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BMC Endocrine Disorders Nov 2023This study was aimed to assess the effectiveness of Glucagon-like peptide 1 receptor agonists on pregnancy rate, menses, anthropometric and hormonal parameters in PCOS... (Meta-Analysis)
Meta-Analysis
PURPOSE
This study was aimed to assess the effectiveness of Glucagon-like peptide 1 receptor agonists on pregnancy rate, menses, anthropometric and hormonal parameters in PCOS patients.
METHODS
We conducted searches of the published literature in PubMed, EMBASE, Cochrane Library, Web of Science up to September 2022. Data from randomized controlled trials were obtained to assess the effects of GLP1RAs in PCOS women. Weighted mean difference, standardized mean difference, and risks ratio were employed for effect size estimation using a random-effects model.
RESULTS
A total of 840 patients with 469 individuals in GLP1RAs group and 371 individuals in control group from 11 RCTs were included. GLP1RAs usage was associated with an improvement in natural pregnancy rate (RR: 1.72, 95% CI 1.22 to 2.43, P = 0.002, I = 0%) and menstrual regularity (SMD: 1.72, 95% CI 0.60 to 2.85, P < 0.001, I = 95.6%). There were no statistically significant differences in total pregnancy rate, IVF pregnancy rate between two groups, but total PR elevated in a short time after GLP1RAs as shown in subgroup analysis. Randomization to GLP1RAs treatment was associated with great improvement in HOMA-IR, BMI, WC, SHBG and a slight reduction in TT compared to control group. A decrease in TBF was seen in European population. GLP1RAs monotherapy was not superior to metformin when it came to fT, DHEAS, FAI.
CONCLUSIONS
Prescription of GLP1RAs improves natural pregnancy rate, menstrual cyclicity and insulin sensitivity, anthropometrics, hormonal indexes in PCOS women.
Topics: Pregnancy; Humans; Female; Polycystic Ovary Syndrome; Pregnancy Rate; Metformin; Insulin Resistance; Periodicity
PubMed: 37940910
DOI: 10.1186/s12902-023-01500-5 -
BMC Endocrine Disorders Nov 2023Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of childbearing age. Randomized controlled trials (RCTs) have reported that... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of childbearing age. Randomized controlled trials (RCTs) have reported that exenatide and metformin are effective in the treatment of PCOS. In this meta-analysis, we aimed to compare the effectiveness and safety of exenatide alone or in combination with metformin versus metformin in patients suffering from PCOS.
METHODS
RCTs of exenatide therapy were identified through a search of electronic databases in November 2022 and updated in October 2023. Eligible studies were identified independently by the reviewers. Outcomes were analysed with Revman 5.4.
RESULTS
Nine RCTs among 214 studies on 1059 women with PCOS were included in the analysis, and among the nine RCTs, eight studies compared exenatide with metformin. Our meta-analysis demonstrated that exenatide was more effective than metformin in terms of pregnancy rate (RR 1.85 [95% CI 1.19,2.86] P = 0.006), sex hormone-binding globulin (SHBG) (MD 5 [95% CI 3.82,6.18] P < 0.001), and follicle-stimulating hormone (FSH) (MD 0.82 [95% 0.41,1.24] P < 0.001). The reductions in total testosterone (TT) (SMD -0.43 [95% CI -0.84, -0.03] P = 0.04) was more significant after treatment with exenatide than after treatment with metformin. In terms of safety, exenatide had a lower diarrhea rate (RR 0.11 [95% CI 0.01, 0.84]) than metformin. In the other three studies, exenatide plus metformin was compared with metformin. Exenatide combined with metformin was more effective in improving SHBG (MD 10.38[95%CI 6.7,14.06] P < 0.001), Matsuda index (MD 0.21[95%CI 0.05,0.37]) and reducing free androgen index (FAI) (MD -3.34 [-4.84, -1.83] P < 0.001), Weight (MD -2.32 [95%CI -3.89, -0.66]) and WC (MD-5.61[95%CI -8.4, -2.82] P < 0.001). The incidence of side effects between exenatide plus metformin and metformin was not statistically significant.
CONCLUSIONS
Exenatide alone or in combination with metformin is more effective than metformin for women with PCOS. Considering the evidence on effectiveness and safety, exenatide alone or in combination with metformin may be a better treatment approach than metformin for women with PCOS.
TRIAL REGISTRATION
INPLASY https://inplasy.com/inplasy-protocols/ ID: 10.37766/inplasy2022.11.0055.
Topics: Pregnancy; Female; Humans; Metformin; Polycystic Ovary Syndrome; Exenatide; Pregnancy Rate; Hypoglycemic Agents
PubMed: 37974132
DOI: 10.1186/s12902-023-01497-x -
Gynecological Endocrinology : the... Dec 2024The main purpose of this systematic review and meta-analysis was to investigate the diagnostic value of ultrasound elastography in the evaluation of polycystic ovary... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The main purpose of this systematic review and meta-analysis was to investigate the diagnostic value of ultrasound elastography in the evaluation of polycystic ovary syndrome (PCOS).
METHODS
A comprehensive and methodical investigation was carried out in the databases of PubMed, EMBASE, Cochrane, Scopus, Web of Science, and China National Knowledge Infrastructure, covering the entire duration of these databases until October 18, 2023. The primary purpose of this research was to evaluate and contrast ovarian tissue elasticity in people with and without PCOS. The elasticity of ovarian tissue was quantified using standardized mean difference (SMD).
RESULTS
A total of eight studies were ultimately selected for systematic evaluation and meta-analysis. Five studies used shear wave elastography (SWE) as a diagnostic tool, and it was discovered that women with PCOS had higher levels of ovarian shear wave elasticity than their healthy counterparts. The SMD was determined to be 1.86 kilopascal (95% CI: 1.27 to 2.44). Three studies were conducted using strain elastography (SE) to compare the ovarian strain ratio of patients with PCOS to that of a healthy control group. The SMD for the PCOS group was 2.07 (95% CI: 1.79 to 2.34), which indicated that the ovarian strain ratio was significantly higher in that group.
CONCLUSION
This systematic review and meta-analysis found that women with PCOS had stiffer ovarian tissue than women without the disorder. Ultrasound elastography may provide clinicians with value beyond 2D ultrasound in the diagnosis of PCOS.
Topics: Polycystic Ovary Syndrome; Humans; Elasticity Imaging Techniques; Female; Ovary; Elasticity
PubMed: 38733361
DOI: 10.1080/09513590.2024.2352139 -
Frontiers in Endocrinology 2024Unexplained recurrent implantation failure and the high cost of assisted reproductive techniques for those experiencing infertility have increasingly resulted in the use... (Review)
Review Meta-Analysis
BACKGROUND
Unexplained recurrent implantation failure and the high cost of assisted reproductive techniques for those experiencing infertility have increasingly resulted in the use of acupuncture. However, the trends and research status of acupuncture on infertility resulting in natural conception have not been systematically summarized. This scoping review and knowledge graph analysis aimed to summarize existing clinical studies on acupuncture for infertility that resulted in natural conception.
METHODS
Seven databases, namely, PubMed, Embase, the Cochrane Library, CNKI, VIP, Wanfang Data, and SinoMed, were searched up to August 2023 (updated on 1 April). Two authors independently identified related clinical studies and systematic reviews, and extracted data from included studies on acupuncture for infertility; any discrepancies were resolved by discussion or judged by a third author. A meta-analysis was conducted based on randomized controlled trials (RCTs), and data were synthesized using risk ratios with 95% confidence intervals.
RESULTS
Of the 310 articles meeting the inclusion criteria, 274 were primary studies, 7 were systematic reviews, and 29 were case reports. Reported adverse events included mild ovarian irritation and early signs of miscarriage. Out of the 274 primary studies, there were 40 (14.60%) cases of male infertility and 234 (85.40%) cases of female infertility. Current research highlights on acupuncture for infertility focused on female infertility caused by polycystic ovary syndrome, ovulation disorder, and luteinized unruptured follicle syndrome (LUFS), while acupuncture for male infertility was a hotspot in the early research stage. The meta-analysis also suggested that acupuncture was more effective than human chorionic gonadotropin (HCG) [RR = 1.89, 95% CI (1.47, 2.42), 11 RCTs, 662 participants]. Acupuncture combined with HCG was comparable to HCG [RR = 2.33, 95% CI (1.53, 3.55), four RCTs, 259 participants]. Compared with no treatment, acupuncture resulted in a higher pregnancy rate [RR = 22.12, 95% CI (1.39, 353.09), one RCT, 47 participants]. There was no statistical difference between acupuncture combined with HCG plus letrozole and HCG plus letrozole [RR = 1.56, 95% CI (0.84, 2.89), one RCT, 84 participants].
CONCLUSION
Current research highlights on acupuncture for infertility resulting in natural conception focused on female infertility caused by polycystic ovary syndrome, ovulation disorder, and LUFS, while studies on male infertility and female infertility caused by blockage in the fallopian tube, thin endometrium, and other factors were insufficient. Well-designed confirmatory clinical studies are still needed as the research hypotheses of most studies were unclear.
Topics: Humans; Acupuncture Therapy; Female; Bibliometrics; Infertility, Female; Male; Infertility; Pregnancy; Infertility, Male
PubMed: 38894745
DOI: 10.3389/fendo.2024.1351281 -
Cureus Dec 2023Gestational diabetes mellitus (GDM) is the most common complication of pregnancy that arises in the 2nd and 3rd trimesters, leading to significant complications for the... (Review)
Review
Gestational diabetes mellitus (GDM) is the most common complication of pregnancy that arises in the 2nd and 3rd trimesters, leading to significant complications for the mother and her neonates, such as an increased rate of pregnancy-induced hypertension and miscarriages, while neonates may have a large birth weight, hypoglycemia, or macrosomnia. Numerous risk factors can lead to GDM; however, a significant one is polycystic ovarian syndrome (PCOS). PCOS is the most common endocrine pathology beginning before puberty, and due to significant hormonal changes, it is not diagnosed until after puberty. PCOS requires at least three of the following symptoms: hyperandrogenism, menstrual irregularities, or polycystic ovary morphology. While it is agreed that women with PCOS are at a significantly increased risk of GDM, no publication to our knowledge has evaluated the full relationship of GDM in the setting of PCOS. This paper aimed to assess this relationship and determine how it may differ for pregnant women with only GDM by determining the prevalence of GDM, the variations within phenotypes, the influence of fertilization methods, specific risk factors, maternal outcomes, and neonatal outcomes. The prevalence of GDM was significantly increased in women with PCOS compared to healthy controls, and some studies have found that phenotype A may be more likely to lead to GDM. Risk factors were similar to pregnant women with only GDM, but with GDM and PCOS specifically, preconception low sex hormone-binding globulin, increased BMI > 25 kg/m2, and preconception impaired glucose tolerance were specific. While maternal outcomes were similar to pregnant women with only GDM, women with GDM and PCOS were even more likely to develop pregnancy-induced hypertension and early miscarriage. Neonates from mothers with GDM and PCOS were more likely to have low birth weights compared to mothers with just GDM who had high birth weights. The evaluation of the relationship between GDM and PCOS allows for illumination of the need to evaluate influences that currently lack research, such as phenotype variation and influences of fertilization method. This also promotes the need to develop predictive algorithms based on risk factors to prevent these adverse outcomes for mothers and neonates.
PubMed: 38234933
DOI: 10.7759/cureus.50725 -
International Journal of Molecular... Dec 2023Infertility affects around 1 in 5 couples in the world. Congenital absence of the uterus results in absolute infertility in females. Müllerian agenesis is the... (Review)
Review
Infertility affects around 1 in 5 couples in the world. Congenital absence of the uterus results in absolute infertility in females. Müllerian agenesis is the nondevelopment of the uterus. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a condition of uterovaginal agenesis in the presence of normal ovaries and the 46 XX Karyotype. With advancements in reproductive techniques, women with MA having biological offspring is possible. The exact etiology of MA is unknown, although several genes and mechanisms affect the development of Müllerian ducts. Through this systematic review of the available literature, we searched for the genetic basis of MA. The aims included identification of the genes, chromosomal locations, changes responsible for MA, and fertility options, in order to offer proper management and counseling to these women with MA. A total of 85 studies were identified through searches. Most of the studies identified multiple genes at various locations, although the commonest involved chromosomes 1, 17, and 22. There is also conflicting evidence of the involvement of various candidate genes in the studies. The etiology of MA seems to be multifactorial and complex, involving multiple genes and mechanisms including various mutations and mosaicism.
Topics: Humans; Female; Mullerian Ducts; Infertility; 46, XX Disorders of Sex Development; Mosaicism; Congenital Abnormalities
PubMed: 38203291
DOI: 10.3390/ijms25010120 -
Taiwanese Journal of Obstetrics &... Jan 2024Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder characterized by multifactorial and intricate pathogenesis. The discovery of novel markers has... (Meta-Analysis)
Meta-Analysis Review
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder characterized by multifactorial and intricate pathogenesis. The discovery of novel markers has been a significant step toward understanding the mechanisms of PCOS. Galectin-3 has emerged as a novel factor in metabolic disorders. This meta-analysis examines the association between circulating Galectin-3 and PCOS. A systematic review and meta-analysis were performed to identify relevant articles in the electronic databases PubMed, Web of Science, Scopus, Cochrane, EMBASE, and Google Scholar. The search covered the period from January 2000 to March 2023 and followed a predefined search strategy. Eight articles were included in the analysis with a total of 594 participants (322 patients with PCOS and 272 controls). Pooled standardized mean difference (SMD) and 95 % confidence interval [CI] were used to evaluate the association between Galectin-3 levels and PCOS. The results indicated a significant association between PCOS and galectin-3 levels (SMD = 0.58; 95 % CI: 0.15-1.01; p = 0.007). In addition, subgroup analysis showed a significant difference in serum Galectin-3 levels in women with PCOS and a higher homeostatic model assessment for insulin resistance ratio (SMD = 0.89; 95 % CI: 0.45-1.33; p < 0.001). The researchers also performed meta-regression and subgroup analyses to specify sources of heterogeneity. The results of our meta-analysis suggest an association between increased levels of galectin-3 and PCOS. Galectin-3 plays a significant role in the progression of PCOS and could be used as a novel diagnostic biomarker. Nevertheless, it is essential to perform further studies to confirm and support our conclusions.
Topics: Female; Humans; Galectin 3; Insulin Resistance; Polycystic Ovary Syndrome
PubMed: 38216266
DOI: 10.1016/j.tjog.2023.10.003 -
Cardiovascular Endocrinology &... Dec 2023Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of childbearing age, causing hormonal imbalances, reproductive issues, and metabolic... (Review)
Review
BACKGROUND
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of childbearing age, causing hormonal imbalances, reproductive issues, and metabolic disturbances. Women with PCOS have an increased risk of cardiovascular disease due to insulin resistance, obesity, and hyperandrogenism. Detecting impaired left ventricular (LV) function is important in managing this condition. Echocardiography, a non-invasive imaging technique, can effectively detect LV dysfunction.
AIM
The goal of this systematic review was to assess whether there are any variations in echocardiographic measures between women with PCOS and those without the condition in order to determine the potential impact of PCOS on LV function.
METHODS
This review followed the PRISMA reporting guidelines. A thorough search of databases including PubMed, Scopus, Web of Science, and Cochrane was conducted. The quality of the selected studies was assessed using the Joanna Briggs Institute appraisal instruments. After applying strict eligibility criteria, data were extracted and organized in Microsoft Excel sheets. Review Manager (RevMan) software was used for the analysis.
RESULTS
Analysis of 29 studies revealed significant differences in echocardiographic measures related to diastolic function between women with PCOS and healthy controls. However, there were no significant differences in measures of systolic function.
CONCLUSION
These findings indicate that PCOS may be linked to impaired LV function, thereby increasing the risk of cardiovascular disease. Further research is necessary to better understand this association and its clinical implications. Early detection and management of PCOS could potentially help prevent cardiovascular complications in affected women.
PubMed: 37900050
DOI: 10.1097/XCE.0000000000000294 -
Frontiers in Endocrinology 2023Previous studies have investigated the relationship between nesfatin-1 level and polycystic ovary syndrome (PCOS). However, these studies have produced conflicting... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies have investigated the relationship between nesfatin-1 level and polycystic ovary syndrome (PCOS). However, these studies have produced conflicting results. Thus, in this meta-analysis, we aimed to clarify the association between blood nesfatin-1 levels and PCOS, and the ability of nesfatin-1 as a biomarker in PCOS.
METHODS
Meta-analysis was performed using STATA 12.0 software. We computed standard mean difference (SMD) and 95% confidence interval (CI) regarding the comparison of blood nesfatin-1 in patients with PCOS and controls.
RESULTS
The present meta-analysis showed no significant difference in blood nesfatin-1 level between patients with PCOS and controls with a random effects model (SMD = 0.03; 95%CI: -0.71, 0.77; I 97.1%, value for Q test < 0.001). Subgroup analysis for different ethnicities reported no significant difference in blood nesfatin-1 level between patients with PCOS and controls in both Caucasian and Asian populations. Subgroup analysis for different sample types reported no significant difference in serum nesfatin-1 level between patients with PCOS and controls. Subgroup studies reported no significant difference in blood nesfatin-1 level between PCOS and controls in both obese and non-obese populations.
CONCLUSION
In conclusion, there is no significant relationship between blood nesfatin-1 levels and PCOS.
Topics: Female; Humans; Biomarkers; Ethnicity; Obesity; Polycystic Ovary Syndrome; Nucleobindins
PubMed: 38327900
DOI: 10.3389/fendo.2023.1275753 -
Heliyon Oct 2023Polycystic Ovary Syndrome (PCOS) is among the most prevalent endocrinological abnormalities seen in reproductive female bodies posing serious health hazards. The...
Polycystic Ovary Syndrome (PCOS) is among the most prevalent endocrinological abnormalities seen in reproductive female bodies posing serious health hazards. The correctness of interpreting this condition depends heavily on the wide spectrum of associated symptoms and the doctor's expertise, making real-time clinical detection quite challenging. Thus, investigations on computer-aided PCOS detection systems have recently been explored by several researchers worldwide as a potential replacement for manual assessment. This review study's objective is to analyze the relevant research works on computer-assisted methods for automatically identifying PCOS through a systematic literature review (SLR) methodology as well as investigate the research limitations and explore potential future research scopes in this domain. 28 articles have been selected using the PRISMA approach based on a set of inclusion-exclusion criteria for conducting the review. The data synthesis of the selected articles has been conducted using six data exploration themes. As outcomes, the SLR explored the topical association between the studies; their research profiles; objectives; data size, type, and sources; methodologies applied for the detection of PCOS; and lastly the research outcomes along with their evaluation measures and performances. The study also highlights areas for future research directions examining the study gaps to enhance the current efforts for autonomous PCOS identification; such as integrating advanced techniques with the current methods; developing interactive software systems; exploring deep learning and unsupervised machine learning techniques; enhancing datasets and country context; and investigating more unknown factors behind PCOS. Thus, this SLR provides a state-of-the-art paradigm of autonomous PCOS detection which will support significantly efficient clinical assessment, diagnosis and treatment of PCOS.
PubMed: 37867807
DOI: 10.1016/j.heliyon.2023.e20524