This issue’s Views and Reviews series furthers our understanding of the phenotyping and the environmental, genetic, and evolutionary determinants of polycystic ovary syndrome, assisting in elucidating the fundamental etiologies underlying this common and pervasive syndrome.

The authors review the evolution of the criteria used to diagnosis polycystic ovary syndrome, the prevalence of the disorder, the distribution of polycystic ovary syndrome phenotypes, their morbidity, and the role that referral bias plays in the epidemiology of this syndrome.

This paper reviews the current research on the role of environmental factors in the development and progression of polycystic ovary syndrome, including toxins, diet, socioeconomic status, and geography.

High-throughput disease gene mapping has identified 16 susceptibility loci for polycystic ovary syndrome and functional analysis to understand how these genes act in disease pathways will help to illuminate the pathophysiology of polycystic ovary syndrome.

Although polycystic ovary syndrome is the most common cause of anovulatory infertility, its high prevalence is an evolutionary paradox. In this article the potential explanations for this enigma are explored.

Polycystic ovary syndrome (PCOS) is a prehistoric evolutionary paradox. Although there are claims that PCOS has undergone positive selection, it is more likely that nonadaptive evolutionary mechanisms have driven its persistence across time.

Inklings

Male relatives of women with polycystic ovary syndrome have a distinct reproductive phenotype. We report novel features of this phenotype including elevated antimullerian hormone, luteinizing hormone, and follicle-stimulating hormone levels.

This document defines embryo donation and distinguishes between embryo donation and adoption.

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Reflections

Reflections

50 Years Ago Today

In a cohort of 214 patients with testicular cancer, larger tumors were associated with lower rates of spermatozoa in the cancerous testis. Importantly, 58% of patients with azoospermia and cryptozoospermia had spermatozoa in their histologic sections.

Preimplantation genetic screening performed in fresh in vitro fertilization cycles during 2011–2012 decreased chances of live birth for most patients. Older women observed small improvements, which are likely consequence of favorable patient selection biases.

Elective single-embryo transfer (eSET) is more likely with infertility treatment insurance coverage, and specific demographic and reproductive characteristics. Term non–low birth weight singleton live birth is most likely with eSET.

Tubal infertility is the main risk factor for ectopic pregnancy in assisted reproductive technology.

Although we observed a small improvement in live birth/ongoing pregnancy and clinical PRs, the evidence is of very low quality and the best interpretation is that we are still very uncertain about differences in this comparison.

Blastocyst biopsy and vitrification were associated with a higher incidence of gestational hypertension but better neonatal outcomes compared with cleavage-stage biopsy and fresh embryo transfer, especially in twins.

Nondominant small follicles are a promising supplementary source of in vivo–matured oocytes, and their use increases the live birth rate in natural cycle in vitro fertilization.

The relationship between metabolism oxygen consumption, cleavage patterns, and embryo outcome were analyzed by combining embryo oxygen consumption rates with time-lapse cleavage analysis, depicting associations of cytokinesis and embryo development kinetics.

Cross-contamination by bacteria may not occur in cryopreserved oocytes/embryos that are stored in either open or closed storage devices. Microorganisms survive in liquid nitrogen, so storage containers should be cleaned periodically.

When multinucleation occurs after normal cytokinesis at first mitosis, embryos develop to the blastocyst stage at a high rate, retain normal chromosome numbers, and develop into healthy babies.

Among women giving birth to in vitro fertilization twins, there is a statistically significant association between first-trimester bleeding and low birth weight.

Many studies have been reported that investigate and improve success rates after in in vitro fertilization. Thyroid autoimmunity may be an important factor determining fertility treatment outcome.

The levonorgestrel intrauterine system total content 13.5 mg (average, w8 mg/24 hours during the first year) was associated with a significantly lower 12- month discontinuation rate than the etonogestrel subdermal implant, mainly because etonogestrel implant users more frequently discontinued due to increased bleeding.

Although improved temporal precision suggests steeper human chorionic gonadotropin increases in early intrauterine gestation, current estimation of human chorionic gonadotropin rise is appropriately conservative for determination of a nonviable gestation.

Patients with endometriosis have a lower pregnancy rate with in vitro fertilization compared with other diagnoses, with the exception of the small percentage of women in whom endometriosis is the sole infertility-related diagnosis.

Increasing serum 25-hydroxyvitamin D is associated with reduced odds of long menstrual cycles in African American women. A growing body of evidence suggests that vitamin D is important for ovarian function.

Incidence of pregnancy loss was 28%. Risk of loss was 74% higher among couples consuming >2 daily caffeinated beverages, and 55% lower among women taking daily multivitamins.

Following the initial publication in 1998 of the Society for Assisted Reproductive Technology guidelines limiting number of embryos to transfer, more than 16,000 higher-order multiple live births have been avoided, corresponding to $6.0 billion healthcare dollars saved.

Misoprostol should be administered 12 hours before office hysteroscopy.

Adolescents who were securely attached to their mothers were more accepting of their donor conception than insecurely attached adolescents, suggesting that quality of mother-child relationships influences feelings about donor conception.

Psychological distress is common during fertility treatment, but most patients and partners, even those who are very distressed, are not referred for and do not receive mental health services.

The ASRM has recommended that providers develop policies concerning age cutoffs, but questions are asked about how clinicians make these decisions. This article provides the first data exploring several of these issues.

Three 46,XY girls with primary amenorrhea carried novel homozygous nonsense mutations in the LHCGR gene. LHCGR mutations may be a more common cause of primary amenorrhea than previously considered.

The human corpus luteum produces estrogens metabolites: methoxyestrogen, chatecolestrogens, and ketoestrogens. However, their biological activity has not been studied in the human ovary.