In Search of New Therapeutics—Molecular Aspects of the PCOS Pathophysiology: Genetics, Hormones, Metabolism and Beyond

In a healthy female reproductive system, a subtle hormonal and metabolic dance leads to repetitive cyclic changes in the ovaries and uterus, which make an effective ovulation and potential implantation of an embryo possible. However, that is not so in the case of polycystic ovary syndrome (PCOS), in which case the central mechanism responsible for entraining hormonal and metabolic rhythms during the menstrual cycle is notably disrupted. In this review we provide a detailed description of the possible scenario of PCOS pathogenesis. We begin from the analysis of how a set of genetic disorders related to PCOS leads to particular malfunctions at a molecular level (e.g., increased enzyme activities of cytochrome P450 (CYP) type 17A1 (17a-hydroxylase), 3b-HSD type II and CYP type 11A1 (side-chain cleavage enzyme) in theca cells, or changes in the expression of aquaporins in granulosa cells) and discuss further cellular- and tissue-level consequences (e.g., anovulation, elevated levels of the advanced glycation end products in ovaries), which in turn lead to the observed subsequent systemic symptoms. Since gene-editing therapy is currently out of reach, herein special emphasis is placed on discussing what kinds of drug targets and which potentially active substances seem promising for an effective medication, acting on the primary causes of PCOS on a molecular level

Gluten-free diet — remedy for infertility or dangerous trend?

Association between celiac disease (CD) and infertility has been a point of consideration for many years. There are lots of studies which present contradictory results. It is accepted that women with unexplained infertility have three times higher risk of CD compared to the healthy women. This finding leads to the conclusion that a gluten-free diet (GFD), as the only effective method of treatment CD, is important to improve fertility. It is observed that women diagnosed with CD and treated by GFD, have positive pregnancy outcomes including better effects of assisted reproductive technology (ART). Excluding gluten from diet by women without CD diagnosis could bring adverse outcomes, because the risk of malnutrition if diet is unbalanced. On the other hand, some research show that not only GFD but CD is related to malnutrition which could be the cause of problems with getting pregnant or with termination of pregnancy. Regarding CD influence on women's reproductive system, it is not only connected with unexplained infertility and adverse pregnancy outcomes, but also with delayed menarche, early menopause and decrease of anti-Müllerian hormone (AMH). What is more, non-celiac wheat sensitivity affects the reproductive system by increasing risk of menstrual disorders too. The main aim of this paper is presenting scientific facts about the link between gluten elimination and fertility. It is very important to provide patients with reliable fact-checked information in the context of their symptoms