Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), affects approximately 8%–13% of reproductive-aged women worldwide and is one of the most common endocrine disorders in women. Psychiatric comorbidities represent a substantial but often underrecognised component of this multisystem condition. This narrative review summarises current evidence on the prevalence, mechanisms and management of psychiatric disorders in PMOS across the lifespan. Women with PMOS have significantly higher rates of depression, anxiety, eating disorders, ADHD, bipolar disorder and OCD than women without PMOS. Reduced quality of life, body image distress and emerging evidence of increased suicidal ideation further contribute to the disease burden. Psychiatric morbidity persists beyond the reproductive years and appears to be amplified by obesity and metabolic dysfunction. Proposed mechanisms include hyperandrogenism, insulin resistance, neuroinflammation, hypothalamic–pituitary–adrenal axis dysregulation, sleep disturbance and psychosocial stressors. Evidence-based management includes routine screening, psychological interventions, pharmacotherapy when indicated, lifestyle modification and coordinated endocrine, metabolic and mental health care. Psychiatric comorbidity is a core clinical feature of PMOS and warrants routine screening, longitudinal surveillance and integrated management across the lifespan.
Introduction: Microfluidic sperm selection systems (MFSSs) have emerged as centrifugation-free alternatives to conventional sperm preparation methods, such as density gradient centrifugation (DGC), which may induce oxidative stress and sperm DNA damage. Although commercial MFSS devices have shown potential benefits, their clinical use is limited by cost and reliance on proprietary systems. Manual MFSS has been proposed as a simplified and cost-effective alternative. However, the clinical effectiveness of MFSS, particularly in relation to embryological and clinical outcomes in intracytoplasmic sperm injection (ICSI), remains largely unvalidated. Aims: To evaluate whether manual MFSS improves sperm quality and clinical outcomes compared with DGC in ICSI cycles. Methods: This prospective cohort study was conducted at My Duc Hospital, HCMC, Vietnam and included couples undergoing ICSI between February and November 2024. The primary outcome was the Day-3 embryo formation rate. Secondary outcomes included sperm motility, morphology, fertilisation, blastocyst development and clinical pregnancy outcomes. Between-group comparisons were performed using the [Formula: see text]-test, Mann–Whitney [Formula: see text] test or Fisher’s exact test, as appropriate. A [Formula: see text]-value <0.05 was considered statistically significant. Results: Sixty couples were included, with 30 undergoing sperm preparation using MFSS or 30 using DGC. The Day-3 embryo formation rate did not differ significantly between the MFSS and DGC groups (83% vs 94%, [Formula: see text] [Formula: see text] 0.2). Compared with DGC, MFSS resulted in significantly higher progressive motility (91.8% vs 82.4%, [Formula: see text] < 0.001) and significantly lower proportions of immotile sperm (0.3% vs 8.5%, [Formula: see text] < 0.001 and sperm with head abnormalities (80.8% vs 88.5%, [Formula: see text] [Formula: see text] 0.01); sperm concentration was higher in the DGC group. Fertilisation, blastocyst development and clinical pregnancy outcomes were comparable between the two groups (all [Formula: see text] > 0.05). Conclusions: Use of MFSS achieved similar embryological and clinical outcomes to use of DGC while improving sperm motility and morphology.
Introduction: Polycystic ovarian syndrome (PCOS) is a multifactorial endocrine disorder with diverse clinical manifestations. Recent evidence suggests an association between gut microbiota imbalance and PCOS pathophysiology, indicating a potential role of probiotics as a therapeutic adjunct. This study was designed to assess the association between probiotic supplementation and changes in hormonal, biochemical and clinical parameters in women with PCOS. Aims: To determine the impact of probiotic supplementation on hormonal, biochemical and clinical profiles of women with PCOS. Methods: A prospective observational cohort study was conducted on 150 PCOS women at a tertiary care hospital to assess the association of probiotics and alterations in PCOS profiles. Participants received a daily dose of probiotics for 12 weeks. Hormonal parameters including luteinising hormone (LH), follicle-stimulating hormone (FSH), testosterone, thyroid-stimulating hormone (TSH), prolactin and Anti-Mullerian hormone (AMH) levels; biochemical parameters including lipid profile and insulin resistance; and clinical parameters including menstrual irregularities, hirsutism and body mass index (BMI) were assessed before and after supplementation of probiotics using appropriate tests of significance. Statistical analyses were performed using SPSS 26.0. Results: Probiotic supplementation significantly reduced LH, testosterone and prolactin levels (LH: 10.62 ± 5.39 to 6.23 ± 2.10 (IU/L): [Formula: see text] < 0.001, testosterone: 3.42 ± 9.68 to 0.54 (ng/dL) ± 0.25: [Formula: see text] < 0.001, prolactin: 20.37 ± 21.88 to 13.00 ± 5.68 (mIU/ml): [Formula: see text] < 0.001). Lipid profiles improved significantly, with a reduction in LDL, triglyceride and total cholesterol levels ([Formula: see text] < 0.001) and improved HOMA-IR scores (2.05 ± 1.83 to 1.03 ± 0.32, [Formula: see text] < 0.001). AMH levels showed a marginal decrease (6.86 ± 4.26 to 5.94 ± 3.56 (ng/ml), [Formula: see text] [Formula: see text] 0.043), suggesting a potential reduction in ovarian dysfunction in PCOS. Conclusions: Probiotic supplementation appears to exert a favourable influence on hormonal and metabolic profiles in women diagnosed with PCOS, enhancing insulin sensitivity and optimising dyslipidaemia and thyroid dysfunction. However, clinical profiles remained unaltered. Therefore, probiotics can act as a promising adjunct to lifestyle modification in PCOS management, potentially reducing the risk of long-term complications.
Introduction: Recurrent pregnancy loss (RPL), defined as two or more pregnancy losses, affects 1%–2% of women of reproductive age. Approximately 50% of cases remain unexplained recurrent pregnancy loss (uRPL). Antinuclear antibodies (ANAs) are detected in about 22% of women with uRPL, but whether ANA status predicts subsequent pregnancy outcomes is unclear. Aims: This study aimed to investigate the correlation between pre-pregnancy ANA positivity and subsequent pregnancy outcomes in women with uRPL. Methods: In this prospective cohort study, 386 women with uRPL underwent pre-pregnancy ANA screening via magnetic chemiluminescence immunoassay. Participants were followed for 2 years, with documentation of conception methods, any immunomodulatory treatments received, and pregnancy outcomes. Results: Of the 386 participants, 77 (20.0%) were ANA-positive and 309 were ANA-negative. During follow-up, 300 women in the ANA-negative group and 64 in the ANA-positive group achieved a pregnancy. No significant differences were observed in pregnancy outcomes (early pregnancy loss or live birth) between the ANA-positive and ANA-negative groups, nor when ANA-positive women were stratified by titre level (low vs. high). Conclusions: Pre-pregnancy ANA positivity was not associated with an increased risk of early pregnancy loss in women with uRPL, regardless of the titre cut-off used. A history of prior live birth emerged as a significant protective factor. Future research should focus on the dynamics of ANA levels during pregnancy and their prognostic implications.
Introduction: Recent improvements in mercury-free piezo-assisted intracytoplasmic sperm injection (P-ICSI) devices have renewed interest in this technique, and reports on its usefulness are increasing. Aims: This study compares laboratory outcomes of P-ICSI and conventional ICSI (C-ICSI) and examines whether results differ by maternal age or embryologist experience. Methods: This retrospective observational cohort study included all eligible oocyte retrieval cycles performed at a single high-volume assisted reproductive technology (ART) centre (Sugiyama Clinic Shinjuku) from January 2018 to February 2023 after prespecified exclusions. A total of 15,687 cycles yielded 65,033 mature metaphase II (MII) oocytes. C-ICSI was performed from 2018 to early 2019, and P-ICSI was introduced in 2019. Outcomes included fertilisation per MII oocyte, post-ICSI oocyte degeneration and blastocyst formation per fertilised oocyte. Prespecified subgroup analyses were performed by female age (<40 vs [Formula: see text]40 years) and embryologist experience (senior [Formula: see text]10 years; intermediate 5–10 years; junior <5 years). Results: Amongst 65,033 MII oocytes, 13,549 underwent C-ICSI and 51,484 underwent P-ICSI. Compared with C-ICSI, P-ICSI was associated with a higher fertilisation (83.8% vs 74.8%; [Formula: see text] < 0.01), lower degeneration (2.9% vs 6.9%; [Formula: see text] < 0.01) and higher blastocyst formation (54.0% vs 36.3%; [Formula: see text] < 0.01). These advantages persisted in women aged <40 years (fertilisation 84.6% vs 75.9%; degeneration 2.8% vs 6.8%; blastocyst 58.9% vs 42.0%; all [Formula: see text] < 0.01) and [Formula: see text]40 years (82.6% vs 72.8%; 3.0% vs 7.1%; 46.9% vs 25.8%; all [Formula: see text] < 0.01). With C-ICSI, fertilisation decreased with less experience (77.2%, 70.6% and 63.8%; [Formula: see text] < 0.001), whereas fertilisation remained stable with P-ICSI (82.2%, 82.0% and 82.2%). Conclusions: P-ICSI is associated with improved fertilisation and blastocyst formation and reduced oocyte degeneration compared with C-ICSI, with consistent benefits across maternal age strata and reduced dependency on operator experience. These findings support broader adoption of P-ICSI as a gentler and more reproducible micromanipulation technique.
