilized to avoid ovarian hyperstimulation syndrome and decrease the cost of IVF. However, there are different opinions regarding its utility. We evaluated outcomes of rescue IVM in polycystic ovary syndrome, diminished and normal ovarian reserve.

This retrospective cohort involves 615 immature oocytes retrieved from 221 IVF cycles. Outcomes of in-vitro matured oocytes were compared to sibling in-vivo mature oocytes. Association between stimulation an study trigger protocol were analyzed.

Laboratory outcomes of Rescue-IVM (R-IVM) matured oocytes showed no statistically significant difference among groups. In-vivo mature oocytes showed a significantly higher fertilization rate and blastocyst rate (p < 0.0001) compared to in-vitro matured oocytes. Progestin primed protocol and combination/dual trigger had significantly higher maturation rates.

Immature oocytes undergoing R-IVM can potentially undergo maturation, fertilization and even developed to blastocyst stage. However, given the low efficiency of development to blastocyst stage, higher power studies are needed to evaluate its practical use.

Background: PCOS is a common gynecologic disorder and recent studies have found that they are more prone in developing depression and anxiety compared to the general population. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument reliable for detecting states of anxiety and depression. Using this simple screening tool, it may lead to the identification of such mental disorders that may warrant timely psychiatric referral. Objectives: We aim to determine the prevalence of anxiety and depression among PCOS patients using the HADS-P questionnaire. We also aim to determine association between depression & anxiety and disease characteristics. Methods: This is a cross-sectional study using convenience sampling of PCOS patients >18 years old in Philippine General Hospital. The HADS-P, a self-administered rating scale with independent subscales for anxiety and depression, was administered to the participants after securing consent. A cut–off score of >8 points on either of the depression and anxiety subscale was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression. Results: A total of 253 patients with PCOS were recruited. On the basis of a HADS-P score of >8.0 per category, the prevalence of PCOS patients who were suggestive to have anxiety was 46.25% (n: 117, 95% CI: 39.98-52.60%), while 9.09% (n: 23, 95% CI: 5.85-13.33%) of them were suggestive to have depression. Crude logistic regression identified presence of depression, infertility, impaired glucose tolerance and prominent acne as predictors of anxiety; whereas low parity, hirsutism and presence of anxiety were predictors of depression. Adjusted logistic regression identified only presence of depression and infertility were significant predictors of anxiety (n: 116, LR χ2 (5): 15.46, p<0.01); while presence of anxiety increase the odds of depression by 2 to 13 fold, it was not statistically significant (n: 116, LR χ2 (5): 9.79, p: 0.08). Conclusion There is a high prevalence of anxiety and depression among PCOS patients. The factors that were seen to be significantly associated with the development of anxiety were the presence of depression, impaired glucose tolerance, infertility and prominent acne, while for the development of depression were the presence of anxiety, hirsutism and low parity. Screening for anxiety and depression is of paramount importance and physicians should be vigilant for the need of possible psychiatric intervention.
Anxiety ; Depression ; Hads ; 4-amino-4' ; -hydroxylaminodiphenylsulfone ; Polycystic Ovary Syndrome

This study aimed to investigate the relationship between coagulating cold and blood stasis syndrome and glycolysis, and observe the intervention effect of Liangfang Wenjing Decoction(LFWJD) on the expression of key glycolytic enzymes in the uterus and ovaries of rats with coagulating cold and blood stasis. The rat model of coagulating cold and blood stasis syndrome was established by ice-water bath. After modeling, the quantitative scoring of symptoms were performed, and according to the scoring results, the rats were randomly divided into a model group and LFWJD low-, medium-and high-dose groups(4.7, 9.4, 18.8 g·kg~(-1)·d~(-1)), with 10 in each group. Another 10 rats were selected as the blank group. After 4 weeks of continuous administration by gavage, the quantitative scoring of symptoms was repeated. Laser speckle flowgraphy was used to detect the changes of microcirculation in the ears and uterus of rats in each group. Hematoxylin-eosin(HE) staining was used to observe the pathological morphology of uterus and ovaries of rats in each group. The mRNA and protein expressions of pyruvate dehydrogenase kinase 1(PDK1), hexokinase 2(HK2) and lactate dehydrogenase A(LDHA) in the uterus and ovaries of rats were examined by real-time quantitative polymerase chain reaction(RT-qPCR) and Western blot, respectively. The rats in the model group showed signs of coagulating cold and blood stasis syndrome, such as curl-up, less movement, thickened veins under the tongue, and reduced blood perfusion in the microcirculation of the ears and uterus, and HE staining revealed a thinning of the endometrium with disorganized arrangement of epithelial cells and a decrease in the number of ovarian follicles. Compared with the model group, the treatment groups had alleviated coagulating cold and blood stasis, which was manifested as red tongue, reduced nail swelling, no blood stasis at the tail end as well as increased blood perfusion of the microcirculation in the ears and uterus(P<0.05 or P<0.01). Among the groups, the LFWJD medium-and high-dose groups had the most significant improvement in coagulating cold and blood stasis, with neatly arranged columnar epithelial cells in uterus, and the number of ovarian follicles was higher than that in the model group, especially mature follicles. The mRNA and protein expressions of PDK1, HK2, LDHA in uterus and ovaries were up-regulated in the model group(P<0.05 or P<0.01), while down-regulated in LFWJD medium-and high-dose groups(P<0.05 or P<0.01). The LFWJD low-dose group presented a decrease in the mRNA expressions of PDK1, HK2 and LDHA in uterus and ovaries as well as in the protein expressions of HK2 and LDHA in uterus and HK2 and PDK1 in ovaries(P<0.05 or P<0.01). The therapeutic mechanism of LFWJD against coagulating cold and blood stasis syndrome is related to the down-regulation of key glycolytic enzymes PDK1, HK2 and LDHA, and the inhibition of glycolytic activities in uterus and ovaries.
Female ; Animals ; Rats ; Ovary ; Uterus ; Ovarian Follicle ; Lactate Dehydrogenase 5 ; Glycolysis

This study aims to investigate the efficacy and possible mechanism of Liuwei Dihuang Pills in the treatment of diminished ovarian reserve(DOR) by using proteomic techniques. Firstly, cyclophosphamide(60 mg·kg~(-1)) combined with busulfan(6 mg·kg~(-1)) was injected intraperitoneally to establish the mouse model of DOR. After drug injection, the mice were continuously observed and the success of modeling was evaluated by the disturbance of the estrous cycle. After successful modeling, the mice were administrated with the suspension of Liuwei Dihuang Pills by gavage for 28 days. At the end of the gavage, four female mice were selected and caged together with males at a ratio of 2∶1 for the determination of the pregnancy rate. Blood and ovary samples were collected from the remaining mice on the next day after the end of gavage. Hematoxylin-eosin(HE) staining and transmission electron microscopy(TEM) were then employed to observe the morphological and ultrastructural changes in the ovaries. The serum levels of hormones and oxidation indicators were measured by enzyme-linked immunosorbent assay. Quantitative proteomics techniques were used to compare the ovarian protein expression before and after modeling and before and after the intervention with Liuwei Dihuang Pills. The results showed that Liuwei Dihuang Pills regulated the estrous cycle of DOR mice, elevated the serum levels of hormones and anti-oxidation indicators, promoted follicle development, protected the mitochondrial morphology of ovarian granulosa cells, and increased the litter size and survival of DOR mice. Furthermore, Liuwei Dihuang Pills negatively regulated the expression of 12 differentially expressed proteins associated with DOR, which were mainly involved in lipid catabolism, inflammatory response, immune regulation, and coenzyme biosynthesis. These differentially expressed proteins were significantly enriched in sphingolipid metabolism, arachidonic acid metabolism, ribosomes, ferroptosis, and cGMP-PKG signaling pathway. In summary, the occurrence of DOR and the treatment of DOR with Liuwei Dihuang Pills are associated with multiple biological pathways, mainly including oxidative stress response, inflammatory response, and immune regulation. "Mitochondria-oxidative stress-apoptosis" is the key to the treatment of DOR by Liuwei Dihuang Pills. YY1 and CYP4F3 may be the key upstream targets that trigger mitochondrial dysfunction and ROS accumulation, and the metabolism of arachidonic acid is the main signaling pathway of drug action.
Female ; Male ; Pregnancy ; Animals ; Mice ; Arachidonic Acid ; Ovarian Reserve ; Proteomics ; Ovary ; Lipid Metabolism

Polycystic ovary syndrome (PCOS) is a common endocrine disease in women of childbearing age, which seriously affects women's reproductive health. In recent years, more and more studies have found that serum anti-Müllerian hormone (AMH) has certain significance in the diagnosis and treatment evaluation of PCOS. In addition, with the improvement of detection methods, more attention has been paid to the significance of female androgens and AMH in the evaluation of PCOS. This article reviews the recent research progress of serum AMH and androgens in the evaluation of PCOS.
Female ; Humans ; Polycystic Ovary Syndrome/diagnosis* ; Androgens ; Anti-Mullerian Hormone

The ovary is the reproductive organ of female mammals, which is responsible for producing mature eggs and secreting sex hormones. The regulation of ovarian function involves the ordered activation and repression of genes related to cell growth and differentiation. In recent years, it has been found that histone posttranslational modification can affect DNA replication, damage repair and gene transcriptional activity. Some regulatory enzymes mediating histone modification are co-activators or co-inhibitors associated with transcription factors, which play important roles in the regulation of ovarian function and the development of ovary-related diseases. Therefore, this review outlines the dynamic patterns of common histone modifications (mainly acetylation and methylation) during the reproductive cycle and their regulation of gene expression for important molecular events, focusing on the mechanisms of follicle development and sex hormone secretion and function. For example, the specific dynamics of histone acetylation are important for the arrest and resumption of meiosis in oocytes, while histone (especially H3K4) methylation affects the maturation of oocytes by regulating their chromatin transcriptional activity and meiotic progression. Besides, histone acetylation or methylation can also promote the synthesis and secretion of steroid hormones before ovulation. Finally, the abnormal histone posttranslational modifications in the development of two common ovarian diseases (premature ovarian insufficiency and polycystic ovary syndrome) are briefly described. It will provide a reference basis for understanding the complex regulation mechanism of ovarian function and further exploring the potential therapeutic targets of related diseases.
Female ; Animals ; Histone Code ; Histones ; Protein Processing, Post-Translational ; Ovary ; Oocytes ; Mammals