Sexual Function in Women with Polycystic Ovary Syndrome Living in Stable Heterosexual Relationships: A Cross-Sectional Study.

Background/Objective: The prevalence and character of female sexual dysfunction (FSD) in polycystic ovary syndrome (PCOS) have not been precisely determined. The aim of this study was to assess FSD using the Changes in Sexual Functioning Questionnaire (CSFQ-14) in women with PCOS and their partners compared to a control group, as well as correlations between five subscales, the total score of the CSFQ, and seven questions of the Visual Analogue Scale (VAS). Methods: The study sample (N = 160) comprised two groups: (1) women with PCOS and their partners (n = 91) and (2) women without PCOS and their partners (control group; n = 69). Results: The total scores of the CSFQ did not reveal FSD in either group of women. Regarding all subscales and the total score, the analysis showed a statistically significant difference between women and their partners (in all cases: p < 0.001). The discrepancy in arousal between women and men in the PCOS group was large (the mean difference was -2.32; t = -11.29, p < 0.001, Cohen's d = -1.26). The importance (VAS1), the level (VAS7) of sexual satisfaction, and the intensity of sexual thoughts (VAS2) correlated with almost all domains of the CSFQ. Conclusions: In conclusion, normal sexual function in PCOS does not mean proper sexual functioning in a sexual relationship.

COVID 19 vaccination as a trigger of acute genital ulcers in an immunocompromised adolescent-case study and literature review.

Acute genital ulcers can affect females of all ages. In children, they often appear as an emergency and remain a diagnostic challenge for pediatricians, gynecologists and dermatologists. Prompt diagnosis and identification of disease- related factors help to implement appropriate treatment. Firstly, it is crucial to properly compile the past medical history of the patient. Past infectious, autoimmune, malignant or traumatic conditions, as well as vaccinations may contribute to the occurrence of acute genital ulcers. Moreover, new infectious agents, such as severe acute respiratory syndrome coronavirus 2 and vaccinations against Coronavirus disease of 2019, may play a significant role in the development of atypical clinical symptoms. Here we present a case of a 12-year-old girl with acute genital ulcers. Additional symptoms accompanying the ulcer included: abdominal pain, nausea, vomiting, dysuria, vulvar pain and fever. Blood test showed leukocytosis, especially neutrophilia and monocytosis and increased levels of c-reactive protein and procalcitonin. Serological tests for the most common infections were negative. Moreover, the patient had a history of autoimmune diseases. She had periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome, and IgA vasculitis, also known as Henoch-Schönlein purpura in her past medical history. Additionally, she was vaccinated against SARS-CoV-2 shortly before the lesions appeared.

A cross-sectional study of the association between circulating sex hormone-binding globulin levels and selected adipokines in women with polycystic ovary syndrome.

Introduction: Changes in the proportion of pro-inflammatory and anti-inflammatory adipokines may reflect the accumulation of lipids in the liver and the development of insulin resistance. Both liver steatosis and insulin resistance result in decreased sex hormone-binding globulin (SHBG) synthesis. This study aimed to analyze associations between circulating SHBG and adipokines levels in women with polycystic ovary syndrome (PCOS). Material and methods: A cross-sectional cohort study involved 87 women with phenotype A of PCOS (39 normal weight and 48 obese). Body mass, height, and waist circumference were measured, and BMI was calculated. In addition, body composition was assessed using the bioimpedance method. Serum SHBG levels and plasma apelin-36 and apelin-12, adiponectin, leptin, omentin-1, and RBP-4 were determined by using the ELISA method. The participants were divided into subgroups with SHBG concentrations above and below this lower limit [N = 35 (40.2%) and N = 52 (59.8%), respectively]. Results: The median adiponectin, apelin-12, and apelin-36 levels were significantly lower, and leptin levels were significantly higher in the subgroup with low SHBG levels than that in the subgroup above the lower limit of the reference range, while there were no differences in median omentin-1 and RBP-4 between the study subgroups. There were positive correlations between SHBG and omentin-1, adiponectin, apelin-36, and apelin-12 levels, as well as negative correlation with leptin levels. However, after adjustment by BMI, waist circumference, and body fat percentage, only the association between SHBG and omentin-1 remained significant. Conclusion: Our results show associations between circulating SHBG and adipokine levels in women with PCOS and support the role of hormonal dysfunction of the adipose tissue in the pathogenesis of PCOS.

Correlation between Selected Clinical Symptoms and Severity of Aggression, Impulsiveness and Their Selected Behavioral Manifestations in Patients with Polycystic Ovary Syndrome Phenotype A.

Previous studies on aggressiveness and impulsiveness in women with polycystic ovary syndrome (PCOS) are ambiguous. Furthermore, no biochemical or clinical factors related to these variables have been definitively confirmed. The aim of the study was to clarify whether, in women with phenotype A of PCOS, variables such as body mass index and clinical and biochemical hyperandrogenism have an impact on either the intensity of impulsivity or aggression or on other selected behavioral manifestations of these variables. The study included 95 patients diagnosed with PCOS phenotype A. The criterion for recruitment into the study group and the control group was body mass index. The study was conducted with the use of a closed-format questionnaire and calibrated clinical scales. Higher body mass index (BMI) values in women with PCOS phenotype A are associated with poor eating habits. The severity of impulsivity and aggression syndrome, as well as the tendency to engage in risky sexual behavior and patterns of alcohol consumption among patients diagnosed with PCOS phenotype A, are not dependent on BMI. The severity of impulsiveness and the syndrome of aggression in women with phenotype A PCOS are not associated with clinical symptoms of hyperandrogenism or with androgen levels.

The cut-off value for HOMA-IR discriminating the insulin resistance based on the SHBG level in women with polycystic ovary syndrome.

Introduction: The study aimed to estimate the cut-off value for homeostatic model assessment for insulin resistance (HOMA-IR) discriminating the insulin resistance based on the sex hormones binding globulin (SHBG) level in women with polycystic ovary syndrome (PCOS). Materials and methods: Data from medical records of 854 Caucasian women diagnosed with PCOS were analyzed. Anthropometric data, fasting plasma glucose, insulin and SHBG levels were measured. HOMA-IR was calculated with a standard formula. The cut-off value was calculated using receiver-operating characteristics. Results: Circulating SHBG levels below the normal range (26.1 nmol/L) were found in 25.4% of study participants. This subgroup had a significantly higher BMI, fasting glucose and insulin concentrations and HOMA-IR values. Empirical optimal cut-off values for HOMA-IR corresponding to low SHBG levels was ≥2.1 [area under the curve (AUC) 0.73, accuracy 0.65, sensitivity 72.3%, specificity 63.1%, positive predictive value (PPV) 40.0%, negative predictive value (NPV) 87.0%]. Conclusions: Our study suggests that the cut-off point for HOMA-IR discriminating the insulin resistance based on the SHBG level, in young Caucasian women with polycystic ovary syndrome is 2.1, and is consistent with the cut-off value adopted by the European Group for the Study of Insulin Resistance (above 2.0).

Liver phenotypes in PCOS: Analysis of exogenous and inherited risk factors for liver injury in two European cohorts.

BACKGROUND & AIMS: Fatty liver disease (FLD) is common in women with polycystic ovary syndrome (PCOS). Here, we use non-invasive tests to quantify liver injury in women with PCOS and analyse whether FLD-associated genetic variants contribute to liver phenotypes in PCOS. METHODS: Prospectively, we recruited women with PCOS and controls at two university centres in Germany and Poland. Alcohol abuse was regarded as an exclusion criterion. Genotyping of variants associated with FLD was performed using TaqMan assays. Liver stiffness measurements (LSM), controlled attenuation parameters (CAP) and non-invasive HSI, FLI, FIB-4 scores were determined to assess hepatic steatosis and fibrosis. RESULTS: A total of 42 German (age range 18-53 years) and 143 Polish (age range 18-40 years) women with PCOS, as well as 245 German and 289 Polish controls were recruited. In contrast to Polish patients, Germans were older, presented with more severe metabolic profiles and had significantly higher LSM (median 5.9 kPa vs. 3.8 kPa). In the German cohort, carriers of the PNPLA3 p.I148M risk variant had an increased LSM (p = .01). In the Polish cohort, the minor MTARC1 allele was linked with significantly lower serum aminotransferases activities, whereas the HSD17B13 polymorphism was associated with lower concentrations of 17-OH progesterone, total testosterone, and androstenedione (all p < .05). CONCLUSIONS: FLD is common in women with PCOS. Its extent is modulated by both genetic and metabolic risk factors. Genotyping of variants associated with FLD might help to stratify the risk of liver disease progression in women suffering from PCOS.

Clinical Usefulness of Non-Invasive Metabolic-Associated Fatty Liver Disease Risk Assessment Methods in Patients with Full-Blown Polycystic Ovary Syndrome in Relation to the MRI Examination with the Ideal IQ Sequence.

The coexistence of polycystic ovary syndrome (PCOS) and liver steatosis has been studied for years. The gold standards for the diagnosis of liver steatosis are liver biopsy and magnetic resonance imaging (MRI), which are invasive and expensive methods. The main aim of this study is to check the usefulness of lipid accumulation product (LAP) and free androgen index (FAI) in the diagnosis of liver steatosis. The Ideal IQ MRI was performed in 49 women with PCOS phenotype A to assess the degree of liver steatosis, which was expressed with the proton density fat fraction (PDFF). Anthropometric examination and laboratory tests were performed, and the LAP and FAI were calculated. The correlation between MRI results and LAP, FAI, and one of the FAI components, sex hormone binding globulin (SHBG), was checked using statistical tests. There is a statistically significant correlation between PDFF and LAP and also between PDFF and FAI. LAP = 70.25 and FAI = 5.05 were established as cut-offs to diagnose liver steatosis. The SHBG is not a statistically significant parameter to predict liver steatosis. The study showed that especially LAP, but also FAI, can be used to predict liver steatosis with high specificity and sensitivity.

Evaluation of Pro/Antioxidant Imbalance in Blood of Women with Polycystic Ovary Syndrome Based on Determination of Oxidized Low-Density Lipoproteins and Ferric Reducing Ability of Plasma Values.

We investigated selected pro/antioxidant parameters in a group of women with polycystic ovary syndrome (PCOS) divided according to age, body mass index (BMI), waist-to-hip ratio (WHR), homeostatic model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (Quicki). We chose oxidized low-density lipoproteins (oxLDL-C) as a marker of oxidative stress and the ferric reducing ability of plasma (FRAP) as a marker of antioxidant status. In women with PCOS, the values of BMI, WHR, age and concentration of glucose significantly affected oxLDL-C concentration and FRAP values. FRAP correlated with oxLDL-C level in the whole group and in women who were insulin sensitive (HOMA-IR < 2.0). There was a negative relationship between the concentration of Anti-Müllerian hormone and both oxLDL-C and FRAP. Furthermore, the value of FRAP was inversely correlated with luteinizing hormone (LH), follicle-stimulating hormone (FSH) and androstenedione, whereas it was positively correlated with the LH/FSH ratio. The concentration of oxLDL and the value of FRAP are significantly associated with selected metabolic and hormonal parameters in the course of PCOS.

Non-obvious diagnosis and breast development in pure gonadal dysgenesis.

Pure gonadal dysgenesis is a situation when the karyotype is 46, XY, but for various reasons there is a disorder of differentiation of Wolffian and Mullerian structures and in consequence the phenotype is female. It is known that abdominal gonads and the presence of Y chromosome allow to qualify this condition as a high risk of tumor. In most cases breast development is limited because of lack or low level of estrogen. A 27-year-old patient with differences of sexual development (DSD), was admitted to the Department of Endocrinological Gynecology for a control examination. In the history: dysgerminoma, primary amenorrhea and ambiguous karyotype. The patient has not taken hormonal replacement therapy. The breast development is Tanner stage V.

The Activity of Superoxide Dismutase, Its Relationship with the Concentration of Zinc and Copper and the Prevalence of rs2070424 Superoxide Dismutase Gene in Women with Polycystic Ovary Syndrome-Preliminary Study.

Superoxide dismutase (SOD) is a crucial antioxidant enzyme involved in the antioxidant pathway during both normal cellular metabolism and different pathologic processes. We investigated the activity of the copper (Cu)-zinc (Zn) SOD1 as well as the level of Cu and Zn in the serum of women with polycystic ovary syndrome (PCOS) and control group. Moreover, the prevalence of rs2070424 gene polymorphism of the enzyme in the course of PCOS was evaluated. Significantly lower activity of SOD 1 and Cu, Zn concentration was found in the group of women with PCOS than without the syndrome. Insulin resistance in the group of women with PCOS caused a further SOD1 activity decrease, while Cu concentration and the value of Cu/Zn was increased when compared to women with normal insulin levels. Furthermore, we assessed for the first time the rs2070424 polymorphism of SOD1 in the women with PCOS, and in these patients we detected dominant variant AA (93.3%). Due to a small number of other genotypes, it is difficult to state if lower SOD1 activity was strictly associated with the AA variant or if other factors play a crucial role, but this should be taken into account.

The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome.

Insulin resistance is documented in clamp studies in 75% of women with polycystic ovary syndrome (PCOS). Although it is not included in the diagnostic criteria of PCOS, there is a crucial role of this metabolic impairment, which along with hormonal abnormalities, increase each other in a vicious circle of PCOS pathogenesis. Insulin resistance in this group of patients results from defects at the molecular level, including impaired insulin receptor-related signaling pathways enhanced by obesity and its features: Excess visceral fat, chronic inflammation, and reactive oxygen species. While lifestyle intervention has a first-line role in the prevention and management of excess weight in PCOS, the role of anti-obesity pharmacological agents in achieving and maintaining weight loss is being increasingly recognized. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) not only act by reducing body weight but also can affect the mechanisms involved in insulin resistance, like an increasing expression of glucose transporters in insulin-dependent tissues, decreasing inflammation, reducing oxidative stress, and modulating lipid metabolism. They also tend to improve fertility either by increasing LH surge in hypothalamus-pituitary inhibition due to estrogen excess connected with obesity or decreasing too high LH levels accompanying hyperinsulinemia. GLP1-RAs seem promising for effective treatment of obese PCOS patients, acting on one of the primary causes of PCOS at the molecular level.

Macro-TSH - tips and tricks for gynecologists.

Thyroid disorders are one of the most common endocrinopathies in women of reproductive age. Measurement of TSH (thyroid-stimulating hormone) concentration in women planning pregnancy/pregnant is a golden standard of thyroid function assessment. When the laboratory findings do not correspond with the clinical signs, it is reasonable to mark macro-TSH.

Gluten-free diet - remedy for infertility or dangerous trend?

Association between celiac disease (CD) and infertility has been a point of consideration for many years. There are lots of studies which present contradictory results. It is accepted that women with unexplained infertility have three times higher risk of CD compared to the healthy women. This finding leads to the conclusion that a gluten-free diet (GFD), as the only effective method of treatment CD, is important to improve fertility. It is observed that women diagnosed with CD and treated by GFD, have positive pregnancy outcomes including better effects of assisted reproductive technology (ART). Excluding gluten from diet by women without CD diagnosis could bring adverse outcomes, because the risk of malnutrition if diet is unbalanced. On the other hand, some research show that not only GFD but CD is related to malnutrition which could be the cause of problems with getting pregnant or with termination of pregnancy. Regarding CD influence on women's reproductive system, it is not only connected with unexplained infertility and adverse pregnancy outcomes, but also with delayed menarche, early menopause and decrease of anti-Müllerian hormone (AMH). What is more, non-celiac wheat sensitivity affects the reproductive system by increasing risk of menstrual disorders too. The main aim of this paper is presenting scientific facts about the link between gluten elimination and fertility. It is very important to provide patients with reliable fact-checked information in the context of their symptoms.

Prediction of Insulin Resistance and Impaired Fasting Glucose Based on Sex Hormone-Binding Globulin (SHBG) Levels in Polycystic Ovary Syndrome.

OBJECTIVE: Decreased synthesis of sex hormone-binding globulin (SHBG) related to hyperinsulinemia is one of the disturbances characteristic of polycystic ovary syndrome (PCOS). Hyperinsulinemia is a compensatory mechanism for liver insulin resistance (IR); thus, SHBG may be considered as a surrogate marker of liver IR. Therefore, this study aimed to assess the prediction of IR and impaired fasting glucose (IFG) based on SHBG levels in women with PCOS. METHODS: This analysis included data retrieved from medical records of 854 patients with PCOS hospitalized in the Gynecological Endocrinology Clinic from 2012 to 2019. Data including anthropometric parameters, fasting plasma glucose, insulin, and SHBG levels were analyzed. BMI and HOMA-IR were calculated with standard formulas. RESULTS: IFG and IR assessed based on HOMA-IR values > 2.0 were found in 19.5% and 47.8% of the study group, respectively. Empirical optimal cutoff values for SHBG levels were ≤41.5 nmol/L typical for IR (AUC 0.711, sensitivity 61.1%, specificity 71.6%, positive predictive value (PPV) 70.7%, and negative predictive value (NPV) 62.1%). The probability of insulin resistance occurrence for SHBG concentration 26.1 nmol/L (the lower normal range) was 61.6% (95% CI: 57.4%-65.8%). The SHBG concentration of 36.4 nmol/L and 8.1 nmol/L was related to a 10% and 20% probability of IFG, respectively. CONCLUSION: In conclusion, this is the first study estimating the probability of liver IR and IFG occurrence based on SHBG levels in women with PCOS. Despite the low sensitivity, SHBG level below 42 nmol/L should cause closer monitoring for the fatty liver and prediabetes.

Body Composition and Its Impact on the Hormonal Disturbances in Women with Polycystic Ovary Syndrome.

We investigated the relationship between selected body composition (BC) parameters and included 55 women diagnosed with PCOS and 29 women in which PCOS was excluded. Hormone concentration and BC parameters were assessed during hospitalization. Women with PCOS had higher concentration of luteinizing hormones, total testosterone, androstenedione, and Anti-Müllerian hormones compared to women that were not diagnosed with PCOS. We did not observe any significant differences in the BC parameters between both groups as well as between four PCOS phenotype subgroups. Only in the group of women with PCOS was the concentration of sex hormone binding globulin and free testosterone correlated with all investigated BC parameters. Correspondence analysis did not confirm unambiguously associations between phenotypes of PCOS and the value of BC parameters, while logistic regression revealed that increased Anti-Müllerian hormone concentration and the value of body mass index could be useful parameters in differentiating women with PCOS and women with other disorders. The ROC analysis performed on the entire group of women also confirmed that the concentration of Anti-Müllerian hormones could be a powerful parameter to categorize women as suffering from PCOS.

The Influence of Treated and Untreated Subclinical Hypothyroidism on Metabolic Profile in Women with Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) and hypothyroidism are the most common endocrinological disorders among women of reproductive age. Since hypothyroidism occurs more frequently in PCOS patients, it is vital to explain its clinical impact. AIM: To evaluate the impact of subclinical hypothyroidism (SCH) and its treatment on the metabolic profile of patients with PCOS. METHODS: 190 women with PCOS phenotype A were enrolled in the case-control study. They were divided into three groups: 38 women with PCOS and subclinical hypothyroidism, 76 women with PCOS and SCH under thyroid replacement therapy, and 76 women with PCOS and normal thyroid function (control group). Serum lipids, fasting glucose, and insulin, as well as oral glucose tolerance tests were performed. RESULTS: In the analyzed parameters, there were no statistic differences between the groups in relation to thyroid function. BMI turned out to be the main factor dividing the patients in terms of serum lipids, fasting glucose, fasting insulin, and oral glucose tolerance test. TSH was associated with total cholesterol and LDL cholesterol levels, whereas BMI has a dominant impact on HDL cholesterol, triglycerides, glucose, and insulin resistance. CONCLUSIONS: SCH is associated with mild lipid serum alterations in women with PCOS, but it is BMI to have a dominant impact on glucose and insulin. It seems that treatment of SCH in PCOS does not significantly alter lipid and glucose metabolism.

The Associations between Sex Hormones and Lipid Profiles in Serum of Women with Different Phenotypes of Polycystic Ovary Syndrome.

We aimed to evaluate the relationship between selected serum sex hormones and lipid profiles in a group of women with polycystic ovary syndrome (PCOS) dividing according to four phenotypes, value of body mass index (BMI), and presence of hyperlipidemia. The study included 606 Caucasian women. Lipids and selected hormones were estimated using commercially available procedures during hospitalization in 2017. Phenotype of PCOS, BMI value, and hyperlipidemia were significant factors that influenced androgen hormone concentrations, such as total and free testosterone and androstenedione as well as the value of free androgen index (FAI). Moreover, significant changes in concentrations of dehydroepiandrosterone sulphate and sex hormone binding globulin (SHBG) were found between those groups. Higher quartiles of triglyceride concentrations increased the odds ratio of decreased concentrations of SHBG or increased values of FAI, while an adverse relation was found in case of HDL-C. The concentration of estradiol in the blood of women with PCOS was not associated with lipid profile parameters in any investigated groups. Probably, irregularities in sex hormone concentrations during PCOS is not directly associated with lipid profile parameters but could be reflective of the concentration of SHBG or the ratio of SHBG and total testosterone and their association with lipids.

Fresh insight into premature ovarian insufficiency.

Premature ovarian insufficiency (POI) is one of the vital reasons of anovulatory infertility among women under 40 years old. However, because of the unacknowledged causative factor in most cases, it still remains a huge challenge in gynecology. Recently, the most promising opportunities in diagnosing are connected with the use of some serum biomarkers, such as interleukin-17 (IL-17), Frizzled-5 protein, Soggy-1 protein and other cytokines. Additionally, environmental toxicants such as chemicals and heavy metals might be relevant in the near future when investigating the causes of premature ovarian insufficiency. One of the main aims of the therapy is to focus on maintaining fertility among women with POI, since it is essential for patients considering their young age. Among the newest approaches listed there are different types of stem cells, oocytes donation and in-vitro activation, all of which are recently gaining in importance.

A comprehensive use of ultrasound examination in infertility workup.

Considering the growing availability of ultrasound diagnostic methods in gynecology, its role in the infertility setting is increasing.In this review, we present an up-to-date ultrasound based diagnostic scheme in infertility workup comprising the evaluation of ovarian anatomy and function, uterine exploration, as well as tubal patency. The possibility of performing the vast majority of infertility diagnostics by ultrasound in the ambulatory settings is not only attractive and beneficial to patients, but also to health care system.Thus, it is vital for gynecologists to implement modern non-invasive ultrasound modalities in their everyday practice.

The role of proprotein convertase subtilisin/kexin type-9 concentration and paraoxonase 1 activities in the blood of women with polycystic ovary syndrome.

This study aimed to evaluate the concentration of proprotein convertase subtilisin/kexin type-9 (PCSK9) and the activities of paraoxonase 1 in women with and without polycystic ovary syndrome (PCOS). We found significant higher PCSK9, whereas lower high-density lipoprotein concentration in the serum of women with PCOS when compared to the group without PCOS. Also paraoxonase 1 activities were significantly different between women with PCOS than without PCOS. In addition, the women with PCOS and insulin resistance had higher concentrations of PCSK9 than women with PCOS and insulin sensitivity. Higher PCSK9 concentration in the group with PCOS could be also associated with hormones concentrations. Changes in paraoxonase 1 activities and lipid profile parameters as well as higher concentration of PCSK9 in the group of women with PCOS could be associated with metabolism disorders, but due to the small clinical sample size, the study should be continued.