Unfortunately, the work of Kohama et al. Regarding the observational studies available, in 2015 Venegas et al. Green, Eulalee 07 March 2022. For this reason, they are classified as phytoestrogensplant-derived compounds with estrogenic activity (1). Li, Hang Moreover, urinary concentrations seem to reflect the isoflavone intakes in a short time window. Table 2 summarises main limitations about the studies discussed. Improvements were observed only in lipid profile (circulating total cholesterol, LDL and LDL/HDL ratio and triglycerides). The influence of high-dose of isoflavones on fertility emerging from the studies is difficult to be transferred to other groups of individuals with other ethnicity or different treatments. However, only 106 individuals provided information on soy intake. This suggests a protective effect of soy against fertility disturbance by BPA. The only study found about the effect of exposure to soy in childhood and reproductive functions is the retrospective study by Strom and colleagues(Reference Strom, Schinnar and Ziegler30). No significant differences were found in the spontaneous abortion rate, the number and quality of embryos transferred or oocytes fertilised. This may have influenced the presence of large confidence intervals. Furthermore, there was no characterisation of dietary regimen, although it was a standard hospital diet. Furthermore, hormone levels were evaluated only at baseline, without taking into account the differences between the two groups. The article processing charge was funded by the Baden-Wuerttemberg Ministry of Science, Research and Art and the University of Freiburg in the funding programme Open Access Publishing. The limitations of these studies have already been discussed in the previous paragraph. Black soy, in addition to the content of isoflavones, is known to be rich in antioxidant substances, especially in external seed integuments, which are rich in anthocyanins(Reference Choung, Baek and Kang49). With regards to available clinical trials, Lu and colleagues conducted two interventional studies using 36 Oz of soy milk (about one litre) divided into three daily intakes for a total daily intake of about 200mg of isoflavones(Reference Lu, Anderson and Grady26,Reference Lu, Anderson and Grady29) . However, ethnicity was not used for outcomes stratification. Even if the clinical trial did not include a placebo group or randomisation, the presence of a control group and the evaluation of equol-producer individuals mitigated these issues. Flowchart for studies selection. SHBG levels were not associated with the intake of soy foods, except in the case of miso intake on the 22nd day of cycle (r: 036, P=002). The results of selected manuscripts were grouped according to the outcomes used, for a clear comparison. The authors responsibilities were as follows: G. R. study conception and drafting the manuscript. Only three articles declared power analysis to assess adequate sample size(Reference Strom, Schinnar and Ziegler30,Reference Jamilian and Asemi43,Reference Haudum, Lindheim and Ascani46) . The present study used a community-based approach with recruitment of couples seeking pregnancy. Fig. After 6 months, estradiol levels of patients in the intervention group were higher compared with basal (P<005), whereas luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were unchanged. To our knowledge, this is the first comprehensive review on soy effect on women's fertility. The interaction between isoflavones and ER estrogen receptor results in a competitive effect which in turn blunts endogenous estrogens action(Reference Rosselli, Reinhart and Imthurn72), as suggested by estrogenic activity of biochanin A and genistein on BT-474 human breast cancer(Reference Zand, Jenkins and Diamandis73). Moreover, significant improvement of oxidative markers such as total glutathione and malondialdehyde levels was observed. Interestingly, soy often appears in literature as a food with a beneficial effect on fertility, especially in the case of pregnancy search(Reference Gaskins, Nassan and Chiu68). There was no dose-response relation in either cohort. Isoflavones are produced via a branch of the general phenylpropanoid pathway that produces flavonoid compounds in higher plants. These also included non-soy derived phytoestrogens, such as lignans. Although this was a randomised, placebo-controlled and double-blinded trial with a sample size appropriate to the power of detection, there was no evaluation of serum and urinary levels of isoflavones and/or metabolites. Regarding the two mentioned studies, the use of very high amounts of isoflavones is noteworthy because it is not possible to obtain such a dose through diet, therefore the effects found can be interpreted as a pharmacological and not nutritional intervention. Any later it delays ovulation. However, even in the West, it is currently widely used, especially due to its versatility in plant-based products for health purposes and vegetarian diets (Reference Rizzo and Baroni 1).Interest in soy is particularly driven by its possible beneficial effects on human . Soy isoflavones are generally considered safe .Numerous randomized controlled trials in menopausal women reported that side effects were not significantly different between soy isoflavone and placebo groups .Adverse events were generally mild and included gastrointestinal and musculoskeletal complaints .One systematic review of over 100 studies in patients with or at risk of breast cancer . Although the clinical trial was quasi-randomised, with a placebo group, double-blinded, authors did not characterise the dietary regimen of individuals as well as their ability to effectively absorb and metabolise soy isoflavones. From data that emerged on individuals with PCOS, there is no homogeneous improvement effect on hormonal picture, on menstrual cycle and therefore on fertility associated with soy consumption. Among selected prospective cohort studies, in 2012 Jarrell and colleagues conducted an observational study of 323 Canadian women with late pregnancy (aged at least 35) followed from the second month of pregnancy until delivery(Reference Jarrell, Foster and Kinniburgh36). Isoflavones are non-steroidal compounds with a chemical structure similar to endogenous estrogens and for this reason, they are defined as phytoestrogens: a functional classification that also includes lignans, coumestans and stilbenes(Reference Basu and Maier12). Genistein treatment reduced LDL cholesterol and triglycerides levels. RANCHO CUCAMONGA. Recently, Wesselink and colleagues evaluated the fertility of 7778 healthy American or Canadian women in two cohort studies that followed participants for 12 months or until pregnancy(Reference Wesselink, Hatch and Mikkelsen44). Microbial alpha diversity and glucose homeostasis improved in PCOS group after isoflavone intervention, resembling the control group profile at baseline. The researchers found that the isoflavones resulted in increased cell growth. 2 highlights the main cellular mechanisms attributed to isoflavones. The soy isoflavones block the estrogen receptors in your brain and fool your body into thinking its natural estrogen levels are low. Soy is a very popular food and its consumption is part of the traditional cuisine of South-East Asian countries. Isoflavones are plant-based compounds found almost exclusively in beans, like soybeans, that mimic the action of the hormone estrogen. There was a significant correlation between dietary soy consumption and fertilisation rate (77% v. 71%, P=0004), age-adjusted pregnancy (52% v. 41%, P=003) or age-adjusted live birth rate (44% v. 31%, P=0007) among soy consumers compared with non-consumers. The clinical trial was limited to a small sample size, lacking of control/placebo group and there was no characterisation of equol-competence. In the first of the two papers by Lu and colleagues(Reference Lu, Anderson and Grady26), the intake of 36 Oz/d of soy milk (~200mg/d IF) for 1 month caused a reduction in mean estradiol levels of 31% at days 57, P=009; 81% at days 1214, P=003; 49% at days 2022, P=002, compared with the baseline. Introduction. } Using food frequency questionnaires, researchers found that women with high isoflavone intake ( 40 mg/day) had a 3% lower lifetime probability of giving birth to a live child compared to women with a low intake (< 10mg/day). The generalisation of these results is complex due to the type of study, which does not allow to define a causal relationship. The use of urinary phytoestrogens and their metabolites is a more reliable system compared to the evaluation of dietary intake. The authors found an association between pregnancy outcomes and urinary Bisphenol A (BPA), dependent on soy consumption in the multivariable-adjusted mixed model. (Reference Filiberto, Mumford and Pollack37). Jacobsen and colleagues included 11688 American women aged 3050 years of age who participated in Adventist Health Study-2 (AHS-2)(Reference Jacobsen, Jaceldo-Siegl and Knutsen38). However, the number of combined participants of the two studies was very limited (n: 40). Romualdi and colleagues in 2008 enrolled twelve Italian women with metabolic syndrome and PCOS and with a follow-up of 6 months using 36mg/d of oral genistein as an intervention(Reference Romualdi, Costantini and Campagna34). The mice were then switched to an isoflavone-free diet - and their tumours regressed over the following nine weeks.. In addition to the interventional study by Kohama and colleagues, we found three longitudinal cohort observational studies(Reference Jarrell, Foster and Kinniburgh36,Reference Mumford, Sundaram and Schisterman39,Reference Wesselink, Hatch and Mikkelsen44) and a cross-sectional study(Reference Jacobsen, Jaceldo-Siegl and Knutsen38) that investigated the association between soy and fertility. On consumption, they increase estrogen production in a woman's body. For these reasons, studies that evaluated the ovarian hormones secretion were aimed at exploring the potential beneficial effect of soy on breast cancer prevention, but they were not designed for the evaluation of endocrine consequences, including fertility. 2022. Day 22 should correspond to the mid-luteal phase, however, the authors pointed out that participants exhibited different lengths of menstrual cycle and this could have been a source of heterogeneity that was used as a covariate in the regression model. However, the number of participants was limited for a cross-sectional study, and dietary survey through frequency questionnaires in the absence of an assessment of blood or urine isoflavone levels could lead to uncertainty. The disease etiology is still debated but it seems to involve inflammatory mechanisms and oxidative stress(Reference Escobar-Morreale, Luque-Ramrez and Gonzlez65,Reference Showell, Mackenzie-Proctor and Jordan66) . Used for outcomes stratification they are classified as phytoestrogensplant-derived compounds with estrogenic activity ( 1 ) almost. Urinary concentrations seem to reflect the isoflavone intakes in a short time window, for a comparison. The two studies was very limited ( n: 40 ) mice were then switched to an diet! Results is complex due to the outcomes used, for a clear.! 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