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. 2024 Dec 12:15:1400880.
doi: 10.3389/fendo.2024.1400880. eCollection 2024.

Follicular development and endometrial receptivity of different androgen phenotypes in women with polycystic ovary syndrome

Xinling Wen  1 , Li Wang  2 , Shulan Lv  2
Affiliations

Follicular development and endometrial receptivity of different androgen phenotypes in women with polycystic ovary syndrome

Xinling Wen et al. Front Endocrinol (Lausanne). .

Abstract

Objective: Polycystic ovary syndrome (PCOS) is an important factor contributing to infertility in reproductive-aged women. Hyperandrogenism (HA) plays an important role in the pathogenesis of PCOS. This study was conducted to explore the follicular development and endometrial receptivity of different androgen phenotypes in reproductive-aged patients with PCOS.

Methods: A total of 268 PCOS patients with infertility were recruited and divided into two groups according to the different androgen phenotypes in this study: abnormal menstruation and hyperandrogenism (AM-HA group, n = 127) and abnormal menstruation and polycystic ovarian morphology (AM-PCOM group, n = 141). The follicular development, endometrial receptivity, pregnancy rate, and live birth rate during the natural menstrual cycle were compared between the two groups.

Results: The number of dominant follicles, number of ovulations, and normal ovulation rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group (p < 0.05). The endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), and vascularization flow index (VFI) on days 14 to 24 of the menstrual cycle before ovulation were significantly lower in the AM-HA group than in the AM-PCOM group (p < 0.05). The endometrial VI, FI, and VFI, the integrin αvβ3, and VEGF concentrations in the uterine fluid during the implantation window were significantly lower in the AM-HA group compared with the AM-PCOM group (p < 0.05). However, no statistically significant differences were observed in the uterine artery blood flow parameters, ET and EV, between the two groups (p > 0.05). The biochemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group (p < 0.05).

Conclusion: PCOS patients with the AM-HA phenotype were vulnerable to ovulation disorders and impaired endometrial receptivity, which resulted in reduced pregnancy rate. Treatment with HA is likely to become an effective approach for improving endometrial receptivity and fecundity disorders in patients with PCOS.

Keywords: endometrial receptivity; follicular development; hyperandrogenism; infertility; polycystic ovary syndrome; reproductive-aged women.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of follicular development and ovulation rate between the two groups. (A) Number of dominant follicle. (B) Number of ovulation. (C) Average diameter of dominant follicle. (D) Incidence rate of normal ovulation and LUFS (*p < 0.05).
Figure 2
Figure 2
Ultrasonic parameters of endometrial receptivity before ovulation during the natural menstrual cycle between the two groups. (A) Uterine artery blood flow parameters. (B) Endometrial thickness. (C) Endometrial volume. (D) Endometrial VI. (E) Endometrial FI. (F) Endometrial VFI (*p < 0.05).
Figure 3
Figure 3
Comparison of endometrial receptivity parameters during the implantation window between the two groups. (A) Uterine artery blood flow parameters. (B) Endometrial thickness. (C) Endometrial volume. (D) Endometrial VI and VFI. (E) Endometrial FI. (F) Biochemical parameter concentrations in uterine fluid. UA-PI, uterine artery pulsatility index; UA-RI, uterine artery resistance index; VI, vascularization index; VFI, vascularization flow index (*p < 0.05).
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