Enhancing Understanding of Endometrial Function in Patients with PCOS: Clinical and Immunological Insights

Overview

Journal J Ovarian Res

Publisher Biomed Central

Specialties Gynecology & Obstetrics
Reproductive Medicine

Date 2025 Mar 13

PMID 40075432

Authors

Yaxin Guo

Jingfei Yang

Hong Chen

Yueping Zhou

Yan Yang

Biao Wang

Luyang Zha

Dijia Bai

Wenxuan Li

Xiaojuan Tang

Zishui Fang

Fei Li

Lei Jin

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the pregnancy and perinatal outcomes of different phenotypes of polycystic ovary syndrome (PCOS) patients during the frozen embryo transfer (FET) cycles. Additionally, to analyze the T cell balance in the endometrium of PCOS patients and explore its relationship with various PCOS phenotypes.

Design: Retrospective cohort study.

Setting: A single academically affiliated reproductive medicine center.

Patients: 21,074 FET cycles were included and divided into two groups based on the diagnosis of PCOS. Patients with PCOS were further categorized into four phenotypic groups: PCOM + HA + OA, PCOM + HA, PCOM + OA, and HA + OA. Endometrial biopsies from 21 PCOS patients and 26 controls were obtained to analyze T cell subsets.

Methods: Pregnancy and perinatal outcomes, as well as T cell subset abundance were compared between women with and without PCOS. Multiple logistic regression models were employed to adjust for confounding factors impacting pregnancy-related outcomes. Flow cytometry was utilized to analyze the abundance of T cell subsets.

Main Outcome Measures: Pregnancy and perinatal outcomes were assessed. T cell subsets including CD4CD8T cells, CD4CD8T cells, Th1, Th2, Th17 and Treg cells in the endometrium were determined by flow cytometry.

Results: There was a significantly increased incidence of miscarriage, hypertensive disorders of pregnancy (HDP), preterm birth (PTB), and even fetal malformations across different phenotypes of PCOS women, especially those with the hyperandrogenic phenotype. Th1 cells decreased while Th2 cells increased significantly in the PCOS endometrium.

Conclusions: The unfavorable pregnancy and perinatal outcomes in FET cycles and T cell imbalance both suggest the endometrial dysfunction of PCOS patients, especially those with the hyperandrogenic phenotype.

References

Moffett A, Shreeve N . Local immune recognition of trophoblast in early human pregnancy: controversies and questions. Nat Rev Immunol. 2022; 23(4):222-235. PMC: 9527719. DOI: 10.1038/s41577-022-00777-2. View

Filion K, Azoulay L, Platt R, Dahl M, Dormuth C, Clemens K . A Multicenter Observational Study of Incretin-based Drugs and Heart Failure. N Engl J Med. 2016; 374(12):1145-54. DOI: 10.1056/NEJMoa1506115. View

. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2018; 133(1):1. DOI: 10.1097/AOG.0000000000003018. View

Krasnow J, Tollerud D, Naus G, Deloia J . Endometrial Th2 cytokine expression throughout the menstrual cycle and early pregnancy. Hum Reprod. 1996; 11(8):1747-54. DOI: 10.1093/oxfordjournals.humrep.a019480. View

van Delden J, van der Graaf R . Revised CIOMS International Ethical Guidelines for Health-Related Research Involving Humans. JAMA. 2016; 317(2):135-136. DOI: 10.1001/jama.2016.18977. View

Robertson S, Moldenhauer L, Green E, Care A, Hull M . Immune determinants of endometrial receptivity: a biological perspective. Fertil Steril. 2022; 117(6):1107-1120. DOI: 10.1016/j.fertnstert.2022.04.023. View

Mumm H, Jensen D, Sorensen J, Andersen L, Ravn P, Andersen M . Hyperandrogenism and phenotypes of polycystic ovary syndrome are not associated with differences in obstetric outcomes. Acta Obstet Gynecol Scand. 2014; 94(2):204-11. DOI: 10.1111/aogs.12545. View

Liu S, Hong L, Mo M, Xiao S, Chen C, Li Y . Evaluation of endometrial immune status of polycystic ovary syndrome. J Reprod Immunol. 2021; 144:103282. DOI: 10.1016/j.jri.2021.103282. View

Hu C, Pang B, Ma Z, Yi H . Immunophenotypic Profiles in Polycystic Ovary Syndrome. Mediators Inflamm. 2020; 2020:5894768. PMC: 7106920. DOI: 10.1155/2020/5894768. View

10.

Garovic V, Dechend R, Easterling T, Karumanchi S, McMurtry Baird S, Magee L . Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2021; 79(2):e21-e41. PMC: 9031058. DOI: 10.1161/HYP.0000000000000208. View

11.

Jie H, Zhou X, Zhao M, Hu M, Mai Q, Zhou C . Pregnancy outcomes in patients with polycystic ovary syndrome who conceived after single thawed blastocyst transfer: a propensity score-matched study. BMC Pregnancy Childbirth. 2022; 22(1):718. PMC: 9487057. DOI: 10.1186/s12884-022-05011-4. View

12.

Zheng B, Sun X, Xian J, Niu P . Maternal Testosterone and Offspring Birth Weight: A Mendelian Randomization Study. J Clin Endocrinol Metab. 2022; 107(9):2530-2538. DOI: 10.1210/clinem/dgac389. View

13.

Kotlyar A, Seifer D . Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes. Reprod Biol Endocrinol. 2023; 21(1):70. PMC: 10391774. DOI: 10.1186/s12958-023-01120-7. View

14.

Dai L, Deng C, Li Y, Zhu J, Mu Y, Deng Y . Birth weight reference percentiles for Chinese. PLoS One. 2014; 9(8):e104779. PMC: 4134219. DOI: 10.1371/journal.pone.0104779. View

15.

Xu X, Yang A, Tian P, Zhang K, Liu Y, Wang Y . Expression profile analysis of LncRNAs and mRNAs in pre-receptive endometrium of women with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer. BMC Med Genomics. 2024; 17(1):26. PMC: 10799537. DOI: 10.1186/s12920-024-01806-w. View

16.

Ban M, Sun Y, Chen X, Zhou X, Zhang Y, Cui L . Association between maternal polycystic ovarian syndrome undergoing assisted reproductive technology and pregnancy complications and neonatal outcomes: a systematic review and meta-analysis. J Ovarian Res. 2024; 17(1):6. PMC: 10770902. DOI: 10.1186/s13048-023-01331-x. View

17.

Hoffman M . The great obstetrical syndromes and the placenta. BJOG. 2023; 130 Suppl 3:8-15. PMC: 10834844. DOI: 10.1111/1471-0528.17613. View

18.

Sha T, Wang X, Cheng W, Yan Y . A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF. Reprod Biomed Online. 2019; 39(2):281-293. DOI: 10.1016/j.rbmo.2019.03.203. View

19.

Deshmukh H, Way S . Immunological Basis for Recurrent Fetal Loss and Pregnancy Complications. Annu Rev Pathol. 2018; 14:185-210. PMC: 6566855. DOI: 10.1146/annurev-pathmechdis-012418-012743. View

20.

Vallve-Juanico J, Houshdaran S, Giudice L . The endometrial immune environment of women with endometriosis. Hum Reprod Update. 2019; 25(5):564-591. PMC: 6737540. DOI: 10.1093/humupd/dmz018. View