Polycystic ovary syndrome: Pathways and mechanisms for possible increased susceptibility to COVID-19

Figure 1 Criteria for defining polycystic ovary syndrome and describing its phenotypes (summarized from[5-7]). ¹Sine qua non for diagnosis, when excluding all similar/mimicking disorders after thorough laboratory and instrumental investigations. NIH: National Institutes of Health (United States) criteria; Rotterdam: European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine criteria; AE/PCOS S: Androgen Excess and Polycystic Ovary Syndrome Society criteria; HA: Hyperandrogenism; OD: Ovulatory dysfunction; M: Polycystic ovary morphology: At least one ovary with volume > 10 cm³ or at least 12-20 antral follicles (with a diameter of 5-9 mm) per ovary; Dx: Diagnosis.

Figure 2 Polycystic ovary syndrome may increase susceptibility to coronavirus disease 2019 via its associated comorbidities (non-alcoholic fatty liver disease, metabolic syndrome, obesity, insulin resistance and alterations in the gut microbiome); the gut-lung axis is apparently implicated. SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; IL-22: Interleukin 22, IL-6: Interleukin 6; PCOS: Polycystic ovary syndrome; NAFLD: Non-alcoholic fatty liver disease; COVID-19: Coronavirus disease 2019; MetSy: Metabolic syndrome.