Reproductive Sciences Center, Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Int J Mol Sci. 2024 Jan 18;25(2):1203. doi: 10.3390/ijms25021203.
Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, affecting 5-15% globally with a large proportion undiagnosed. This review explores the multifaceted nature of PCOS and its impact on pregnancy, including challenges in fertility due to hormonal imbalances and insulin resistance. Despite restoring ovulation pharmacologically, women with PCOS face lower pregnancy rates and higher risks of implantation failure and miscarriage. Our review focuses on the complexities of hormonal and metabolic imbalances that impair endometrial receptivity and decidualization in PCOS. Disrupted estrogen signaling, reduced integrity of endometrial epithelial tight junctions, and insulin resistance impair the window of endometrial receptivity. Furthermore, progesterone resistance adversely affects decidualization. Our review also examines the roles of various immune cells and inflammatory processes in the endometrium, contributing to the condition's reproductive challenges. Lastly, we discuss the use of rodent models in understanding PCOS, particularly those induced by hormonal interventions, offering insights into the syndrome's impact on pregnancy and potential treatments. This comprehensive review underscores the need for advanced understanding and treatment strategies to address the reproductive complications associated with PCOS, emphasizing its intricate interplay of hormonal, metabolic, and immune factors.
多囊卵巢综合征（PCOS）是一种常见的育龄期女性内分泌疾病，全球范围内发病率为 5-15%，其中很大一部分未被诊断。本综述探讨了 PCOS 的多面性及其对妊娠的影响，包括由于激素失衡和胰岛素抵抗导致的生育挑战。尽管通过药理学恢复排卵，但 PCOS 患者的妊娠率较低，着床失败和流产的风险较高。我们的综述重点关注了激素和代谢失衡对 PCOS 中子宫内膜容受性和蜕膜化的影响。雌激素信号转导受损、子宫内膜上皮紧密连接完整性降低以及胰岛素抵抗会损害子宫内膜容受性窗口。此外，孕激素抵抗也会对蜕膜化产生不利影响。我们的综述还研究了各种免疫细胞和炎症过程在子宫内膜中的作用，这些过程导致了该病症的生殖挑战。最后，我们讨论了使用啮齿动物模型来理解 PCOS 的作用，特别是那些由激素干预引起的模型，这些模型为理解 PCOS 对妊娠的影响和潜在治疗方法提供了深入的见解。本综述强调了需要深入了解和治疗策略来解决与 PCOS 相关的生殖并发症，重点强调了其激素、代谢和免疫因素的复杂相互作用。
