An update of polycystic ovary syndrome: causes and therapeutics options.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by menstrual irregularities, chronic anovulation, hirsutism, androgenic alopecia, and acne. At diagnosis, patients can with different manifestations according to the disease phenotype, patient's age, and lifestyle. However, most patients pursue medical care because of the clinical symptoms of PCOS, such as hyperandrogenism, menstrual irregularities and infertility. Recent studies have shown that PCOS is associated with 80% of anovulatory infertility; however, the precise mechanism of PCOS-induced anovulation is still undetermined. The treatment strategies of PCOS are symptomatic depending mainly on the desired goals and clinical benefits. Life style intervention is still the first line treatment option for overweight females seeking pregnancy. In addition, there are many pharmacological agents that could be added to induce ovulation such as metformin, and clomiphene citrate. Nowadays, many patients preferred to use some herbal medicine that was proved to have potential therapeutic benefits in many studies in the management of PCOS. The purpose of this review was to discuss PCOS-induced infertility and the available therapeutic options as well as the impact of COVID-19 infection on the success of fertility attempts. To address this purpose, Pubmed, Scopus, EMBASE and Google databases were searched for studies discussing PCOS-induced infertility. The literature search revealed the proper therapeutic plans to treat PCOS-induced infertility, and that treatment should be modified according to patient's complaints, reproductive desires, and disease phenotypes. In conclusion, the use of specific therapeutic agents and patients' adherence to lifestyle interventions could help patients recover their reproductive and metabolic health.

The effect of COVID-19 vaccinations on menstrual cycle and serum anti-Mullerian hormone levels in reproductive age women.

The aim of this prospective cohort study was to investigate the effect of coronavirus disease 2019 (COVID-19) vaccinations on menstrual cycle and ovarian reserve in reproductive aged-women. Health care providers (n = 258) vaccinated with inactivated (CoronaVac) and mRNA based (Pfizer-BioNTech®) COVID-19 vaccines were included. All subjects completed a gynaecological and menstrual history questionnaire and Anti-Mullerian Hormone (AMH) levels were measured in serum samples collected before first vaccination and at 1st, 3rd, 6th and 9th months. The prevalence of new-onset menstrual dysregulation following vaccination was 20.6% and it was statistically significant compared to baseline (p = 0.001). Menstrual pattern turned back to normal in 59.6% of vaccinated women. Serum AMH levels gradually decreased until 6th month of follow-up compared to baseline (p < 0.001). A significant increase in serum AMH level was observed at 9th month of follow-up compared to 6th month follow-up levels (p < 0.001). The decrease in serum AMH level was statistically significant regardless of serum anti SARS-CoV-2 antibody levels, subgroups of age, occupation, menstrual dysregulation following vaccination and presence of gynaecological diseases. In conclusion, vaccination against SARS-CoV-2 causes a transient decrease on serum AMH levels and moderate irregularities in menstrual pattern increasing with age and is mostly reversible.

CoronaVac vaccine does not affect ovarian reserve.

OBJECTIVES: In this study, our aim is to investigate the effect of CoronaVac vaccine on ovarian reserve in female patients followed up for infertility. MATERIAL AND METHODS: Our study is a retrospective study. Forty-six infertile patients who received two doses of CoronaVac vaccine one month apart and had not had a previous Covid 19 infection were included in the study. Anti-müllerian hormone (AMH) and folliculometry of 46 patients one month before CoronaVac vaccine and one month after the second dose of vaccine were compared. RESULTS: There was no statistically significant difference in the change of AMH level and follicle number before and after vaccination (respectively p = 0.366; 0.610). CONCLUSIONS: Considering that having a COVID-19 infection has a negative effect on female fertility and causing ovarian damage in recent studies, vaccination is a rational and cost-effective approach to protect ovarian reserve. Knowing that the vaccine does not have a negative effect on fertility may increase the application of the vaccine in women of reproductive age.

THE IMPACT OF COVID-19 ON THE OVARIAN RESERVE IN WOMEN

Objective: To investigate ovarian reserve and menstrual function in women with COVID-19 of various severity. Material(s) and Method(s): This prospective study analyzed parameters of ovarian reserve (AMH, FSH, and the AFC) and menstrual cycle (cycle length, menstrual duration) in 41 patients before and after COVID-19 disease. The interval between measurements was 6-12 months. Mild and moderate COVID-19 was observed in 31 (group 1) and 10 (group 2) patients. The inclusion criteria were age 18-45 years, preserved menstrual function. Non-inclusion criteria were decreased ovarian reserve before the onset of COVID-19 (AMH<1.2 ng/mL, AFC<5), a history of COVID-19 vaccination, pregnancy and lactation, severe somatic and infectious comorbidities affecting ovarian reserve. Result(s): In patients of late reproductive age (LRA) (>35 years), COVID-19 was associated with a reduction in ovarian reserve. Furthermore, patients with more severe COVID-19 had a more pronounced decrease in AFC. When simultaneously assessing the effect of infection severity and age on ovarian reserve, it was found that LRA patients with a more severe form of infection had the biggest decrease in ovarian reserve. The menstrual cycle did not change significantly. Conclusion(s): The study findings reflect the impact of both age and severity of COVID-19 on ovarian reserve in women. In women of LRA, a decrease in ovarian reserve can occur spontaneously, and the time difference can be very significant. Therefore, one cannot accurately state that ovarian reserve reduction was due to the disease. Nevertheless, the effect of infection severity on the degree of ovarian reserve reduction suggests an adverse effect of SARS-CoV-2 on ovarian function in women. Copyright © A group of authors, 2022.

The effect of SARS-CoV-2 mRNA vaccination on AMH concentrations in infertile women.

RESEARCH QUESTION: Does SARS-CoV-2 mRNA vaccination affect the ovarian reserve of infertile women undergoing IVF? DESIGN: This was a prospective observational study at a single university-affiliated IVF unit that included infertile women aged 18-44 years who were undergoing IVF/intracytoplasmic sperm injection between November 2020 and September 2021, had received two doses of SARS-CoV-2 mRNA vaccination and had undergone measurement of baseline anti-Müllerian hormone (AMH) concentration within the 12 months preceding their recruitment. AMH concentrations before and after vaccination were evaluated and compared. RESULTS: Overall, 31 women were included in the study. The median AMH concentrations before and after COVID-19 vaccine were comparable (1.7 versus 1.6 g/ml, respectively, P = 0.96). No correlation was found between the participant's anti-COVID-19 antibody titre and the change in AMH concentration. CONCLUSIONS: SARS-CoV-2 mRNA vaccination does not adversely affect ovarian reserve, as shown by comparing serum AMH concentrations before and after vaccination. These findings may serve as a counselling tool for clinicians to reassure women undergoing fertility treatment that SARS-CoV-2 mRNA vaccination is safe.

The effect of Covid-19 mRNA vaccine on serum anti-Müllerian hormone levels.

STUDY QUESTION: Does the administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine have an association with ovarian reserve as expressed by circulating anti-Müllerian hormone (AMH) levels? SUMMARY ANSWER: Ovarian reserve as assessed by serum AMH levels is not altered at 3 months following mRNA SARS-CoV-2 vaccination. WHAT IS KNOWN ALREADY: A possible impact of SARS-CoV-2 infection or vaccination through an interaction between the oocyte and the somatic cells could not be ruled out, however, data are limited. STUDY DESIGN, SIZE, DURATION: This is a prospective study conducted at a university affiliated tertiary medical center between February and March 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Study population included reproductive aged women (18-42 years) that were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart). Women with ovarian failure, under fertility treatments, during pregnancy, previous Covid-19 infection or vaccinated were excluded from the study. Blood samples were collected for AMH levels before the first mRNA vaccine administration. Additional blood samples after 3 months were collected for AMH and anti-Covid-19 antibody levels. Primary outcome was defined as the absolute and percentage change in AMH levels. MAIN RESULTS AND THE ROLE OF CHANCE: The study group consisted of 129 women who received two mRNA vaccinations. Mean AMH levels were 5.3 (±SD 4.29) µg/l and 5.3 (±SD 4.50) µg/l at baseline and after 3 months, respectively (P = 0.11). To account for possible age-specific changes of AMH, sub-analyses were performed for three age groups: <30, 30-35 and >35 years. AMH levels were significantly lower for women older than 35 years at all times (P = 0.001 for pre and post vaccination AMH levels versus younger women). However, no significant differences for the changes in AMH levels before and after vaccinations (Delta AMH) were observed for the three age groups (P = 0.46). Additionally, after controlling for age, no association was found between the degree of immunity response and AMH levels. LIMITATIONS, REASONS FOR CAUTION: Although it was prospectively designed, for ethical reasons we could not assign a priori a randomized unvaccinated control group. This study examined plasma AMH levels at 3 months after the first vaccination. It could be argued that possible deleterious ovarian and AMH changes caused by the SARS-CoV-2 mRNA vaccinations might take effect only at a later time. Only longer-term studies will be able to examine this issue. WIDER IMPLICATIONS OF THE FINDINGS: The results of the study provide reassurance for women hesitant to complete vaccination against Covid 19 due to concerns regarding its effect on future fertility. This information could be of significant value to physicians and patients alike. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by Sheba Medical Center institutional sources. All authors have nothing to disclose. TRIAL REGISTRATION NUMBER: The study protocol was approved by the 'Sheba Medical Center' Ethical Committee Review Board (ID 8121-21-SMC) on 8 February 2021 and was registered at the National Institutes of Health (NCT04748172).

Low Anti-Mullerian Hormone Levels Are Associated with the Severity of Anxiety Experienced by Healthcare Professionals During the COVID-19 Pandemic.

The objective of this study is to investigate a possible correlation between anxiety status and anti-Mullerian hormone (AMH) levels among healthcare professionals who provide medical care directly to COVID-19-positive patients during the recent pandemic. Fifty-two healthcare professionals (nurses, midwives, and residents) who provide medical care directly to COVID-19-positive patients in inpatient clinics or intensive care units were enrolled in this study. Serum AMH levels were analyzed to reflect ovarian reserve. The Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI-S and STAI-T, respectively) were completed by participants to assess their anxiety status. A linear regression model with participant age as the constant variable was applied to analyze the relationship between inventory scale scores and AMH levels. P-values less than 0.05 were considered statistically significant. The mean AMH value was significantly lower for the participants in the moderate/severe anxiety group compared to the minimal/mild anxiety group (p = 0.007). A linear regression analysis revealed a significant negative correlation between AMH levels and both BAI (B = -0.030, standard error = 0.010, p = 0.004) and STAI-S and STAI-T scores when age was controlled (both p = 0.003). The severity of anxiety experienced during the recent COVID-19 pandemic among healthcare professionals, who provide medical care directly to COVID-19-positive patients, is found to be related to low AMH levels.