IMPACTOS FISIOPATOLÓGICOS DA SÍNDROME DOS OVÁRIOS POLICÍSTICOS NA INFERTILIDADE FEMININA
Resumo
A Síndrome do Ovário Policístico (SOP) é uma das principais endocrinopatias associadas à infertilidade feminina, principalmente devido às alterações ovulatórias características da síndrome. Entretanto, evidências recentes demonstram que seus impactos ultrapassam a anovulação, envolvendo alterações metabólicas, hormonais e inflamatórias que comprometem diferentes etapas da função reprodutiva. O presente estudo teve como objetivo analisar os mecanismos fisiopatológicos relacionados à infertilidade em mulheres com SOP, além de discutir aspectos clínicos e terapêuticos associados à síndrome. Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados PubMed, SciELO e LILACS, incluindo artigos publicados entre 2016 e 2025. Após aplicação dos critérios de elegibilidade e das etapas metodológicas baseadas no PRISMA 2020, foram selecionados 22 estudos científicos para análise. A seleção dos artigos ocorreu a partir da leitura dos títulos, resumos e textos completos, considerando estudos relacionados à fisiopatologia da SOP e sua associação com infertilidade feminina. Os estudos foram analisados em categorias temáticas relacionadas à resistência à insulina, hiperandrogenismo, alterações no eixo hipotálamo-hipófise-ovariano, inflamação sistêmica, qualidade oocitária, receptividade endometrial e estratégias terapêuticas. Os resultados evidenciaram associação significativa entre SOP e alterações metabólicas e hormonais que interferem diretamente na fertilidade feminina. Além disso, observaram-se benefícios de abordagens terapêuticas individualizadas, incluindo mudanças no estilo de vida, uso de letrozol, metformina e técnicas de reprodução assistida. Conclui-se que a infertilidade relacionada à SOP possui caráter multifatorial e requer abordagem multidisciplinar e individualizada.
Referências
AZZIZ, Ricardo et al. Polycystic ovary syndrome. Nature Reviews Disease Primers, London, v. 2, p. 1–18, 2016 DOI: https://doi.org/10.1038/nrdp.2016.57 DOI: https://doi.org/10.1038/nrdp.2016.57
ESCOBAR-MORREALE, Héctor F. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, London, v. 14, n. 5, p. 270–284, 2018 DOI: https://doi.org/10.1038/nrendo.2018.24 DOI: https://doi.org/10.1038/nrendo.2018.24
ESCUDERO, Elena et al. Neuroendocrine dysfunction in polycystic ovary syndrome. Frontiers in Endocrinology, Lausanne, v. 11, p. 1–12, 2020 DOI: https://doi.org/10.3389/fendo.2020.00345 DOI: https://doi.org/10.3389/fendo.2020.00345
FITZ, Victoria et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. Journal of Clinical Endocrinology & Metabolism, Oxford, v. 109, n. 6, p. 1630–1655, 2024 DOI: https://doi.org/10.1210/clinem/dgae124 DOI: https://doi.org/10.1210/clinem/dgae588
GLINTBORG, Dorte; ANDERSEN, Marianne. Management of endocrine disease: morbidity in polycystic ovary syndrome. European Journal of Endocrinology, Bristol, v. 176, n. 2, p. R53–R65, 2017 DOI: https://doi.org/10.1530/EJE-16-0836 DOI: https://doi.org/10.1530/EJE-16-0373
HAN, Ya et al. Dietary supplements in polycystic ovary syndrome: current evidence. Frontiers in Endocrinology, Lausanne, v. 15, p. 1–12, 2024 DOI: https://doi.org/10.3389/fendo.2024.1369322 DOI: https://doi.org/10.3389/fendo.2024.1456571
KATYAL, Gitika et al. Systematic review of the roles of inositol and vitamin D in improving fertility among patients with polycystic ovary syndrome. Clinical and Experimental Reproductive Medicine, Seoul, v. 51, n. 3, p. 181–191, 2024 DOI: https://doi.org/10.5653/cerm.2023.06245 DOI: https://doi.org/10.5653/cerm.2023.06485
KOTLYAR, Alexander M.; SEIFER, David B. Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes. Reproductive Biology and Endocrinology, London, v. 21, n. 70, p. 1–18, 2023 DOI: https://doi.org/10.1186/s12958-023-01118-4 DOI: https://doi.org/10.1186/s12958-023-01120-7
MCCARTNEY, Christopher R.; MARSHALL, John C. Polycystic ovary syndrome. New England Journal of Medicine, Boston, v. 375, n. 1, p. 54–64, 2016 DOI: https://doi.org/10.1056/NEJMra1414837 DOI: https://doi.org/10.1056/NEJMcp1514916
MOGHETTI, Paolo; TOSI, Flavia. Insulin resistance and PCOS: chicken or egg? Journal of Endocrinological Investigation, Rome, v. 44, n. 2, p. 233–244, 2021 DOI: https://doi.org/10.1007/s40618-020-01351-0 DOI: https://doi.org/10.1007/s40618-020-01351-0
NEVEN, Anne C. H. et al. Endocrine and metabolic disorders in women with PCOS. Best Practice & Research Clinical Obstetrics & Gynaecology, Amsterdam, v. 48, p. 5–15, 2018 DOI: https://doi.org/10.1016/j.bpobgyn.2017.08.018
PAGE, Matthew J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, London, v. 372, n. 71, p. 1–9, 2021 DOI: https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
PASQUALI, Renato et al. Obesity and reproductive disorders in women. Human Reproduction Update, Oxford, v. 22, n. 5, p. 1–20, 2016 DOI: https://doi.org/10.1093/humupd/dmw019 DOI: https://doi.org/10.1093/humupd/dmw019
ROSENFIELD, Robert L.; EHRMANN, David A. The pathogenesis of polycystic ovary syndrome. Nature Reviews Endocrinology, London, v. 12, n. 5, p. 270–284, 2016 DOI: https://doi.org/10.1038/nrendo.2016.27 DOI: https://doi.org/10.1038/nrendo.2016.27
SHARMA, Shruti et al. Oxidative stress and polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive Biology and Endocrinology, London, v. 19, n. 1, p. 1–15, 2021 DOI: https://doi.org/10.1186/s12958-021-00729-y DOI: https://doi.org/10.1186/s12958-020-00687-9
SKIBA, Magdalena A. et al. Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update, Oxford, v. 24, n. 6, p. 694–709, 2018 DOI: https://doi.org/10.1093/humupd/dmy022 DOI: https://doi.org/10.1093/humupd/dmy022
SNYDER, Hannah. Literature review as a research methodology: an overview and guidelines. Journal of Business Research, Amsterdam, v. 104, p. 333–339, 2019 DOI: https://doi.org/10.1016/j.jbusres.2019.07.039 DOI: https://doi.org/10.1016/j.jbusres.2019.07.039
TEEDE, Helena J. et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023. Human Reproduction, Oxford, v. 38, n. 9, p. 1607–1643, 2023 DOI: https://doi.org/10.1093/humrep/dead186 DOI: https://doi.org/10.1093/humrep/dead186
TORRACO, Richard J. Writing integrative literature reviews: using the past and present to explore the future. Human Resource Development Review, Thousand Oaks, v. 15, n. 4, p. 404–428, 2016 DOI: https://doi.org/10.1177/1534484316671606 DOI: https://doi.org/10.1177/1534484316671606
WALTERS, Kimberly A. et al. New perspectives on the pathogenesis of PCOS: neuroendocrine origins. Trends in Endocrinology & Metabolism, Amsterdam, v. 29, n. 12, p. 841–852, 2018 DOI: https://doi.org/10.1016/j.tem.2018.08.005 DOI: https://doi.org/10.1016/j.tem.2018.08.005
WITCHEL, Selma F. et al. The diagnosis and treatment of polycystic ovary syndrome in adolescents. Pediatrics, Springfield, v. 145, n. 6, p. 1–18, 2019 DOI: https://doi.org/10.1542/peds.2019-2056
ZHANG, Y. et al. Advances in the study of the correlation between insulin resistance and infertility. Frontiers in Endocrinology, Lausanne, v. 13, p. 1–14, 2022 DOI: https://doi.org/10.3389/fendo.2022.1067228
