Gynecological Endocrinology

Objectives To assess the effect and safety of Zoladex (Goserelin acetate) 10.8 mg in patients with uterine fibroids. Methods Fifty-three patients received Goserelin acetate 10.8 mg once and surgery was conducted at 12 weeks ± 7 days after drug injection. All assessments form baseline to week12/before surgery were carried out: fibroids volume, uterine volume, serum hormone (E2, FSH, LH), hemoglobin concentration, uterine arterial resistance index (UA-RI), fibroid arterial RI (FA-RI) and improvements of symptoms (Uterine Fibroid Symptom and Quality of Life (UFS-QOL) and Health-Related Quality of Life (HRQL) scores). Adverse events (AEs) were recorded to evaluate the safety. Results After 12 weeks of treatment, the volume of uterine fibroids was significantly smaller than before (249.19 ± 297.04 vs. 195.77 ± 418.27 cm3, p < 0.0001). The volume of the uterus was also smaller than before (372.02 vs. 263.58 cm3, p < 0.0001). Serum levels of E2, FSH, and LH showed significant decreasing trend (61.13 pmol/L, 5.23 IU/L and 4.75 IU/L respectively, p < 0.0001) and hemoglobin levels were increased significantly (108.30 ± 26.28 VS. 134.90 ± 9.21g/L, p < 0.0001). Left and right UA-RI showed slight increase of 0.04 and 0.02 respectively from baseline without significance. Mean FA-RI showed slight decrease of 0.03 from baseline (p = 0.22). Patient symptoms were alleviated after treatment. In addition, AEs occurred in 81.1% of enrolled patients and all AEs were well tolerably. Conclusions Goserelin acetate 10.8 mg pretreatment can effectively reduce the volume of uterine fibroids and uterus, lower estrogen levels and improve anemia symptoms. It could also improve the quality of life of patients, showing good safety and tolerance. This pretreatment was effective, safe, and generally well tolerated.

Ovarian tissue cryopreservation and transplantation is one of the most advanced and promising fertility preservation methods. Prior to any procedure that may lead to a toxic ovarian injury (such as chemotherapy or radiotherapy), a portion of the ovary is removed and cryopreserved. At an appropriate time, after toxic therapy is concluded, the cryopreserved ovarian tissue is then thawed and transplanted back to the patient when conditions permit. This technique can not only preserve female fertility but also restore ovarian endocrine function. However, there is no standardization for ovarian tissue cryopreservation and transplantation in China. In order to promote the standardized development of ovarian tissue cryopreservation technology in the whole country, it is urgent to establish the standard of this technology.

Objective To explore the combined effect of pre-pregnancy body mass index (BMI) and assisted reproductive technology (ART) on the risk of pregnancy-induced hypertension (PIH). Methods This retrospective cohort study included 3,220,103 women with singleton pregnancies from the National Vital Statistics System database for 2021. The outcome was the occurrence of PIH. Logistic regression analyses were utilized to assess the association between pre-pregnancy BMI and ART and PIH. To evaluate the interaction of pre-pregnancy BMI and ART on PIH, the relative excess risk of interaction (RERI), the attributable proportion due to interaction (API), and synergy index (SI) were applied. Results Of these 3,220,103 women, 302,789 [9.40% (95%CI: 9.37%-9.43%)] occurred PIH. Women with a pre-pregnancy BMI ≥25 kg/m² [odds ratio (OR)=2.06, 95% confidence interval (CI): 2.04-2.08] or using ART (OR = 1.43, 95%CI: 1.39-1.47) were related to a higher risk of PIH. There was a positive additive interaction of pre-pregnancy BMI and ART on the risk of PIH, with an interaction RERI, API, and SI of 0.20 (95%CI: 0.08-0.33), 0.07 (95%CI: 0.03-0.11), and 1.13 (95%CI: 1.05-1.21), respectively. Stratified analyses demonstrated that the positive additive interactions of pre-pregnancy BMI and ART on PIH were observed in women aged <35 years or ≥35 years and in women with unipara or multipara, whereas only in White women. Conclusion A positive additive interaction of pre-pregnancy BMI and ART on the risk of PIH was found, with an interaction of 7%.

Purpose This study aimed to compare the efficacies of Femoston and Dydrogesterone therapy in patients with incomplete abortions. Methods Patients with incomplete abortions were included if they preferred medication over surgical intervention. The participants were categorized into three groups: the Femoston group received Femoston, the Dydrogesterone group was administered Dydrogesterone, and the control group was followed up without treatment. Basic clinical information, complete abortion success rate, and menstrual recovery rate were collected to evaluate the efficacy of Femoston and Dydrogesterone in patients with incomplete abortions. Results We analyzed 332 patients with incomplete abortions. The success rate of complete abortion was significantly higher in the Femoston group than in the control group (relative risk (RR)=1.708, 95% CI 1.304–2.237, p = .001) and the Dydrogesterone group (RR = 1.200, 95% CI 1.015–1.418, p = .023). The effectiveness of Dydrogesterone was also significantly higher than that in the control group (RR = 1.439, 95% CI 1.068–1.938, p = .015). After 60 days, the rate of menstrual recovery in the Femoston group was significantly higher than that in the control group (RR =1.322, 95% CI 1.103–1.609, p = .001), while the rate in the Dydrogesterone group was significantly lower than that in the Femoston group (RR =1.200, 95% CI 1.035–1.391, p = .009). Conclusions Femoston and Dydrogesterone were effective in treating incomplete abortions, with Femoston being more effective. Patients receiving Femoston had shorter menstrual recovery times than those receiving dydrogesterone. Therefore, Femoston and Dydrogesterone are potential treatment options for incomplete abortion, with Femoston being the more effective.

Background Preconditioning before hematopoietic stem cell transplantation (HSCT) severely damages ovarian function, resulting in infertility and premature ovarian insufficiency (POI) in young women and girls. Ovarian function and fertility preservation before HSCT is crucial. In China, many patients miss this opportunity, highlighting the need for ovarian function and fertility preservation after HSCT. Ovarian tissue cryopreservation (OTC) is a standard method for fertility preservation and protecting ovarian function. The objective of this case report is to report a case of OTC performed on an 8-year-old girl after HSCT, and present a review about the necessity and feasibility of ovarian preservation after HSCT. Case An 8-year-old girl required a second HSCT due to a relapse of dermatomyositis. Before the procedure, she visited our center for OTC. Hormonal assessments showed FSH 1.17 IU/L, LH 0.00 IU/L, E2 < 11.80 pg/ml, and AMH 0.81 ng/ml. Pelvic ultrasound revealed bilateral ovarian sizes of approximately 1.5 × 0.7 × 0.7 cm and 1.6 × 0.9 × 0.7 cm, with 10 and 4 visible follicles, respectively. We proceeded with OTC, surgically retrieving the entire left ovary via laparoscopy. Seven ovarian cortical slices were cryopreserved by slow freezing, with an average of 1079 follicles in per 2 mm diameter cortical tissue slice. Conclusion Patients who miss fertility preservation before HSCT should consult fertility preservation and gynecological endocrinology experts as early as possible after HSCT and undergo regular follow-up. If clinical evidence indicates residual ovarian function, fertility protection measures should be discussed promptly. OTC should be assessed as a successful option for women after HSCT.

Objective To assess the prevalence and the characteristics of pelvic floor dysfunction (PFD) in women with endometriosis. Methods This is a methodological paper that describes the ‘Endometriosis and Pelvic Floor Dysfunction’ (EndoPFD) multicenter study protocol. It involves three sites: the University Hospital of Pisa, the San Raffaele Hospital of Milan and the Vanvitelli University Hospital of Naples. Women are recruited through web links and are asked whether they want to participate to the clinical evaluation or only to the web survey. The web survey gathers personal history, endometriosis history and symptoms, and performs a subjective evaluation of PFD through questionnaires: Urinary Distress Inventory 6, Colorectal-Anal Distress Inventory 8, Wexner Scale for Fecal Incontinence, Wexner Constipation Scoring System, and Female Sexual Function Index. Those interested in the clinical evaluation will add to the questionnaires the following exams: gynecological and proctological exam, pelvic ultrasound, urodynamic test, and anorectal manometry. Preliminary results Recruitment for the web survey was completed. A total of 1,149 women signed the electronic consent, 329 were excluded due to inclusion/exclusion criteria; hence, 525 completed all the questionnaires (response rate of 64.02%). Recruitment for the clinical evaluation is ongoing. Discussion This study protocol offers the possibility to define the prevalence of PFD in endometriosis patients with a subjective and an objective assessment of signs and symptoms. This may pave the way for changing the approach to patients with endometriosis. Moreover, it demonstrates the validity of the method used (online survey and recruitment) to reach a high number of patients.

Objective Polycystic ovary syndrome (PCOS) is a prevalent cause of menstrual irregularities and infertility in women, impacting quality of life. Despite advancements, current understanding of PCOS pathogenesis and treatment remains limited. This study uses machine learning-based data mining to identify acetylation-related genetic markers associated with PCOS, aiming to enhance diagnostic precision and therapeutic efficacy. Methods Advanced machine learning techniques were used to improve the precision of key gene identification and reveal their biological mechanisms. Validation on an independent dataset (GSE48301) confirmed their diagnostic value, assessed through ROC curves and nomograms for PCOS risk prediction. Molecular mechanisms of acetylation-related gene regulation in PCOS were further examined through clustering, immune-environmental, and gene network analyses. Results Our analysis identified 15 key acetylation-regulated genes differentially expressed in PCOS, including SGF29, NOL6, KLF15, and INO80D, which are relevant to PCOS pathogenesis. ROC curve analyses on training and validation datasets confirmed the model’s high diagnostic accuracy. Additionally, these genes were associated with immune cell infiltration, offering insights into the inflammatory aspect of PCOS. Conclusion The identified acetylation gene markers offer novel insights into the molecular mechanisms underlying PCOS and hold promise for enhancing the development of precise diagnostic and therapeutic strategies.

Objective Methylenetetrahydrofolatereductase (MTHFR) is important for folate metabolism, which is involved in DNA synthesis and cell growth. However, the relationship between Maternal MTHFR polymorphisms and outcomes in assisted reproduction remains controversial. This is the first study to explore the effect of MTHFR polymorphisms on the embryological outcomes in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles in Korean patients with infertility. Materials and methods This retrospective cohort study included 173 women who underwent MTHFR genotyping between July, 2021 and June, 2022. The embryologic outcomes of 301 IVF/ICSI cycles were compared between groups according to MTHFR polymorphisms using ANOVA and Chi-square test. Results Oocyte maturation rates were 80.0%, 75.0%, and 71.4% for MTHFR 677CC, 677CT, and 677TT, respectively. Cleaved embryo formation and transplantable embryo rates were comparable across various maternal MTHFR 677 genotypes. Good-quality embryo (GQE) rate was higher for MTHFR 677CT than those for 677CC and 677TT (40.0% vs. 29.4%, p = 0.001 and 40.0% vs. 33.3%, p = 0.025, respectively). When analyzing the combined MTHFR genotypes, the oocyte maturation rate was significantly lower in 677TT than in 677CC 1298AA/677CC 1298AC and 677CC 1298CC/677CT 1298AA/677CT 1298AC (71.4% vs. 76.7%, p = 0.012 and 71.4% vs. 75.7%, p = 0.029, respectively). The MTHFR 677CC/1298CC, 677CT/1298AA, and 677CT/1298AC genotypes had the highest GQE rates. Conclusions MTHFR 677TT genotype, which had the lowest enzymatic activity, had the lowest oocyte maturation rate. The combined MTHFR 677CC/1298CC, 677CT/1298AA, and 677CT/1298AC genotypes with intermediate enzyme activities had higher GQE rates. However, no differences were observed in the transplantable embryo rate between MTHFR genotypes.

Background Endometriosis (EM) is a major cause of infertility, but the pathogenesis and mechanisms are not yet fully elucidated. MiR-19b-3p is involved in many diseases, but its functional role in EM-associated infertility remains unexplored. This study aimed to examine miR-19b-3p abundance and IGF1 concentration in cumulus cells (CCs) and follicular fluid of EM-associated infertility patients, and to investigate the potential role of miR-19b-3p in KGN cells by identifying its target and elucidating the underlying mechanisms. Results The results from the case-control study indicated that, compared to the control group consisting of patients with tubal infertility, patients with EM-associated infertility exhibited a lower percentage of mature oocytes. MiR-19b-3p level was elevated in CCs from EM-associated infertility patients. IGF1 was identified as a direct target of miR-19b-3p and was negatively regulated by miR-19b-3p in KGN cells. Overexpression of miR-19b-3p significantly inhibited cell viability and proliferation, promoted apoptosis, and arrested the cell cycle at G0/G1 phase in KGN cells. The effects of miR-19b-3p were reversed by co-transfection of IGF1, and the biological effects of miR-19b-3p in KGN cells were mediated by IGF1. Additionally, miR-19b-3p targeted IGF1 to down-regulate AKT phosphorylation and participate in the apoptotic pathway in KGN cells. Conclusions This study demonstrates that miR-19b-3p level is elevated in CCs and IGF1 concentration is decreased in follicular fluid in patients with EM-associated infertility. MiR-19b-3p regulates the biological effects of KGN cells by targeting IGF1.

Objective To analyze the correlation between arm muscle area and handgrip strength among postmenopausal community dwelling low-income women in order to provide an easy anthropometric indicator to assess muscle mass quantity and quality. Methods This was a cross-sectional study involving postmenopausal women (n = 171) from three urban-marginal communities of Guayaquil, Ecuador. Corrected arm muscle area was calculated using the Frisancho formula. Dynapenia was defined as HGS < 16 kg. Spearman’s correlation coefficient was calculated at a 5% significance level to test the correlation between corrected arm muscle area and handgrip strength. Results Median (interquartile range: IQR) age of the sample was 72.0 years (17.0). The median of corrected arm muscle area was 34.8 cm² (20.7). The overall prevalence of dynapenia was 57.9% (n = 99). There was a significant decreasing trend with age regarding all anthropometric characteristics and handgrip strength, as well as a higher prevalence of dynapenia with age. For the whole sample, a statistically significant positive correlation was found between corrected arm muscle area and handgrip strength [r = 0.267; p < .001]. Conclusion: There was a significant yet weak positive correlation between corrected arm muscle area and handgrip strength in this postmenopausal sample. There is a need for additional research in this regard.

Background It has been recognized that the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol has a detrimental effect on clinical outcomes compared to the GnRH agonist (GnRH-a) protocol during in vitro fertilization-fresh embryo transfer (IVF-ET) cycles. However, the related mechanisms were unclear. Methods A total of 18,561 patients, who underwent fresh IVF-ET cycles in the Center for Assisted Reproduction of Jiangxi Maternal and Child Health Hospital from January 2014 to September 2021, were retrospectively analyzed. The propensity score matching (PSM) technique was used to control for confounding factors between the GnRH-ant and GnRH-a groups. Human endometrial stromal cells (hESCs) were collected for primary culture and treated with relevant receptor antagonists and activators. RT-PCR, Western Blot, immunofluorescence staining, cell migration and adhesion assays, and animal experiments were employed to elucidate the molecular mechanism by which GnRH antagonist affects the migration and adhesion ability of hESCs. Results There was no statistical difference between the two groups in terms of baseline characteristics after matching basal status by propensity score matching. The result showed that the endometrial thickness (10.4 ± 2.35 vs. 11.03 ± 2.61 mm, p < .001) on trigger day was significantly lower in the GnRH-ant group. Compared with the GnRH-a protocol, the implantation rate (39.71% vs. 50.36%, p < .001), biochemical pregnancy rate (64.26% vs. 72.7%, p < .001), clinical pregnancy rate (56.39% vs. 65.24%, p < .001), live birth rate (45.25% vs. 56.1%, p < .001) in the GnRH-ant group were significantly decreased. Contrarily, the rate of early miscarriage in the GnRH-ant group (13.95% vs. 9.04%, p < .001) was higher than in the GnRH-a group. Furthermore, after treating with GnRH-ant, hESCs showed a reduced expression of HOXA10 and MMP-9 proteins, and a weakened migration ability. Subsequently, by establishing the co-culture system of hESCs and JAR trophoblast spheroids, we found that GnRH-ant inhibited the adhesion and invasion ability of trophoblast cells. Moreover, we also found a decreased expression and phosphorylation of c-kit receptor in decidualized hESCs after treating with GnRH-ant. Similar results as observed above were also confirmed when inhibiting the activation of c-kit receptor by imatinib. Conclusions GnRH-ant could reduce the motility of hESCs by inhibiting the expression and activation of the C-kit receptor, which impaired the process of embryo implantation.

Introduction Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. The current study sought to assess vitamin D status in women with PCOS compared to the control group and to describe the association between vitamin D deficiency and the features of PCOS. Material and methodology A descriptive retrospective study about 176 women of reproductive age was conducted. The sample was divided into two groups: individuals with PCOS (82 women) and healthy individuals without PCOS (94 women). Vitamin D deficiency was defined as a serum concentration less than 10 ng/ml. We used the Statistical Package for the Social Sciences (SPSS), version 21 for all analyses. Results In our study, vitamin D deficiency was observed in 40.2% PCOS patients and 24% controls. The 25(OH)D level was lower in PCOS women and the incidence of vitamin D deficiency and insufficiency were significantly higher in comparison with the control group (p < 0.05). Furthermore, PCOS women with insulin resistance or obesity had lower 25(OH)D levels in comparison with PCOS individuals without IR or obesity. Furthermore, a significant correlation was found between homeostatic model assessment for insulin resistance (HOMA-IR)/body mass index (BMI) and vitamin D status. Discussion and conclusion Vitamin D deficiency could be one of the etiological mechanisms of PCOS. In fact, the prevalence of vitamin D deficiency in PCOS women is evident, principally in those with obesity or IR. Also, the serum 25(OH)D level was correlated with parameters of insulin resistance and metabolic syndrome. Therefore, it is proposed that vitamin D supplementation may be beneficial for the management of PCOS patients.

Background Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, marked by hormonal imbalances and disruptions in glucose and lipid metabolism. Emerging research has indicated a correlation between lipids and PCOS, yet the specific lipid profiles or associated genes identified in various studies vary, and observational data alone cannot establish causation. Therefore, our study seeks to establish a causal association between lipidome and PCOS. Methods Data from genome-wide association studies, liposomes, metabolites, and PCOS-related information were collected. Four rounds of double-sample bidirectional intermediate Mendelian Randomization analyses including liposomes to disease, liposomes to metabolites, metabolites to disease, and reverse Mendelian Randomization analysis of lipids, total effect values and intermediary effect values were calculated. The proportion mediated by the intermediary effect was determined by dividing the intermediary effect value by the total effect value. Results The analyses revealed that three liposomes and nine metabolites were causally associated with PCOS. Specifically, phosphatidylcholine and 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol were identified as independent risk factors for PCOS through further Mendelian Randomization analysis. The risk of developing PCOS increased by 32% for every one standard deviation increase in phosphatidylcholine and by 17% for every one standard deviation increase in 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol. Furthermore, the study revealed that phosphatidylcholine can influence the development of PCOS with 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol acting as a mediator, explaining 4.97% of the effect. Conclusions This study confirmed a causal relationship between phosphatidylcholine and 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol with PCOS, where phosphatidylcholine can influence the occurrence of PCOS with 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol as a mediator.

Endometriosis is a common estrogen-dependent inflammatory disease with a chronic course and a tendency to recur. The association between endometriosis and cancer has been studied for several years. Numerous reports have demonstrated a strong association between specific ovarian malignancies and endometriotic lesions. Atypical endometriosis has been widely described as a malignant precursor to ovarian epithelial tumors, particularly clear cell carcinomas and endometrioid carcinomas. These histological types associated with endometriosis develop predominantly in the ovary rather than in extragonadal sites. The detailed molecular mechanism of etiology remains unclear. Recent studies have analyzed the genetic and molecular mechanisms involved in endometriosis-associated ovarian cancer. A critical role appears to be played by a carcinogenic model based on iron-induced oxidative stress, which is typical of the endometriosis microenvironment. It has been hypothesized that trans-tubal reflux of blood, endometrial cells and associated iron-induced oxidative stress underlie the development of endometriosis-associated ovarian cancer. However, the multifactorial mechanisms of this malignant transformation are not fully understood. The aim of this review is to summaries the current epidemiological, histopathological, genetic and molecular findings in the progression of endometriosis-associated ovarian cancer.

Background: Progestin-primed ovarian stimulation (PPOS) stimulates ovaries to block the premature surge of luteinizing hormone (LH) by using micronized progesterone or a progestin during the follicular phase instead of the conventional gonadotropin-releasing hormone (GnRH) analogues or GnRH antagonists downregulating LH to obtain multi-follicle engagement. Current work aims to assess the influence of progestogen treatment on ovarian stimulation and the ability to control LH surge, its efficacy and suitability in retrieving oocytes, without affecting the embryo quality and its benefit among infertile women long-term outcomes on children compared to standard stimulation protocols. Materials and Methods: The literature review used the randomized control trials published in the Pubmed database from January 2015 to April 2021. To generate the citation list, the following keywords were used: ‘progestin-primed ovarian stimulation’, ‘PPOS’, ‘micronized progesterone’, ‘medroxyprogesterone’, and/or ‘dydrogesterone’. The selected articles analyzed the cohort, intervention, and scheme of the progestin-primed ovarian stimulation protocol in controlled ovarian stimulation (COS) for in-vitro fertilization (IVF)/intra cytoplasmic sperm injection (ICSI) used in Assisted Reproductive Technologies (ART). Results: Overall we concluded that PPOS for IVF/ICSI in ART results in a higher number of obtained embryos, lower incidence of OHSS, equal duration of stimulation, number of retrieved oocytes, and number of MII oocytes. It is also suggested that long-term safety in children shows no significant difference between the study and control groups. Conclusions: Despite the outcomes of progestin stimulation cycles among all cohorts, we concluded that poor ovarian responders, patients with PCOS, women of advanced age and oocyte donors benefit the most from using PPOS.

Purpose Previous studies have reported the involvement of long noncoding RNAs (lncRNAs) in reproductive diseases via the regulation of target genes. This study aimed to determine whether lnc-prostate androgen-regulated transcript 1 (lnc-PART1)could be used as a biomarker of unexplained recurrent pregnancy loss (URPL) and a possible predictor of poor pregnancy outcomes in women with URPL. Materials and methods Sixty patients with URPL and 15 healthy women were included in this study. PART1 expression was detected in plasma and endometrial tissues using a quantitative reverse transcription polymerase chain reaction. Logistic regression and receiver operating characteristic curve analyses were performed to analyze the association between PART1 expression and pregnancy outcomes in women with URPL. Results The expression of PART1transcript variant 2 was significantly up-regulated in the endometrial specimens from patients with URPL compared to control tissues. High tissue expression levels of PART1transcript variant 2 were associated with poor pregnancy outcomes in women with URPL, indicating that it could serve as a potential risk factor. Additionally, PART1 could serve as a potential risk factor for adverse pregnancy outcomes in patients with URPL (OR = 4.374; 95% CI = 1.052–18.189; p = .042). Conclusion lncRNA PART1 transcript variant 2 was highly expressed in patients with URPL. Therefore, it is important to conduct in-depth studies on the relationship between PART1 expression and URPL.

Aims This study aims to explore the alterations of dendritic cells (DCs) subpopulations in ectopic endometrial lesions and unveil the underlying mechanisms. Materials and methods Patients with endometriosis (n = 81) and women without endometriosis (n = 19) were recruited in this study. Dendritic cells (DCs) in the endometrial samples were counted after immunohistochemistry staining. The proportion of myeloid DCs and plasmacytoid DCs was calculated by flow cytometry. Primary DCs were isolated from tissues, and the cell viability and apoptosis were examined by MTT assay and flow cytometry. Cytokines were detected by the enzyme-linked immunosorbent assay. Differentially expressed genes were filtered by analyzing two datasets that were downloaded from GEO database and detected by RT-qPCR in tissues and isolated DCs. The function of HSD11B1 was examined in an endometrial stromal cell-DCs co-culture system and in vitro cultured DCs. Results Reduced myeloid DCs and increased CD11c-CD304-DCs were found in ectopic endometrium compared to control endometrium and eutopic endometrium from endometriosis patients. Myeloid DCs isolated from ectopic endometrium expressed less CD80, CD83, CD86 and had reduced proliferation, increased apoptosis, and reduced cytokine production. The expression of HSD11B1 was significantly increased in both ectopic endometrium and isolated myeloid DCs. Overexpression of HSD11B1 in immature DCs could repress DCs maturation and cytokine production. Endometrial stromal cells overexpressing HSD11B1 secreted increased cortisol, which repressed DCs maturation. Conclusions HSD11B1 is upregulated in ectopic endometrial lesions, which may contribute to endometriosis through repressing myeloid DCs maturation.

Purpose To investigate whether pregnancy outcomes of natural cycle intrauterine insemination (IUI) with donor sperm can be improved by performing insemination after confirmation of ovulation. Methods This retrospective cohort study evaluated 751 couples undergoing 1170 cycles of artificial insemination with donor sperm (AID) in natural cycles between January 2018 and January 2021. Patients underwent AID either within 6–12 h after spontaneous luteinizing hormone (LH) surge (pre-ovulation group) or after ovulation was confirmed by ultrasound (post-ovulation group). Propensity score matching was performed to account for differences in baseline characteristics between groups. The main outcome measures of this study were clinical pregnancy rate and live birth rate. Results After propensity score matching, each group comprised 216 cycles. No significant differences were observed between the pre-ovulation and post-ovulation groups in terms of clinical pregnancy rate (30.6% vs 27.3%, respectively, p = .458) and live birth rate (25.0% vs 22.7%, respectively, p = .651). However, upon excluding cases of luteinized unruptured follicle syndrome (LUFS) from the pre-ovulation group, the clinical pregnancy rate (33.5% vs 27.3%, respectively, p = .043) and live birth rate (27.4% vs 22.7%, respectively, p = .039) were significantly higher in the pre-ovulation group. Conclusions For fertile women undergoing AID in natural cycles, pre-ovulation insemination timing yielded superior pregnancy outcomes compared to post-ovulation insemination when ovulation was achieved. However, due to the occurrence of LUFS, pre- and post-ovulation AID resulted in comparable overall pregnancy outcomes in natural cycles.

Objective We carried out this study to explore the possibility of initiating goserelin therapy during the non-menstrual period in patients diagnosed with adenomyosis. Methods 115 premenopausal adenomyosis patients were enrolled and divided into three groups based on their menstrual cycle phase during the initial outpatient visit: menstrual, follicular, and luteal. Each received a 3.6 mg subcutaneous dose of goserelin monthly for three months. The endpoints encompassed alterations in uterine volume, dysmenorrhea Numerical Rating Scale (NRS) score, CA125 level, hemoglobin (HGB) after a 12-week treatment course, and the occurrence and duration of uterine hemorrhage during the first treatment cycle. Results Analysis revealed that the timing of goserelin therapy initiation in the menstrual cycle did not significantly impact its effectiveness in reducing uterine size, alleviating pain, lowering CA125 levels, or improving hemoglobin concentrations. However, patients starting treatment during the luteal phase experienced increased uterine bleeding (reference: menstrual period, OR = 4.33, 95% CI 1.23–15.25, p = .023). Conclusions The results suggested non-inferiority of goserelin therapy initiated during the non-menstrual period, but the uterine bleeding rate was higher in the luteal phase group. Therefore, goserelin treatment for outpatient adenomyosis patients should not be limited to starting during the menstrual period; it can also be initiated outside the menstrual period, providing more convenience for patients as most consultations occur outside the menstrual period. However, the use of goserelin during the luteal phase should be avoided to reduce the risk of exacerbated bleeding, especially in anemic patients with heavy menstrual bleeding. This study highlights the importance of individualizing treatment initiation based on the patient’s health profile to optimize therapeutic outcomes and minimize adverse effects. Trial registration ChiCTR2200059548

Pregnancy is a critical period marked by intricate physiological changes and maintaining maternal and fetal well-being is paramount. Inositols, a group of naturally occurring sugar alcohols, have gained attention for their potential benefits during pregnancy. This abstract provides a comprehensive review of the current literature on using inositols, primarily myo-inositol (MI) and D-chiro-inositol (DCI) in pregnancy. Inositols are crucial in cellular signal transduction and insulin sensitivity, making them integral to various physiological processes. Several studies suggest that inositols may contribute to preventing and managing gestational diabetes mellitus (GDM). MI, in particular, has shown promise in improving insulin sensitivity and mitigating insulin resistance, thereby influencing glucose metabolism. As our understanding of inositol’s role in pregnancy deepens, it may emerge as a valuable supplement to enhance maternal and fetal health outcomes.

Objective To disclose the relationships between serum LH and reproductive outcomes in Gonadotropin-releasing hormone (GnRH) antagonist protocol pretreated with luteal estradiol. Methods 371 patients, pretreated with estradiol, followed the GnRH antagonist protocol. They were divided into four groups based on the quartiles of serum LH levels on the day of gonadotropin (Gn) initiation(LHGI) and trigger (LHtrigger). Data on various pregnancy outcomes were collected. Results As serum LHGI increased, anti-Müllerian hormone (AMH) level, antral follicle count (AFC), LHtrigger, estradiol (E2) and P on the trigger day, E2/oocytes, and oocyte numbers increased and peaked in Q4, while Gn dose decreased. Good-quality embryo and blast formation rates increased and peaked in Q3. LHGI <3.93 mIU/ml impaired ongoing pregnancy rate and LBR. After adjusting for AMH and AFC, the impacts were not significant. As LHtrigger increased, E2/oocytes and good-quality embryo rate increased and peaked in T4 and implantation rate increased and peaked in T3. LHtrigger <1.49 mIU/ml independently influenced clinical pregnancy rate (CPR) after adjusting for AMH and AFC. LHGI was positively related to AMH, AFC, LHtrigger, blast formation rate and negatively related to BMI, age and Gn dose. LHtrigger was positively related to E2/oocytes and good quality embryo rate. Conclusions Lower serum LH represents as a potential indicator for embryo quality and reproductive outcomes in GnRH antagonist fixed protocol pretreated with estradiol. Early identification of excessive suppression of LH levels will benefit individuals with normal ovarian reserve more.

Introduction The use of vitamin D-calcium supplementation for treating gestational diabetes remains unclear. This meta-analysis aims to evaluate the efficacy of vitamin D-calcium supplementation in the treatment of gestational diabetes. Methods Several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systemically searched from inception to August 2023, and we included the randomized controlled trials (RCTs) assessing the effect of vitamin D-calcium supplementation on the metabolic profile of gestational diabetes. Results We included five eligible RCTs and 306 pregnant women in this meta-analysis. Compared with control group in pregnant women with gestational diabetes, vitamin D-calcium supplementation was associated with remarkably decreased fasting plasma glucose (SMD=-0.67; 95% CI=-0.93 to −0.41; p <0.00001), serum insulin (SMD=-1.09; 95% CI=-1.89 to −0.29; p = .007) and LDL (SMD=-0.35; 95% CI=-0.63 to −0.06; p = .02), but demonstrated no impact on total cholesterol (SMD=-0.05; 95% CI=-0.81 to 0.71; p = .90) or triglycerides (SMD=-0.14; 95% CI=-0.86 to 0.58; p = .70). Conclusions Vitamin D-calcium supplementation is effective to improve metabolic profile for the treatment of gestational diabetes.

Background This study aimed to investigate the impact of body mass index (BMI) and Polycystic Ovary Syndrome (PCOS) subtypes on periodontal parameters in Chinese women with PCOS and periodontitis. Method We conducted a retrospective case-control study analyzing data from 88 women with PCOS and 82 healthy controls. Participants were categorized by BMI (<24.0 kg/m²and ≥24.0 kg/m²) and PCOS subtypes. We compared periodontal parameters [including probing depth (PD), gingival bleeding index (GBI)] and reproductive hormone-related parameters. Results Women with PCOS and periodontitis had a significantly higher GBI (2.71 ± 0.53) compared to controls (2.25 ± 0.41, p < 0.0001). Among patients with BMI <24.0 kg/m², those with PCOS had a younger age [25.00(5.00) vs. 26.00(6.00) years, p < 0.05], lower PD [3.24(0.55) mm vs. 3.43 (0.48) mm, p < 0.01], and higher GBI [2.63(0.76) vs. 2.23(0.55), p < 0.0001]. For BMI ≥24.0 kg/m², PCOS patients had a higher GBI [2.91(0.36) vs. 2.38(0.59), p < 0.01] but a lower percentage of severe periodontal disease (p < 0.05). Conclusion PCOS could potentially worsen gingival inflammation among women already suffering from periodontitis, and a higher BMI might further intensify this correlation.

Background Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder in premenopausal women, often linked to abdominal obesity, insulin resistance, and metabolic issues. With its heterogeneous nature, PCOS treatment should be tailored to individual symptoms and patient preferences. This study examines collaboration networks among countries, institutions, authors, references, and journals related to PCOS treatment. Methods Web of Science data was analyzed using VOSviewer and CiteSpace for bibliometric visualization. Chinese and Western medicine treatments for PCOS were reviewed, emphasizing symptom-targeted solutions. Results Data from 4682 records authored by 400 individuals from 515 institutes in 62 countries revealed China as the leading contributor. Notable authors include Monash University and Richard S. Legro. Common research themes include adipocytes, inflammation, insulin sensitivity, oxidative stress, and the gut microbiome. Tailoring treatment to individual needs is essential, focusing on hyperandrogenism, ovulation, and insulin resistance, with lifestyle counseling to address obesity. Conclusion This bibliometric analysis provides valuable insights into the research status of PCOS treatment. China has made significant contributions, and complementary and alternative therapies, such as traditional Chinese medicine and acupuncture, have also shown beneficial effects recently. The research on inflammation, oxidative stress, and the gut microbiome may provide new targets and strategies for the treatment of PCOS. The recognition of the metabolic problems in PCOS patients facilitates the formulation of more personalized treatment plans to improve the prognosis of patients.

Objective This research was conducted to assess the therapeutic advantage of combined letrozole and clomiphene citrate versus monotherapy for polycystic ovarian syndrome (PCOS) patients. Study Design Five databases were searched using the search string: (letrozole and clomiphene) AND (clomiphene OR clomiphene citrate OR CC) AND (letrozole OR LE) AND (ovulation induc* OR fertility induc* OR fertility preserv*) AND (polycystic ovarian syndrome OR PCOS). All statistical analyses were conducted in Review Manager 5.4.1. Random effect-effect model was used to pool risk ratio (RR), mean difference (MD), and odds ratio (OR) and their corresponding 95% confidence interval (CI). Moreover, qualitative analysis was conducted to qualitatively analyze ovulation, secondary outcomes, and cycle characteristics. Results One clinical trial and three randomized clinical trials (RCTs) were used in the study. Two studies were used in a quantitative analysis showing that combination was superior for ovulation induction (RR = 1.86 [1.37, 2.53]; p < 0.0001; I² = 0%), but the number of follicles ≥15 mm was significantly associated with the combination (MD = 0.40[0.14, 0.66]; p = 0.002; I² = 0%). On subgroup analysis, only hot flushes were significantly associated with the combination (RR = 2.67[1.12, 6.36]; p = 0.03; I² = 0%). The meta-analysis of two studies reported a significantly higher ovulation rate and number of dominant follicles in the combination therapy group compared with the LE alone arm but no significant difference in pregnancy rate, endometrial thickness, and adverse events. Conclusion Our study demonstrates a significant effect of the combination on ovulation induction. The combination yielded a better chance of conception and viable pregnancy. Further studies are needed to determine the live birth rate. Highlights Combined Letrozole and Clomiphene is superior to either of these drugs alone for ovulation induction in PCOS. Our results conclude that the combination results in better ovulation, cycle characteristics, and secondary changes. Only the incidence of hot flushes as an adverse effect is increasingly reported in combination.