RESUMEN
BACKGROUND For a number of reasons, the results of previous meta-analyses may not fully reflect the mental health status of the average woman suffering from polycystic ovary syndrome (PCOS), or the causes of this distress. Our objective was to examine emotional distress and its associated features in women with PCOS. METHODS A comprehensive meta-analysis of comparative studies reporting measures of depression, anxiety or emotional-subscales of quality of life (emoQoL) was performed. PubMed, Embase, PsychInfo and the Cochrane trial register databases were searched up to November 2011 (see Supplementary Data for PUBMED search string). Unpublished data obtained through contact with authors were also included. The standardized mean difference (SMD) of distress scores was calculated. Subgroup analyses and meta-regression analysis of methodological and PCOS-related features were performed. RESULTS Twenty-eight studies (2384 patients and 2705 control women) were included. Higher emotional distress was consistently found for women with PCOS compared with control populations [main outcomes: depression: 26 studies, SMD 0.60 (95% confidence interval (CI) 0.47-0.73), anxiety: 17 studies, SMD of 0.49 (95% CI 0.36-0.63), emoQoL: 8 studies, SMD -0.66 (95% CI -0.92 to -0.41)]. However, heterogeneity was present (I(2) 52-76%). Methodological and clinical aspects only partly explained effect size variation. CONCLUSIONS Women with PCOS exhibit significantly more emotional distress compared with women without PCOS. However, distress scores mostly remain within the normal range. The cause of emotional distress could only partly be explained by methodological or clinical features. Clinicians should be aware of the emotional aspects of PCOS, discuss these with patients and refer for appropriate support where necessary and in accordance with patient preference.
Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Síndrome del Ovario Poliquístico/complicaciones , Ansiedad/complicaciones , Depresión/complicaciones , Femenino , Humanos , Calidad de Vida , RiesgoRESUMEN
To study the effects of different ovarian stimulation approaches on oocyte and embryo quality, it is imperative to assess embryo quality with a reliable and objective method. Embryos rated as high quality by standardized morphological assessment are associated with higher implantation and pregnancy rates. However, embryo morphology on day 3 after fertilization is not a reliable indication of a normal chromosomal constitution. Therefore, using embryo morphology as the sole parameter for embryo quality is not ideal. Screening of embryos for chromosomal aneuploidies before transfer can be used to assess the chromosomal competence of embryos, which has been shown to have a direct relationship with the approach used for ovarian stimulation. However, gene expression analysis of cumulus granulosa cells is a promising non-invasive technique for determining embryo quality. Cumulus cells are closely associated with oocytes, and oocyte-cumulus cell communication is vital to oocyte development. Cumulus cells respond to both gonadotrophins and paracrine factors from oocytes, with a distinct gene expression pattern. Future approaches analysing the expression of relevant genes in cumulus cells using real-time polymerase chain reaction may enable us to monitor the consequences of different stimulation protocols and identify the underlying molecular mechanisms by which they influence oocyte/embryo quality.
Asunto(s)
Blastocisto/citología , Embrión de Mamíferos/citología , Inducción de la Ovulación/métodos , Blastocisto/efectos de los fármacos , Aberraciones Cromosómicas , Células del Cúmulo/metabolismo , Implantación del Embrión , Embrión de Mamíferos/efectos de los fármacos , Femenino , Expresión Génica , Humanos , Oocitos/citología , Oocitos/efectos de los fármacos , Folículo Ovárico/efectos de los fármacos , Folículo Ovárico/crecimiento & desarrolloRESUMEN
OBJECTIVE: The aim of this study was to assess which of the basal ovarian reserve markers provides the best reflection of the changes occurring in ovarian function over time (i.e., reproductive aging). DESIGN: Prospective longitudinal study. SETTING: Healthy volunteers in an academic research center. PATIENT(S): Eighty-one women with normal reproductive performance during the course of their lives were longitudinally assessed. In this select group of women, becoming chronologically older was considered as a proxy variable for becoming older from a reproductive point of view. INTERVENTION(S): The women were assessed twice, with on average a 4-year interval (T(1) and T(2)). The number of antral follicles on ultrasound (AFC) and blood levels of antimullerian hormone (AMH), FSH, inhibin B, and E(2) were assessed. MAIN OUTCOME MEASURE(S): Longitudinal changes of the markers mentioned and the consistency of these parameters over time. RESULT(S): The mean ages at T(1) and T(2) were 39.6 and 43.6 years, respectively. Although AFC was strongly associated with age in a cross-sectional fashion, it did not change over time. The AMH, FSH, and inhibin B levels showed a significant change over time, in contrast to E(2) levels. The AMH and AFC were highly correlated with age both at T(1) and T(2), whereas FSH and inhibin B predominantly changed in women more than 40 years of age. To assess the consistency of these parameters over time, we investigated whether a woman's individual level above or below the mean of her age group at T(1) remained above or below the mean of her age group at T(2). Serum AMH concentrations showed the best consistency, with AFC as second best. The FSH and inhibin B showed only modest consistency, whereas E(2) showed no consistency at all. CONCLUSION(S): These results indicate that serum AMH represents the best endocrine marker to assess the age-related decline of reproductive capacity.