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PCOS by Rotterdam criteria is defined by the presence of at least two of the following: oligomenorrhea, hyperandrogenism and polycystic ovaries. Although not required for diagnosis, PCOS often has metabolic manifestations, particularly insulin resistance. In studies of non-PCOS populations, it appears a nexus may exist between insulin resistance and neuropsychological outcomes, such as cognitive performance (particularly executive function skills), cognitive aging, and depression. Cognitive performance, such as verbal and spatial skills, may also be impacted by gonadal hormones. It is therefore surprising that the relationship between PCOS and neuropsychological outcomes has been only minimally investigated. This study was therefore designed to measure and compare cognition in Rotterdam-PCOS subjects with and without hyperandrogenism and to test the hypothesis that executive function performance (cognitive control, verbal fluency and working memory) is lower in those with hyperandrogenism. Methods Forty-eight sequential subjects with PCOS were recruited from a multi-disciplinary PCOS clinic. Those with clinical/biochemical hyperandrogenism (in addition to oligomenorrhea/polycystic ovaries) were designed "NIH-PCOS" (n=35); while those without hyperandrogenism (only oligomenorrhea and polycystic ovaries) were designated "non-androgenic PCOS" (n=13). Neuropsychological test administration and scoring were performed by trained personnel. Verbal and perceptual reasoning were measured with Wechsler Adult Intelligence Scale (WAIS); memory was measured by California Verbal Learning Trials (long delay recall), and processing speed by WAIS symbol search. Executive functions were measured with Delis-Kaplan System: Stroop and Trail Making (cognitive control); Design and Verbal Fluency (generativity); WAIS: Digit Span (working memory); and Weschler Memory Scale: Symbol Span (working memory). Sample-based z-scores were calculated for cognitive outcomes. We compared z-scores using linear regressions, adjusting for age, race, and years of education. A composite executive function score was calculated as the mean z-score on all six executive function tests. Results Groups were similar for age and BMI, but NIH-PCOS showed greater mean (SD) Homa-IR (4.2 (6.1) vs. 1.82 (1.9); p=.06), compared to non-androgenic PCOS. Cognitive performance was similar for measures of "pre-morbid" IQ, including verbal and perceptual reasoning, memory and processing speed. However, subjects with NIH-PCOS demonstrated lower relative performance for executive functions (β-coefficient for executive function composite z-score: -0.44, 95% CI: -0.79, -0.09; p=0.016). Subdomains showing decreased performance (β-coefficient) included verbal fluency (-0.62; p=.04), working memory (-0.75; p=.04) and cognitive control (-0.53; p=.05). We additionally assessed cognitive performance in relation to insulin resistance (Homa >2.1). Considering non-androgenic PCOS without insulin resistance as referent, NIH-PCOS subjects with insulin resistance showed the lowest performance on the executive function composite score, followed by those with NIH-PCOS without insulin resistance (p-trend = .001). Conclusion People with hyperandrogenic PCOS may experience challenges in executive functioning compared to non-androgenic counterparts. Additional research is needed to confirm findings in larger cohorts and to investigate the role of modifiable factors. Presentation: Sunday, June 12, 2022 12:00 p.m. - 12:15 p.m.

To quantify the level of decision regret in women ≥42 years of age after autologous in vitro fertilization (IVF) and identify factors associated with moderate-to-severe regret.Cross-sectional survey.Academic center.Ninety-four women ≥42 years of age who underwent autologous IVF between 2012 and 2018.None.Decision regret score, with25 as threshold for moderate-to-severe regret.The overall response rate was 22%. Respondents had a median age of 43 years at the time of IVF. The median and mean decision regret scores were 10 and 17.1 (range, 0-75), respectively. Seventy-three percent (n = 69) had absent-to-mild regret (score, 0-25), and 27% (n = 25) had moderate-to-severe regret (score,25) after IVF. Having no live births was associated with increased regret (odds ratio [OR], 22 [95% confidence interval {CI}, 2.82-171.82]). Among those who were unsuccessful, 40% (n = 24) had moderate-to-severe regret. Predictors for moderate-to-severe regret in this group included the lack of insurance coverage (OR, 0.33 [95% CI, 0.12-0.99]). Conversely, the perceived adequacy of information/counseling (OR, 0.44 [95% CI, 0.2-0.77]) and the perceived adequacy of emotional support (OR, 0.29 [95% CI, 0.15-0.55]) were protective factors inversely correlated with regret.Autologous IVF carries a low success rate and a considerable risk of decision regret in women ≥42 years of age. In those who were unsuccessful, the perceived adequacy of information and that of emotional support were protective factors against increased regret. Although concluding from a small, selected pool, our results strongly suggest that ample counseling and psychological support should be particularly emphasized within this patient population.

Background: In this manuscript, we review the various criteria used to diagnosis PCOS, and discuss how the specific diagnostic criteria used can impact recruitment for PCOS studies. PCOS is a common diagnosis, but with a number of differing definitions. We were interested in addressing these differing stringencies and application in clinical trial, such as our group’s PCOS diet study.Methods: For our study on the effects of diets to alter insulin resistance, we adopted the one using more stringent criteria, consisting of biochemical abnormalities, menstrual abnormalities, insulin resistance and abnormal ovarian size and structure. Our study actively recruits from PCOS clinics in the Bay Area. We reported number of women successfully recruited using our PCOS diagnosis stringency, and how these numbers differ from women referred to PCOS clinics in the Bay Area. We also report the reasons patients did not fit our diagnosis criteria to shed insight into how diagnosis differ between healthcare professionals.Results: To our surprise, the vast majority of subjects seen in the tertiary referral PCOS center at UCSF did not qualify for the study.Conclusion: The definition of PCOS may be important in study design, and can impact the ability to recruit for the study.Trial registration: Date of registration: June 20, 2014, NIH ClinicalTrials.gov identifier: NCT02190097

Background: In this manuscript, we review the various criteria used to diagnosis PCOS, and discuss how the specific diagnostic criteria used can impact recruitment for PCOS studies. PCOS is a common diagnosis, but with a number of differing definitions. We were interested in addressing these differing stringencies and application in clinical trial, such as our group’s PCOS diet study. Methods: For our study on the effects of diets to alter insulin resistance, we adopted the one using more stringent criteria, consisting of biochemical abnormalities, menstrual abnormalities, insulin resistance and abnormal ovarian size and structure. Our study actively recruits from PCOS clinics in the Bay Area. We reported number of women successfully recruited using our PCOS diagnosis stringency, and how these numbers differ from women referred to PCOS clinics in the Bay Area. We also report the reasons patients did not fit our diagnosis criteria to shed insight into how diagnosis differ between healthcare professionals. Results: To our surprise, the vast majority of subjects seen in the tertiary referral PCOS center at UCSF did not qualify for the study. Conclusion: The definition of PCOS may be important in study design, and can impact the ability to recruit for the study.

Polycystic ovary syndrome (PCOS) is an endocrine syndrome with variable phenotypic expression and important systemic associations and sequelae, including obesity, insulin resistance, infertility, risk of endometrial cancer, and possible risk of cardiovascular events. PCOS is recognized as a condition influenced by genetic and environmental factors and distinct manifestations in all stages of life, including the prenatal period, childhood, adolescence, and adulthood. Identification of this disorder in childhood and adolescence has received growing attention, in part because of emerging evidence of the benefit of early intervention, but the diagnosis and management of PCOS in children and adolescents can be challenging. Diagnostic and therapeutic considerations of PCOS in children are reviewed to enhance identification and evaluation of patients suspected of having this disorder. When a diagnosis of PCOS is suspected in a child but cannot be confirmed, a provisional diagnosis is strongly recommended so as to prompt ongoing monitoring with an emphasis on important early interventions such as obesity reduction.

Viruses and fetuses face similar immunologic challenges. Each must evade immune detection and destruction. The virus must avoid host recognition of intracellular infection; the fetus allogenic recognition. Each has manipulated the process of antigen presentation to allow survival in an immunologic environment otherwise predictably hostile. How have these approaches co-evolved? What can they teach us about viral pathogenesis and immunologic interactions at the maternal-fetal interface?Review of relevant literature.Special classical and non-classical MHC class I products are spared from downregulation in the placenta and from viral immunoevasive strategies.Viruses rely upon some of the same strategies to avoid immune detection as do trophoblast cells. In the future, viral infections may prove a useful tool for studies of immunology at the maternal-fetal interface.