Discussion
PCOS
Based on the findings of the present clinical trial on the effects of ASX on infertile patients with PCOS, the FF levels of MDA were reduced by ASX, while SOD and TAC levels represented an increase. Moreover, a 60-day course of ASX in the present work resulted in increased ATF4 mRNA expression levels. However, the expression levels of GRP78, CHOP, XBP1, and ATF6 mRNA were reduced compared to the placebo group. Our findings revealed that the protein levels of GRP78 and CHOP were also reduced after the pharmacological intervention. There is strong evidence that OS can result in ER stressUltimately, this study discovered that administering ASX to PCOS patients before assisted reproductive technology (ART) cycles enhanced the proportion of MII and high-quality oocytes, as well as the rate of high-quality embryos. It seems that in our study, ASX might have been associated with the high-quality rate of oocyte and embryo by decreasing OS. Compared to the control group, the fertilization rate of the ASX group was not statistically greater (One strength of our study is the coverage of all PCOS phenotypes, providing a considerably larger potential to derive generalizable results. Moreover, managing the nutritional intake and physical activity are beneficial aspects of our research. Nonetheless, this study had some limitations as well. Given that our sample size was relatively small, it may be difficult to detect small changes in response to ASX treatment. In addition, our study’s follow-up period was short; non-significant improvements in ART outcomes may be meaningful with longer follow-ups. The study was also limited by the lack of objective measurement of patient compliance; more precisely, the serum or plasma levels of ASX could not be measured in this study. However, these results may shed fresh light on the potential involvement of ASX in modulating several conditions in PCOS patients. Future studies are needed with larger sample sizes and various doses and durations to corroborate our findings. It is recommended that ASX concentrations in serum or plasma be measured as well.It is concluded that the molecular pathways of ER stress can be modified by ASX as a natural supplement through antioxidant activity. Therefore, it can influence the expression of genes and proteins involved in the UPR in the GCs. Furthermore, OS markers may be modulated by ASX in the FF of patients. In addition, ASX may improve some of the ART outcomes for PCOS patients. Thus, ASX administration may be beneficial for PCOS patients. Eventually, the results of our study indicated that ER stress could be used as a potential therapeutic target in PCOS.