Polycystic Ovary Syndrome Markers and Mechanism

Erna Yovi Kurniawati, Noor Pramono, Syarief Thaufik Hidayat, Endang Mahati

Abstract


Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by hormonal imbalances, metabolic dysregulation, and reproductive abnormalities. This study aims to elucidate the significance of PCOS markers and their mechanisms while outlining the methodology employed. A comprehensive literature review was conducted from 2020 to 2023 using databases like PubMed, ScienceDirect, EMBASE, and Google Scholar. Key search terms included "pathophysiology," "pathogenesis," "PCOS," "marker," and "biomarker," aligned with the PICOT criteria. After removing duplicates, articles underwent a two-phase screening process based on predefined inclusion criteria. Additionally, a marker mechanism flowchart was created using the Biorender application. Results highlighted the pivotal role of various markers in understanding PCOS pathophysiology and guiding clinical management. Anthropometric, visual, metabolic, inflammatory, endocrine, and oxidative stress markers were analyzed for their diagnostic, prognostic, and therapeutic implications in PCOS. The study underscores the importance of marker interactions in personalized PCOS management. Limitations in marker interpretation warrant further research to refine diagnostic accuracy and optimize therapeutic interventions. Integrating marker mechanisms enhances understanding of PCOS heterogeneity and informs targeted treatment approaches tailored to individual phenotypic variations.


Keywords


biomarker; pathophysiology; polycystic ovary syndrom

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References


Hoeger KM, Dokras A, Piltonen T. Update on PCOS: Consequences, Challenges, and Guiding Treatment. Journal of Clinical Endocrinology and Metabolism. 2021;106(3):E1071–83.

Chen W, Pang Y. Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites. Metabolites 2021, Vol 11, Page 869. 2021;11(12):869.

Elsayed AM, Al-Kaabi LS, Al-Abdulla NM, Al-Kuwari MS, Al-Mulla AA, Al-Shamari RS, et al. Clinical Phenotypes of PCOS: a Cross-Sectional Study. Reproductive Sciences. 2023;

Walters KA, Gilchrist RB, Ledger WL, Teede HJ, Handelsman DJ, Campbell RE. New Perspectives on the Pathogenesis of PCOS: Neuroendocrine Origins. Trends Endocrinol Metab. 2018;29(12):841–52.

Bannigida DM, Nayak BS, Vijayaraghavan R. Insulin resistance and oxidative marker in women with PCOS. Arch Physiol Biochem. 2018;126(2):183–6.

Abraham Gnanadass S, Divakar Prabhu Y, Valsala Gopalakrishnan A. Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update. Archives of Gynecology and Obstetrics 2021;303(3):631–43.

Armanini D, Boscaro M, Bordin L, Sabbadin C. Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. Int J Mol Sci. 2022;23(8).

Wawrzkiewicz-Ja?owiecka A, Kowalczyk K, Trybek P, Jarosz T, Radosz P, Setlak M, et al. In Search of New Therapeutics—Molecular Aspects of the PCOS Pathophysiology: Genetics, Hormones, Metabolism and Beyond. International Journal of Molecular Sciences 2020, Vol 21, Page 7054. 2020;21(19):7054.

Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Systematic Reviews. 2022;18(2):e1230.

BioRender. Scientific Image and Illustration Software. (Online) 2024 at from: https://www.biorender.com/. [cited 2024 Feb 9].

Khamoshina MB, Artemenko YS, Bayramova AA, Ryabova VA, Orazov MR. Polycystic ovary syndrome and obesity: a modern paradigm. RUDN Journal of Medicine. 2022;26(4):382–95.

Long X, Yang Q, Qian J, Yao H, Yan R, Cheng X, et al. Obesity modulates cell-cell interactions during ovarian folliculogenesis. iScience. 2022;25(1):103627.

Mirzohidovna HE. OBESITY AS A RISK FACTOR FOR RECURRENT POLYCYSTIC OVARY DISEASE. Asian journal of pharmaceutical and biological research. 2021;10(3).

Yang PK, Chou CH, Huang CC, Wen WF, Chen HF, Shun CT, et al. Obesity alters ovarian folliculogenesis through disrupted angiogenesis from increased IL-10 production. Mol Metab. 2021;49:101189.

Sartori C, Lazzeroni P, Merli S, Patianna VD, Viaroli F, Cirillo F, et al. From Placenta to Polycystic Ovarian Syndrome: The Role of Adipokines. Mediators Inflamm. 2016;2016.

Bongrani A, Mellouk N, Ramé C, Cornuau M, Guerif F, Froment P, et al. Vaspin, a novel adipokine in woman granulosa cells physiology and PCOS pathogenesis? J Endocrinol. 2021;249(1):57–70.

Lin K, Sun X, Wang X, Wang H, Chen X. Circulating Adipokine Levels in Nonobese Women With Polycystic Ovary Syndrome and in Nonobese Control Women: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021;11.

Barrea L, Muscogiuri G, Pugliese G, De Alteriis G, Colao A, Savastano S. Metabolically Healthy Obesity (MHO) vs. Metabolically Unhealthy Obesity (MUO) Phenotypes in PCOS: Association with Endocrine-Metabolic Profile, Adherence to the Mediterranean Diet, and Body Composition. Nutrients. 2021;13(3925):1–17.

Waniczek D, Jabczyk M, Nowak J, Jagielski P, Hudzik B, Kulik-Kupka K, et al. Metabolic Deregulations in Patients with Polycystic Ovary Syndrome. Metabolites. 2023;13(302):1–10.

Neubronner SA, Indran IR, Chan YH, Thu AWP, Yong EL. Effect of body mass index (BMI) on phenotypic features of polycystic ovary syndrome (PCOS) in Singapore women: a prospective cross-sectional study. BMC Womens Health. 2021;21(1):1–12.

Pirotta S, Joham A, Grieger JA, Tay CT, Bahri-Khomami M, Lujan M, et al. Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome. Semin Reprod Med. 2020;38(6):342–51.

Dini Mustari A, Rostini T, Rengga Indrati A, Bayuaji H, Rachmayati S, Kesehatan Kabupaten Bandung Barat D, et al. Correlation between Antral Follicles Count and Serum 25(OH)D Levels in Polycystic Ovary Patients. Majalah Kedokteran Bandung. 2018;50(4):222–9.

Vuong LN, Ho VNA, Ho TM, Dang VQ, Phung TH, Giang NH, et al. Effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilisation in women with high antral follicle count: Study protocol for a randomised controlled trial. BMJ Open. 2018;8(12).

Salehi R, Mazier HL, Nivet AL, Reunov AA, Lima P, Wang Q, et al. ovarian mitochondrial dynamics and cell fate regulation in an androgen-induced rat model of polycystic ovarian syndrome. Sci Rep. 2020;10(1):1021

Walters KA, Paris VR, Aflatounian A, Handelsman DJ. Androgens and ovarian function: Translation from basic discovery research to clinical impact. Journal of Endocrinology. 2019 Aug 1;242(2):R23–50.

Bahrah, Suryono, Widyawati M. Follicular Analysis Graafian Follicle Due To Giving Red Fruit Oil Extract. Advances in Health Sciences Research. 2019;15:61–5.

Gupta V, Mishra S, Mishra S, Gupta V. L:A ratio, Insulin resistance and metabolic risk in women with polycystic ovarian syndrome. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2017;11:S697–701.

Chen W, Pang Y. Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites. Metabolites. 2021;11(12).

Laven JSE. Follicle stimulating hormone receptor (FSHR) polymorphisms and polycystic ovary syndrome (PCOS). Front Endocrinol (Lausanne). 2019;10(FEB):418507.

Orisaka M, Miyazaki Y, Shirafuji A, Tamamura C, Tsuyoshi H, Tsang BK, et al. The role of pituitary gonadotropins and intraovarian regulators in follicle development: A mini-review. Reprod Med Biol. 2021;20(2):169–75.

Oduwole OO, Huhtaniemi IT, Misrahi M. The Roles of Luteinizing Hormone, Follicle-Stimulating Hormone and Testosterone in Spermatogenesis and Folliculogenesis Revisited. International Journal of Molecular Sciences. 2021;22(23):12735.

Kamada S, Yamamoto Y, Aoki H, Tamura K, Takeda A, Minato S, et al. A novel PCOS rat model and an evaluation of its reproductive, metabolic, and behavioral phenotypes. Reprod Med Biol. 2022 Jan 1;21(1).

Ali AT, Al-ani O, Al-ani F, Guidozzi F. Polycystic ovary syndrome and metabolic disorders: A review of the literature. Afr J Reprod Health. 2022;26(8):89–99.

Perovic Blagojevic IM, Vekic JZ, MacUt DP, Ignjatovic SD, Miljkovic-Trailovic MM, Zeljkovic AR, et al. Overweight and obesity in polycystic ovary syndrome: Association with inflammation, oxidative stress and dyslipidaemia. British Journal of Nutrition. 2022 Aug 28;128(4):604–12.

Placidi M, Di Emidio G, Virmani A, D’Alfonso A, Artini PG, D’Alessandro AM, et al. Carnitines as Mitochondrial Modulators of Oocyte and Embryo Bioenergetics. Antioxidants (Basel). 2022;11(4).

Popa Ilie IR, Herdean AM, Herdean AI, Georgescu CE. Lipidomic biomarkers in polycystic ovary syndrome: An overview. Ann Endocrinol (Paris). 2023 Feb 1;84(1):69–80.

Evans A, Hoeger KM. Polycystic ovary syndrome in adolescence: Toward a better diagnosis and treatment. Curr Opin Endocr Metab Res. 2020;2020:105–11.

Mumusoglu S, Okan Yildiz B. Polycystic ovary syndrome phenotypes and prevalence: Differential impact of diagnostic criteria and clinical versus unselected population. Endocrine and Metabolic Research. 2020;12:66–71.

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the different PCOS phenotypes based on clinical metabolic, and hormonal profile, and their response to clomiphene. Indian J Endocrinol Metab. 2019;23(3):326.

Shaaban Z, Khoradmehr A, Amiri-Yekta A, Shirazi MRJ, Tamadon A. Pathophysiologic mechanisms of obesity- and chronic inflammation-related genes in etiology of polycystic ovary syndrome. Iran J Basic Med Sci. 2019;22(12):1378.

Zhang Y, Che L, Zhang M, He J. Common cytokine polymorphisms and predisposition to polycystic ovary syndrome: A meta-analysis. Endocr J. 2020;67(5):561–7.

Gözüküçük M, Yarcl Gürsoy A, Destegül E, Ta?kln S, Satlro?lu H. Adiponectin and leptin levels in normal weight women with polycystic ovary syndrome. Horm Mol Biol Clin Investig. 2020;41(4).

Wo?odko K, Castillo?fernandez J, Kelsey G, Galvão A. Revisiting the impact of local leptin signaling in folliculogenesis and oocyte maturation in obese mothers. Int J Mol Sci. 2021;22(8).

Rudnicka E, Suchta K, Grymowicz M, Calik?ksepka A, Smolarczyk K, Duszewska AM, et al. Chronic low grade inflammation in pathogenesis of pcos. Int J Mol Sci. 2021 Apr 1;22(7).

Aboeldalyl S, James C, Seyam E, Ibrahim EM, Shawki HED, Amer S. The role of chronic inflammation in polycystic ovarian syndrome—a systematic review and meta-analysis. Int J Mol Sci. 2021 Mar 1;22(5):1–31.

Shan H, Luo R, Guo X, Li R, Ye Z, Peng T, et al. Abnormal Endometrial Receptivity and Oxidative Stress in Polycystic Ovary Syndrome. Front Pharmacol. 2022;13:904942.

Bacopoulou F, Kolias E, Efthymiou V, Antonopoulos CN, Charmandari E. Vitamin D predictors in polycystic ovary syndrome: a meta-analysis. Eur J Clin Invest. 2017;47(10):746–55.

Maysara AM, Nassar AT, Jubran HK. The effect of correction of serum level of vitamin D on hyperandrogenism in women with polycystic ovary syndrome and hypovitaminosis D. Clin Exp Obstet Gynecol. 2020;47(2):272–6.

Krul-Poel YHM, Koenders PP, Steegers-Theunissen RP, ten Boekel E, ter Wee MM, Louwers Y, et al. Vitamin D and metabolic disturbances in polycystic ovary syndrome (PCOS): A cross-sectional study. PLoS One. 2018;13(12).

Agrawal S, Chhatrapati Bisen A, Sanap SN, Biswas A, Choudhury D, Kumar Verma S, et al. LC-MS/MS based quantification of steroidal biomarkers in polycystic ovary syndrome induced rats. J Pharm Biomed Anal. 2023;234:115484.

Saadia Z. Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women. Medical Archives. 2020;74(4):289.

Lledó B, Ortiz JA, Hortal M, Cascales A, Morales R, Guerrero J, et al. FSH receptor genotype and its influence on the results of donor ovarian stimulation using corifollitropin alfa. Reprod Biomed Online. 2022;45(5):943–6.

Li Y, Fang L, Yan Y, Wang Z, Wu Z, Jia Q, et al. Association between human SHBG gene polymorphisms and risk of PCOS: a meta-analysis. Reprod Biomed Online. 2021;4(1):227–36.

Moolhuijsen LME, Visser JA. AMH in PCOS: Controlling the ovary, placenta, or brain? Curr Opin Endocr Metab Res. 2020 Jun 1;12:91–7.

Chen J, Katznelson L. The role of growth hormone for fertility in women with hypopituitarism. Growth Hormone & IGF Research. 2022;63:1096–6374.

Chappell NR, Gibbons WE, Blesson CS. Pathology of hyperandrogenemia in the oocyte of polycystic ovary syndrome. Steroids. 2022;180:108989.

Ozegowska K, Korman M, Szmyt A, Pawelczyk L. Heterogeneity of endocrinologic and metabolic parameters in reproductive age polycystic ovary syndrome (Pcos) women concerning the severity of hyperandrogenemia—a new insight on syndrome pathogenesis. Int J Environ Res Public Health. 2020;17(24):1–16.

Purwar A, Nagpure S. Insulin Resistance in Polycystic Ovarian Syndrome. Cureus. 2022;14(10).

Dabravolski SA, Nikiforov NG, Eid AH, Nedosugova L V., Starodubova A V., Popkova T V., et al. Mitochondrial Dysfunction and Chronic Inflammation in Polycystic Ovary Syndrome. Int J Mol Sci. 2021;22(8):22.

Pandey V, Singh A, Singh A, Krishna A, Pandey U, Tripathi YB. Role of oxidative stress and low-grade inflammation in letrozole-induced polycystic ovary syndrome in the rat. Reprod Biol. 2016;16(1):70–7.

Zangeneh FZ, Naghizadeh MM, Masoumi M. Polycystic ovary syndrome and circulating inflammatory markers. Int J Reprod Biomed. 2017;15(6):375.

Kanafchian M, Esmaeilzadeh S, Mahjoub S, Rahsepar M, Ghasemi M. Status of Serum Copper, Magnesium, and Total Antioxidant Capacity in Patients with Polycystic Ovary Syndrome. Biol Trace Elem Res. 2020;193(1):111–7.

Mizgier M, Jarz?bek-Bielecka G, Wendland N, Jod?owska-Siewert E, Nowicki M, Bro?ek A, et al. Relation between inflammation, oxidative stress, and macronutrient intakes in normal and excessive body weight adolescent girls with clinical features of polycystic ovary syndrome. Nutrients. 2021;13(3):1–16.

Li A, Zhang L, Jiang J, Yang N, Liu Y, Cai L, et al. Follicular hyperandrogenism and insulin resistance in polycystic ovary syndrome patients with normal circulating testosterone levels. The Journal of Biomedical Research. 2018;32(3):208–14.

Mishra P, Mittal P, Rani A, Bharti R, Agarwal V, Suri J. Adiponectin to Leptin Ratio and its Association with Insulin Resistance in Women with Polycystic Ovarian Syndrome. Indian J Endocrinol Metab. 2022;26(3):239.

Mohammad MB, Seghinsara AM. Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pac J Cancer Prev. 2017;18(1):17.

Sahmay S, Aydogan Mathyk B, Sofiyeva N, Atakul N, Azemi A, Erel T. Serum AMH levels and insulin resistance in women with PCOS. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018;224:159–64.

Ka?u?na M, Cz?apka-Matyasik M, Wachowiak-Ochma?ska K, Moczko J, Kaczmarek J, Janicki A, et al. Effect of central obesity and hyperandrogenism on selected inflammatory markers in patients with pcos: A whtr-matched case-control study. J Clin Med. 2020;9(9):1–17.

Kambale T, Sawaimul KD, Prakash S. A Study of Hormonal and Anthropometric Parameters in Polycystic Ovarian Syndrome. Ann Afr Med. 2023;22(1):112.

van der Ham K, Louwers Y V., Laven JSE. Cardiometabolic biomarkers in women with polycystic ovary syndrome. Fertil Steril. 2022;117(5):887–96.

Liu T, Liu D, Song X, Qu J, Zheng X, Li J, et al. Lipid Metabolism Was Associated With Oocyte in vitro Maturation in Women With Polycystic Ovarian Syndrome Undergoing Unstimulated Natural Cycle. Front Cell Dev Biol. 2021;9:719173.

Ka?u?na M, Czlapka-Matyasik M, Kompf P, Moczko J, Wachowiak-Ochma?ska K, Janicki A, et al. Lipid ratios and obesity indices are effective predictors of metabolic syndrome in women with polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2022;13.

Elkind-Hirsch KE, Chappell N, Shaler D, Storment J, Bellanger D. Liraglutide 3 mg on weight, body composition, and hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled-phase 3 study. Fertil Steril. 2022;118(2):371–81.

Lensen SF, Wilkinson J, Leijdekkers JA, La Marca A, Mol BWJ, Marjoribanks J, et al. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI). Cochrane Database of Systematic Reviews. 2018;2018(2).

Kheirollahi A, Teimouri M, Karimi M, Vatannejad A, Moradi N, Borumandnia N, et al. Evaluation of lipid ratios and triglyceride-glucose index as risk markers of insulin resistance in Iranian polycystic ovary syndrome women. Lipids Health Dis. 2020;19(1).

Mouanness M, Nava H, Dagher C, Merhi Z. Contribution of Advanced Glycation End Products to PCOS Key Elements: A Narrative Review. Nutrients 2022;14(17):3578.

Tatone C, Di Emidio G, Placidi M, Rossi G, Ruggieri S, Taccaliti C, et al. AGEs-related dysfunctions in PCOS: evidence from animal and clinical research. J Endocrinol. 2021;251(2):R1–9.

Li T, Zhang T, Cui T, Yang Y, Liu R, Chen Y, et al. Involvement of endogenous testosterone in hepatic steatosis in women with polycystic ovarian syndrome. Journal of Steroid Biochemistry and Molecular Biology. 2020;204:105752.

Luo X, Cai WY, Ma HL, Cong J, Chang H, Gao JS, et al. Associations of Serum Magnesium With Insulin Resistance and Testosterone in Women With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne). 2021;12.

Kelley AS, Puttabyatappa M, Ciarelli JN, Zeng L, Smith YR, Lieberman R, et al. Prenatal Testosterone Excess Disrupts Placental Function in a SheepModelof Polycystic Ovary Syndrome. Endocrinology (United States). 2019;160(11):2663–72.

Qu X, Donnelly R. Sex Hormone-Binding Globulin (SHBG) as an Early Biomarker and Therapeutic Target in Polycystic Ovary Syndrome. International Journal of Molecular Sciences. 2020;21(21):8191.

Karakas SE. New biomarkers for diagnosis and management of polycystic ovary syndrome. Clinica Chimica Acta. 2017;471:248–53.

Murat Altinkilic E, Du Toit T, Sakin O, Attar R, Groessl M, Flück CE. The serum steroid signature of PCOS hints at the involvement of novel pathways for excess androgen biosynthesis. Journal of Steroid Biochemistry and Molecular Biology. 2023;233:106366.

Dewailly D, Robin G, Peigne M, Decanter C, Pigny P, Catteau-Jonard S. Interactions between androgens, FSH, anti-mullerian hormone and estradiol during folliculogenesis in the human normal and polycystic ovary. Médecine de la Reproduction. 2019;21(2):145–63.

Muharam R, Purba JS, Hestiantoro A, Elvira SD. Profile on personality types and cortisol in polycystic ovarian syndrome. Middle East Fertil Soc J . 2018;23:189–94.

Vitale SG, Riemma G, Cianci A. Antimüllerian hormone in polycystic ovarian syndrome: from a key role in the pathogenesis to a sentinel for pre-term birth prediction. Fertil Steril. 2020;113(2):335–6.

Zhou S, Lu D, Wen S, Sheng Y, Kang D, Xu L. Elevated Anti-Müllerian Hormone Levels in Newborns of Women with Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis Based on Observational Studies. Reproductive Sciences. 2022 Jan 1;29(1):301–11.

Wiweko B, Susanto C. The Effect of Metformin and Cinnamon on Serum Anti-Mullerian Hormone in Women Having PCOS: A Double-Blind, Randomized, Controlled Trial. J Hum Reprod Sci. 2017;10(1):31.

Wiweko B, Indra I, Susanto C, Natadisastra M, Hestiantoro A. The correlation between serum AMH and HOMA-IR among PCOS phenotypes. BMC Res Notes. 2018;11(1):1–6. Available from:

Kurniati M, Suryandari DA, Wiweko B, Sari P, Yunaini L, Panghiyangani R. HUBUNGAN KADAR SERUM AMH DENGAN JUMLAH MUTASI PADA GEN PROMOTER AMH (ANTI-MULLERIAN HORMONE) PADA PASIEN SOPK (SINDROM OVARIUM POLIKISTIK). Jurnal Ilmu Kedokteran dan Kesehatan. 2022;9(1):2549–4864.

Teede H, Misso M, Tassone EC, Dewailly D, Ng EH, Azziz R, et al. Anti-Müllerian Hormone in PCOS: A Review Informing International Guidelines. Trends in Endocrinology and Metabolism. 2019;30(7):467–78.

Mumford SL, Legro RS, Diamond MP, Coutifaris C, Steiner AZ, Schlaff WD, et al. Baseline AMH level associated with ovulation following ovulation induction in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 2016;101(9):3288–96.

Tsukui Y, Kitahara Y, Hasegawa Y, Kobayashi M, Osuka S, Iwase A. Anti-Müllerian hormone levels in the diagnosis of adolescent polycystic ovarian syndrome: a systematic review and meta-analysis. Endocr J. 2022;69(8):897–906.

Monieum A, Zakaria M, Osama A, Kamal A, Sheashea MA. Anti-Mullerian Hormone as A new Marker for Diagnosis of Poly Cystic Ovary Syndrome. Egypt J Hosp Med . 2019;77(3):5096–100.

Kurniawati EY, Hadisaputro S, Suwandono A. The Effect of Holistic Programs on Cortisol Serum Levels in Polycistic Ovarium Syndrome. Indonesian Journal of Medicine. 2019;4(4):376–82.

Siahaan SCPT, Santoso B, Widjiati. Effectiveness of Moringa oleifera Leaves on TNF-? Expression, Insulin Levels, Glucose Levels and Follicle Count in Rattus norvegicus PCOS Model. Diabetes, Metabolic Syndrome and Obesity. 2022;15:3255–70.

Lang Q, Yidong X, Xueguang Z, Sixian W, Wenming X, Tao Z. ETA-mediated anti-TNF-? therapy ameliorates the phenotype of PCOS model induced by letrozole. PLoS One. 2019;14(6).

Chugh RM, Park H soo, El Andaloussi A, Elsharoud A, Esfandyari S, Ulin M, et al. Mesenchymal stem cell therapy ameliorates metabolic dysfunction and restores fertility in a PCOS mouse model through interleukin-10. Stem Cell Res Ther. 2021 Dec 1;12(1).

Durmu? M, Uzunlar Ö, Çelik H, Çandar T. Does alpha-1-acid glycoprotein determine for infertility in polycystic ovary syndrome? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2022;274:155–9.

Li Y, Zheng Q, Sun D, Cui X, Chen S, Bulbul A, et al. Dehydroepiandrosterone stimulates inflammation and impairs ovarian functions of polycystic ovary syndrome. J Cell Physiol. 2019 May 1;234(5):7435–47.




DOI: https://doi.org/10.32502/sm.v15i1.7829

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