Role of hyperhomocysteinemia in the pathogenesis of polycystic ovary syndrome

Abstract

Background:  Polycystic  ovary  syndrome  is  the  reason  not  only  of  infertility  but  also  the  one  of  the  most  important  risk  factors  of   miscarriage.

Until  recent  period  hyperinsulinemia  and  hyperandrogenemia  were  considered  in  the  pathogenesis  of  polycystic  ovary  syndrome,  but  in  recent  years,  the  studies  have  been  reported  that  miscarriage  in  patients  with  polycystic  ovary  syndrome  can  be  associated  with  hyperhomocysteinemia.  Therefore,  hyperhomocysteinemia  may  be  considered  as  one  of  the  newly  identified  characteristics  of   polycystic  ovary  syndrome.

Nowadays  the  matter  of  interest  is  to  determine  associations  between  hyperhomocysteinemia  and  metabolic  syndrome  and  their  contribution  in  the  processes  of  ovulation,  conception,  pregnancy,  pregnancy  loss  and  live  birth  in  infertile  women  with  polycystic  ovary  syndrome.  This  data  may  give  possibility  to  predict  reduction  in  the  ovulation  rate  and  determination  of  the  prognosis  of  miscarriages  in  women  with  polycystic  ovary  syndrome  based  on  elevated  homocysteine  levels.

Aim  of  the  study:  We  aimed  to  observe  literature  data   to  review  the  current  understanding  of  the  role  of  hyperhomocysteinemia  in  the  pathogenesis  of  polycystic  ovary  syndrome  and  analyse  of   modern  management  of  polycystic  ovary  syndrome.

Materials  and  methods:  For  this  purpose  following  electronic  databases  were  searched:  Pubmed,  Medline,  Cochrane Library,  Web of Science,  EMBASE,   Europe  PMC,  Science  Direct,  NCBI,  Semantic  Scholar,  Natonal  Library  of  Medicine,  Springer.

Results:  129  article  was  reviewed,  70  of  them  attracted  our  attention  by  their  statistical  significance  and  were  analysed  and  discussed  in  our  article.

Conclusion:  Obtained  controversial  results  do  not  allow  specifying  the  role  of  hyperhomocysteinemia  in  the  pathogenesis  of  polycystic  ovary  syndrome. That means the research in this direction should be continued  because  understanding  the  mechanisms  of  pathogenesis  of  polycystic  ovary  syndrome,  is  very  important  for  effective  management.

Keywords: polycystic ovary syndrome; PCOS, homocysteine, hyperhomocysteinemia, MTHFR