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Journal of Gynecology Obstetrics and... May 2024We aimed to determine the association between polycystic ovarian syndrome (PCOS) and cervical incompetence (CI). We hypothesise that insulin resistance induces a glucose... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We aimed to determine the association between polycystic ovarian syndrome (PCOS) and cervical incompetence (CI). We hypothesise that insulin resistance induces a glucose metabolism disorder that could potentially cause cervical incompetence, resulting in an adverse outcome.
DESIGN
We conducted a systematic review and meta-analysis of observational studies to summarise the evidence regarding the strength of the association of occurrence of CI in a PCOS pregnant woman compared to a non-PCOS pregnant woman. We defined PCOS as the presence of two of the three Rotterdam criteria, and a combination of clinical symptoms and ultrasound findings were used to diagnose CI.
METHOD
This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) reporting standards and the PROSPERO registration. We systematically searched PubMed, Embase and Cochrane databases to identify observational studies up to December 2022. We included studies in English which compared the PCOS and non-PCOS pregnant women who were diagnosed using Rotterdam criteria and subsequently developed CI in the same pregnancy. We excluded the studies which did not report CI as an outcome. Two reviewers independently screened studies, extracted data, and assessed the risk of bias (JBI critical appraisal tools). In the meta-analysis, effect estimates were pooled using the random effects model, and heterogeneity was measured using I statistics.
RESULTS
We identified 23 articles, of which 19 were screened, and three studies were included in the meta-analysis. Three observational studies reported the data of 3845 pregnant women with PCOS and 9449 pregnant women without PCOS. One hundred and forty-one (3.7 %) pregnant women with PCOS developed CI compared to 58 (0.6 %) non-PCOS pregnant women [Risk ratio: 5.3; 95 % confidence interval: 1.9-14.6; I: 89 %]. Of the three studies included, two had a low risk of bias, and one had a moderate risk of bias.
CONCLUSION
The findings of the review suggested higher risk of CI in a pregnant woman with PCOS compared to pregnant women without PCOS. These findings highlight the necessity of establishing guidelines for early identification of CI in PCOS pregnant mothers to prevent adverse maternal and neonatal outcomes following preterm labour.
Topics: Humans; Polycystic Ovary Syndrome; Female; Pregnancy; Uterine Cervical Incompetence; Pregnancy Complications; Insulin Resistance; Observational Studies as Topic
PubMed: 38432628
DOI: 10.1016/j.jogoh.2024.102763 -
European Journal of Obstetrics,... May 2024To combine all literature describing cases of isolated fallopian tube torsion in adult non pregnant patients in a systematic manner, to optimize knowledge and practice... (Review)
Review
OBJECTIVE
To combine all literature describing cases of isolated fallopian tube torsion in adult non pregnant patients in a systematic manner, to optimize knowledge and practice both for diagnosis and management.
STUDY DESIGN
EMBASE and PubMed databases were searched for the terms 'tubal' OR 'fallopian tube' AND 'isolated' AND 'torsion' from the inception of these databases to July 5, 2023. All case reports or case series of adult patients (18 years or older) with isolated fallopian tube torsion were included. Exclusion criteria included: all other study types; cases involving children and adolescents (less than 18 years old); pregnant patients of all trimesters; tubo-ovarian torsion; studies not published in English; duplicates and those not available in text. Following the database search, two authors independently screened the studies and search results were subsequently reported in accordance with PRISMA guidelines. Data was extracted independently by two authors and analysed using Excel. All cases were assessed for bias using a modified version of the tool proposed by Murad et al. RESULTS: 92 unique articles enrolling 131 individual cases were included in this systematic review. Isolated fallopian tube torsion most commonly occurs during reproductive ages between 18 and 45 years. It is uncommon in postmenopausal women. The most common presenting symptoms include unilateral lower abdominal or pelvic pain along the affected side with nausea and vomiting. Risk factors can be intrinsic or extrinsic and can include conditions such as hydrosalpinx, sterilization, pelvic inflammatory disease or cysts. Ultrasound is the optimal imaging modality however Computed Tomography and Magnetic Resonance Imaging can also be used. Imaging in general has low sensitivity, however isolated fallopian tube torsion can be identified with appropriate expertise. The gold standard for isolated fallopian tube torsion management is laparoscopy and detorsion however currently, the most common intervention performed is salpingectomy.
CONCLUSIONS
Isolated fallopian tube torsion is a rare but important gynaecological emergency with significant fertility implications. This study summarizes the most common presentations, investigation findings and surgical interventions in patients with isolated fallopian tube torsion. This study also emphasizes the importance of clinicians maintaining a high degree of suspicion and low threshold for early laparoscopic intervention to retain fertility.
Topics: Adult; Adolescent; Child; Female; Humans; Young Adult; Middle Aged; Fallopian Tubes; Fallopian Tube Diseases; Ovarian Torsion; Torsion Abnormality; Salpingectomy
PubMed: 38432020
DOI: 10.1016/j.ejogrb.2024.02.050 -
Nutrition & Diabetes Feb 2024The optimal dietary regimen for polycystic ovary syndrome (PCOS) has not been identified. High-protein diets (HPDs) are effective for weight control in individuals with... (Meta-Analysis)
Meta-Analysis Review
The optimal dietary regimen for polycystic ovary syndrome (PCOS) has not been identified. High-protein diets (HPDs) are effective for weight control in individuals with metabolic abnormalities, but no systematic meta-analyses have yet summarised the effects of HPDs on PCOS. Seven electronic databases were searched from inception to 30 April 2023, and studies comparing the effects of HPDs and other diets on the anthropometrics, metabolic factors, and hormonal profiles for PCOS were identified. Data were pooled using random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by Cochrane Collaboration tool. Eight trials involving 300 women with PCOS were included. Compared with isocaloric balanced diets (BDs), HPDs significantly reduced fasting insulin (-2.69 μIU/mL, 95% CI [-3.81, -1.57], P < 0.0001, I = 46%) and homoeostatic model assessment for insulin resistance (HOMA-IR-0.41, 95% CI [-0.80, -0.02], P = 0.04, I = 94%) in women with PCOS. However, HPDs and BDs had comparable effects on weight loss, abdominal adiposity, lipid profiles, and reproductive hormones (all P ≥ 0.05). HPDs may benefit women with PCOS in terms of improving insulin resistance, supporting for their use as one of the dietary management options for PCOS, however further RCTs in larger and broader settings are required to confirm these observations and investigate the mechanism behind it.
Topics: Humans; Female; Polycystic Ovary Syndrome; Insulin Resistance; Insulin; Diet, High-Protein; Cardiovascular Diseases
PubMed: 38424054
DOI: 10.1038/s41387-024-00263-9 -
Journal of Reproductive Immunology Jun 2024Polycystic Ovary Syndrome (PCOS) and Autoimmune Thyroiditis (AIT) are two prevalent endocrine disorders affecting women, often coexisting within the same patient... (Meta-Analysis)
Meta-Analysis Review
Polycystic Ovary Syndrome (PCOS) and Autoimmune Thyroiditis (AIT) are two prevalent endocrine disorders affecting women, often coexisting within the same patient population. This meta-analysis aims to systematically assess and synthesize the existing body of literature to elucidate the intricate relationship between PCOS and AIT. A systematic literature search for relevant observational studies was conducted in electronic databases such as Web of Science, Google Scholar, PubMed, Cochrane, and Scopus until March 2023. All Statistical analyses were performed using CMA Software v3.7 in a random-effects network meta-analysis. In addition, sensitivity and meta-regression analyses were conducted to identify sources of Heterogeneity based on related risk factors. Our meta-analysis included eighteen studies with 3657 participants, which revealed significant differences between PCOS patients and control groups. In particular, a considerable association was detected between PCOS and the presence of AIT (OR = 2.38; 95% CI: 1.63-3.49; P< 0.001) and elevated levels of TSH (SMD = 0.24; 95% CI: 0.06-0.42; P= 0.01), anti-TPO (SMD = 0.36; 95% CI: 0.19-0.53; P< 0.001), anti-TG (SMD = 1.24; 95% CI: 0.37-2.10; P< 0.001), and other positive serum antibodies compared to the control groups. The findings from this meta-analysis may contribute to enhanced diagnostic strategies like complete thyroid function tests, more targeted interventions, and improved patient care for individuals presenting with both PCOS and AIT. Additionally, identifying commonalities between these conditions may pave the way for future research directions, guiding the development of novel therapeutic approaches that address the interconnected nature of PCOS and AIT.
Topics: Polycystic Ovary Syndrome; Humans; Female; Thyroiditis, Autoimmune; Autoantibodies; Thyrotropin
PubMed: 38402811
DOI: 10.1016/j.jri.2024.104215 -
Reproductive Health Feb 2024Polycystic ovary syndrome (PCOS) is a common condition in women, characterised by reproductive and metabolic dysfunction. While dietary approaches have been evaluated as... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Polycystic ovary syndrome (PCOS) is a common condition in women, characterised by reproductive and metabolic dysfunction. While dietary approaches have been evaluated as a first-line treatment for patients with PCOS, there is limited evidence to support preference for a specific dietary composition. This systematic review and network meta-analysis was performed with the objective of comparing different dietary interventions in terms of positive impact. Metformin, the currently preferred treatment, was also compared.
METHODS
The latest systematic search was performed on the 20th of March, 2023. Eligible randomised controlled trials (RCTs) included patients with PCOS and compared the dietary approach with another intervention or a standard diet. Outcomes were expressed via anthropometric measurements and hormonal, glycemic, and lipid levels. The Bayesian method was used to perform a network meta-analysis and to calculate the surface under the cumulative ranking curve (SUCRA) values in order to rank the dietary interventions. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system.
RESULTS
19 RCTs were identified, comprising data from 727 patients who were variously treated with 10 types of dietary interventions and metformin. The Dietary Approaches to Stop Hypertension (DASH) diet was the most effective in reducing Homeostatic Model Assessment of Insulin Resistance (SUCRA 92.33%), fasting blood glucose (SUCRA 85.92%), fasting insulin level (SUCRA 79.73%) and triglyceride level (SUCRA 82.07%). For body mass index (BMI), the most effective intervention was the low-calorie diet (SUCRA 84.59%). For weight loss, the low-calorie diet with metformin (SUCRA 74.38%) was the most effective intervention. Metformin produced the greatest reductions in low-density lipoprotein cholesterol (SUCRA 78.08%) and total testosterone levels (SUCRA 71.28%). The low-carb diet was the most effective intervention for reducing cholesterol levels (SUCRA 69.68%), while the normal diet (SUCRA 65.69%) ranked first for increasing high-density lipoprotein cholesterol levels.
CONCLUSION
Dietary interventions vary in their effects on metabolic parameters in women with PCOS. Based on our results, the DASH diet is the most effective dietary intervention for treating PCOS. Registration PROSPERO ID CRD42021282984.
Topics: Female; Humans; Polycystic Ovary Syndrome; Network Meta-Analysis; Metformin; Diet; Cholesterol
PubMed: 38388374
DOI: 10.1186/s12978-024-01758-5 -
Patient Education and Counseling Jun 2024To provide an overview of healthcare professionals' experience of PCOS management and identify the relevant facilitators and barriers. (Review)
Review
OBJECTIVE
To provide an overview of healthcare professionals' experience of PCOS management and identify the relevant facilitators and barriers.
METHODS
A systematic search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL database from the earliest available date to April 2023. Qualitative and mixed methods studies that described healthcare professionals' experiences of PCOS management were included.
RESULTS
A total of 74 findings were extracted from the 8 included studies, which were categorized into facilitators and barriers. The barriers were meta-aggregated into four themes: the weakness of clinical evidence; women's low adherence to PCOS management; various obstacles that healthcare professionals face, and the influence of social environment and culture. The facilitators were meta-aggregated into three themes: chronic disease healthcare plan, communication techniques and healthcare professionals' ability and awareness.
CONCLUSION
The findings of this study have the potential to improve the care provided to women with PCOS. However, it is important for national health professionals and policy markers to consider the cultural context of their own country when implementing these findings.
PRACTICAL IMPLICATIONS
This study illustrated several challenges in managing the heterogeneous condition of PCOS and provide insights for the development of medical policies and future research directions.
Topics: Humans; Female; Polycystic Ovary Syndrome; Health Personnel; Social Environment; Qualitative Research; Delivery of Health Care
PubMed: 38377709
DOI: 10.1016/j.pec.2024.108197 -
Obesity Reviews : An Official Journal... May 2024This systematic review and meta-analysis evaluated the efficacy of anti-obesity agents for hormonal, reproductive, metabolic, and psychological outcomes in polycystic... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis evaluated the efficacy of anti-obesity agents for hormonal, reproductive, metabolic, and psychological outcomes in polycystic ovary syndrome (PCOS) to inform the 2023 update of the International Evidence-based Guideline on PCOS. We searched Medline, EMBASE, PsycInfo, and CINAHL until July 2022 with a 10-year limit to focus on newer agents. Eleven trials (545 and 451 participants in intervention and control arms respectively, 12 comparisons) were included. On descriptive analyses, most agents improved anthropometric outcomes; liraglutide, semaglutide and orlistat appeared superior to placebo for anthropometric outcomes. Meta-analyses were possible for two comparisons (exenatide vs. metformin and orlistat + combined oral contraceptive pill [COCP] vs. COCP alone). On meta-analysis, no differences were identified between exenatide versus metformin for anthropometric, biochemical hyperandrogenism, and metabolic outcomes, other than lower fasting blood glucose more with metformin than exenatide (MD: 0.10 mmol/L, CI 0.02-0.17, I = 18%, 2 trials). Orlistat + COCP did not improve metabolic outcomes compared with COCP alone (fasting insulin MD: -8.65 pmol/L, -33.55 to 16.26, I = 67%, 2 trials). Published data examining the effects of anti-obesity agents in women with PCOS are very limited. The role of these agents in PCOS should be a high priority for future research.
Topics: Female; Humans; Polycystic Ovary Syndrome; Anti-Obesity Agents; Contraceptives, Oral, Combined; Orlistat; Exenatide; Metformin; Hypoglycemic Agents
PubMed: 38355887
DOI: 10.1111/obr.13704 -
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 -
Journal of Cystic Fibrosis : Official... Feb 2024This systematic review summarizes the impact of cystic fibrosis (CF) on sexual and reproductive health (SRH) in males and females, covering pubertal development,... (Review)
Review
This systematic review summarizes the impact of cystic fibrosis (CF) on sexual and reproductive health (SRH) in males and females, covering pubertal development, hormonal function, family planning, and fertility. Included articles featured historical CF diagnostic criteria, preclinical or clinical data (retrospective cohorts or open label trials), while excluded articles lacked full text availability, explicit methodology, or comparisons between CF and non-CF patients. Genotype differences in CFTR mutations influenced symptom severity. Males with CF experienced delayed puberty, hypogonadism, infertility from obstructive azoospermia, and semen parameter issues. Female CF patients showed decreased fertility, possibly linked to disrupted ionic balance and ovarian cystic disease. Assistive reproductive technologies addressed fertility issues, but success varied based on disease severity and genotype. CFTR modulators aided pulmonary function and sexual health but require further assessment for fertility benefits.
PubMed: 38311513
DOI: 10.1016/j.jcf.2024.01.009 -
International Journal of Molecular... Jan 2024Endometriosis, as a chronic disorder that is a source of severe pain ailments and infertility, requires a comprehensive therapeutic approach. Sclerotherapy, consisting... (Review)
Review
Endometriosis, as a chronic disorder that is a source of severe pain ailments and infertility, requires a comprehensive therapeutic approach. Sclerotherapy, consisting of the administration of sclerosing agents into the cyst, is a constantly evolving minimally invasive treatment method for this disease. Hence, the main objective of this systematic review was to evaluate the impact of its most often used variant, transvaginal ethanol sclerotherapy, on endometriosis-related symptoms, endometrial cyst recurrence rate, ovarian reserve, assisted reproductive technology (ART) outcomes, and pregnancy outcomes, as well as to assess potential complications resulting from this treatment. This systematic review was undertaken using PubMed, Scopus, Web of Science, and Cochrane Library databases on 24 November 2023. The risk of bias in included studies was assessed with the use of the Newcastle-Ottawa scale (NOS) and the revised Cochrane risk of bias 2.0 tool for randomized controlled trials. From the 1141 records obtained from all databases, 16 studies have been included in this review. The use of ethanol sclerotherapy was characterized by a low rate of post-procedural complications. The recurrence rate of endometrial cysts after the procedure depended on the ethanol instillation time within the cyst. Although ethanol sclerotherapy had negligible influence on ovarian reserves when compared to laparoscopic cystectomy, the effects of both these methods on pregnancy outcomes were comparable. This review identifies that sclerotherapy is safe, provides significant relief of symptoms, and does not impair the reproductive potential of the patients.
Topics: Female; Humans; Pregnancy; Endometriosis; Ethanol; Neoplasm Recurrence, Local; Pregnancy Outcome; Sclerotherapy; Treatment Outcome; Ovarian Cysts
PubMed: 38279336
DOI: 10.3390/ijms25021337