Distribution and anthropometric characteristics of Rotterdam criteria-based phenotypic forms of Polycystic ovaries syndrome in Ukraine.

OBJECTIVE: To explore the distribution of Rotterdam-based PCOS phenotypes and their associations with anthropometric parameters predictive of cardiometabolic risks in Ukrainian referral PCOS women. STUDY DESIGN: It was a cross-sectional study conducted by the Ukrainian Society of Gynecological Endocrinology between September 2021 and January 2022 involving 42 clinics in 10 regional centres representing the major geographical parts of Ukraine. Two hundred obstetrician-gynecologists whose practice facilities corresponded to study criteria were committed to entering records of their PCOS patients aged 20-45 years into the uniform data collection forms. The recorded parameters were: PCOS phenotype with the mandatory assessment of biochemical hyperandrogenism, age, BMI, waist circumference, and hyperandrogenism symptoms. RESULTS: 5254 patients' records were completed. Phenotype A was the most prevalent - 47.7 %, phenotypes B, C, and D were almost equally distributed in the studied population: 17.6 %, 17.4 %, and 17.3 % respectively. The total prevalence of androgenic phenotypes based on the presence of biochemical hyperandrogenism was 82.7 %. The incidence of obesity and hyperandrogenism symptoms, and mean BMI values were higher in phenotypes A and B compared to C and D. At the same time, the presence of 34.1 % and 46.2 % of normal-weight subjects in phenotypes A and B respectively, supports the fact that the excessive BMI is not a universal characteristic of androgenic phenotypes. In younger age groups, phenotypes C and D demonstrated the predominance of normal weight, but in older subgroups, the situation changed: in the age group of 36-45 y.o. compared to 18-25 y.o., the percentage of overweight and obese subjects for the non-classic phenotypes increased more than for the classic ones: C (OR = 3.91, 95 % CI: 2.41-6.38), D (OR = 4.14, 95 % CI: 2.64-6.52), A (OR = 2.30, 95 % CI:1.72-2.08), and B (OR = 2.56, 95 % CI:1.69-3.89). CONCLUSIONS: In thoroughly assessed Ukrainian referral PCOS population the classic phenotypes prevailed as in other clinical cohorts. The classic phenotypes were characterized by the higher rate of adiposity and severity of clinical hyperandrogenism. At the same time, obese, overweight, and normal-weight subjects were present in all phenotypes, and the risk of obesity in non-classic phenotypes was higher in older age groups.

The Effect of Gastric Sleeve Resection on Menstrual Pattern and Ovulation in Premenopausal Women with Classes III-IV Obesity.

PURPOSE: Bariatric surgery is very efficacious in treating severe obesity. However, its effect on menstruation and ovulation is currently unknown. The purpose of this study was to assess the effect of gastric sleeve resection (GSR) on menstrual pattern in women with stages III-IV obesity and ovulatory dysfunction compared with conventional management. METHODS: This was a prospective, multicentre, non-randomized trial, in premenopausal women, who fulfilled the criteria for gastric sleeve resection (GSR). Both women with and without polycystic ovary syndrome (PCOS) were evaluated at 3, 6, 9, 12 and 15 months post-surgery. RESULTS: Menstrual cycle irregularities were identified in 122 severely obese women (60 with PCOS; 62 without PCOS). The % total weight loss was greater with GSR than with conventional management (33.4% vs. 3.6% in PCOS; 24.8% vs. 3.6% in non-PCOS, respectively). Intermenstrual interval was shortened towards normal length (≤ 35 days) both in PCOS and non-PCOS GSR groups, by the 6th and 12th post-surgical month, respectively. Furthermore, ovulation at 6 months was achieved in 63.6% of PCOS and 45% of non-PCOS subjects post-GSR, which was higher than in controls (11.1% and 13.6%, respectively; p < 0.05). This percentage rose to 75.7% and 81.8% at 12 and 15 months in PCOS, respectively, but not in the non-PCOS group (55% and 52.5%, respectively; p < 0.05). CONCLUSIONS: Weight reduction after GSR improved menstrual irregularity towards normality in women with severe obesity. Ovulation dysfunction was also resumed in more than half of these patients at 6-15 months. These effects were more evident in women with PCOS.

HCMV seropositivity is associated with specific proinflammatory immune phenotype in women with implantation failure.

HCMV coevolved with humans for millions of years and is now one of the most widespread infections worldwide. For a long time HCMV seropositivity was considered a safe clinical condition. In recent decades both clinical observations and research results indicated that the very presence of HCMV in human organism specifically influences immune system and may affect reproduction as a process greatly dependent on immune cells function. Anti-HCMV IgG, IgG avidity, lymphocyte subsets as well as NK cytotoxicity was investigated in 470 infertile women who were eligible for IVF/ET. 419 patients were IgG anti-HCMV-positive (HCMV-seropositive) and only 51 (10.8 %) were IgG anti- HCMV-negative (HCMV-seronegative). There was not a single case of clinically significant level of low-avidity IgG. HCMV-seropositive patients had significantly increased levels of HLA-DR expression on T-lymphocytes (both on CD3CD8 and especially on CD3CD4 subsets) and HLA-DR expression on NK-lymphocytes (CD56+CD3-), increased levels of NKT-like cells (CD3+CD8+CD56+) but decreased levels of CD8 + NK lymphocytes compared to HCMV-seronegative patients. That difference was caused by significant numbers of individuals with deviated "accentuated" immune phenotypes in HCMV seropositive patients. The latter had increased (>7.5 %) levels of HLA-DR expression on T helpers in 136 cases from 419 (32.4 %) while in HCMV-seronegative group this accentuation was observed only in 3 of 51 patients (5.8 %), (OR -5.9, p < 0.0003). The number of cases with significantly increased CD56 expression on Tc lymphocytes, HLA-DR on NK and decrease of CD8-positive NK cells was more often observed in HCMV-seropositive group compared to seronegative. Thus, possibly HCMV seropositivity specifically influences immune system and results in pro-inflammatory phenotype formation in part of infected population. It was found that accentuations in immune phenotype of HCMV-seropositive women are very similar to previously described in association with reproductive failures but without HCMV serostatus taken into account.