Tag Archives: infertility

Polycystic ovary syndrome and infertility: A narrative review of diagnostic and therapeutic approaches

Adelina-Georgiana Vârciu1,2

1. Bistrița County Emergency Hospital, Bistrița, Romania
2. Platinia Medical Center, Bistrița, Romania

DOI: 10.2478/amma-2025-0050

Objective: To synthesize current evidence on mechanisms, diagnostic evaluation, and treatment of infertility in PCOS, with emphasis on phenotype-specific implications and integrative management.
Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science from January 2015 to March 2024. Search terms included “PCOS,” “infertility,” “phenotype,” “letrozole,” “metformin,” “gonadotropins,” and “ART.” Eligible studies involved human females aged 18–45 years, written in English, and focused on PCOS-related infertility. Randomized trials, meta-analyses, and international guidelines were critically assessed for methodological rigor and clinical relevance.
Results: PCOS accounts for 70–80% of anovulatory infertility, with marked variability across phenotypes. Phenotype A, combining hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology, carries the greatest reproductive and metabolic burden. Biomarkers such as AMH, testosterone, DHEAS, fasting insulin, and HOMA-IR improve risk stratification. Lifestyle modification restores ovulation in up to 60% of overweight patients. Letrozole is superior to clomiphene, while gonadotropins and ART are effective in resistant cases. Metformin enhances ovulatory and pregnancy outcomes in insulin-resistant women. IVF protocols using antagonists and agonist triggers improve safety by reducing ovarian hyperstimulation syndrome. Psychological comorbidities, particularly anxiety and depression, are frequent and negatively affect fertility outcomes.
Conclusion: PCOS-related infertility requires a personalized, multidisciplinary approach. Integration of phenotype-based assessment, biomarker evaluation, lifestyle intervention, and tailored reproductive strategies optimizes outcomes. Addressing metabolic and psychological dimensions further improves reproductive success and long-term health.

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Histological patterns of testicular biopsy in patients with azoospermia: single-institution experience

Nina Čamdžić1, Višnja Muzika2, Samra Čustović2, Mirsad Babić1, Mirsad Dorić1, Edina Lazović Salčin1, Suada Kuskunović-Vlahovljak1

1. Department of Pathology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
2. Department of Histology and Embryology, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2023-0038

Objective of this study was to identify the histopathological patterns and their frequency in testicular biopsy specimens from azoospermic patients and to categorize it according to Modified Johnsen scoring system.
Methods: Testicular biopsies from male patients with clinical diagnosis of azoospermia were included in this study. All tissue samples were fixed in buffered 10% formalin, routinely processed and stained with Hematoxylin and Eosin. All cases were examined microscopically and categorized according to the histopathological patterns and Modified Johnsen scoring system.
Results: Total 219 cases of testicular biopsies from 125 azoospermic male patients were evaluated, with 94 cases of bilateral testicular biopsy. The most prevalent age group was of 30-39 years (66.2%). The most common histological pattern was of Sertoli cell only syndrome (58.4%) while the least represented pattern was germ cell maturation arrest, seen in 4.6% cases. The most common Modified Johnsen score was 2 (66.7%). There was discordance in histologic pattern in both testes in 12.76% of patients who had bilateral testicular biopsy.
Conclusion: Our study gives an insight on the most common histopathological patterns of azoospermic patients and emphasizes the need for a better national statistics and epidemiological studies of this entity. It also points out the significance of the bilateral testicular biopsy, as both, diagnostic and therapeutic procedure.

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Statistical Study of Pathology Associated to Urethral Infection with Ureaplasma urealyticum and Mycoplasma hominis

Chiujdea Natalia-Simona1, Tilinca Mariana2, Chiujdea A3

1 County Emergency Clinical Hospital Tîrgu Mureş, Clinic of Gynecology II, Laboratory
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Cell Biology
3 County Emergency Clinical Hospital Tîrgu Mureş, Clinic of Urology

Introduction: Ureaplasma urealyticum and Mycoplasma hominis are present as part of the normal flora of the urethra, but in some conditions of multiplication they can cause infections of the prostate or sterility.
Material and method: Two-hundred-fifty patients were tested in the laboratory under the proposed criteria of selection.The Stamey test was done for the differential diagnosis of chronic prostatitis. The harvesting was done with Dacron swab, which was then placed in a transport medium. We used the Mycofast Duo kit for the identification and quantification of Mycoplasmas, as well as for the testing of antibiotic susceptibility.
Results: Of the 43 positive cases, 15 presented only Ureaplasma and 28 presented both bacterias. Mycoplasmas were found in 8.57% of urethritis cases and 10.25% of prostatitis cases. 33.33% of patients with a diagnosis of infertility had a positive Mycoplasma test. 23.6% of cases were associated with Gram positive or Gram negative infections and 2 with Chlamydia trachomatis.
Discussions: The incidence of Ureaplasma urealyticum has been reported to be between 9% and 42% in the literature. It is noted this bacteria has a good sensitivity to the new macrolides, josamycine, pristamycine and roxithromycine. However, Doxycycline is still on the first place, azithromycin on the 4th place, and fluoroquinolones have the lowest sensitivity of all.
Conclusions: Our results suggest that infertility in men is significantly associated with the presence of the studied Mycoplasmas. The treatment of urogenital inflammatory disease would require the corroboration of all the results from the Stamey test, stained microscopic examination, testing for Gram positive and negative bacteria – Chlamydia trachomatis and urogenital Mycoplasmas, and an antibiotic or a combination of targeted antibiotics for each pathological strain detected.

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