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1.
Medicine (Baltimore) ; 98(50): e18323, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852122

RESUMO

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. PCOS has a significant negative impact on the health-related quality of life (HRQoL) and psychological function of women, of which there are reports of high levels of depression in women with PCOS compared to those without PCOS. However, the evidence surrounding the effects of exercise and/or dietary intervention participation on the HRQoL of women with PCOS is limited. Therefore, our objective is to examine the effects of lifestyle interventions (definition include exercise-only, diet-only, exercise + diet and behavioral or combined) on health-related quality of life or general quality of life in women with PCOS. METHODS: We will conduct an update of systematic review and we will follow the recommendations and guidelines of the Cochrane handbook for systematic reviews and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). We will search the studies in the following databases: MEDLINE. PubMed, PsychINFO, Embase, SportDiscus, Web of Science, Cochrane Database (via Cochrane library), Cochrane Controlled Register of Trials (CENTRAL), and Google Scholar (advance). Manual search of the reference list of identified works, without language and year restrictions. The process of study selection and data extraction will be performed independently by 2 reviewers, with a third reviewer being responsible for the final decision in case of disagreement between the first two. We will use Egger funnel chart to evaluate possible publication biases, in addition, when possible we will perform a subgroup/meta-regression analysis. The strength of the evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PROTOCOL REGISTRY: PROSPERO number: CRD42019124176.


Assuntos
Estilo de Vida , Síndrome do Ovário Policístico/terapia , Qualidade de Vida , Adolescente , Adulto , Dieta/métodos , Exercício , Feminino , Humanos , Resistência à Insulina , Metanálise como Assunto , Síndrome do Ovário Policístico/psicologia , Projetos de Pesquisa , Revisão Sistemática como Assunto , Adulto Jovem
2.
Medicine (Baltimore) ; 98(39): e17321, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574864

RESUMO

BACKGROUNDS: Polycystic ovary syndrome (PCOS) is common endocrine disorder in women and can lead to serious social burdens associated with various reproductive and metabolic abnormalities. Existing therapy is controversial in its effectiveness including side effects. In traditional Korean Medicine, Cangfu Daotan Decoction (CDD), also known as Changbudodam-tang, is used for PCOS patients who are in the type of stagnation of phlegm and dampness. In this study, we aimed to evaluate the efficacy and safety of CDD for PCOS as alternative treatment. METHODS: Two researchers will search the following databases from their inception to February 2019 for relevant randomized controlled trials (RCTs): The Cochrane Library, PubMed, EMBASE, Chinese National Knowledge Infrastructure Database (CNKI), and 5 Korean medical databases (Korean Studies Information Service System, KoreaMed, DBPIA, Oriental Medicine Advanced Searching Integrated System, and Research Information Service System). The primary outcome will be the scales that assessed drug efficacy including total response rate, sex hormone level (LH, FSH, Testosterone, LH/FSH ratio), BMI, ovulation rate, and pregnancy rate. Adverse events will be assessed as the secondary outcome. Study selection, data extraction, and assessment of risk of bias will be conducted by 2 researchers independently. Statistical analysis will be performed by using the Cochrane Review Manager (RevMan 5.3) software. RESULTS AND CONCLUSION: This review will provide the latest knowledge and evidence on the efficacy and safety of CDD for PCOS women through the analysis of various evaluation scales. ETHICS AND DISSEMINATION: This systematic review does not require ethical approval and will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019134270.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Medicina Tradicional do Leste Asiático/métodos , Síndrome do Ovário Policístico/terapia , Terapias Complementares/métodos , Feminino , Humanos , Preparações de Plantas/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Zhongguo Zhen Jiu ; 39(7): 792-8, 2019 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-31286745

RESUMO

OBJECTIVE: To review systematically the safety and effectiveness of acupuncture-related therapies on ovulation rate and pregnancy rate in patients with polycystic ovary syndrome (PCOS). METHODS: From PubMed, EMbase, the Cochrane Library, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database and VIP database, the randomized controlled trials (RCTs) on PCOS were retrieved in the period from the date of database establishment to January 8, 2018. Two researchers screened the articles, extracted the data and assessed the bias risk of the eligible trials independently. Using Stata 13.0 and WinBUGS 1.4.3 software, the data were analyzed. RESULTS: A total of 39 RCTs were collected, including 4605 cases of PCOS and 14 kinds of acupuncture-related therapies and the comprehensive therapies. The short-term therapeutic effects were observed. The results of mesh meta-analysis showed: regarding the ovulation rate, the effects of the acupuncture-medication therapy were better than western medication. The top 6 therapeutic measures were the treatment with acupoint thread-embedding therapy and medication (93.3%), the treatment with moxibustion and Chinese herbal medicine (91.4%), moxibustion (74.5%), the treatment with acupuncture and medication (65.7%), the treatment with acupuncture-moxibustion and auricular point therapy (61.9%) and the treatment with acupuncture and auricular point therapy (49.6%). Regarding the pregnancy rate, the effects of the acupuncture-medication therapy were better than western medication. The top 6 therapeutic measures were the treatment with acupuncture and auricular point therapy (91.5%), the treatment with moxibustion and Chinese herbal medication (86.9%), the treatment with acupuncture-moxibustion and auricular point therapy (81.1%), the treatment with acupoint thread-embedding therapy and medication (69.4%), the treatment with acupuncture and medication (66.1%) and the treatment with placebo and western medication (58.7%). CONCLUSION: Among acupuncture-related therapies, the combined treatment is more advantageous than single therapy and its safety is superior to western medication. The combined therapies are various in advantages. Because of the limitation of the present researches, it needs a large scale of RCTs with rational design, high quality and proper methods to verify this research conclusion.


Assuntos
Terapia por Acupuntura , Síndrome do Ovário Policístico , China , Feminino , Humanos , Meta-Análise em Rede , Ovulação , Síndrome do Ovário Policístico/terapia , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Cochrane Database Syst Rev ; 7: CD007689, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31264709

RESUMO

BACKGROUND: Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of oligo-amenorrhoea, infertility and hirsutism. Conventional treatment of PCOS includes a range of oral pharmacological agents, lifestyle changes and surgical modalities. Beta-endorphin is present in the follicular fluid of both normal and polycystic ovaries. It was demonstrated that the beta-endorphin levels in ovarian follicular fluid of otherwise healthy women who were undergoing ovulation were much higher than the levels measured in plasma. Given that acupuncture impacts on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion, it is postulated that acupuncture may have a role in ovulation induction via increased beta-endorphin production effecting GnRH secretion. This is an update of our previous review published in 2016. OBJECTIVES: To assess the effectiveness and safety of acupuncture treatment for oligo/anovulatory women with polycystic ovarian syndrome (PCOS) for both fertility and symptom control. SEARCH METHODS: We identified relevant studies from databases including the Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CNKI, CBM and VIP. We also searched trial registries and reference lists from relevant papers. CENTRAL, MEDLINE, Embase, PsycINFO, CNKI and VIP searches are current to May 2018. CBM database search is to November 2015. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that studied the efficacy of acupuncture treatment for oligo/anovulatory women with PCOS. We excluded quasi- or pseudo-RCTs. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the studies, extracted data and assessed risk of bias. We calculated risk ratios (RR), mean difference (MD), standardised mean difference (SMD) and 95% confidence intervals (CIs). Primary outcomes were live birth rate, multiple pregnancy rate and ovulation rate, and secondary outcomes were clinical pregnancy rate, restored regular menstruation period, miscarriage rate and adverse events. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS: We included eight RCTs with 1546 women. Five RCTs were included in our previous review and three new RCTs were added in this update of the review. They compared true acupuncture versus sham acupuncture (three RCTs), true acupuncture versus relaxation (one RCT), true acupuncture versus clomiphene (one RCT), low-frequency electroacupuncture versus physical exercise or no intervention (one RCT) and true acupuncture versus Diane-35 (two RCTs). Studies that compared true acupuncture versus Diane-35 did not measure fertility outcomes as they were focused on symptom control.Seven of the studies were at high risk of bias in at least one domain.For true acupuncture versus sham acupuncture, we could not exclude clinically relevant differences in live birth (RR 0.97, 95% CI 0.76 to 1.24; 1 RCT, 926 women; low-quality evidence); multiple pregnancy rate (RR 0.89, 95% CI 0.33 to 2.45; 1 RCT, 926 women; low-quality evidence); ovulation rate (SMD 0.02, 95% CI -0.15 to 0.19, I2 = 0%; 2 RCTs, 1010 women; low-quality evidence); clinical pregnancy rate (RR 1.03, 95% CI 0.82 to 1.29; I2 = 0%; 3 RCTs, 1117 women; low-quality evidence) and miscarriage rate (RR 1.10, 95% CI 0.77 to 1.56; 1 RCT, 926 women; low-quality evidence).Number of intermenstrual days may have improved in participants receiving true acupuncture compared to sham acupuncture (MD -312.09 days, 95% CI -344.59 to -279.59; 1 RCT, 141 women; low-quality evidence).True acupuncture probably worsens adverse events compared to sham acupuncture (RR 1.16, 95% CI 1.02 to 1.31; I2 = 0%; 3 RCTs, 1230 women; moderate-quality evidence).No studies reported data on live birth rate and multiple pregnancy rate for the other comparisons: physical exercise or no intervention, relaxation and clomiphene. Studies including Diane-35 did not measure fertility outcomes.We were uncertain whether acupuncture improved ovulation rate (measured by ultrasound three months post treatment) compared to relaxation (MD 0.35, 95% CI 0.14 to 0.56; 1 RCT, 28 women; very low-quality evidence) or Diane-35 (RR 1.45, 95% CI 0.87 to 2.42; 1 RCT, 58 women; very low-quality evidence).Overall evidence ranged from very low quality to moderate quality. The main limitations were failure to report important clinical outcomes and very serious imprecision. AUTHORS' CONCLUSIONS: For true acupuncture versus sham acupuncture we cannot exclude clinically relevant differences in live birth rate, multiple pregnancy rate, ovulation rate, clinical pregnancy rate or miscarriage. Number of intermenstrual days may improve in participants receiving true acupuncture compared to sham acupuncture. True acupuncture probably worsens adverse events compared to sham acupuncture.No studies reported data on live birth rate and multiple pregnancy rate for the other comparisons: physical exercise or no intervention, relaxation and clomiphene. Studies including Diane-35 did not measure fertility outcomes as the women in these trials did not seek fertility.We are uncertain whether acupuncture improves ovulation rate (measured by ultrasound three months post treatment) compared to relaxation or Diane-35. The other comparisons did not report on this outcome.Adverse events were recorded in the acupuncture group for the comparisons physical exercise or no intervention, clomiphene and Diane-35. These included dizziness, nausea and subcutaneous haematoma. Evidence was very low quality with very wide CIs and very low event rates.There are only a limited number of RCTs in this area, limiting our ability to determine effectiveness of acupuncture for PCOS.


Assuntos
Terapia por Acupuntura , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/terapia , Aborto Espontâneo , Acetato de Ciproterona , Combinação de Medicamentos , Etinilestradiol , Feminino , Humanos , Infertilidade Feminina/terapia , Menstruação , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Gravidez Múltipla , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Int J Mol Sci ; 20(11)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31163591

RESUMO

Hormonal disturbances, such as hyperandrogenism, are considered important for developing polycystic ovary syndrome (PCOS) in humans. Accordingly, directly hormone-regulated animal models are widely used for studying PCOS, as they replicate several key PCOS features. However, the pathogenesis and treatment of PCOS are still unclear. In this review, we aimed to investigate animal PCOS models and PCOS-like phenotypes in animal experiments without direct hormonal interventions and determine the underlying mechanisms for a better understanding of PCOS. We summarized animal PCOS models that used indirect hormonal interventions and suggested or discussed pathogenesis of PCOS-like features in animals and PCOS-like phenotypes generated in other animals. We presented integrated physiological insights and shared cellular pathways underlying the pathogenesis of PCOS in reviewed animal models. Our review indicates that the hormonal and metabolic changes could be due to molecular dysregulations, such as upregulated PI3K-Akt and extracellular signal-regulated kinase (ERK) signalling, that potentially cause PCOS-like phenotypes in the animal models. This review will be helpful for considering alternative animal PCOS models to determine the cellular/molecular mechanisms underlying PCOS symptoms. The efforts to determine the specific cellular mechanisms of PCOS will contribute to novel treatments and control methods for this complex syndrome.


Assuntos
Hormônios/metabolismo , Síndrome do Ovário Policístico/etiologia , Síndrome do Ovário Policístico/metabolismo , Animais , Biomarcadores , Dieta , Modelos Animais de Doenças , Sistema Endócrino/metabolismo , Meio Ambiente , Feminino , Terapia de Reposição Hormonal , Hormônios/administração & dosagem , Humanos , Camundongos Transgênicos , Fenótipo , Síndrome do Ovário Policístico/terapia
6.
Med. clín (Ed. impr.) ; 152(11): 450-457, jun. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183907

RESUMO

El síndrome de ovario poliquístico es la enfermedad endocrinometabólica más prevalente en mujeres premenopáusicas. Su etiopatogenia es compleja, multifactorial y heterogénea, incluyendo la interacción de factores genéticos, epigenéticos y ambientales. El exceso androgénico constituye el principal mecanismo fisiopatológico de la enfermedad, resultando en alteraciones reproductivas, metabólicas y cosméticas que impactarán negativamente en la calidad de vida de estas pacientes. Los criterios establecidos en el consenso de Róterdam, y su correcta aplicación, constituyen la base necesaria para el correcto diagnóstico de este síndrome. Ante la inexistencia de un tratamiento etiológico este tiene como objetivo mejorar los síntomas y signos clínicos derivados del hiperandrogenismo, de la disfunción ovárica y de las complicaciones metabólicas existentes y, por lo tanto, debe ser crónico e individualizado


Polycystic ovary syndrome is the most prevalent endocrine-metabolic pathology in pre-menopausal women. Its etiopathogenesis is complex, multifactorial and heterogeneous, including the interaction of genetic, epigenetic and environmental factors. Androgenic excess constitutes the disease's main physiopathological mechanism and results in reproductive, metabolic and cosmetic alterations which negatively impact these patients’ quality of life. The criteria established in the Rotterdam consensus and their correct application form the necessary basis for this syndrome's proper diagnosis. In the absence of an aetiological treatment, the aim is to improve the clinical signs and symptoms derived from hyperandrogenism, ovarian dysfunction and existing metabolic complications, and, therefore, they must be chronic and individualised


Assuntos
Humanos , Feminino , Síndrome do Ovário Policístico , Síndrome do Ovário Policístico/fisiopatologia , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/terapia
7.
Endokrynol Pol ; 70(2): 198-212, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31039273

RESUMO

Women with PCOS are characterised by ovarian hyperandrogenism, which, apart from fertility problems, hirsutism, acne, and androgenic alopecia, also leads to the development of central (android) obesity and its adverse metabolic consequences. Additionally, women with PCOS have intrinsic insulin resistance (IR) with its consequent hyperinsulinaemia, which leads to the development of atherosclerosis, arterial hypertension, and type 2 diabetes mellitus (T2DM), which give rise to cardiovascular disease (CVD), being the main cause of death among women. Although there are several publications on the topic of life-style changes in women with PCOS to normalise body weight and thus to reduce the adverse metabolic consequences of obesity, such as T2DM and CVD, the number of randomised studies that would enable the formation of strong recommendations is very limited. Nevertheless, taking into consideration the pathophysiology, any intervention implementing healthy dietary habits leading to the reduction of body weigh should be the core of non-pharmacological treatment in women with PCOS. The aim of the given recommendations herein is to point out and systemise the interventions on lifestyle change in women with PCOS as well as to form a practical guideline for the health care specialists, dieticians, and mental-therapists (psychologist) who take care of women with this syndrome.


Assuntos
Comportamentos Relacionados com a Saúde , Educação em Saúde/normas , Estilo de Vida Saudável , Síndrome do Ovário Policístico/terapia , Saúde da Mulher/normas , Peso Corporal , Feminino , Humanos , Resistência à Insulina , Síndrome Metabólica/prevenção & controle , Síndrome do Ovário Policístico/prevenção & controle , Índice de Gravidade de Doença , Perda de Peso
8.
Fertil Steril ; 111(6): 1065-1075, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31056313

RESUMO

Maternal PCOS status may negatively influence offspring infant and childhood growth, cardiometabolic health, reproductive health, and neurodevelopment. Current findings across studies are divergent, often because of small numbers of subjects, as well as heterogeneous selection criteria, ethnicities, and definitions of control groups. Coexisting maternal obesity, pregnancy complications, and comorbidity make it difficult to identify the contribution of maternal PCOS. Large, prospective, international, multiethnic studies with standardized investigation protocols and questionnaires on PCOS offspring health and development are needed.


Assuntos
Saúde da Criança , Filho de Pais Incapacitados , Infertilidade Feminina/etiologia , Síndrome do Ovário Policístico/complicações , Efeitos Tardios da Exposição Pré-Natal , Fatores Etários , Criança , Desenvolvimento Infantil , Pré-Escolar , Suscetibilidade a Doenças , Feminino , Fertilidade , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Infertilidade Feminina/terapia , Masculino , Saúde Materna , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/fisiopatologia , Síndrome do Ovário Policístico/terapia , Gravidez , Prognóstico , Medição de Risco , Fatores de Risco
9.
J Pediatr Endocrinol Metab ; 32(6): 549-559, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31141485

RESUMO

Study objective Polycystic ovary syndrome (PCOS) in adolescence, a disorder of exclusion, has proved to be a timeless diagnostic challenge for the clinician. Since 1990, several attempts to provide clear diagnostic criteria have been published, most of the time leading to inconsistencies. We attempted to elucidate the controversies and convergences of this subject by conducting a systematic review of the literature concerning official guidelines or proposed criteria for the diagnosis of PCOS in adolescent girls. Design Based on a term search sequence via electronic databases such as Pubmed, Cochrane, Embase, Scopus and a hands-on review of references and learned societies, all available data were classified and analyzed. Single case reports, original studies with adult population or articles with incomplete diagnostic guidelines were excluded. Results Twelve reports dated from 2006 to 2018 fulfilled the inclusion criteria. Seven of them were endorsed or published by learned societies. All suggested a stricter diagnosis than in adulthood. Polycystic ovarian morphology was used as a necessary criterion only in three guidelines, and there was a tendency for a more objective diagnosis of hyperandrogenism, defined either by clinical features or by biochemical hyperandrogenemia, although in one case both were required. Conclusion Irregular menstrual cycles, allowing for an interval of at least 2 years postmenarche, and hyperandrogenism, usually reinforced by biochemical confirmation, are the main accepted features for PCOS diagnosis in adolescence. Discrepancies among endocrine and reproductive medicine societies still remain, although recent intensified attempts at reaching a consensus should allow for more universally accepted diagnostic criteria.


Assuntos
Hiperandrogenismo/fisiopatologia , Distúrbios Menstruais/fisiopatologia , Síndrome do Ovário Policístico/diagnóstico , Adolescente , Saúde do Adolescente , Feminino , Humanos , Síndrome do Ovário Policístico/terapia
10.
Complement Ther Med ; 44: 182-188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31126554

RESUMO

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common and heterogeneous endocrine disorder in reproductive-age women. Tung's acupuncture, a Traditional Chinese Medicine (TCM) treatment, is widely used for PCOS in East Asia, but evidence on its efficacy is rare. The aim of this RCT study was to examine whether the Tung's acupuncture could be a complementary treatment method for PCOS. METHODS: A total of 60 PCOS patients were randomly assigned to a Tung's acupuncture group (n = 30) or a cyproterone acetate/ethinylestradiol (CPA/EE) group (n = 30). Each participant received treatments for 12 weeks to assess the short-term treatment efficacy and then followed up for another 12 weeks to assess the long-term treatment efficacy. The primary outcome examined was change in the ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH); the secondary outcomes examined were changes in body mass index (BMI), LH, FSH, total testosterone (TT), ovarian volume, polycystic ovary number and menstrual frequency. RESULTS: Both groups showed significant reductions in the LH/FSH ratio, LH and TT after 12-week treatment (p < 0.001) and 12-week follow-up (p < 0.05). No significant differences existed between the two groups (p > 0.05). Both groups showed significant improvement in BMI, menstrual frequency and polycystic ovary number after 12-week treatment (p < 0.05). CONCLUSION: Compared with CPA/EE, Tung's acupuncture showed no better improvement on LH/FSH ratio for PCOS although it could reduce the ratio. Tung's acupuncture might have some effect on long-term weight control and menstruation frequency. Further studies addressing this study's limitations are recommended.


Assuntos
Hormônios Esteroides Gonadais/metabolismo , Síndrome do Ovário Policístico/terapia , Acupuntura/métodos , Terapia por Acupuntura/métodos , Adulto , Índice de Massa Corporal , Acetato de Ciproterona/uso terapêutico , Combinação de Medicamentos , Etinilestradiol/uso terapêutico , Feminino , Humanos , Síndrome do Ovário Policístico/tratamento farmacológico
11.
Fertil Steril ; 112(2): 371-377, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31126712

RESUMO

OBJECTIVE: To investigate whether live birth rate (LBR) following frozen-thawed embryo transfer in letrozole-stimulated cycles (L-FET) differs from LBR after artificial-cycle frozen-thawed embryos transfers (AC-FET) in women with polycystic ovary syndrome (PCOS). DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENT(S): A total of 2,664 patients with PCOS who fulfilled the inclusion criteria were enrolled in the period from 2011 to 2016. INTERVENTIONS(S): Letrozole use versus hormone replacement therapies during FET. MAIN OUTCOME MEASURE(S): LBR per embryo transfer was the primary outcome. The secondary end points included ongoing and clinical pregnancy rate, cancellation rate, endometrial thickness, and pregnancy loss rate. Multivariable logistic regression analysis was performed to adjust for potential confounders. RESULT(S): In our crude analysis, LBR per embryo transfer was similar between groups (54.4% in the L-FET vs. 50.7% for the AC-FET). The crude odds of pregnancy loss was significantly lower in L-FET compared with AC-FET (9.1% vs. 17%). Nonetheless, after adjusting for possible confounding factors, LBR was significantly higher in L-FET compared with AC-FET. Moreover, the rates of pregnancy loss remained consistently lower in the L-FET group than in the AC-FET group. CONCLUSION(S): In patients with PCOS undergoing FET, letrozole use for endometrial preparation was associated with higher LBR compared with artificial cycles, albeit after statistical adjustment for confounding factors. Future prospective randomized studies are needed to verify our findings.


Assuntos
Transferência Embrionária/métodos , Infertilidade Feminina/terapia , Letrozol/uso terapêutico , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/terapia , Adulto , Blastocisto , Criopreservação , Transferência Embrionária/estatística & dados numéricos , Feminino , Fertilização In Vitro/métodos , Fertilização In Vitro/estatística & dados numéricos , Congelamento , Terapia de Reposição Hormonal/métodos , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Retrospectivos , Resultado do Tratamento
12.
J Pediatr Nurs ; 47: 85-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31079016

RESUMO

PURPOSE: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among females. The foundation of PCOS self-management is engaging in healthy lifestyle habits, however, there is limited literature regarding adolescents' transition to PCOS self-management. The purpose of this study, therefore, is to explore parental and adolescent views of the transition to PCOS self-management. DESIGN AND METHODS: A qualitative descriptive approach was used through focus groups (N = 4) with adolescents diagnosed with PCOS and their parents. RESULTS: A total of seven adolescents and eight parents participated in two focus groups each. The primary theme from the parent groups was Concerns for Transition to Self-Care with the subthemes of facilitation versus direction and recognition of personal habits. The primary theme identified from the adolescent groups was Taking Control with subthemes of managing symptoms, cognitive dissonance, support, and balance. CONCLUSIONS: Study findings provide insight into the experiences of adolescents with PCOS and their parents as they navigate both a family-level transition in health habits and anticipate the adolescent transition to self-management as an emerging adult. PRACTICE IMPLICATIONS: Nurses and other health care providers can help facilitate transition to self-management among adolescents with PCOS by encouraging increased independence in health behavior decisions while they are still living at home. Middle and older adolescents who begin to take ownership of their physical activity, nutritional choices, and sleep hygiene will have a firm foundation on which to build as they transition into life beyond high school.


Assuntos
Pais/psicologia , Síndrome do Ovário Policístico/terapia , Psicologia do Adolescente , Autogestão/psicologia , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pesquisa Qualitativa , Texas
13.
Trials ; 20(1): 221, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992038

RESUMO

BACKGROUND: Polycystic ovary syndrome (PCOS) is a reproductive-metabolic condition. Insulin resistance is a hallmark of PCOS and is related to increased hyperandrogenism that drives inherent metabolic, reproductive and psychological features of the syndrome. Insulin resistance in women with PCOS is managed by weight loss, lifestyle interventions (i.e. exercise, diet) and insulin-sensitising medications. This manuscript describes the protocol of our study evaluating the effectiveness of high intensity intermittent training (HIIT) or moderate intensity exercise on cardiometabolic, reproductive and mental health in overweight women with PCOS. METHODS/DESIGN: We will employ a three arm, parallel-group, randomised controlled trial recruiting 60 women diagnosed with PCOS, aged between 18 and 45 years and with a body mass index (BMI) greater than 25 kg/m2. Following screening and baseline testing, women will be randomised by simple randomisation procedure using computer generated sequence allocation to undergo one of two 12-week supervised interventions: either HIIT or moderate intensity exercise (standard supervised exercise), or to standard care [Con] (unsupervised lifestyle advice) at a 1:1:1 allocation ratio. The primary outcome for this trial is to measure the improvements in metabolic health; specifically changes in insulin sensitivity in response to different exercise intensities. Baseline and post-intervention testing include anthropometric measurements, cardiorespiratory fitness testing, reproductive hormone profiles (anti-müllerian hormone and steroid profiles), metabolic health, health-related quality of life and mental health questionnaires and objective and subjective lifestyle monitoring. Reporting of the study will follow the CONSORT statement. DISCUSSION: This trial aims to demonstrate the comparative efficacy and maintenance of different exercise intensities to advance the understanding of PCOS management and provide insight into the optimal exercise intensity for improved cardiometabolic outcomes. Secondary outcomes will include the impact of different exercise protocols on reproductive hormone profiles, mental health and health-related quality of life. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12615000242527 . Registered on 17 March 2015.


Assuntos
Terapia por Exercício/métodos , Saúde Mental , Síndrome do Ovário Policístico/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Saúde Reprodutiva , Adolescente , Adulto , Feminino , Humanos , Resistência à Insulina , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/metabolismo , Síndrome do Ovário Policístico/psicologia , Qualidade de Vida , Tamanho da Amostra , Adulto Jovem
14.
Hum Cell ; 32(3): 285-296, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993568

RESUMO

Obese women with polycystic ovary syndrome (PCOS) often suffer from ovulation failure, which may be driven by granulosa cells (GCs) injury caused by increased levels of circulating oxidized low-density lipoprotein (ox-LDL) and luteinizing hormone (LH). PGC-1α may play an important role in this pathophysiological processes. However, the effect and the potential mechanism of PGC-1α on GCs injury evoked by obese PCOS is fully unclear. To investigate the protective effect and the potential mechanism of PGC-1α on GCs injury evoked by ox-LDL + LH stimulation. Patients with PCOS and women of normal reproductive age who undergoing egg retrievals and consenting for this research were collected. Those women were divided into normal-weight non-PCOS group, obese non-PCOS group, normal-weight PCOS group and obese PCOS group according to the body mass index (BMI) and PCOS diagnosis. Follicular fluid was collected and primary GCs were isolated. The levels of LH and ox-LDL in follicular fluid in the four groups were measured. And, the expressions of PGC-1α, cell apoptosis and ROS generation in primary GCs in the four groups were evaluated. After GCs from women of normal reproductive age at normal-weight pre-treated with adenovirus encoding PGC-1α (Ad-PGC-1α) prior to ox-LDL + LH treatment in vitro, the cell viability, apoptosis, apoptosis-related proteins expressions and ROS generation were evaluated by CCK-8 assay, AnnexinV/PI double staining, Western blot and H2DCF-DA staining, respectively. The expression of PGC-1α was significantly decreased, whereas the cell apoptosis and ROS generation were significantly increased in GCs of PCOS group, especially obese PCOS group. Our data also revealed that over-expression of PGC-1α in GCs from women of normal reproductive age at normal-weight markedly inhibited cell injury, ROS generation and p38 activation, accompanied by increased Bcl-2 expression, decreased Bax and cleaved caspase-3 expressions induced by ox-LDL + LH stimulation. Ox-LDL + LH-induced cell apoptosis was abrogated by attenuation of ROS generation or p38 activation. Attenuation of ROS generation reversed ox-LDL + LH-induced p38 activation, however, p38 inhibitors had an effect on ROS generation. Our findings suggested that PGC-1α protected against ox-LDL + LH-induced GCs injury through inhibiting cell apoptosis. And, the mechanism may be related to the inhibition of ROS-initiated p38 pathway. Our data indicated that PGC-1α may be a potential therapeutic target for obese PCOS.


Assuntos
Células da Granulosa/patologia , Lipoproteínas LDL/efeitos adversos , Lipoproteínas LDL/metabolismo , Hormônio Luteinizante/efeitos adversos , Hormônio Luteinizante/metabolismo , Sistema de Sinalização das MAP Quinases/genética , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/genética , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/fisiologia , Síndrome do Ovário Policístico/etiologia , Síndrome do Ovário Policístico/genética , Espécies Reativas de Oxigênio/metabolismo , Apoptose/genética , Células Cultivadas , Feminino , Expressão Gênica , Humanos , Terapia de Alvo Molecular , Síndrome do Ovário Policístico/terapia
15.
Angiology ; 70(9): 797-801, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30969784

RESUMO

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. The criteria required for the diagnosis identify various phenotypes, with different reproductive, metabolic, and cardiovascular (CV) risk characteristics. Emerging evidence links adipocyte-secreted hormones as candidates in the pathogenesis of endothelial dysfunction in PCOS, independently of additional risk factors. The aim of this review was to collect, analyze, and qualitatively resynthesize evidence on biomarkers of endothelial dysfunction (visfatin, vascular endothelial growth factor [VEGF], matrix metalloproteinase 9 [MMP-9]) in women with PCOS. Women with PCOS exhibit (a) increased plasma visfatin concentrations compared with controls with a similar body mass index; (b) increased VEGF production along with chronic, mild inflammation; and (c) increased MMP-9 concentrations, which might be related to either excessive CV risk or abnormalities of ovarian extracellular matrix remodeling, multiple cyst formation, follicular atresia, and chronic anovulation. As PCOS has been associated with CV risk, early identification of endothelial dysfunction is clinically relevant.


Assuntos
Biomarcadores/sangue , Endotélio Vascular/metabolismo , Nicotinamida Fosforribosiltransferase/metabolismo , Síndrome do Ovário Policístico/metabolismo , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/terapia , Doenças Vasculares/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/sangue
16.
Gynecol Endocrinol ; 35(8): 695-700, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30880505

RESUMO

The purpose of this study was to evaluate the effect of two doses of D-chiro-inositol (DCI) in combination with Myo-inositol (MYO) in women with PCOS undergoing ICSI. This was a multicenter controlled, randomized, double-blind parallel group study with two MYO-DCI formulations for 12 weeks. The study group (SG) was administered 550 mg of MYO + 150 mg of DCI twice daily; the control group (CG) was administered 550 mg of MYO + 13.8 mg of DCI twice daily. The participants comprised 60 women with PCOS undergoing ICSI. At baseline, no differences were found between the two groups regarding age, BMI, HOMA-IR or testosterone levels. The pregnancy and live birth rates were significantly higher in the SG than in the CG (65.5 vs. 25.9 and 55.2 vs. 14.8, respectively) [risk ratio (RR) = 0.4; 95%CI (0.2, 0.79); p = .003 and RR = 0.27; 95%CI (0.10, 0.70); p = .002 respectively]. The risk of ovarian hyperstimulation syndrome (OHSS) was lower in the SG (3.44 vs. 18.5%, p = .07). The combination of MYO-DCI at high doses of DCI improves the pregnancy rates and reduces the risk of OHSS in women with PCOS undergoing ICSI.


Assuntos
Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Inositol/administração & dosagem , Síndrome do Ovário Policístico/terapia , Injeções de Esperma Intracitoplásmicas , Adolescente , Adulto , Coeficiente de Natalidade , Relação Dose-Resposta a Droga , Método Duplo-Cego , Composição de Medicamentos , Feminino , Humanos , Recém-Nascido , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Gravidez , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Adulto Jovem
17.
Acupunct Med ; 37(1): 40-46, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30843421

RESUMO

OBJECTIVE: To evaluate the efficacy of electroacupuncture (EA) for the treatment of anxiety and depression in unmarried patients with polycystic ovarian syndrome (PCOS) by secondary analysis of a randomised controlled trial. METHODS: A prospective pilot randomised controlled trial of unmarried women with PCOS was conducted from November 2012 to March 2016. Participants were assigned to the acupuncture group (receiving EA for 16 weeks) or the control group (receiving sham acupuncture for 16 weeks), with 27 patients in each group. The pre-specified primary outcomes and all secondary outcomes, with the exception of serum levels of neurotransmitters including norepinephrine (NE), epinephrine (AD), serotonin (5-HT) and γ-aminobutyric acid (GABA), will be reported separately. Additional outcome measures selected for this secondary analysis included anxiety and depression scale scores (Zung-SAS and Zung-SDS), 36-Item Short Form (SF-36) scale scores, PCOS Quality of Life (PCOSQOL) scale scores and Chinese Quality of Life (CHQOL) scale scores. RESULTS: After the16-week intervention, an increase in serum NE and reduction in 5-HT were observed in the acupuncture group (P=0.028 and P=0.023, respectively). The serum level of GABA decreased in both groups after the interventions (both P<0.001). However, there were no significant differences between the two groups in the levels of any neurotransmitters (p>0.05). After EA treatment, SAS and SDS scores were decreased in the acupuncture group (P=0.007 and P=0.027, respectively) and were lower than those of the control group (P=0.003 and P=0.004, respectively). The SF-36 domain scores for mental health, vitality, social functioning, general health and health transition, the total CHQOL scores, and the infertility problems and body hair domains of the PCOSQOL improved significantly after EA (P<0.05). CONCLUSION: EA appears to improve symptoms of anxiety/depression and quality of life in PCOS patients and may influence serum levels of NE and 5-HT. These findings should be interpreted with caution, given the secondary nature of the outcome measures reported herein. TRIAL REGISTRATION NUMBER: NCT01812161; ChiCTR-TRC-12002529.


Assuntos
Ansiedade/terapia , Depressão/terapia , Eletroacupuntura , Síndrome do Ovário Policístico/psicologia , Síndrome do Ovário Policístico/terapia , Pessoa Solteira/psicologia , Pontos de Acupuntura , Adolescente , Adulto , Epinefrina/sangue , Feminino , Humanos , Neurotransmissores/sangue , Norepinefrina/sangue , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Serotonina/sangue , Resultado do Tratamento , Adulto Jovem
18.
Biomed Pharmacother ; 113: 108687, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30851546

RESUMO

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and follicular arrest. These two characteristics may result from an imbalance between anti-Müllerian hormone and follicle stimulating hormone. Electroacupuncture is effective in improving hyperandrogenism and follicular arrest in PCOS; however, the mechanism is not sufficiently clear. This study aimed to elucidate whether electroacupuncture in PCOS is exerted by regulating an imbalance of anti-Müllerian hormone and follicle stimulating hormone. In this study, a rat model of polycystic ovary syndrome was treated with low-frequency electroacupuncture at acupoints (CV-3 and CV-4). To observe the mechanism of electroacupuncture in PCOS, we first observed the estrous cycle. We then observed ovarian morphology by hematoxylin-eosin staining and evaluated levels of testosterone, estradiol, P450arom, follicle stimulating hormone and its receptor, and anti-Müllerian hormone and its receptor by enzyme-linked immunosorbent assay, western blotting, double immunofluorescence assay and real-time PCR. Our results showed that in 80% of rats in the electroacupuncture acupoints group, their estrous cycle recovered, ovarian morphology significantly improved, testosterone level significantly decreased, and levels of estradiol and P450arom significantly increased in peripheral serum after 14 consecutive days of treatment (P < 0.01). The expression of anti-Müllerian hormone and anti-Müllerian hormone type II receptor decreased (P < 0.05), whereas the expression of follicle stimulating hormone receptor increased (P < 0.05). These results indicated that electroacupuncture improved hyperandrogenism and follicular arrest by decreasing the excessive expression of AMH to regulate FSH and AMH imbalance in granulosa cells in PCOS.


Assuntos
Hormônio Antimülleriano/sangue , Eletroacupuntura , Hormônio Foliculoestimulante/sangue , Hiperandrogenismo/sangue , Folículo Ovariano/crescimento & desenvolvimento , Síndrome do Ovário Policístico/terapia , Animais , Aromatase/sangue , Modelos Animais de Doenças , Estradiol/sangue , Ciclo Estral/sangue , Feminino , Síndrome do Ovário Policístico/sangue , Ratos Sprague-Dawley
19.
Eur J Obstet Gynecol Reprod Biol ; 234: 149-154, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30690191

RESUMO

OBJECTIVES: 1. To study the efficacy of exercise in improving clinical symptoms, anthropometry, glucose tolerance and laboratory profile in women with Polycystic ovarian syndrome. 2. To study the combined efficacy of exercise and metformin on above parameters in women with polycystic ovary syndrome. STUDY DESIGN: A Randomised double blinded placebo controlled trial was performed at a district hospital in New Delhi. Sixty six women were included in the study. Block randomisation was done to divide the women into two groups. Women were treated with fixed exercise schedule along with oral placebo in Group A and exercise with oral metformin in Group B. Outcomes stated in objectives were studied and statistically analysed. Quantitative variables were compared using unpaired t-test and Paired t-test within the groups across follow-ups. Qualitative variable has been compared using Chi-Square test /Fisher's exact test. RESULTS: In Group A and B significant improvement was noted in menstrual cycles, mean waist circumference, mean waist-hip ratio and body mass index. The mean weight loss was 0.78 ± 0.19 kg and 1.71 ± 0.19 kg in group A and B respectively after 3 months. The mean weight loss was 1.08 ± 0.30 kg and 1.71 ± 0.19 kg in group A and B respectively. The mean difference in modified Ferriman Gallwey score at 0, 3 and 6 months were statistically significant in both groups. On comparing group A with group B at 6 months, significant improvement was found in menstrual cycle symptoms (55.17% vs 83.33%), mean weight loss (1.08 kg vs 2.5 kg), waist circumference reduction (2.56 cm vs 4.75 cm) and change in mean waist hip ratio (0.02 vs 0.04). Significant changes were noted in OGTT and Serum testosterone level at 6 months in Group B, but not in Group A. Statistically no significant differences were found in acne, acanthosis nigricans and other biochemical parameters. CONCLUSION: Regular exercise should be recommended for the women with PCOS. It results in statistically significant improvement in menstrual cycle pattern, hirsutism, body mass index, weight, waist circumference waist-hip ratio. Addition of metformin resulted in added benefits on menstrual cycle, hirsutism, weight, body mass index, waist circumference, waist hip ratio, serum testosterone and Oral Glucose Tolerance Test (OGTT).


Assuntos
Terapia por Exercício/métodos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Síndrome do Ovário Policístico/terapia , Adulto , Índice de Massa Corporal , Terapia Combinada , Feminino , Teste de Tolerância a Glucose , Hirsutismo/etiologia , Hirsutismo/terapia , Humanos , Ciclo Menstrual , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/fisiopatologia , Resultado do Tratamento , Circunferência da Cintura , Relação Cintura-Quadril , Perda de Peso , Adulto Jovem
20.
J Ovarian Res ; 12(1): 5, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30665436

RESUMO

OBJECTIVE: The aim of this study was to determine the effect of vitamin D and probiotic co-administration on mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome (PCOS). METHODS: This randomized, double-blinded, placebo-controlled clinical trial was carried out on 60 subjects, aged 18-40 years old. Subjects were randomly allocated to take either 50,000 IU vitamin D every 2 weeks plus 8 × 109 CFU/day probiotic (n = 30) or placebo (n = 30) for 12 weeks. RESULTS: Vitamin D and probiotic co-supplementation, compared with the placebo, significantly improved beck depression inventory [ß (difference in the mean of outcomes measures between treatment groups) - 0.58; 95% CI, - 1.15, - 0.02; P = 0.04], general health questionnaire scores (ß - 0.93; 95% CI, - 1.78, - 0.08; P = 0.03) and depression, anxiety and stress scale scores (ß - 0.90; 95% CI, - 1.67, - 0.13; P = 0.02). Vitamin D and probiotic co-supplementation was associated with a significant reduction in total testosterone (ß - 0.19 ng/mL; 95% CI, - 0.28, - 0.10; P < 0.001), hirsutism (ß - 0.95; 95% CI, - 1.39, - 0.51; P < 0.001), high-sensitivity C-reactive protein (hs-CRP) (ß - 0.67 mg/L; 95% CI, - 0.97, - 0.38; P < 0.001) and malondialdehyde (MDA) levels (ß - 0.25 µmol/L; 95% CI, - 0.40, - 0.10; P = 0.001), and a significant increase in total antioxidant capacity (TAC) (ß 82.81 mmol/L; 95% CI, 42.86, 122.75; P < 0.001) and total glutathione (GSH) levels (ß 40.42 µmol/L; 95% CI, 4.69, 76.19; P = 0.02), compared with the placebo. CONCLUSIONS: Overall, the co-administration of vitamin D and probiotic for 12 weeks to women with PCOS had beneficial effects on mental health parameters, serum total testosterone, hirsutism, hs-CRP, plasma TAC, GSH and MDA levels. TRIAL REGISTRATION: This study was retrospectively registered in the Iranian website ( www.irct.ir ) for registration of clinical trials ( IRCT20170513033941N37 ).


Assuntos
Síndrome do Ovário Policístico/terapia , Probióticos/administração & dosagem , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Adolescente , Adulto , Proteína C-Reativa/análise , Método Duplo-Cego , Feminino , Glutationa/sangue , Hirsutismo/sangue , Hirsutismo/psicologia , Hirsutismo/terapia , Humanos , Inflamação/sangue , Inflamação/psicologia , Inflamação/terapia , Malondialdeído/sangue , Saúde Mental , Estresse Oxidativo/efeitos dos fármacos , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/psicologia , Testosterona/sangue , Adulto Jovem
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