A survey of the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities: a cross-sectional study 

A survey of the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A survey of the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities: a cross-sectional study Shohreh Irani, Atiyeh Najafi, Samira Vesali, Mehri Mashayekhi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4562369/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. Several studies have shown an association between PCOS and Mullerian anomalies. This study aimed to evaluate the prevalence of polycystic ovary morphology (PCOM) in infertile patients with uterine anomalies (septate and arcuate uterine) who attended the Royan Research Institute in Tehran (Iran) between January 2021 and December 2022. The current cross-sectional study was conducted on a total of 884 infertile women who were referred to our Institute for 3D-hysterosonography. These women were divided into two groups: the first group consisted of 127 infertile women with uterine anomalies, while the second group included 757 infertile women without uterine anomalies. Information about the participants was extracted from their medical records at the Royan Research Institute. This study demonstrated that the frequency of PCOM in patients with uterine anomalies was 40.9% (52 women) and in those without such anomalies, it was 14/7% (111 women) (p = 0.0001). According to the study's findings, the prevalence of polycystic ovary morphology in women who have uterine anomalies is greater than that in women without these anomalies. Health sciences/Diseases Health sciences/Medical research Uterine abnormalities Polycystic ovary morphology Septate uterus Arcuate uterus Introduction One of the common endocrine system disorders that affects women of reproductive age is polycystic ovary syndrome (PCOS)(1) and numerous investigations have documented its association with Müllerian abnormalities(2–5) .The prevalence of PCOS ranges from 4–21%, contingent upon the specific diagnostic criteria employed (1). The present agreement is to employ the Rotterdam criteria: irregular menstrual cycles, clinical or laboratory indications of hyperandrogenaemia, and polycystic ovary morphology (≥ 12 follicles measuring 2–9 mm in diameter and/or an ovarian volume > 10 mL in at least one ovary). Patients who meet at least two of these three requirements will be eligible for a PCOS diagnosis (6). The etiology of PCOS is multifactorial, including genetic, environmental, and trans-generational influences (7). Women with PCOS commonly experience metabolic dysfunction and obesity (8). In addition, within the domain of fertility, these women exhibit elevated rates of miscarriage, heightened susceptibility to ovarian hyperstimulation syndrome (OHSS), and reduced APGAR scores in infants conceived through assisted reproduction technology (ART) (9). Mullerian ducts serve as the embryological precursors of the female reproductive tract, which consists of the fallopian tubes, uterus, cervix, and superior segment of the vagina (10, 11). The development of the reproductive system in females involves a series of mechanisms in the Mullerian duct system that are involve differentiation, migration, fusion, and canalization (12). Müllerian duct anomalies arise when the Müllerian ducts undergo abnormal development (10, 11). Müllerian anomalies are categorized by the ASRM (2021) into nine groups: Müllerian agenesis, cervical agenesis, unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, longitudinal vaginal septum, transverse vaginal septum and complex anomalies (13). Women who have uterine anomalies experience a greater frequency of miscarriage, preterm birth, and fetal growth restriction (14, 15). Up to 7% of the general population and 18% of people who have experienced recurrent abortions are likely to have uterine abnormalities (16). A significant proportion of women with uterine abnormalities have been reported to have polycystic ovaries, which has resulted in further infertility. Since infertility treatment causes several emotional and financial problems for both patients and society, understanding the association between polycystic ovaries and uterine anomalies is essential for preventing overspending and wasting time. This study aimed to estimate the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities (arcuate and septate uterine). Anytime uterine abnormalities are discussed in this article, it refers to arcuate and septate uterus. Methods This retrospective cross-sectional study was conducted on infertile women who were referred to the Royan Research Institute in Tehran (Iran) for 3D-hysterosonography between January 2021 and December 2022. Participants were divided into two groups based on the presence or absence of uterine abnormalities. Information about age, duration of infertility, type of infertility, cause of infertility, and the presence of polycystic ovary morphology (PCOM) was obtained from the patients’ files and patients were not included in this study. The collected data were analyzed and compared between the two groups. The eligibility criteria for participating in the study were as follows: reproductive age (20–48 years), no systemic disease, no history of previous uterine surgery or ovarian cyst, no use of hormonal drugs, and absence of uterine leiomyoma, polyps, and uterine cavity adhesions. The exclusion criterion was a defect in the patient's medical records. PCOM was determined according to the Rotterdam criteria and through ultrasound (an ovarian volume > 10 mL or the existence of 12 or more follicles 2–9 mm in size). The uterine anomalies were diagnosed via 3D-hystereosonography and classified according to the ASRM (2021) classification. method of sampling was convenient and available. Initially, a total of 897 women were included in the research, and among them, 13 women were found to exhibit unicorn, T-shaped, bicorn, and didelphys uterus. Subsequently, these 13 women were excluded from the study due to their relatively low prevalence. Ultimately, the research was carried out on 884 women: 127 women in the infertility group with uterine abnormalities and 757 women in the infertility group with a normal uterus. The distribution of variables was tested by the Kolmogorov-Smirnov test.Student’s t-test was used for variables with a normal distribution. The comparison of proportions was carried out using the chi-square test. Continuous variables are presented as the mean ± standard deviation, and categorical variable are presented as numbers (percentages). P-value < 0.05 was considered significant. All the statistical analyses were performed using SPSS for Windows (SPSS ver. 20; SPSS Inc., Delaware). The research was approved by the Ethical Committee of the Royan Institute (IR.ACECR.ROYAN.REC.1402.124). All procedures complied with the Helsinki Declaration of 1964 and its subsequent amendments,as well as the ethical guidelines established by the Regional Research Committee. Due to the retrospective nature of the study, (Ethical Committee of the Royan Institute) waived the need of obtaining informed consent. Result Initially, 897 women were included in the study; among them 6 presented with a unicorn uterus, 3 exhibited a bicorn uterus,3 had a T-shaped uterus and 1 presented with a didelphys uterus. Consequently, these 13 women were omitted from the study due to their relatively low prevalence and because they needed more evaluations.Ultimately, 884 women participated in this research. Anomalies were observed in 127 women (14.4%), and 757 (85.6%) were without anomalies. The distribution of the types of anomalies was as follows: 112 women (88.1%) had arcuate uterus (septum length =10 ) (Table 1). As shown in Table 2, the mean age of the women with anomalies was 35.64±5.47 years, and the mean age of the women without anomalies was 36.84 ±5.24 years (p=0.019). The mean duration of infertility in those with anomalies was 6.24 ± 3.61 years, and the mean duration of infertility in those without anomalies was 5.72 ± 3.61 years. A total of 78% of women with uterine anomalies and 71.2% of women without uterine anomalies reported primary infertility. Although, female factors were the most common cause of infertility in patients with uterine anomalies (51.2%), for women without uterine anomalies the most common cause of infertility was male factors (36.9%) (p = 0.002). The data showed that the frequency of PCOM history in patients with uterine anomalies was 40.9% (52 women) and in those without anomaly the frequency of PCOM history was 14.7% (111 women). There was a significant difference in PCOM frequency between patients with uterine anomalies and women without anomalies (p=0.0001) (Table 3). Table 4 shows the depth of fundal indentation of the uterine cavity (length of concavity) in women with anomalies according to PCOM history. The depth of fundal indentation of the uterine cavity (length of concavity) measured in patients with uterine anomalies, in women with PCOM was 7.10 ± 3.90 and in those without PCOM, it was 7.25±3.67 (p=0.829). Discussion In the present study, the prevalence of PCOM in infertile patients with uterine anomalies admitted to our institute was greater than that in infertile patients without such anomalies (40/9% compared to 14/7%). A statistically significant difference was found between the two groups (p = 0/0001). Such differences have also been reported in previous studies. Similarly, Edg et al noted that in 3033 patients with infertility who were assessed, 57 (8%) of 710 infertile patients with PCOS, and 74 (3%) of 2323 non-PCOS patients with infertility exhibited uterine anomalies (p < 0/0001) (3). Additionally, Aldabiri et al. demonstrated an elevated proportion of polycystic ovary syndrome (PCOS) in patients with a septate uterus(31/9%) compared to women with a normal hysteroscopy (24/0%)( p = 0.001) (17). Likewise, Al-Rshoud et al. demonstrated that out of the 49 patients diagnosed with PCOS, 15 patients (31%) were confirmed to have uterine anomalies (2). Additionally, Saleh et al.'s study showed that uterine abnormalities were present in nearly one-third (n = 149, 31.4%) of 409 patients with diagnosed PCOS(p < 0/001) (4). Additionally, Moramezi et al. reported that among 83 patients with PCOS, 29(34/9%) had uterine anomalies (18). Similarly, Aslan et al. showed that the percentage of patients with a normal uterine cavity (51%) in the PCOS group was significantly lower than that in the control group (77%) (19). As mentioned, several research findings indicate an evident association between uterine abnormalities and PCOS in infertile women. The occurrence of uterine anomalies can be attributed to an abnormality in the process of combination, canalization, and resorption of the septum while the Mullerian ducts are developing (15). the Anti-Müllerian hormone (AMH) undeniably plays a crucial role in the deterioration of the Müllerian ducts in the initial stages of life. Several investigations have demonstrated markedly elevated levels of AMH in individuals afflicted with polycystic ovary syndrome (PCOS) (20–23). Given the substantial heredity of PCOS and the role that AMH plays in the early degeneration of Müllerian ducts, high prenatal AMH exposure may cause both PCOS and Müllerian duct abnormalities in female offspring (11). In our study, measurements of the depth of fundal indentation of the uterine cavity (length of concavity) in women with uterine abnormalities demonstrated that the mean length in patients with uterine anomalies and in women with PCOM was 7.10 ± 3.90, and the mean length in those without PCOM was 7.25 ± 3.67; this difference between the two groups was not statistically significant (p = 0/82). In contrast Fujii et al. reported that compared to women without PCOS, women with PCOS had more acute indentation angles and deeper uterine cavity indentations (p < 0/0001)(24). This could be attributed to our focus on women diagnosed with PCOM rather than PCOS. The findings of the present study indicate that the prevalence of uterine anomalies among women experiencing infertility is estimated to be 14.4%. Nisha et al. reported that the frequency of uterine anomalies in infertile women was 8/13% (25). Müllerian anomalies were found in 4.4% of infertile women in the Reyes et al. investigation (26). The present study is limited by the fact that the sample of patients consisted solely of infertile women. Therefore, these findings may not reflect the prevalence of PCOM in women with Müllerian malformation in the general population. To the best of our knowledge, this is the first study assessing the prevalence of PCOM in women with uterine anomalies-afflicted infertility in our region. One of the strengths of this study is its large sample size. Conclusion The results of this study indicate that women with uterine anomalies (septate and arcuate uterine) have a greater prevalence of polycystic ovary morphology than women without these anomalies. Clinically, recognizing the association between uterine abnormalities and PCOM can assist in improving infertility. Therefore, it is advised that infertility treatment providers pay attention to this issue. Abbreviations APGAR: APGAR score is a quick test performed on a newborn at 1 and 5 minutes after birth and includes the examination of Appearance, Grimace, Activity, and Respiration. ASRM: American Society for Reproductive Medicine Declarations Competing interests The authors declare that they have no competing interests. Author Contribution S.I. collected and assembled data and A.N. drafted the manuscript and S.V. and F.N. statistically analyzed the data and M.M. The individuals involved in this research were part of her patient cohort, all of whom received care and consultation from her, and were subsequently directed to our facility, F.A. organized and reviewed all ultrasound measurements and was involved in revising the manuscript. Acknowledgement The personnel working within the imaging department at Royan Research Institute are acknowledged for their contribution to providing the archival material. Data Availability The datasets used and/or analyzed during the current study are available upon reasonable request from the corresponding author , Dr. Firoozeh Ahmadi ( [email protected] ) References Dong ,J. Rees, DA. Polycystic ovary syndrome: pathophysiology and therapeutic opportunities. BMJ Med . 2023; 2 (1):e000548. Al-Rshoud, F. Kilani, R. Al-Asali, F. Alsharaydeh, IJO. Journal GI . The prevalence of uterine septum in polycystic ovarian syndrome (PCOS), a series of 49 cases. 2020; 9 . Ege, S. Peker, N. Bademkıran, MH. The prevalence of uterine anomalies in infertile patients with polycystic ovary syndrome: A retrospective study in a tertiary center in Southeastern Turkey. Turk J Obstet Gynecol . 2019; 16 (4):224-7. Saleh, HA. Shawky Moiety, FM. Polycystic ovarian syndrome and congenital uterine anomalies: the hidden common player. Arch Gynecol Obstet . 2014; 290 (2):355-60. Ugur, M. et al. Polycystic ovaries in association with müllerian anomalies. 1995; 62 (1):57-9. Smet, ME. McLennan, A. Rotterdam criteria, the end. Australas J Ultrasound Med . 2018; 21 (2):59-60. Fahs, D. Salloum, D. Nasrallah, M. Ghazeeri, G. Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. Diagnostics (Basel) . 2023; 13 (9). Christ, JP. Cedars, MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel) . 2023; 13 (6). Chappell, NR. Gibbons, WE. Blesson, CS. Pathology of hyperandrogenemia in the oocyte of polycystic ovary syndrome. Steroids . 2022; 180 :108989. Wu, CQ. Childress, KJ. Traore, EJ. Smith, EA. A Review of Mullerian Anomalies and Their Urologic Associations. Urology . 2021; 151 :98-106. Yang, M. et al. Müllerian Duct Anomalies and Anti-Müllerian Hormone Levels in Women With Polycystic Ovary Syndrome. Cureus . 2023; 15 (8):e43848. Jayaprakasan, K. Ojha, K. Diagnosis of Congenital Uterine Abnormalities: Practical Considerations. J Clin Med . 2022; 11 (5). Pfeifer, SM. et al. ASRM müllerian anomalies classification 2021. Fertil Steril . 2021; 116 (5):1238-52. Kim, M-A.Kim, HS. Kim, Y-H. Reproductive, Obstetric and Neonatal Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review and Meta-Analysis. J Clin Med .2021; 10 . Panagiotopoulos, M. Tseke, P.Michala, L. Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy Classification: A Systematic Review and Meta-analysis. Obstet Gynecol . 2022; 139 (1):138-48. Bhagavath, B. et al. Uterine Malformations: An Update of Diagnosis, Management, and Outcomes. Obstet Gynecol Surv . 2017; 72 (6):377-92. Albdairi, A-A. Al-Shalah, A-N. Study of the association between the congenital uterine septum and Polycystic ovarian syndrome in infertility tertiary center in Iraq. Revista Latinoamericana de Hipertension . 2021; 16 (1):107-13. Moramezi, F. Barati, M. Shahbazian, N. Golbabaei, M. Hemadi, M. Sonographic evaluation of mullerian anomalies in women with polycystic ovaries. Health .;2013; 05 (08) Aslan, K. Albayrak, O. Orhaner, A. Kasapoglu, I. Uncu, G. Incidence of congenital uterine abnormalities in polycystic ovarian syndrome (CONUTA Study). Eur J Obstet Gynecol Reprod Biol. 2022; 271 :183-8. Bedenk, J. Vrtačnik-Bokal, E. Virant-Klun, I. The role of anti-Müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet . 2020; 37 (1):89-100. Bhide, P. Homburg, R. Anti-Müllerian hormone and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynecol . 2016; 37 :38-45. Rudnicka, E. et al. Anti-Müllerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS. Int J Mol Sci . 2021; 22 (22). Russell, N. Gilmore, A. Roudebush, WE. Clinical Utilities of Anti-Müllerian Hormone. J Clin Med . 2022; 11 (23). Fujii, S. Oguchi, T. Shapes of the uterine cavity are different in women with polycystic ovary syndrome. Reprod Med Biol . 2023; 22 (1):e12508. Nisha, S. Singh, K. Kumari SJEJoM, Medicine C. Prevalence of Mullerian anomaly among infertile patients. European Journal of Molecular & Clinical Medicine (EJMCM) . 2020; 7 (10):2020. Reyes-Muñoz, E.et al. Müllerian anomalies prevalence diagnosed by hysteroscopy and laparoscopy in mexican infertile women: results from a cohort study. Diagnostics (Basel). 2019; 9 (4):149. Tables Table 1. distribution of anomalies in the women studied Frequency Percent .short septom=10 15 1.7 757 85.6 884 100.0 Table 2. Demographic and clinical characteristics of the women studied Variables anomaly Mean or n Standard Deviation or % p-value Age (years) yes 35.64 5.47 no 36.84 5.24 0.019 Duration of infertility (years) yes 6.24 4.35 no 5.72 3.61 0.145 Type of infertility Yes Primary 99 78% 0.116 Secondary 28 22% no Primary 539 71.2% Secondary 218 28.8% Causeof infertility yes Male 30 23.6% 0.002 Female 65 51.2% Male & Female 15 11.8% Unexplained 17 13.4% no Male 279 36.9% Female 264 34.9% Male & Female 80 10.6% Unexplained 134 17.7% The data are presented as the means ± SDs or n (%). P-values were obtained by independent sample t-test and chi-square test,and statistically significant differences at 0.05 Table 3. PCOM frequency in women studied anomaly p-value yes no PCOM history no n 75 646 % 59.1% 85.3% 0.0001 yes n 52 111 % 40.9% 14.7% Table 4. Depth of fundal indentation of the uterine cavity(concavity measurements) in women with anomalies according to PCOM history PCOM N Mean Std. Deviation 95% Confidence Interval for Mean Minimum Maximum p-value Lower Bound Upper Bound length of concavity no 72 7.25 3.67 6.39 8.11 3 27 yes 50 7.10 3.90 5.99 8.21 3 20 0.829 The data are presented as the means ± SDs. P-value were Obtained by independent sample t test,and statistically significant differences were indicated by P values of 0.05. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 20 Aug, 2024 Reviews received at journal 19 Aug, 2024 Reviewers agreed at journal 19 Aug, 2024 Reviews received at journal 03 Aug, 2024 Reviewers agreed at journal 19 Jul, 2024 Reviewers invited by journal 28 Jun, 2024 Editor assigned by journal 28 Jun, 2024 Editor invited by journal 18 Jun, 2024 Submission checks completed at journal 15 Jun, 2024 First submitted to journal 11 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4562369","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":320751424,"identity":"7b35136a-80e5-4eb4-a42b-cf70140f0658","order_by":0,"name":"Shohreh Irani","email":"","orcid":"","institution":"ACECR","correspondingAuthor":false,"prefix":"","firstName":"Shohreh","middleName":"","lastName":"Irani","suffix":""},{"id":320751426,"identity":"d7fbd5fe-16e9-4750-b0fa-9252012d15d3","order_by":1,"name":"Atiyeh Najafi","email":"","orcid":"","institution":"ACECR","correspondingAuthor":false,"prefix":"","firstName":"Atiyeh","middleName":"","lastName":"Najafi","suffix":""},{"id":320751428,"identity":"ab074dae-466f-4a8a-bbc3-7a2bf1bea6ad","order_by":2,"name":"Samira Vesali","email":"","orcid":"","institution":"ACECR","correspondingAuthor":false,"prefix":"","firstName":"Samira","middleName":"","lastName":"Vesali","suffix":""},{"id":320751431,"identity":"f39b07d3-860f-4cfa-913d-bf9e994cfa9e","order_by":3,"name":"Mehri Mashayekhi","email":"","orcid":"","institution":"ACECR","correspondingAuthor":false,"prefix":"","firstName":"Mehri","middleName":"","lastName":"Mashayekhi","suffix":""},{"id":320751432,"identity":"1934c779-5851-480e-8df5-d776545cfc04","order_by":4,"name":"Fatemeh Niknejad","email":"","orcid":"","institution":"ACECR","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Niknejad","suffix":""},{"id":320751433,"identity":"5ed3e569-f64e-46ed-9583-a5ce864ccbbd","order_by":5,"name":"Firoozeh Ahmadi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYDCCAwwMzECKsY2Z/eCDhAogk5m5gUgt7DzJBh/OgLQwEqmlgZ/BTHJmGwOYjVcH3+0DjJ8Lc+xk+5gZ0qR559VG87cDtfyo2IZTi+S5BGbpmduSjduYGQ9b8247njvjMGMDY8+Z2zi1GABdL827jTmxjZkh8TbvtmO5DUAtzIxteLUw/+bdVg/SYiDNO+dY7nwitLABbTkM0mIkObOhJncDIS2SZxjbQF4A+gUUyMcO5G4EajmIzy98Z5gPA71QLTu//zgwKmvqcuedP3zwwY8K3FrQY+EwmDyARz0GqCNF8SgYBaNgFIwQAACAF1pZoqHPDQAAAABJRU5ErkJggg==","orcid":"","institution":"ACECR","correspondingAuthor":true,"prefix":"","firstName":"Firoozeh","middleName":"","lastName":"Ahmadi","suffix":""}],"badges":[],"createdAt":"2024-06-11 08:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4562369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4562369/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-91531-w","type":"published","date":"2025-02-27T15:57:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":77622498,"identity":"b967cb5c-ec07-4ed6-9ef8-7e8dd69b6c81","added_by":"auto","created_at":"2025-03-03 16:07:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":459657,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4562369/v1/946de859-1364-4ced-824b-6ffe3c6a5367.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":" A survey of the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities: a cross-sectional study ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOne of the common endocrine system disorders that affects women of reproductive age is polycystic ovary syndrome (PCOS)(1) and numerous investigations have documented its association with M\u0026uuml;llerian abnormalities(2\u0026ndash;5) .The prevalence of PCOS ranges from 4\u0026ndash;21%, contingent upon the specific diagnostic criteria employed (1). The present agreement is to employ the Rotterdam criteria: irregular menstrual cycles, clinical or laboratory indications of hyperandrogenaemia, and polycystic ovary morphology (\u0026ge;\u0026thinsp;12 follicles measuring 2\u0026ndash;9 mm in diameter and/or an ovarian volume\u0026thinsp;\u0026gt;\u0026thinsp;10 mL in at least one ovary). Patients who meet at least two of these three requirements will be eligible for a PCOS diagnosis (6). The etiology of PCOS is multifactorial, including genetic, environmental, and trans-generational influences (7). Women with PCOS commonly experience metabolic dysfunction and obesity (8). In addition, within the domain of fertility, these women exhibit elevated rates of miscarriage, heightened susceptibility to ovarian hyperstimulation syndrome (OHSS), and reduced APGAR scores in infants conceived through assisted reproduction technology (ART) (9).\u003c/p\u003e \u003cp\u003eMullerian ducts serve as the embryological precursors of the female reproductive tract, which consists of the fallopian tubes, uterus, cervix, and superior segment of the vagina (10, 11). The development of the reproductive system in females involves a series of mechanisms in the Mullerian duct system that are involve differentiation, migration, fusion, and canalization (12). M\u0026uuml;llerian duct anomalies arise when the M\u0026uuml;llerian ducts undergo abnormal development (10, 11). M\u0026uuml;llerian anomalies are categorized by the ASRM (2021) into nine groups: M\u0026uuml;llerian agenesis, cervical agenesis, unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, longitudinal vaginal septum, transverse vaginal septum and complex anomalies (13). Women who have uterine anomalies experience a greater frequency of miscarriage, preterm birth, and fetal growth restriction (14, 15). Up to 7% of the general population and 18% of people who have experienced recurrent abortions are likely to have uterine abnormalities (16).\u003c/p\u003e \u003cp\u003eA significant proportion of women with uterine abnormalities have been reported to have polycystic ovaries, which has resulted in further infertility. Since infertility treatment causes several emotional and financial problems for both patients and society, understanding the association between polycystic ovaries and uterine anomalies is essential for preventing overspending and wasting time.\u003c/p\u003e \u003cp\u003eThis study aimed to estimate the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities (arcuate and septate uterine). Anytime uterine abnormalities are discussed in this article, it refers to arcuate and septate uterus.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective cross-sectional study was conducted on infertile women who were referred to the Royan Research Institute in Tehran (Iran) for 3D-hysterosonography between January 2021 and December 2022. Participants were divided into two groups based on the presence or absence of uterine abnormalities.\u003c/p\u003e \u003cp\u003eInformation about age, duration of infertility, type of infertility, cause of infertility, and the presence of polycystic ovary morphology (PCOM) was obtained from the patients\u0026rsquo; files and patients were not included in this study. The collected data were analyzed and compared between the two groups.\u003c/p\u003e \u003cp\u003eThe eligibility criteria for participating in the study were as follows: reproductive age (20\u0026ndash;48 years), no systemic disease, no history of previous uterine surgery or ovarian cyst, no use of hormonal drugs, and absence of uterine leiomyoma, polyps, and uterine cavity adhesions. The exclusion criterion was a defect in the patient's medical records.\u003c/p\u003e \u003cp\u003ePCOM was determined according to the Rotterdam criteria and through ultrasound (an ovarian volume\u0026thinsp;\u0026gt;\u0026thinsp;10 mL or the existence of 12 or more follicles 2\u0026ndash;9 mm in size). The uterine anomalies were diagnosed via 3D-hystereosonography and classified according to the ASRM (2021) classification. method of sampling was convenient and available.\u003c/p\u003e \u003cp\u003eInitially, a total of 897 women were included in the research, and among them, 13 women were found to exhibit unicorn, T-shaped, bicorn, and didelphys uterus. Subsequently, these 13 women were excluded from the study due to their relatively low prevalence. Ultimately, the research was carried out on 884 women: 127 women in the infertility group with uterine abnormalities and 757 women in the infertility group with a normal uterus.\u003c/p\u003e \u003cp\u003eThe distribution of variables was tested by the Kolmogorov-Smirnov test.Student\u0026rsquo;s t-test was used for variables with a normal distribution. The comparison of proportions was carried out using the chi-square test. Continuous variables are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variable are presented as numbers (percentages). P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. All the statistical analyses were performed using SPSS for Windows (SPSS ver. 20; SPSS Inc., Delaware).\u003c/p\u003e \u003cp\u003e The research was approved by the Ethical Committee of the Royan Institute (IR.ACECR.ROYAN.REC.1402.124). All procedures complied with the Helsinki Declaration of 1964 and its subsequent amendments,as well as the ethical guidelines established by the Regional Research Committee. Due to the retrospective nature of the study, (Ethical Committee of the Royan Institute) waived the need of obtaining informed consent.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eInitially, 897 women were included in the study; among them 6 presented with a unicorn uterus, 3 exhibited a bicorn uterus,3 had a T-shaped uterus and 1 presented with a didelphys uterus. Consequently, these 13 women were omitted from the study due to their relatively low prevalence and because they needed more evaluations.Ultimately, 884 women participated in this research. Anomalies were observed in 127 women (14.4%), and 757 (85.6%) were without anomalies. The distribution of the types of anomalies was as follows: 112 women (88.1%) had arcuate uterus (septum length \u0026lt;=9), and 15 women (11.9%) had septate uterus (septum length \u0026gt;=10 ) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, the mean age of the women with anomalies was 35.64\u0026plusmn;5.47 years, and the mean age of the women without anomalies was 36.84 \u0026plusmn;5.24 years (p=0.019). \u0026nbsp;The mean duration of infertility in those with anomalies was 6.24 \u0026plusmn; 3.61 years, and the mean duration of infertility in those without anomalies was 5.72 \u0026plusmn; 3.61 years. A total of \u0026nbsp;78% of women with uterine anomalies and 71.2% of women without uterine anomalies reported primary infertility. Although, female factors were the most common cause of infertility in patients with uterine anomalies (51.2%), for women without uterine anomalies the most common cause of infertility was male factors (36.9%) (p = 0.002).\u003c/p\u003e\n\u003cp\u003eThe data showed that the frequency of PCOM history in patients with uterine anomalies was 40.9% (52 women) and in those without anomaly the frequency of PCOM history was 14.7% (111 women). \u0026nbsp;There was a significant difference in PCOM frequency between patients with uterine anomalies and women without anomalies (p=0.0001) (Table 3). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 4 shows the depth of fundal indentation of the uterine cavity (length of concavity) in women with anomalies according to PCOM history. The depth of fundal indentation of the uterine cavity (length of concavity) measured in patients with uterine anomalies, in women with PCOM was 7.10 \u0026plusmn; 3.90 and in those without PCOM, it was 7.25\u0026plusmn;3.67 (p=0.829).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, the prevalence of PCOM in infertile patients with uterine anomalies admitted to our institute was greater than that in infertile patients without such anomalies (40/9% compared to 14/7%). A statistically significant difference was found between the two groups (p\u0026thinsp;=\u0026thinsp;0/0001). Such differences have also been reported in previous studies. Similarly, Edg et al noted that in 3033 patients with infertility who were assessed, 57 (8%) of 710 infertile patients with PCOS, and 74 (3%) of 2323 non-PCOS patients with infertility exhibited uterine anomalies (p\u0026thinsp;\u0026lt;\u0026thinsp;0/0001) (3). Additionally, Aldabiri et al. demonstrated an elevated proportion of polycystic ovary syndrome (PCOS) in patients with a septate uterus(31/9%) compared to women with a normal hysteroscopy (24/0%)( p\u0026thinsp;=\u0026thinsp;0.001) (17). Likewise, Al-Rshoud et al. demonstrated that out of the 49 patients diagnosed with PCOS, 15 patients (31%) were confirmed to have uterine anomalies (2). Additionally, Saleh et al.'s study showed that uterine abnormalities were present in nearly one-third (n\u0026thinsp;=\u0026thinsp;149, 31.4%) of 409 patients with diagnosed PCOS(p\u0026thinsp;\u0026lt;\u0026thinsp;0/001) (4). Additionally, Moramezi et al. reported that among 83 patients with PCOS, 29(34/9%) had uterine anomalies (18). Similarly, Aslan et al. showed that the percentage of patients with a normal uterine cavity (51%) in the PCOS group was significantly lower than that in the control group (77%) (19). As mentioned, several research findings indicate an evident association between uterine abnormalities and PCOS in infertile women. The occurrence of uterine anomalies can be attributed to an abnormality in the process of combination, canalization, and resorption of the septum while the Mullerian ducts are developing (15). the Anti-M\u0026uuml;llerian hormone (AMH) undeniably plays a crucial role in the deterioration of the M\u0026uuml;llerian ducts in the initial stages of life. Several investigations have demonstrated markedly elevated levels of AMH in individuals afflicted with polycystic ovary syndrome (PCOS) (20\u0026ndash;23). Given the substantial heredity of PCOS and the role that AMH plays in the early degeneration of M\u0026uuml;llerian ducts, high prenatal AMH exposure may cause both PCOS and M\u0026uuml;llerian duct abnormalities in female offspring (11).\u003c/p\u003e \u003cp\u003eIn our study, measurements of the depth of fundal indentation of the uterine cavity (length of concavity) in women with uterine abnormalities demonstrated that the mean length in patients with uterine anomalies and in women with PCOM was 7.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.90, and the mean length in those without PCOM was 7.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67; this difference between the two groups was not statistically significant (p\u0026thinsp;=\u0026thinsp;0/82). In contrast Fujii et al. reported that compared to women without PCOS, women with PCOS had more acute indentation angles and deeper uterine cavity indentations (p\u0026thinsp;\u0026lt;\u0026thinsp;0/0001)(24). This could be attributed to our focus on women diagnosed with PCOM rather than PCOS.\u003c/p\u003e \u003cp\u003eThe findings of the present study indicate that the prevalence of uterine anomalies among women experiencing infertility is estimated to be 14.4%. Nisha et al. reported that the frequency of uterine anomalies in infertile women was 8/13% (25). M\u0026uuml;llerian anomalies were found in 4.4% of infertile women in the Reyes et al. investigation (26).\u003c/p\u003e \u003cp\u003eThe present study is limited by the fact that the sample of patients consisted solely of infertile women. Therefore, these findings may not reflect the prevalence of PCOM in women with M\u0026uuml;llerian malformation in the general population. To the best of our knowledge, this is the first study assessing the prevalence of PCOM in women with uterine anomalies-afflicted infertility in our region. One of the strengths of this study is its large sample size.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study indicate that women with uterine anomalies (septate and arcuate uterine) have a greater prevalence of polycystic ovary morphology than women without these anomalies. Clinically, recognizing the association between uterine abnormalities and PCOM can assist in improving infertility. Therefore, it is advised that infertility treatment providers pay attention to this issue.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPGAR: \u0026nbsp;APGAR score is a quick test performed on a newborn at 1 and 5 minutes after birth and includes the examination of Appearance, Grimace, Activity, and Respiration. ASRM: American Society for Reproductive Medicine\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.I. collected and assembled data and A.N. drafted the manuscript and S.V. and F.N. statistically analyzed the data and M.M. The individuals involved in this research were part of her patient cohort, all of whom received care and consultation from her, and were subsequently directed to our facility, F.A. organized and reviewed all ultrasound measurements and was involved in revising the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe personnel working within the imaging department at Royan Research Institute are acknowledged for their contribution to providing the archival material.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available upon reasonable request from the corresponding author , Dr. Firoozeh Ahmadi ([email protected])\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDong ,J. Rees, DA. Polycystic ovary syndrome: pathophysiology and therapeutic opportunities. \u003cem\u003eBMJ Med\u003c/em\u003e. 2023;\u003cstrong\u003e2\u003c/strong\u003e(1):e000548.\u003c/li\u003e\n\u003cli\u003eAl-Rshoud, F. Kilani, R. Al-Asali, F. Alsharaydeh, IJO. \u003cem\u003eJournal GI\u003c/em\u003e. The prevalence of uterine septum in polycystic ovarian syndrome (PCOS), a series of 49 cases. 2020;\u003cstrong\u003e9\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eEge, S. Peker, N. Bademkıran, MH. The prevalence of uterine anomalies in infertile patients with polycystic ovary syndrome: A retrospective study in a tertiary center in Southeastern Turkey. \u003cem\u003eTurk J Obstet Gynecol\u003c/em\u003e. 2019;\u003cstrong\u003e16\u003c/strong\u003e(4):224-7.\u003c/li\u003e\n\u003cli\u003eSaleh, HA. Shawky Moiety, FM. Polycystic ovarian syndrome and congenital uterine anomalies: the hidden common player. \u003cem\u003eArch Gynecol Obstet\u003c/em\u003e. 2014;\u003cstrong\u003e290\u003c/strong\u003e(2):355-60.\u003c/li\u003e\n\u003cli\u003eUgur, M. et al. Polycystic ovaries in association with m\u0026uuml;llerian anomalies. 1995;\u003cstrong\u003e62\u003c/strong\u003e(1):57-9.\u003c/li\u003e\n\u003cli\u003eSmet, ME. McLennan, A. Rotterdam criteria, the end. \u003cem\u003eAustralas J Ultrasound Med\u003c/em\u003e. 2018;\u003cstrong\u003e21\u003c/strong\u003e(2):59-60.\u003c/li\u003e\n\u003cli\u003eFahs, D. Salloum, D. Nasrallah, M. Ghazeeri, G. Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. \u003cem\u003eDiagnostics (Basel)\u003c/em\u003e. 2023;\u003cstrong\u003e13\u003c/strong\u003e(9).\u003c/li\u003e\n\u003cli\u003eChrist, JP. Cedars, MI. Current Guidelines for Diagnosing PCOS. \u003cem\u003eDiagnostics (Basel)\u003c/em\u003e. 2023;\u003cstrong\u003e13\u003c/strong\u003e(6).\u003c/li\u003e\n\u003cli\u003eChappell, NR. Gibbons, WE. Blesson, CS. Pathology of hyperandrogenemia in the oocyte of polycystic ovary syndrome. \u003cem\u003eSteroids\u003c/em\u003e. 2022;\u003cstrong\u003e180\u003c/strong\u003e:108989.\u003c/li\u003e\n\u003cli\u003eWu, CQ. Childress, KJ. Traore, EJ. Smith, EA. A Review of Mullerian Anomalies and Their Urologic Associations. \u003cem\u003eUrology\u003c/em\u003e. 2021;\u003cstrong\u003e151\u003c/strong\u003e:98-106.\u003c/li\u003e\n\u003cli\u003eYang, M. et al. M\u0026uuml;llerian Duct Anomalies and Anti-M\u0026uuml;llerian Hormone Levels in Women With Polycystic Ovary Syndrome. \u003cem\u003eCureus\u003c/em\u003e. 2023;\u003cstrong\u003e15\u003c/strong\u003e(8):e43848.\u003c/li\u003e\n\u003cli\u003eJayaprakasan, K. Ojha, K. Diagnosis of Congenital Uterine Abnormalities: Practical Considerations. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2022;\u003cstrong\u003e11\u003c/strong\u003e(5).\u003c/li\u003e\n\u003cli\u003ePfeifer, SM. et al. ASRM m\u0026uuml;llerian anomalies classification 2021. \u003cem\u003eFertil Steril\u003c/em\u003e. 2021;\u003cstrong\u003e116\u003c/strong\u003e(5):1238-52.\u003c/li\u003e\n\u003cli\u003eKim, M-A.Kim, HS. Kim, Y-H. Reproductive, Obstetric and Neonatal Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review and Meta-Analysis. \u003cem\u003eJ Clin Med\u003c/em\u003e .2021;\u003cstrong\u003e10\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003ePanagiotopoulos, M. Tseke, P.Michala, L. Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy Classification: A Systematic Review and Meta-analysis. \u003cem\u003eObstet Gynecol\u003c/em\u003e. 2022;\u003cstrong\u003e139\u003c/strong\u003e(1):138-48.\u003c/li\u003e\n\u003cli\u003eBhagavath, B. et al. Uterine Malformations: An Update of Diagnosis, Management, and Outcomes. \u003cem\u003eObstet Gynecol Surv\u003c/em\u003e. 2017;\u003cstrong\u003e72\u003c/strong\u003e(6):377-92.\u003c/li\u003e\n\u003cli\u003eAlbdairi, A-A. Al-Shalah, A-N. Study of the association between the congenital uterine septum and Polycystic ovarian syndrome in infertility tertiary center in Iraq. \u003cem\u003eRevista Latinoamericana de Hipertension\u003c/em\u003e. 2021;\u003cstrong\u003e16\u003c/strong\u003e(1):107-13.\u003c/li\u003e\n\u003cli\u003eMoramezi, F. Barati, M. Shahbazian, N. Golbabaei, M. Hemadi, M. Sonographic evaluation of mullerian anomalies in women with polycystic ovaries.\u003cem\u003eHealth\u003c/em\u003e.;2013; \u003cstrong\u003e05\u003c/strong\u003e(08)\u003c/li\u003e\n\u003cli\u003eAslan, K. Albayrak, O. Orhaner, A. Kasapoglu, I. Uncu, G. Incidence of congenital uterine abnormalities in polycystic ovarian syndrome (CONUTA Study). \u003cem\u003eEur J Obstet Gynecol Reprod Biol.\u003c/em\u003e 2022;\u003cstrong\u003e271\u003c/strong\u003e:183-8.\u003c/li\u003e\n\u003cli\u003eBedenk, J. Vrtačnik-Bokal, E. Virant-Klun, I. The role of anti-M\u0026uuml;llerian hormone (AMH) in ovarian disease and infertility. \u003cem\u003eJ Assist Reprod Genet\u003c/em\u003e. 2020;\u003cstrong\u003e37\u003c/strong\u003e(1):89-100.\u003c/li\u003e\n\u003cli\u003eBhide, P. Homburg, R. Anti-M\u0026uuml;llerian hormone and polycystic ovary syndrome. \u003cem\u003eBest Pract Res Clin Obstet Gynecol\u003c/em\u003e. 2016;\u003cstrong\u003e37\u003c/strong\u003e:38-45.\u003c/li\u003e\n\u003cli\u003eRudnicka, E. et al. Anti-M\u0026uuml;llerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS. \u003cem\u003eInt J Mol Sci\u003c/em\u003e. 2021;\u003cstrong\u003e22\u003c/strong\u003e(22).\u003c/li\u003e\n\u003cli\u003eRussell, N. Gilmore, A. Roudebush, WE. Clinical Utilities of Anti-M\u0026uuml;llerian Hormone. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2022;\u003cstrong\u003e11\u003c/strong\u003e(23).\u003c/li\u003e\n\u003cli\u003eFujii, S. Oguchi, T. Shapes of the uterine cavity are different in women with polycystic ovary syndrome. \u003cem\u003eReprod Med Biol\u003c/em\u003e. 2023;\u003cstrong\u003e22\u003c/strong\u003e(1):e12508.\u003c/li\u003e\n\u003cli\u003eNisha, S. Singh, K. Kumari SJEJoM, Medicine C. Prevalence of Mullerian anomaly among infertile patients. \u003cem\u003eEuropean Journal of Molecular \u0026amp; Clinical Medicine (EJMCM)\u003c/em\u003e. 2020;\u003cstrong\u003e7\u003c/strong\u003e(10):2020.\u003c/li\u003e\n\u003cli\u003eReyes-Mu\u0026ntilde;oz, E.et al. M\u0026uuml;llerian anomalies prevalence diagnosed by hysteroscopy and laparoscopy in mexican infertile women: results from a cohort study. \u003cem\u003eDiagnostics (Basel).\u003c/em\u003e2019;\u003cstrong\u003e9\u003c/strong\u003e(4):149.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. distribution of anomalies in the women studied\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"359\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.36768802228412%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.462395543175486%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eFrequency\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.16991643454039%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003ePercent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.05464480874317%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e.short septom\u0026lt;=9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.956284153005466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e112\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.76502732240437%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e12.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.224043715846996%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.05464480874317%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eseptom\u0026gt;=10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.956284153005466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.76502732240437%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.224043715846996%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.05464480874317%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.956284153005466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e757\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.76502732240437%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e85.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.224043715846996%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.05464480874317%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.956284153005466%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e884\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.76502732240437%\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.224043715846996%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. Demographic and clinical characteristics of the women studied \u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.3768115942029%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eanomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.434782608695652%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean or n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.18840579710145%\" valign=\"top\"\u003e\n \u003cp\u003eStandard \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDeviation or %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.3768115942029%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.434782608695652%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e35.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.18840579710145%\" valign=\"top\"\u003e\n \u003cp\u003e5.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.898617511520737%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.70967741935484%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e36.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.493087557603687%\" valign=\"top\"\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.898617511520737%\" valign=\"top\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.3768115942029%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDuration of infertility (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.434782608695652%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e6.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.18840579710145%\" valign=\"top\"\u003e\n \u003cp\u003e4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.898617511520737%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.70967741935484%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.493087557603687%\" valign=\"top\"\u003e\n \u003cp\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.898617511520737%\" valign=\"top\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.3768115942029%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eType of infertility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.3768115942029%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.057971014492754%\" valign=\"top\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.18840579710145%\" valign=\"top\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.904109589041095%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.32876712328767%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.698630136986301%\" valign=\"top\"\u003e\n \u003cp\u003e539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.06849315068493%\" valign=\"top\"\u003e\n \u003cp\u003e71.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e28.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.3768115942029%\" rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eCauseof infertility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.3768115942029%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.057971014492754%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.18840579710145%\" valign=\"top\"\u003e\n \u003cp\u003e23.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e51.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eMale \u0026amp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e11.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eUnexplained\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e13.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.904109589041095%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.32876712328767%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.698630136986301%\" valign=\"top\"\u003e\n \u003cp\u003e279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.06849315068493%\" valign=\"top\"\u003e\n \u003cp\u003e36.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e34.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eMale \u0026amp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e10.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.86486486486486%\" valign=\"top\"\u003e\n \u003cp\u003eUnexplained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.89189189189189%\" valign=\"top\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003e17.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe data are presented as the means \u0026plusmn; SDs or n (%). P-values were obtained \u0026nbsp;by independent sample t-test and chi-square test,and statistically significant differences at 0.05\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. PCOM frequency in women studied\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"403\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.883374689826304%\" colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.99503722084367%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eanomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.121588089330025%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.81188118811881%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003ePCOM history\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.336633663366335%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.613861386138614%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07920792079208%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07920792079208%\" valign=\"top\"\u003e\n \u003cp\u003e646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07920792079208%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.99236641221374%\" valign=\"top\"\u003e\n \u003cp\u003e%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.33587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e59.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.33587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e85.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.33587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.121951219512194%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.76829268292683%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.036585365853657%\" valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.036585365853657%\" valign=\"top\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.036585365853657%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.99236641221374%\" valign=\"top\"\u003e\n \u003cp\u003e%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.33587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e40.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.33587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.33587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. \u0026nbsp;Depth of fundal indentation of the uterine cavity(concavity measurements) in women with anomalies according to PCOM history\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"613\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.621931260229132%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePCOM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.346972176759412%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147299509001636%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.983633387888707%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.058919803600656%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95% Confidence Interval for Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.8379705400982%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00163666121113%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.00163666121113%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.45320197044335%\" valign=\"top\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.45320197044335%\" valign=\"top\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.0935960591133%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.418300653594772%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003elength of concavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.169934640522875%\" valign=\"top\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.130718954248366%\" valign=\"top\"\u003e\n \u003cp\u003e7.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.967320261437909%\" valign=\"top\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.091503267973856%\" valign=\"top\"\u003e\n \u003cp\u003e6.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.091503267973856%\" valign=\"top\"\u003e\n \u003cp\u003e8.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.823529411764707%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.986928104575163%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.986928104575163%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.328358208955224%\" valign=\"top\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.514925373134329%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.567164179104477%\" valign=\"top\"\u003e\n \u003cp\u003e7.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.380597014925373%\" valign=\"top\"\u003e\n \u003cp\u003e3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.805970149253731%\" valign=\"top\"\u003e\n \u003cp\u003e5.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.805970149253731%\" valign=\"top\"\u003e\n \u003cp\u003e8.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.074626865671641%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.261194029850746%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.261194029850746%\" valign=\"top\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe data are presented as the means \u0026plusmn; SDs. P-value were Obtained by independent sample t test,and statistically significant differences were indicated by P values of 0.05.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Uterine abnormalities, Polycystic ovary morphology, Septate uterus, Arcuate uterus","lastPublishedDoi":"10.21203/rs.3.rs-4562369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4562369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePolycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. Several studies have shown an association between PCOS and Mullerian anomalies. This study aimed to evaluate the prevalence of polycystic ovary morphology (PCOM) in infertile patients with uterine anomalies (septate and arcuate uterine) who attended the Royan Research Institute in Tehran (Iran) between January 2021 and December 2022. The current cross-sectional study was conducted on a total of 884 infertile women who were referred to our Institute for 3D-hysterosonography. These women were divided into two groups: the first group consisted of 127 infertile women with uterine anomalies, while the second group included 757 infertile women without uterine anomalies. Information about the participants was extracted from their medical records at the Royan Research Institute. This study demonstrated that the frequency of PCOM in patients with uterine anomalies was 40.9% (52 women) and in those without such anomalies, it was 14/7% (111 women) (p\u0026thinsp;=\u0026thinsp;0.0001). According to the study's findings, the prevalence of polycystic ovary morphology in women who have uterine anomalies is greater than that in women without these anomalies.\u003c/p\u003e","manuscriptTitle":" A survey of the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities: a cross-sectional study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-02 06:37:32","doi":"10.21203/rs.3.rs-4562369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-20T12:20:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-19T20:38:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300918540306329440105937186160848540154","date":"2024-08-19T20:29:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-03T15:38:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311418978246750896109504096162138035297","date":"2024-07-19T05:26:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-28T09:37:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-28T09:33:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-18T15:18:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-15T04:57:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-11T08:12:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6d2823e-1b32-4e0f-a3d4-fcb7af128dad","owner":[],"postedDate":"July 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":33910395,"name":"Health sciences/Diseases"},{"id":33910396,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-03-03T16:02:12+00:00","versionOfRecord":{"articleIdentity":"rs-4562369","link":"https://doi.org/10.1038/s41598-025-91531-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-02-27 15:57:12","publishedOnDateReadable":"February 27th, 2025"},"versionCreatedAt":"2024-07-02 06:37:32","video":"","vorDoi":"10.1038/s41598-025-91531-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-91531-w","workflowStages":[]},"version":"v1","identity":"rs-4562369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4562369","identity":"rs-4562369","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}