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Polycystic Ovary Syndrome (PCOS) represents a heterogeneous disorder and, using Rotterdam diagnostic criteria, four main phenotypes (A, B, C, and D) have been distinguished. However, it remains unclear whether lean versus obesity status influences findings in the various phenotypes of women with PCOS. 274 women with PCOS were consecutively assessed. Among these women, there were 149 with phenotype A, 24 with phenotype B, 94 with phenotype C, and 7 with phenotype D. We found normal body weight to be very common (65%) in phenotype C patients, common (43%) in phenotype A and D patients, and less represented (but still 25%) in phenotype B patients. Obesity was common in phenotype B (54%) and phenotype A (33%) patients and uncommon in phenotype C (only 11%) and phenotype D (14%) patients. Obese and lean patients of each phenotype were compared. Compared to the phenotype C PCOS patients, both phenotype A and B patients had higher total testosterone circulating values and higher luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio (p < 0.01) while anti-Mullerian hormone (AMH) levels were higher only in phenotype A PCOS patients. Instead, in the three obese PCOS phenotypes no differences in serum insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) calculation, and lipid blood values were observed. Analysis of data of lean patients gave similar results. Compared to the phenotype C PCOS patients, both phenotype A and B patients had higher total testosterone circulating values and higher LH/FSH ratio (p < 0.01) while AMH levels were higher only in phenotype A PCOS patients. However, no differences were observed in the circulating insulin levels, HOMA-IR calculation, or blood lipids between the three groups of lean PCOS patients. We conclude that Rotterdam phenotypes express the differences between PCOS patients in terms of ovulatory pattern and androgen secretion but fail to differentiate between obese patients with altered metabolic patterns and lean patients with normal metabolic patterns. A new classification of PCOS patients is needed and it should consider the influence of body weight on the metabolic patterns of PCOS patients.

The growth and maturation of the follicles and oocytes are influenced by many reproductive hormones and growth factors which in turn interfere with the success of fertilization and conception. We assessed the serum and follicular fluid levels of Progesterone, Prostaglandin E2 hormones, and Amphiregulin Growth factor on the day of ova pick-up and embryo transfer using enzyme-linked immunosorbent assay (ELISA). The result showed highly significant differences were encountered between PCOS and non-PCOS groups, serum (P4, PGE2, AREG) on the day of ova pickup (OPU), follicular (P4, PGE2, AREG) on the day of ova pickup (OPU) and embryo transfer (ET), All these variables were significantly (P<0.001) higher in non- PCOS groups in comparison with PCOS group. Conclusion: 1. Women with PCOS had significantly less serum and follicular fluid amount of Progesterone, Prostaglandin, and Amphiregulin growth factor than non-Pcos 2. Amphiregulin can be used as a predictor for increasing the successful pregnancy rate in IVF or ICSI protocol 3. Very strong positive correlation between AREG, PGE2, and P4 in serum and follicular fluid

The diagnosis of PCOS is based on the Rotterdam guidelines: chronic anovulation, hyperandrogenism (biologic or clinical) and polycystic ovaries on ultrasound. Two of these three criteria are sufficient for making diagnosis of PCOS. However, one characteristic that is often associated to PCOS (obesity with severe insulin resistance and metabolic alteration regarding glucose metabolism and lipid pattern) has remained out of the current classification of PCOS. Because of this, patients with different metabolic and cardiovascular risk may be included in the same phenotype, and it makes more difficult to establish clear strategies of follow-up and treatment of the patients with increased risks, and also may hide genetic or environmental differences between PCOS patients. Our recent study has shown that metabolic alterations are linked to the weight and not to the Rotterdam phenotypes. Because of this, we suggest a new classification of PCOS phenotypes that divides each Rotterdam phenotype in obese (ob) or lean (l) sub-phenotype. An improved classification of PCOS may be essential for permitting new progress in our understanding of pathogenesis and treatment of PCOS (or of the different disorders that are part of PCOS).

Background Polycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic disorder affecting health and quality of life of those affected across the lifespan. We currently have limited evidence-based data on the experience of those living with PCOS in the health care system including diagnosis, health concerns and disease management. The aim of this study was to assess the perceptions of health status, health care experience and disease management support in those affected by PCOS in Alberta, Canada. Methods An online questionnaire was completed via REDCap by individuals self-reporting a diagnosis of PCOS. Question categories included demographics, symptoms of PCOS and time to confirm a diagnosis, follow-up care, health concerns, and information resources. Descriptive statistics were used and thematic analyses was applied to open-response questions. Results Responses from 194 participants living in Canada (93% in Alberta) were included. The average age was 34 ± 8 years and BMI was 35 ± 9. Menstrual irregularity was identified in 84% of respondents as the first symptom noticed and the primary reason for seeking a medical consultation. A PCOS diagnosis occurred on average 4.3 years following awareness of first symptoms and required consultation with more than one primary care provider for 57% of respondents. Half (53%) of respondents reported not receiving a referral to specialists for follow-up care and 70% were not informed about long-term health morbidity such as diabetes or cardiovascular disease. Most respondents (82%) did their own research about PCOS using on-line sources, academic literature and advice from peer support. The participant themes from open questions for improving health care included more resources and support, increased and reliable information, better education and training for clinicians, timely diagnosis, prompt referrals to specialists, and generally more compassion and empathy to the challenges faced by those managing their disease. Conclusion Our findings highlight the health concerns and challenges in health care for those with PCOS. In Alberta, Canada we have identified major gaps in health care including a timely diagnosis, follow up care and supports, and multidisciplinary care. This evidence-based data can be used to inform development of pathways to improve the health care experience in those affected by PCOS.

Introduction: PCOS, a common hormonal disorder in women of reproductive age, affects fertility and increases the risks of other diseases. Early detection, risk factor assessment, and intervention are crucial to prevent long-term complications. Materials and Methods: This study was conducted using a pre-validated questionnaire at two medical colleges in the UAE and Oman. The first study (UAE) results are already published. Here, we present the findings of the second study (Oman) and compare them. Results and Discussion: The prevalence of PCOS was 4.6% (n = 7) in Oman and 27.6% (n = 69) in the UAE using the NIH criteria. The most common symptoms were irregular periods, acne, and thinning of hair. Students showed acne as the most prevalent symptom of clinical hyperandrogenism. Omani students showed significantly more acne [70.1% (n = 108) vs. 41.6% (n = 104)], while Emirati students showed a higher prevalence of hirsutism [32% (n = 80) vs. 23.3% (n = 36)]. A higher number of students had irregular periods 30.8% (77/150) in the UAE, although the difference was not statistically significant. The prevalence of PCOS was significantly higher in Emirati medical students than in Omani students (p < 0.05). The prevalence was also lower among medical students in Oman compared to an unselected population, reported by a study that included all consecutive women between 12 and 45 years of age attending a hospital. An increased trend in unhealthy lifestyle practices was observed in the recent study. Obesity was a strong predictor of PCOS symptoms across the populations in both countries (p < 0.05). Conclusion: The prevalence of PCOS and clinical signs of hyperandrogenism vary significantly between countries in the MENA region. There is a need to identify specific risk factors associated with PCOS in different populations, explore the genetic basis, and undertake collaborative efforts among healthcare professionals from various disciplines to raise awareness about PCOS and its associated risks.

Abstract Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders in women and despite this, diagnostic challenges, delayed diagnosis, and less-than-optimal treatment regimens plague the condition. The International PCOS network, consisting of geographically diverse international experts in PCOS as well as consumers, engaged in a multi-year international evidence-based guideline development process that was jointly sponsored by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Medicine (ASRM). The guideline was published in 2018 and endorsed by more than 40 international societies involved in PCOS. Translation of this evidence-based guideline to medical practice and consumer groups remains a priority. However, there remain many challenges to both understanding the diagnosis and treatment of PCOS. Evidence suggests that both clinicians and consumers are not satisfied with the timeliness of diagnosis and treatment options. This review summarizes the important findings for diagnosis and treatment from the guidelines and expands on recent developments in the literature since its publication. Special attention to diagnosis at the ends of the reproductive spectrum are discussed and remaining areas of controversy are noted. Additionally, the review highlights some of the remaining challenges in the understanding and management of PCOS to help guide clinicians and investigators in this perplexing condition.

Heqiu Yan,1,* Li Wang,1,2,* Guohui Zhang,2,3 Yuhong Zhao,2,3 Min Jiang,2,3 Jun Liu,2,3 Qin Zeng,1– 3 Jiuzhi Zeng,1– 3 Fangyi Long,3 Xia Bai,3 Mengjun Luo,4 Weixin Liu1– 3 1Key Laboratory of Reproductive Medicine, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Sichuan Provincial Women’s and Children’s Hospital, Chengdu, Sichuan, People’s Republic of China; 2Reproductive Medicine Center, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Sichuan Provincial Women’s and Children’s Hospital, Chengdu, Sichuan, People’s Republic of China; 3Laboratory Medicine Center, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Sichuan Provincial Women’s and Children’s Hospital, Chengdu, Sichuan, People’s Republic of China; 4Department of Clinical Laboratory, School of Medicine, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mengjun Luo, Email luomengjun2023@163.com Weixin Liu, Email liuweixind@163.comBackground: Dysregulated inflammatory cytokines and adipokines are implicated in PCOS pathogenesis, but their independent role remains unclear due to the confounding effect of obesity. This study employed a BMI-matched design to specifically investigate adipokine alterations intrinsic to PCOS, independent of body mass.Patients and Methods: This investigation employed a case-control design and included 70 PCOS patients and 82 healthy controls matched for age and BMI. Serum levels of leptin (LEP), interleukin-6 (IL-6), omentin, adiponectin (ADPN), ghrelin, retinol-binding protein 4 (RBP4), and orexin-A (OXA) were measured. Spearman correlation analysis was used to analyze the correlation between PCOS and glucose and lipid metabolism, reproductive hormones and adipokines. Multivariate logistic regression analysis identified independent risk factors for PCOS. Subsequently, the diagnostic capacity of significant variables was appraised using ROC analysis.Results: Compared with healthy controls (n = 82), women with PCOS (n = 70) exhibited significantly higher levels of LEP and IL-6, and significantly lower levels of OXA, omentin, and ADPN/LEP ratio (P < 0.05). No significant differences were observed in the levels of ADPN, Ghrelin, and RBP4. PCOS positively correlated with HOMA-IR, TG, testosterone (TSTO), Anti-Müllerian Hormone (AMH), LEP, and IL-6, and negatively correlated with omentin, OXA, ADPN/LEP ratio, and HDL-C (P < 0.05). Multivariable logistic regression analysis identified LEP as an independent risk factor for PCOS, while omentin and OXA were protective factors (P < 0.05).Conclusion: This study reveals that patients with PCOS exhibit a specific pattern of adipokine dysregulation, independent of obesity, characterized by elevated LEP coupled with reduced omentin and orexin-A, which may play a pivotal role in disease pathogenesis. These findings highlight the potential clinical value of assessing adipokine profiles and developing targeted interventions, thereby offering novel strategies for the diagnosis and treatment of PCOS.Keywords: PCOS, adipokines, inflammation, metabolic dysregulation

Background Dysregulation of the HPG axis in PCOS causes increased frequency and amplitude of gonadotropin-releasing hormone (GnRH) pulsatility in the hypothalamus. Single nucleotide polymorphisms (SNPs) in the KISS1 gene may be associated with altered neuroendocrine signaling in PCOS. The present study aims to evaluate the association between two KISS1 polymorphisms (rs4889 and rs5780218), their haplotypes, and the odds of PCOS in Indonesian women. Methods A cross-sectional study was conducted at Yasmin Clinic, dr. Cipto Mangunkusumo General Hospital, Indonesia, involving 60 women with PCOS and 60 healthy controls. Hormonal levels were assessed using ELISA, and genomic DNA was analyzed by Sanger sequencing. Demographic data were compared using independent t-tests, and chi-square tests were used for genotype and allele frequency analysis. Results The genotypic distribution of rs4889 was significantly different between the PCOS and control groups (p<0.05), where the distribution of mutant genotype GG was higher in PCOS than in control (18.3% and 1.7%, respectively). The allele distribution of rs4889 and rs5782018 KISS1 SNPs were significantly different between both groups (p<0.01 and p<0.05, respectively). The rs4889 polymorphism was significantly different between the PCOS and control groups for the codominant and recessive models (p<0.01). Moreover, the rs5780218 polymorphism was significantly different between the PCOS and control groups for the codominant and dominant models (p<0.05). From the haplotype analysis, the G-CT haplotype was significantly different, with an OR value of 2.57 (1.33–4.96, p=0.0057). Conclusions KISS1 rs4889 and rs5780218 polymorphisms, as well as the G–CT haplotype, are associated with increased odds of PCOS in Indonesian women. These findings support a potential role of upstream neuroendocrine genetic variation in PCOS susceptibility; however, causal inferences cannot be drawn from this cross-sectional study.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age. Diagnosing adolescent PCOS is challenging due to the overlap between adult PCOS diagnostic criteria and normal physiological changes in adolescence. This review examines the diagnosis and treatment strategies for adolescent PCOS. The diagnosis of adolescent PCOS should meet two primary criteria-ovulatory dysfunction and biochemical or clinical hyperandrogenism-after excluding other causes. Defining these criteria accurately aids in early diagnosis and management of adolescent PCOS. However, due to limited research, age-specific diagnostic standards remain lacking. Once diagnosed, timely interventions-such as lifestyle, exercise, and dietary changes, along with targeted treatments like metformin and antiandrogens-should be initiated. In addition, the management of adolescent PCOS presents several challenges, including the absence of standardized medication guidelines, adolescent psychological factors that may impede adherence to dietary and exercise recommendations, and parental concerns about the long-term effects of medication on bone health and metabolism. Therefore, additional research is required to establish optimal management protocols to enhance patients' quality of life and prevent complications.

Purpose To determine whether the measurement of serum AMH can be used to diagnose PCOS and as a tool to predict the prognosis of PCOS. Methods This is a case–control study. Women of reproductive age (18–35 years) were recruited consecutively at a tertiary academic hospital during the period of March 2009–October 2011 and were divided into case (PCOS patients defined by the Rotterdam criteria) and control groups (non-PCOS patients). Menstrual history, clinical manifestations of hyperandrogenism, ovarian ultrasound assessments, and the levels of AMH, LH, FSH, and estradiol were collected. Results Seventy-one cases and 71 controls were recruited. AMH serum levels were significantly higher in PCOS patients than in controls. The Area Under the Curve (AUC) of the serum AMH assay in PCOS patients reached a value of 0.870. With a cut-off value of 4.45 ng/ml, the serum AMH level had a sensitivity of 76.1 % and a specificity of 74.6 %. The most common phenotypes of PCOS in this study were anovulation and polycystic ovary (63.4 %). However, the mean level of AMH was highest in the phenotypes of anovulation, polycystic ovaries and hyperandrogenism (11.1 ng/ml). Conclusions In Indonesian women, AMH can be used as an alternative diagnostic criteria for PCOS patients with a cut-off value of 4.45 ng/ml. AMH value rise when hyperandrogenism is present therefore serum AMH levels also reflect the phenotype of PCOS. However, these findings must be confirmed with larger clinical studies.