Assisted Reproductive Technology in the Presence of Polycystic Ovary Syndrome: Current Evidence and Knowledge Gaps.

OBJECTIVE: In this narrative review, we discuss the current evidence as well as the knowledge gaps concerning assisted reproductive technology (ART) indications, protocols, and results in the presence of polycystic ovary syndrome (PCOS). METHODS: An electronic literature search was performed for English-language publications in the last decade in databases such as PubMed, Medline, the Web of Sciences, Embase, and Scopus. RESULTS: We found evidence that ovarian steroidogenesis and folliculogenesis are deeply altered by PCOS; however, the oocyte quality and pregnancy rates after ART are not affected. Patients with PCOS are more sensitive to the action of exogenous gonadotropins and more likely to develop ovarian hyperstimulation syndrome. This risk can be mitigated by the adoption of the gonadotropin-releasing hormone antagonist protocols for pituitary blockade and ovarian stimulation, along with frozen embryo transfer, without compromising the odds of achieving a live birth. Pregnancy complications, such as miscarriage, gestational diabetes, preeclampsia, and very preterm birth, are more frequent in the presence of PCOS, requiring more intense prenatal care. It remains uncertain whether weight reduction or insulin sensitizers used before ART are beneficial for the treatment outcomes. CONCLUSION: Although PCOS is not a drawback for ART treatments, the patients need special care to avoid complications. More in-depth studies are needed to uncover the mechanisms of follicular growth, gamete maturation, and endometrial differentiation during ART procedures in the presence of PCOS.

Variation of endothelial function during the menstrual cycle evaluated by flow-mediated dilatation of brachial artery.

OBJECTIVE: It is well defined that ovarian steroids play a role in the cardiovascular system, acting as vasoactive compounds. The aim of this study is to assess the endothelial function during the menstrual cycle using flow-mediated dilation of the brachial artery. METHODS: A total of 21 healthy premenopausal women, with regular menstrual cycles, were included in this observational, longitudinal, and prospective study. The endothelium function was assessed by ultrasound during four phases of the menstrual cycle: early follicular phase (EFP), late follicular phase (LFP), early luteal phase (ELP) and late luteal phase (LLP). RESULTS: We observed a significant variation among the vasodilatation response during the menstrual cycle phases (P<0.001). The result was higher during LFP than during ELP (P<0.001) or LLP (P<0.001). Late luteal phase had higher response than observed during ELP (P=0.003) and EFP was higher than LLP (P=0.003). There were no significant differences between the results observed during EFP and LFP (P=1.0), or EFP and ELP (P=0.137). CONCLUSION: Our results suggest that the ovarian steroids may play an important role in modulating endothelial function.