Background Hyperandrogenemia (HA) and low sex hormone-binding globulin (SHBG) are core features of polycystic ovary syndrome. The creatinine-to-albumin ratio (CAR), a simple renal–nutritional marker linked to female infertility, has not been studied in relation to HA or low SHBG.Objective To examine the association of CAR with low SHBG and HA, defined by the free androgen index (FAI), in U.S. women of reproductive age.Methods In this cross-sectional analysis of NHANES 2013–2016, we included 683 women aged 18–49 years. CAR (serum creatinine/albumin) was categorized into tertiles; low SHBG was defined as < 30 nmol/L and HA as FAI ≥ 75th percentile. Survey-weighted multivariable logistic regression was used, with multiple imputation (m = 5) as a sensitivity analysis.Results In Model 1 (age, race/ethnicity, education, income), the highest CAR tertile was associated with low SHBG (OR 2.93, 95% CI 1.49–5.75; P = 0.003; P for trend = 0.004) and FAI-defined HA (OR 1.87, 95% CI 1.05–3.34; P = 0.036; P for trend = 0.044). In Model 2 (plus smoking, BMI, low HDL-C), associations attenuated (OR 1.95, 95% CI 1.05–3.64 for low SHBG; 1.24, 95% CI 0.65–2.34 for HA-FAI). HA defined by total testosterone was not associated with CAR.Conclusion Higher CAR was associated with low SHBG and FAI-defined HA after demographic adjustment, with attenuation after metabolic adjustment, suggesting confounding by shared metabolic factors. As CAR derives from routine laboratory tests, it may be a practical marker of reproductive metabolic risk; the cross-sectional design precludes causal inference.
Objective To assess the diagnostic accuracy of inhibin B in evaluating ovarian reserve and ovarian response.Methods We searched EMBASE, PubMed, Web of Science, ScienceDirect, and the Cochrane Library up to July 2, 2025, for diagnostic test accuracy studies comparing inhibin B with anti-Müllerian hormone (AMH). The review followed the PRISMA-DTA and MOOSE guidelines. The risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio (DOR), and diagnostic score were estimated using bivariate random-effects models. Summary receiver operating characteristic (SROC) curves, a Fagan nomogram (pre-test probability = 0.5), and Deeks’ funnel plot were used to evaluate performance and publication bias. Subgroup analyses compared inhibin B’s accuracy between ovarian reserve and response.Results Eight studies (12 datasets; 2878 women) were included, all at low risk of bias. For ovarian reserve, inhibin B showed sensitivity of 0.69, specificity of 0.88, DOR of 16.52, and an SROC AUC of 0.89; for ovarian response: sensitivity of 0.60, specificity of 0.79, DOR of 5.80, and AUC of 0.77. No significant publication bias was detected (P = 0.78 for ovarian reserve; P = 0.21 for ovarian response). The sensitivity was significantly higher for ovarian reserve than for the response (P < 0.001).Conclusions Inhibin B has moderate diagnostic accuracy for the ovarian reserve and lower accuracy for the ovarian response. It may be considered a complementary biomarker, but AMH remains superior.
OBJECTIVE:We aim to clarify the comparative clinical efficacy of ovulation induction and artificial cycle (AC) protocols for frozen-thawed embryo transfer (FET) in reproductive-aged women with polycystic ovary syndrome (PCOS), given the conflicting findings and ongoing controversy surrounding this issue in existing studies. METHODS:This was a retrospective cohort study conducted at a public fertility center in China, which included a total of 1331 women with PCOS who underwent FET between January 2021 and December 2024; the study compared the efficacy of two endometrial preparation interventions during FET, ovulation induction cycles (n = 543) and AC (n = 788). The primary outcome measure was live birth rate, while the secondary outcome measures were categorized into three types: clinical outcomes, maternal outcomes and perinatal outcomes. RESULTS:Endometrial thickness on the day of progesterone administration was significantly greater in the ovulation induction group (10.3 (9.0-12.2) vs. 9.2 (8.0-10.8), p < 0.001) than in the AC group. Following adjustment for potential confounding factors, the ovulation induction cycle group exhibited a significantly higher clinical pregnancy rate (59.5% vs. 51.5%, aOR = 1.3, 95%CI: 1.1-1.7) and live birth rate (48.8% vs. 39.7%, aOR = 1.4, 95%CI: 1.1-1.7) relative to the artificial cycle group. Perinatal outcomes were comparable between AC and ovulation induction. CONCLUSIONS:In conclusion, ovulation induction significantly improves live birth rates over artificial cycles in PCOS women undergoing FET, with comparable perinatal safety. Despite the limitations of retrospective, single-center data, this study provides real-world evidence to guide endometrial preparation. Prospective randomized trials are warranted to confirm these findings.
OBJECTIVE:To examine the effect of DT56a (Femarelle®), a non-hormonal oral treatment for the management of menopause, on symptoms of vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) in postmenopausal women. METHODS:Twelve (n = 12) postmenopausal women with severe VVA (100% parabasal cells on cervical cytology) and at least one severe VVA symptom were recruited for a 12-week open-label pilot study. At baseline and week 12, participants underwent physical examination, Pap smear, vaginal ultrasound, vaginal cultures, vaginal pH assessment, and vaginal maturation index evaluation. Subjects also completed questionnaires assessing atrophy symptoms and quality of life using the Utian Quality of Life (UQoL) scale. Follow-up at 24 months was available for several participants. RESULTS:After 12 weeks of treatment, all patients showed a significant reduction in vaginal pH. In addition, 11 of the 12 women demonstrated significant improvement in the vaginal maturation index and UQoL questionnaire scores. CONCLUSIONS:DT56a significantly improved subjective and objective parameters of VVA/GSM, including vaginal pH, vaginal maturation index, and quality of life. These findings support its potential role as a non-hormonal systemic treatment option for women with VVA/GSM.
