Journal of International Reproductive Health/Family Planning

The Application of Artificial Intelligence in Assisted Reproductive Technology

FENG Yu, ZHANG Ning, XI Jin, YUAN Rong-li, LIU Qi, ZHAO Xian, WANG Meng-jing

2026, 45 (5): 353-357. doi: 10.12280/gjszjk.20260367

Abstract ( 75 )

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In vitro fertilization-embryo transfer (IVF-ET), as a core method of assisted reproductive technology (ART), often faces the limitations of clinical outcomes due to the subjectivity of gamete and embryo quality assessment, laboratory procedural errors, and the complexity of developing individualized treatment plans. Artificial intelligence (AI), as a cutting-edge technological tool, can be deeply integrated into the entire IVF-ET treatment cycle, playing a key supporting role in ovarian stimulation, gamete and embryo assessment, laboratory management, and clinical decision-making. Its core mechanism lies in leveraging the powerful data processing capabilities of machine learning and deep learning algorithms to integrate vast amounts of clinical data, thereby accurately predicting the drug dosage of ovulation induction, and optimizing the follicle monitoring; utilizing the image recognition technology to enable the automated and objective grading of sperm motility and embryonic developmental potential, as well as non-invasive karyotype prediction; and combining the electronic witnessing system with robotic technology to significantly enhance the safety of sample tracking and the standardization of micromanipulation procedures. The comprehensive and multi-dimensional support provided by AI technology throughout the entire process effectively reduces human error, offering a critical technical support for improving the clinical pregnancy rates of IVF-ET and advancing ART toward a precision medicine model. Although existing AI technologies still face challenges, such as insufficient data standardization, their continuous optimization and clinical translation will strongly promote the standardized ART practices and technological innovation.

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Research Progress on the Current Status and Willingness to Adopt Artificial Intelligence Technology among Patients Undergoing Assisted Reproductive Therapy

YANG Ya-nan, HUANG Yun-jia, XU Yu-rui

2026, 45 (5): 358-361. doi: 10.12280/gjszjk.20260221

Abstract ( 84 )

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Artificial intelligence (AI) has been applied extensively across the whole spectrum of assisted reproduction, covering female infertility diagnosis, follicular monitoring, embryo selection, pregnancy outcome prediction, male infertility assessment, follow-up management, patient education and psychological support. Existing studies have demonstrated that AI can improve clinical efficiency, streamline information administration and reduce the workload of medical staff, and that AI has certain strengths in the patient health education and follow-up quality control. Although the patients undergoing assisted reproduction treatment generally recognize the auxiliary value of AI, they prefer to regard it merely as a supporting tool for physicians' clinical judgements and nursing services, rather than a complete replacement for medical practitioners. Patients' acceptance of AI is influenced by the demographic factors including gender, age and occupational background, as well as individual technical affinity. Major concerns that hinder patients' willingness to adopt AI systems stem from the black-box effect, risks to privacy and data security, insufficient emotional support, inadequate clinical validation and ambiguous regulatory accountability. Moving forward, AI application models tailored to assisted reproductive settings should be developed on the premise of rigorous clinical verification, improved ethical supervision, guaranteed data security and retained humanistic care, so as to facilitate the safe, standardized and effective integration of AI into routine clinical practice.

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Impact of Embryo Type on Pregnancy and Neonatal Outcomes in the First Frozen-Thawed Embryo Transfer Cycle of Patients with Polycystic Ovary Syndrome

LIU Min-rui, LIU Min, ZHANG Fu-qing

2026, 45 (5): 362-367. doi: 10.12280/gjszjk.20260265

Abstract ( 65 )

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Objective: To analyze the impact of embryo type on the pregnancy and neonatal outcomes in the first frozen-thawed embryo transfer (FET) cycle of patients with polycystic ovary syndrome (PCOS). Methods: A retrospective analysis was conducted on PCOS patients who underwent their first FET cycle in our hospital, between January 1, 2017 and April 1, 2025. Patients were divided into two groups based on the type of embryos transferred: the double cleavage-stage embryo transfer group (D3 group) and the single blastocyst transfer group (D5 group). The two groups were matched 1∶1 using propensity score matching (PSM), resulting in 97 cases matched in both the D3 and D5 groups. Pregnancy and neonatal outcomes were compared between the two groups after PSM. The D5 group was further subdivided into the top-quality blastocyst group (tD5 group, 65 cases) and the non-top-quality blastocyst group (ntD5 group, 32 cases), which were compared with the D3 group in terms of pregnancy outcomes. Logistic regression was used to analyze the factors influencing clinical pregnancy and live birth. Results: The multiple pregnancy rate in the D3 group was significantly higher than that in the D5 group (36.67% vs. 1.85%, χ²=21.390, P≤0.001). The clinical pregnancy rate in the ntD5 group (40.63%) was lower than that in the D3 group (61.86%), the difference was significant (χ²=4.415, P=0.036). Compared with the D3 group, the D5 group had a higher neonatal birth weight, greater birth length, lower proportion of low birth weight infants and small for gestational age infant (SGA) (all P<0.05). Additionally, the large for gestational age infant (LGA) rate in the tD5 group [22.22% (8/36)] was significantly higher than that in the D3 group [7.02% (4/57)] (χ²=4.539, P=0.033). Logistic regression analysis showed that, using the transfer of 0 high-quality embryos as a reference, the transfer of one high-quality embryo (OR=2.328, 95%CI: 1.002-5.407) and transfer of two high-quality embryos (OR=5.288, 95%CI: 1.517-18.434) were associated with increased probability of clinical pregnancy. Transfer of two high-quality embryos (OR=4.937, 95%CI: 1.347-18.101) was associated with increased probability of live birth. Conclusions: In the first FET cycle of PCOS patients, single blastocyst transfer can improve the neonatal outcomes, yet increase the incidence of LGA, to some extent. Therefore, the cleavage-stage embryo transfer may be considered for those patients at high risk of LGA. By contrast, the single blastocyst transfer is the preferred option for those patients without LGA-related risks.

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Construction of A Nomogram Model for Predicting Pregnancy Outcomes in Fresh Embryo Transfer Cycles Using GnRH Antagonist Protocols

LI Xin-xin, HUANG Yu-shan, GAN Tian, MENG Yue

2026, 45 (5): 368-372. doi: 10.12280/gjszjk.20260383

Abstract ( 48 )

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Objective: To investigate the factors influencing the clinical pregnancy rate in fresh embryo transfer cycles using gonadotropin-releasing hormone (GnRH) antagonist protocols, and to construct and validate a predictive model. Methods: A total of 2 405 fresh embryo transfer cycles using GnRH antagonist protocols were retrospectively analyzed, at the Third Affiliated Hospital of Sun Yat-Sen University between January 2018 and December 2024. The cycles were randomly allocated into a training cohort (n=1 683) and a validation cohort (n=722) at a 7∶3 ratio. The independent factors influencing clinical pregnancy were identified by multivariate logistic regression analysis, which were subsequently used to construct a nomogram. The model performance was then evaluated using the area under the receiver operating characteristic curve and calibration curves. Results: Multivariable logistic regression analysis revealed that a greater number of high-quality D3 embryos (OR=0.88, 95%CI: 0.82-0.94) and the transfer of two embryos (versus one embryo, OR=0.52, 95%CI: 0.37-0.72) were associated with decreased probability of non-clinical pregnancy. Conversely, the advancing female age (OR=1.04, 95%CI: 1.00-1.09) and the elevated serum progesterone on trigger-day (OR=2.44, 95%CI: 1.46-4.09) were associated with increased probability of non-clinical pregnancy. Based on these four independent predictors, a predictive model for clinical pregnancy was developed, and a nomogram was constructed. The model was demonstrated the moderate discriminative performance, with an area under the receiver operating characteristic curve of 0.64 (95%CI: 0.61-0.67) in the training set and 0.65 (95%CI: 0.61-0.69) in the validation set. Calibration curves for both datasets showed a close agreement between predicted and observed probabilities, indicating good model calibration. Conclusions: The developed nomogram demonstrates favorable predictive performance, which may be used for the individualized prediction of clinical pregnancy, thereby providing data-driven recommendations for embryo transfer strategies.

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Status Survey of Sexual and Reproductive Health among Students of A Vocational College in Yantai under the Knowledge-Attitude-Practice Model and Suggested Countermeasures

MIAO Li-dan, REN Fei, LIU Qing, LIU Shuo, LI Xiao-xiao

2026, 45 (5): 373-379. doi: 10.12280/gjszjk.20260321

Abstract ( 56 )

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Objective: By analyzing the current status of Knowledge-Attitude-Practice (KAP) regarding sexual and reproductive health among the students at a vocational college in Yantai, this study aims to provide a empirical evidence for strengthening adolescent reproductive health education and optimizing relevant public health services. Methods: A self-designed questionnaire based on the KAP model was developed for this study. The questionnaires were distributed and collected via the Questionnaire Star platform. A total of 1 875 valid questionnaires were included for analysis. Results: 94.9% (1 779/1 875) of the survey respondents recognized the importance of reproductive health education and responsibility-related education, and 92.9% (1 741/1 875) believed that both men and women share equal responsibility for contraception. Additionally, 85.2% (1 598/1 875) had a correct understanding of emergency contraceptives, and 94.2% (1 766/1 875) acknowledged the importance of using contraception to protect fertility. Regarding the effects of correct condom use, the prevention of HIV infection was the most frequently cited reason (93.1%, 1 745/1 875). Concerning the attitude of adolescent sexual behavior, a combined 10.3% (194/1 875) of respondents "fully agreed" or "somewhat agreed", while a combined 45.4% (851/1 875) "fully disagreed" or "somewhat disagreed". About the most crucial measure to prevent unintended teenage pregnancy, 69.4% (1 302/1 875) selected "self-protection". Regarding whether their acquired reproductive health knowledge was sufficient for future life, a combined 24.1% (452/1 875) felt it was "insufficient" or "severely lacking". Conclusions: The survey respondents demonstrated a high level of recognition for comprehensive sexuality education and a strong demand for reproductive health knowledge. However, their knowledge of scientific contraception was insufficient. Some participants lacked a strong sense of personal responsibility for reproductive health and held cognitive biases regarding adolescent sexual behavior.

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Analysis of A Family with Very Long Chain Acyl-CoA Dehydrogenase Deficiency Caused by Compound Heterozygous Variants in the ACADVL Gene

YANG Rui-qiong, ZHOU Bing-bo, ZHANG Chuan, PAN Hai-rui, WANG Yu-pei, KANG Qi-chao, HUI Ling

2026, 45 (5): 380-385. doi: 10.12280/gjszjk.20260273

Abstract ( 69 )

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We report a child with the very long chain acyl-CoA dehydrogenase deficiency (VLCADD) caused by compound heterozygous variants in the ACADVL gene. The tandem mass spectrometry detection of the patient's blood showed the increased levels of multiple long-chain acylcarnitines, suggesting a potential disorder of long-chain or very long-chain fatty acid oxidation. Trio whole exome sequencing was performed, and candidate pathogenic variants were verified by Sanger sequencing. The child was found to carry the compound heterozygous variants in the ACADVL gene: c.623-3C>G and c.1366C>T(p.Arg456Cys), which were inherited from her mother and father with normal phenotypes. According to the American College of Medical Genetics and Genomics guidelines, the c.623-3C>G variant was initially classified as a variant of uncertain significance (PM2_Supporting+PM3+PP3+PP4), while the c.1366C>T(p.Arg456Cys) variant was classified as likely pathogenic (PM1+PM2_Supporting+PM3_Strong+PP1+PP3). To further clarify the etiology, minigene assays confirmed that the c.623-3C>G variant may affect alternative splicing through an exon-skipping mechanism, based on which this variant was upgraded to a likely pathogenic variant (PS3+PM2_Supporting+PM3+PP3+PP4). This study confirms that the compound heterozygous variants in the ACADVL gene are the causative factors for the proband in this pedigree, thereby expanding the variant and phenotypic spectrum of the ACADVL gene. It also demonstrates that the minigene assay can effectively validate the pathogenicity of splice site variants, providing a reliable basis for the precise interpretation of the variants with uncertain significance.

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A Case of Uterine Septum Necrosis Following Combined Hemostasis Surgery in A Patient with Complete Placenta Previa and Uterine Septum

LIU Su-xin, WANG Man, LIU Li, HUO Yan

2026, 45 (5): 386-389. doi: 10.12280/gjszjk.20260235

Abstract ( 61 )

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Perinatal uterine necrosis is a rare disease, commonly associated with severe postpartum hemorrhage and conservative hemostatic management. Meanwhile, uterine septum necrosis is exceptionally uncommon. We report a patient with complete placenta previa and uterine septum who developed isolated uterine septate necrosis following combined hemostasis-specifically, bilateral uterine artery ligation and Hayman's technique. The patient achieved a favorable outcome following conservative therapy. By reviewing the diagnosis and treatment process of the patient and summarizing the relevant literatures of the uterine septum necrosis caused by combined postpartum hemostatic techniques, we aim to enhance obstetricians' awareness of this under-recognized complication, improve suturing techniques when managing postpartum hemorrhage patients, limit combined surgical procedures, and prevent the occurrence of uterine necrosis.

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A Case of Pelvic Retroperitoneal Leiomyoma

LIANG Hui, CHEN Zi-jun, LUO Yi-hong, LEI Nan-xiang

2026, 45 (5): 390-394. doi: 10.12280/gjszjk.20260199

Abstract ( 46 )

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Retroperitoneal leiomyoma (RL) is a rare disease. Because RL grows deep inside and has a complex anatomical relationship with the surrounding tissue, it's hard to diagnose RL by imaging before surgery. The confirmation of RL diagnosis usually depends on surgical exploration and postoperative pathology. This article reports a case of a 38-year-old woman who was found to have a pelvic mass one year earlier and underwent two previous surgeries at another hospital. Finally, during surgical exploration at our hospital, the mass was found to be located in the retroperitoneum, and the pathological diagnosis was RL. For leiomyomas occurring in unusual extra-uterine location, symptoms, signs, and auxiliary examinations lack specificity, making them frequently misdiagnosed before operation. This article discusses the diagnosis and treatment of retroperitoneal uterine leiomyoma, so as to enhance clinicians' understanding of this condition, and to reduce the rate of misdiagnosis through retroperitoneal exploration for those pelvic masses that were not explored during the operation.

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Research Advances of Nicotinamide Adenine Dinucleotide in Ovarian Dysfunction

LI Jia-man, FANG Ying, YANG Xiao-kui

2026, 45 (5): 395-400. doi: 10.12280/gjszjk.20260191

Abstract ( 57 )

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Ovarian dysfunction disorders, including polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI) and diminished ovarian reserve (DOR), are important causes of female infertility and endocrine disorders. Their pathogenesis involves multiple pathological processes, including oxidative stress imbalance, mitochondrial dysfunction, and metabolic disturbances. Nicotinamide adenine dinucleotide (NAD⁺), a central coenzyme involved in cellular metabolism and redox regulation, has been increasingly recognized as a factor closely associated with ovarian physiology and pathology. The abnormal expression of NAD⁺ participates in the pathogenesis of PCOS by modulating insulin resistance, ovarian inflammation, and oxidative stress. In addition, NAD⁺ may delay the ovarian functional decline through the regulation of inflammatory responses, pyroptosis, and mitochondrial function. Evidence from animal studies suggests that supplementation with NAD⁺ precursors or inhibition of NAD⁺ degradation, can improve ovarian function. However, the clinical efficacy and safety of these interventions remain to be further validated. This review summarizes the biological characteristics and metabolic pathways of NAD⁺, as well as its mechanisms of action and therapeutic strategies in ovarian dysfunction disorders, so as to provide new insights into the pathogenesis of ovarian dysfunction and to identify potential therapeutic targets for their clinical management.

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Reassessment of Clinical Value on Sequential Embryo Transfer in Recurrent Implantation Failure

YU Zhao-juan, GUO Pei-pei

2026, 45 (5): 401-406. doi: 10.12280/gjszjk.20260261

Abstract ( 58 )

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The core objective of assisted reproductive technology (ART) is to achieve a healthy live birth; however, recurrent implantation failure (RIF) remains a critical bottleneck limiting the clinical efficacy of ART. Sequential embryo transfer involves the transfer of a cleavage-stage embryo followed by a blastocyst within the same cycle, which offers a novel approach to improve the pregnancy outcomes in RIF patients. Sequential transfer improves endometrial receptivity primarily through three pathways: the embryo-derived leukemia inhibitory factors upregulate HOXA10 expression via the JAK/STAT3 signaling pathway, thereby enhancing embryo-endometrial adhesion; maternal estrogen and progesterone regulate epithelial differentiation through the FGFs-FGFR2 signaling axis that mediated by stromal cells, contributing to the opening and closure of the implantation window; and mechanical stimulation promotes angiogenesis via the TNF-α-MMP pathway while inducing M2-type macrophage polarization to modulate the local immune microenvironment. Clinically, sequential transfer has shown potential in specific populations, including those patients with RIF, advanced age, or polycystic ovary syndrome, without increasing the risks of multiple pregnancies or ectopic pregnancies. However, most current evidence is derived from the retrospective studies with limited randomized controlled trials, and considerable heterogeneity exists across studies regarding the definition of RIF and protocol design, which limits the integration and generalizability of the findings. Overall, current evidence does not support sequential transfer as the routine recommendation in RIF patients, and further studies with refined patient stratification and prospective design are needed to validate its clinical value.

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Impact of Female Genital Tuberculosis on Fertility and Its Prevention and Management in Women Undergoing In Vitro Fertilization and Embryo Transfer

HE Fang-yu, ZHANG Run-yao, GAO Ming-xia

2026, 45 (5): 407-411. doi: 10.12280/gjszjk.20260208

Abstract ( 79 )

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Genital tuberculosis (GTB) is a significant cause of infertility. It can lead to adhesions and obstructions in the anatomy of female reproductive tract, impair endometrial receptivity and ovarian reserve, and disrupt normal embryo implantation and development, and thereby compromise female reproductive health and pregnancy outcomes. In vitro fertilization-embryo transfer (IVF-ET) is an effective treatment for infertility. However, in women with prior tuberculosis, pregnancy following IVF-ET is associated with an increased susceptibility to Mycobacterium tuberculosis infection and reactivation, and the occurrence of active tuberculosis during pregnancy markedly elevates the risk of adverse maternal and fetal outcomes. Currently, the World Health Organization (WHO) has recommended anti-tuberculosis treatment and preventive regimens for patients with genital tuberculosis, which can improve both maternal and perinatal outcomes.Therefore, the prevention and early identification of TB prior to IVF-ET, and the prompt treatment and management of the TB infection, are crucial for improving the success rates of IVF-ET and reducing maternal and fetal complications.

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Treatment Pathways Selection for Deeply Infiltrating Endometriosis with Infertility: Surgery or IVF?

LI Xiao-lian, ZHANG Meng-yu, TAO Hui-min, FAN Yu-han, LI Mei, YIN Yao-xue, HOU Zhen

2026, 45 (5): 412-417. doi: 10.12280/gjszjk.20260287

Abstract ( 70 )

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Deeply infiltrating endometriosis (DIE) is a special form of endometriosis, in which about 26% of patients are complicated by infertility. Existing evidence shows that both surgery and in vitro fertilization (IVF) are effective treatment strategies for DIE patients with infertility, and that they have similar reproductive outcomes. However, there is no clear basis for clinical decision-making. In this review, we systematically compared the reproductive outcomes of surgery and IVF, integrated imaging evaluation, endometriosis fertility index (EFI) score and ovarian reserve, and proposed the decision-making reference. Imaging examination is helpful to clarify the scope of the lesion, predict the difficulty of surgery, and avoid unnecessary surgery. EFI score is the core tool for predicting the postoperative natural pregnancy: those patients with low EFI score should be suggested direct IVF, and those with high EFI score can be considered postoperative pregnancy test. Operation may damage the ovarian reserve function of DIE patients, and IVF should be given priority to those patients with diminished ovarian reserve. Meta-analysis showed that there was no significant difference in the overall fertility outcomes between surgery and IVF, but surgery may have additional benefits in patients with high EFI scores and severe pain. Direct IVF should be considered preferentially as the first-line treatment, while surgery is mainly suitable for patients with severe pain, organ obstruction risk and specific high EFI scores.

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Protective Effect of Hyperbaric Oxygen Therapy on Female Reproductive Function Damage in High-Altitude Hypoxic Environments

YANG Jiao, YANG Kai-li, GAO Ting, HAN Xue, WANG Ling

2026, 45 (5): 418-424. doi: 10.12280/gjszjk.20260192

Abstract ( 54 )

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High-altitude hypoxic environment can impair female reproductive function through multiple pathological mechanisms. Continuous hypoxic exposure can induce oxidative stress and mitochondrial dysfunction, activate the body's inflammatory responses, disrupt the endocrine balance of the hypothalamic-pituitary-gonadal axis, and abnormally trigger cellular autophagy. These pathological changes collectively damage the normal tissue structures of the ovaries and uterus, inhibit follicle growth and development, reduce endometrial receptivity, and lead to the decreased fertility and the increased risk of adverse pregnancy outcomes in women living at high altitudes. Hyperbaric oxygen therapy, as a safe and effective physical intervention, alleviates hypoxia in the body by increasing the blood oxygen pressure and the oxygen concentration in blood and tissues. Through multiple mechanisms including improving oxidative stress and mitochondrial function, inhibiting inflammatory responses, regulating the hypothalamic-pituitary-gonadal axis, suppressing cell apoptosis, and promoting tissue repair, it effectively mitigates the damage to the female reproductive function caused by high-altitude hypoxia. Therefore, hyperbaric oxygen therapy provides a new intervention idea and feasible strategy for protecting female reproductive health in high-altitude regions.

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Research Progress and Clinical Reflection on Precision Diagnosis and Treatment of Recurrent Spontaneous Abortion

WU Xue-mei, BAI Feng-qin, XIA Huan, LIU Wen-ying

2026, 45 (5): 425-428. doi: 10.12280/gjszjk.20260259

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The precision diagnosis and treatment of recurrent spontaneous abortion (RSA) is often difficult because of its complex etiologies, and even approximately half of cases remaining unexplained. Current routine screening predominantly employs morphological examinations such as ultrasound and hysteroscopy, which can only identify the macroscopic abnormalities in uterine anatomy and embryonic morphology, but is unable to elucidate the deeper pathogenic mechanisms, including maternal-fetal immune tolerance imbalance, local metabolic disturbances, and endometrial dysbiosis, thereby limiting their clinical utility. Recent advances in reproductive immunology, metabolomics, and microbiome technologies have been progressively applied to this field, facilitating a transition from the macroscopic morphological observation to the investigation of cellular and molecular mechanisms. This review summarizes the current state of research in four major areas--morphological examination, maternal-fetal immune microenvironment, metabolomics, and endometrial microbiome, analyzes the challenges in clinical translation, and proposes an integrated diagnostic and therapeutic strategy that combines morphological screening, immune typing, metabolic targeting, and microecological evaluation. This strategy is intended to provide a practical clinical reference for precision diagnosis and treatment, ultimately improving pregnancy outcomes in patients with RSA.

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Bacteroidetes-Related Gut Microbiota in the Pathogenesis of Polycystic Ovary Syndrome: Metabolic Mechanisms and Targeted Interventions

FAN Yan-tong, LIU Fang, WANG Shuo-rong, ZHAO Shu-ran, WANG Zhi-min, YUAN Yuan

2026, 45 (5): 429-433. doi: 10.12280/gjszjk.20260223

Abstract ( 49 )

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In recent years, increasing attention has been paid to the role of gut microbiota in the development and progression of polycystic ovary syndrome (PCOS), among which the altered abundance of Bacteroidetes-related gut microbiota may be related to the clinical characteristics of PCOS. Bacteroidetes-related gut microbiota may hydrolyze primary bile acids via bile salt hydrolase (BSH), thereby downregulating intestinal farnesoid X receptor (FXR) signaling; it may also activate FXR in a bile acid-independent manner through its metabolite agmatine, inhibiting glucagon-like peptide 1 (GLP-1) secretion; furthermore, it may induce insulin resistance via lipopolysaccharide (LPS)-mediated chronic inflammation. In terms of therapeutic interventions, the gut microbiota modulation strategy represented by probiotics/synbiotics has shown potential in improving metabolic parameters in patients with PCOS. However, the precision intervention strategies targeting Bacteroidetes-related gut microbiota remain to be further investigated. Elucidating the Bacteroidetes-PCOS metabolic pathways may provide new targets for the precise treatment of PCOS.

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Research Progress of Gut Microbiota in the Pathogenesis and Traditional Chinese Medicine Treatment of Polycystic Ovary Syndrome

QIN Wen-jing, LI An-qi, WU Xiao-ke

2026, 45 (5): 434-440. doi: 10.12280/gjszjk.20260177

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Patients with polycystic ovary syndrome (PCOS) exhibit significant dysbiosis of the gut microbiome. At the bacterial level, the α-diversity is reduced, with the decreased abundance of beneficial genera such as Bifidobacterium and Akkermansia, and the increased enrichment of opportunistic pathogens including Bacteroides and Escherichia coli. At the fungal level, there is a reduction in abundance of Saccharomyces and an increase in abundance of Candida. Gut microbiota participate in the pathogenesis of PCOS through multiple pathways: the reduction of short-chain fatty acids (SCFA); bile acid metabolism disorders leading to impaired FXR/TGR5 signaling; the elevated branched-chain amino acids (BCAAs) activating mTORC1; the increased intestinal permeability allowing lipopolysaccharide (LPS) translocation into the circulation and triggering chronic low-grade inflammation; and the gut-brain axis dysregulation resulting in aberrant hormone secretion. Traditional Chinese Medicine (TCM) has demonstrated significant efficacy in improving PCOS symptoms through the regulation of gut microbiota. Formulations such as Guizhi Fuling Pill and Bushen Huazhuo Formula can modulate microbial community structure and ameliorate insulin resistance; Yulin Tongbu Formula and Wangshi Yijing Decoction can correct hormonal metabolic disturbances; and Shaoyao Gancao Decoction, Bailing Capsule, and Guishen Pill Jiawei can suppress inflammatory responses and restore intestinal barrier integrity. Future studies should continue to explore the specific mechanisms underlying the influence of gut microbiota on PCOS, systematically dissect the potential of TCM in targeting gut microbiota for PCOS therapy, and thus provide more robust scientific evidence for the prevention and treatment of PCOS.

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