Objective To evaluate the efficacy and safety of rosiglitazone versus metformin in treating polycystic ovary syndrome (PCOS). Methods Randomized controlled trials (RCTs) about rosiglitazone versus metformin in treating PCOS were retrieved on computer in MEDLINE, The Cochrane Library, EMbase, EBSCO, CBM, CNKI, Chinese Medical Association Journal Database and VIP from the date of their establishment to December 2010. The trials were screened according to the inclusion and exclusion criteria by two reviewers independently, the data were extracted, the methodological quality was assessed, and finally meta-analysis was conducted with Stata 11.0 software. Results A total of six RCTs involving 286 PCOS patients were included. The results of meta-analyses showed that there was no significant difference between rosiglitazone and metformin in improving PCOS patients’ insulin sensitivity (SMD= –0.14, 95%CI –0.46 to 0.19, P=0.412) and lowering androgen levels (SMD=0.05, 95%CI –0.26 to 0.36, P=0.747). However, the effect of rosiglitazone was inferior to metformin in lowing patients’ weight with a significant difference (SMD=0.34, 95%CI 0.11 to 0.58, P=0.004). The rosiglitazone showed a lower incidence rate of adverse reaction compared with metformin. Conclusion Compared with metformin, the rosiglitazone is eqully effective in improving PCOS patients’ insulin sensitivity and lowering androgen levels, and has a lower incidence rate of adverse reaction although it is inferior to metformin in lowing patients’ weight. So rosiglitazone is more applicable for the patients who are of underweight or cannot tolerate the gastrointestinal side effects induced by metformin. There is no enough evidence for this conclusion due to the small sample size and limited number of RCTs. More high-quality, large-sample and multicentered RCTs are required to guide clinical treatment and benefit patients.
Objective To evaluate the effectiveness of GnRH antagonist in vitro fertilization-embryo transfer (IVF-ET) in polycystic ovary syndrome (PCOS) patients.Methods Such databases as PubMed (1997 to 2010), PML (1997 to 2010), FMJS (2000 to 2010), CBMdisc (1979 to 2010), CNKI (1994 to 2010), VIP (1989 to 2010), WanFang (1994 to 2010), and duxiu scholar searcher (www.duxiu.com), and nine relevant Chinese journals were searched for retrieving the randomized controlled trails (RCTs) on the effectiveness of GnRH antagonist versus GnRH agonist for IVF-ET in PCOS Patients. The studies were screened according to the inclusive and exclusive criteria by two reviewers independently, the data was abstracted and the quality was evaluated. The RevMan 4.2.7 software was used for Meta-analyses. Results Six grade-B studies involving 699 participants were included. The results of Meta-analyses showed that, compared with the GnRH agonist, there was no significant difference in the GnRH antagonist group about the stimulation duration (WMD= –1.23, 95%CI –2.76 to –0.31), dose of gonadotrophins (Gns) (WMD= –4.87, 95%CI –14.20 to 4.46), serum E2 value on the day of HCG administration (WMD= 31.37, 95%CI –263.40 to 326), number of oocytes retrieved (WMD= 1.34, 95%CI –1.02 to 4.70), clinical pregnancy rate (OR= 1.27, 95%CI 0.77 to2.10), and miscarraige rate (Peto OR= 0.67, 95%CI 0.38 to1.18). But the OHSS rate in the GnRH antagonist group was lower with a significant difference (Peto OR= 0.35, 95%CI 0.24 to 0.50). Conclusions Compared with the GnRH agonist protocol, the GnRH antagonist protocol can obviously reduce the incidence of OHSS, but has the same effect in Gn dose, retrieving oocytes and clinical pregnancy rate. Because the GnRH antagonist can decrease the treatment duration and cost, and has better safety, so it may be an ideal choice for PCOS patients to have IVF-ET therapy. For the quality and quantity limitation, and the methodology difference of the included studies, it is suggested that the conclusion from this study should be only served as a reference of clinical analyses, and should be revaluated and updated unceasingly.
ObjectiveTo quantify cytokine and chemokine mRNA expression in follicular fluid cells obtained at the time of oocyte retrieval before IVF in women with and without polycystic ovary syndrome (PCOS). MethodsBetween January and August 2014, 80 subjects undergoing IVF-ET were chosen to be studied. Among them, 40 had PCOS, and the other 40 were controls. Follicular fluid cells were subjected to quantitative RT-PCR to evaluate growth-regulated oncogene-α (GRO-α), tumor necrosis factor-α (TNF-α), interleukins (IL-6, IL-8) expression relative to β-actin. And the chemokine was measured in serum and follicular fluids by immunoassays. These mRNA transcriptions production was proved by sequencing. ResultsGRO-α, TNF-α, IL-6 and IL-8 mRNA were expressed in follicular fluid cells. Their expressions were significantly higher in PCOS compared with controls (P<0.05). They were also detected higher in PCOS than controls in serum and follicular (P<0.05), but the difference of IL-6 level between PCOS and controls in lean patients was not statistically significant (P>0.05). ConclusionGRO-α, IL-8, TNF-α, and IL-6 may play important roles in the occurrence and development of PCOS. PCOS may be a chronic immunological inflammatory disease.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, which may result in infertility. Because of the complicated etiology and high morbidity, it has attracted wild attention of researchers around the world. The large quantity of blood specimens that have been obtained from multicenter clinical trials (PCOSAct) are precious resources for clinical research. It could not only contain clinical data of the related diseases but also provide vital guidance for the diagnosis and treatment of the disease. This paper discusses the collection, processing, storage, and testing of blood specimens as well as the potential problems, and emphasizes the importance of specimen quality for high quality clinical research. The purpose of this paper is to provide experience and reference for the standardized construction of biobank in future and improve the management of blood specimen in clinical trials.
Polycystic ovary syndrome (PCOS) affects many women of reproductive age, including ovarian and metabolic dysfunction. Major therapeutic goals include weight loss and improved insulin resistance. The effects of weight loss and increased insulin sensitivity of glucagon-like peptide-1 (GLP-1) receptor agonists provide another opportunity and pathway for the treatment of PCOS patients, especially those with metabolic abnormalities. This paper reviews the metabolism and reproductive outcomes about GLP-1 receptor agonists for PCOS by searching for literatures of clinical trials from PubMed in the past 10 years, in oder to provide new ideas and clinical evidence for clinical treatment of PCOS.
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews on acupuncture for polycystic ovary syndrome. Methods We comprehensively searched PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data to collect systematic reviews on acupuncture for polycystic ovary syndrome from the establishment time of databases to January 5th, 2018. The AMSTAR tool was applied for methodological quality assessment of included studies and the GRADE system was applied for evidence quality assessment of included outcomes of systematic reviews. Results A total of 11 systematic reviews were included. The results of assessment using AMSTAR showed that, among the 11 items, most problems occurred in Item 5 " Were there any lists of research articles included and excluded”, followed by Item 1" Was an‘a prior’design provided?”and Item 11" Were potential conflict of interest included?”. GRADE grading results showed that quality of evidence for the outcome measure were" low”or" very low”. Conclusions Current acupuncture treatment of polycystic ovary syndrome has a certain effect, however, the quality of evidence is low. Thus, physicians should apply the evidence to make decision on acupuncture for polycystic ovary syndrome with caution in clinical practice and consider the actual situation, combined with the patient’s value preferences and economic factors.
ObjectivesTo evaluate and compare the clinical impact of different methods of trigger in polycystic ovary syndrome (PCOS) with high ovarian response undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles.MethodsA total of 323 PCOS patients with high ovarian response in an gonadotrophin-releasing hormone antagonist protocol in our reproductive medical center from January 1st, 2017 to December 31st, 2017 were included. Then they were divided into two groups based on the different trigger modes: Group A: gonadotrophin-releasing hormone agonist (GnRH-a) with low dose human chorionic gonadotrophin (HCG); Group B: HCG as trigger. Analysis and comparison of the general data of the two groups of patients, ovulation induction cycle treatment, embryo laboratory indicators and resuscitation cycle treatment outcome were performed retrospectively.ResultsThere were no significant differences in baseline such as ages, BMI, startup dose of Gn, the total dosage of drugs, promote ovulation days and so on (P>0.05). The serum E2 level on trigger day in group A was significantly higher than those in group B (7 256.94±2 031.92 vs. 6 200.26±1 001.44, P<0.05). There were no significant differences in the retrieved oocytes (23.90±7.99 vs. 23.81±7.15), binuclear fertilization rate (58.19% vs. 56.30%), and the number of frozen embryos (12.81±5.45 vs. 11.07±5.36) between two groups (P>0.05). There were also no significant differences between two groups in the incidence of moderate to severe OHSS (5.98% vs. 7.87%), clinical pregnancy rate (59.28% vs. 57.53%), implantation rate (41.05% vs. 38.24%), miscarriage rate (9.28% vs. 8.22%) and live birth rate (47.42% vs. 41.10%) during the frozen-thawed cycles (P>0.05).ConclusionsFor high responders of PCOS patients with GnRH antagonist protocol, using GnRH-a with low dose HCG as trigger maybe could decrease the incidence of moderate to severe OHSS. Embryo resuscitation and transfer cycle can also obtain ideal outcome.
ObjectiveTo systematically review the efficacy of vitamin D supplementation on patients with polycystic ovary syndrome (PCOS).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, EBSCO, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of vitamin D supplementation for PCOS from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 692 patients were included. The results of meta-analysis showed that compared with placebo, vitamin D could reduce the level of hypersensitive C-reactive protein (hs-CRP) (MD=−0.54, 95%CI −1.00 to −0.08, P=0.02) and total testosterone (MD=−0.17, 95%CI −0.29 to −0.05, P=0.004), and increase endometrial thickness (MD=1.78, 95%CI 0.49 to 3.06, P=0.007). However, there were no significant differences between two groups in the incidence of sex hormone binding globulin (SHBG) level and hypertrichosis’s score (mF-G) (P>0.05).ConclusionsCurrent evidence indicates that vitamin D supplementation can significantly reduce the level of total testosterone and hs-CRP, and increase endometrial thickness of PCOS. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
Polycystic ovary syndrome is one of the common reproductive endocrine diseases in women in recent years. A large number of studies have found that serum anti-Müllerian hormone levels in patients with polycystic ovary syndrome are significantly higher than those in normal women, especially in anovulatory patients with polycystic ovary syndrome. This article briefly introduces the relationship between follicular development, hyperandrogenemia, obesity, and insulin resistance in the pathological manifestations of polycystic ovary syndrome and anti-Müllerian hormone, and the application of anti-Müllerian hormone in assisted reproduction, ovarian reserve and diagnosis in patients with polycystic ovary syndrome. It aims to provide a basis for better use of anti-Müllerian in the diagnosis and treatment of polycystic ovary syndrome.
Objective To explore the differential expression of circular RNAs (circRNAs) in polycystic ovary syndrome (PCOS) by bioinformatics, and predict the microRNAs (miRNAs) associated with them. Methods The expression profile of cumulus cells gene chip in PCOS was searched in the Gene Expression Omnibus database, and differential circRNAs were screened by GEO2R tool of the database. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes signaling pathways of different circRNA genes were analyzed using the DAVID 6.8 database. Circular RNA interactome was used to predict the potential regulated miRNAs. Cytoscape software was used to establish circRNA-miRNA network map. The potential regulatory miRNAs were predicted by the 10 circRNAs with the most significant differences in up-regulation and down-regulation. Results A total of 247 circRNAs were obtained in PCOS, and 277 miRNAs binding to up-regulated circRNA genes and 125 miRNAs binding to down-regulated circRNA genes were predicted. The top 10 miRNAs that could bind to multiple differential circRNAs were hsa-miR-557, hsa-miR-507, hsa-miR-224, hsa-miR-136, hsa-miR-127-5p, hsa-miR-579, hsa-miR-502-5p, hsa-miR-186, hsa-miR-1253, and hsa-miR-432. Conclusion The differential expression analysis of circRNAs is helpful to understand the main role of circRNAs in PCOS, and the prediction of potential regulated miRNAs can help to understand the pathogenesis of the disease.