Polycystic ovary syndrome and adverse pregnancy outcomes: potential role of decidual function

Review

The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.">Lisha Li, Hanting Ge, The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.">Jing Zhou, The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.">Jing Wang, The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.">Ling Wang

Author information

Lisha Li
Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.
Hanting Ge
Reproductive Medicine Center, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China.
Jing Zhou
Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.
Jing Wang
Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.
Ling Wang
Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
The Academy of Integrative Medicine of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China.

Keywords: polycystic ovary syndrome, decidualization, adverse pregnancy outcomes, insulin resistance, inflammation

JOURNAL FREE ACCESS

2023 Volume 17 Issue 6 Pages 378-388

DOI https://doi.org/10.5582/ddt.2023.01096

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Details

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting fertility and mental health among women of reproductive age. In addition to anovulation and hyperandrogenism, patients also experience metabolic issues, such as insulin resistance, obesity, and dyslipidemia, as well as chronic low-grade inflammation throughout the body. Recent studies have shown that even with assisted reproductive technology to treat anovulatory issues, patients with PCOS still have higher rates of adverse pregnancy outcomes and abortion compared to normal pregnancies. These findings suggest that PCOS may impair the endometrium and disrupt the onset and maintenance of healthy pregnancies. Decidualization is a crucial step in the process of healthy pregnancy, during which endometrial stromal cells (ESCs) differentiate into secretory decidual stromal cells (DSCs) regulated by hormones and local metabolism. This article comprehensively reviews the pathological processes of PCOS and the mechanisms involved in its impaired decidualization. In addition, we explore how PCOS increases the incidence of adverse pregnancy outcomes (APO). By gaining a better understanding of the adverse effects of PCOS on pregnancy and its specific mechanisms, we hope to provide a theoretical basis for reducing APO and improving the live birth rate among women with PCOS.

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