Endometrial receptivity and PCOS; endometrial gene expression specificities — literature review

Abstract

Objectives:The purpose of this review is to provide an overview of existing studies on the specificities of gene expression in the endometrium in PCOS and possible molecular mechanisms linking those specificities with reproductive and obstetric consequences of PCOS. Mechanism: Polycystic ovary syndrome (PCOS) is a complex disorder combining features of reproductive, metabolic, and psychological disturbances. The effect of metabolic, inflammatory, and endocrine abnormalities on ovulatory function and oocyte quality has been seen as the main reproductive issue in PCOS women. However, even after the restoration of ovulation, this group exhibits lower than expected reproductive outcomes. Functionally relevant sequence alterations in genes involved in regulating endometrial receptivity could also be relevant in PCOS as a property independent of extra-endometrial influences. Findings: Hyperandrogenism, ovulatory dysfunction, and insulin resistance are associated with the alterations in endometrial gene expressions leading to suboptimal endometrial receptivity in PCOS. Endometrial steroid receptor malfunction seems to be a contibuting factor to the intrinsic suboptimal endometrial receptivity in PCOS. Conclusion: epigenetic or epigenomics mechanisms altering gene expressions on the endometrial level in PCOS should not be ruled out. Future studies should focus on investigating specificities of each PCOS phenotype and developing individual treatment strategies to meet the specific needs of every PCOS patient.

The effect of polycystic ovary syndrome on intracytoplasmic sperm injection results in patients with endometriosis

“…In the study of Crespi (3), an increase in spontaneous abortion was reported in women with PCOS. Contrary to the above studies, the study by Alebić (1) showed that the rate of abortion in PCOS syndrome is probably not different from the control group. The difference could be because pregnant women with PCOS in previous studies were older than the control group, as age also plays a destructive role in increasing pregnancy complications (6).…”

“…In endometriosis, the endometrial tissue of the uterus extends out to the pelvic space,peritoneum and on to the organs like ovaries, intestines and the bladder. The disease spectrum is vast and ranges from large endometrioma cysts to small lesions on the pelvic organs, creating significant adhesions in the uterus, bladder and intestine and disrupting the anatomy of the pelvis (1)(2)(3). The disease treatment is still associated with many problems.…”

Pituitary Suppression with Gonadotropin-Releasing Hormone Agonist Prior to Artificial Endometrial Preparation in Frozen–Thawed Embryo Transfer Cycles: A Systematic Review and Meta-Analysis of Different Protocols and Infertile Populations

“…In women suffering PCOS, endometrial receptivity has been postulated to be affected via several mechanisms: (1) sustained androgenic exposure due to the abberant hormonal milieu [69,70], (2) metabolic alterations that regulate decidualization [71], (3) compromised PR functions led to total failure of the uterus in supporting embryo implantation [72], and (4) altered intrauterine microenvironment via deregulation of local inflammatory mediators [73,74]. In clinical practice, PCOS is related to a higher risk of miscarriage and adverse pregnancy outcomes [75], though its effect on IVF and FET cycles remains controversial.…”

Polycystic Ovary Syndrome (PCOS) — A Never-Ending Clinical Challenge

“…In this literature review, Alebić has discussed the specificities of endometrial receptivity in PCOS patients focusing primarily on the association between features of PCOS and endometrial gene expression changes observed in these patients. The paper targeted the clinicians who are interested in possible mechanisms of lower clinical and ongoing pregnancy rates observed among patients with PCOS [4].…”