The effects of adipocytokines on the endocrino-metabolic features and obstetric outcome in pregnant obese women with polycystic ovary syndrome

ObjectiveTo estimate the effects of adipocytokines on the metabolic and endocrine features, and the obstetric outcome in pregnant women with polycystic ovary syndrome (PCOS).DesignProspective cross sectional study.Main outcome measures: plasma concentration of adipocytokines, insulin resistance/hyperinsulinism (IR/HI), lipid profile, androgens and obstetric outcome.Materials and methodsThe study included hundred pregnant PCOS (PPCOS) women with android obesity (group 1), 100 pregnant non-PCOS women with android obesity (group 2), 100 PPCOS women with gynoid obesity (group 3), and 100 pregnant non-PCOS women with gynoid obesity (group 4). All patients in the four groups were primigravidae and women with PCOS (groups 1 and 3) became pregnant after treatment with clomiphene citrate and/or gonadotropins.Plasma concentrations of fasting glucose, fasting serum insulin, insulin sensitivity by quantitative insulin sensitivity check index (QUICKI), serum concentrations of triglycerides (TGs), total cholesterol (TC), high density lipoprotein cholesterol, (HDL-c), low density lipoprotein cholesterol (LDL-c); plasma adipocytokines: interleukin (IL)-10, adiponectin (both are insulin sensitizers and anti-inflammatory), pro-inflammatory cytokines: IL-6, prothrombin activator inhibitor-1(PAI-1), high sensitivity C-reactive protein (hsCRP); serum total testosterone (TT), sex-hormone binding globulin (SHBG), free androgen index (FAI) were estimated for the four groups between 22 and 24 weeks’ gestation Glucose loading test was done at 22–24 weeks’ gestation to check for gestational diabetes mellitus and if normal it was repeated at 30–34 weeks. Gestational hypertension (GH), preeclampsia (PE) and preterm labor (PTL) (delivery <37 weeks’ gestation) were recorded.ResultsGroups 1 and 2 with android obesity had IR/HI, (QUICKI < 0.331 ± 0.010). Groups 3 and 4 with gynoid obesity had normal insulin sensitivity (NIS), (QUICKI > 0.331 ± 0.010). Serum concentration of TGs, LDL-c, and plasma concentration of IL-6, PAI-1, hsCRP were significantly higher in groups 1 and 2 than groups 3 and 4. Serum HDL-c, plasma IL-10 and adiponectin were significantly higher in groups 3 and 4 than groups 1 and 2. Serum TT and FAI were significantly higher in groups 1 and 3 (cases of PPCOS) than their controls. There was no significant difference in the serum concentration of TC between the four groups.Incidence of spontaneous early miscarriage (SM) in groups 1, 2, 3, and 4 was 36%, 12%, 33%, and 11% respectively. Incidence of SM was significantly higher in PPCOS than non-PCOS pregnancy irrespective of the type of obesity.Rate of late pregnancy complications, GDM, GH, PE and PTL was significantly higher in groups 1 and 2 with android obesity than groups 3 and 4 with gynoid obesity. There was no significant difference in the rates of cesarean section (CS) between the 4 groups. The rates of neonatal complications and perinatal mortality were significantly higher in groups 1 and 2 (android obesity) than groups 3 and 4 (gynoid obesity).Conclusion

• 1.TT and FAI were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity.
• 2.Incidence of early SM (9–12 weeks) was significantly higher in PPCOS than in non-PCOS pregnancy irrespective of the type of obesity.
• 3.Incidence of late-onset pregnancy complications, GDM, GH, PE and PTL was significantly higher in patients with android obesity than patients with gynoid obesity. PCOS per se seemed to be not related to the incidence of late-onset pregnancy complications.Pregnant patients with android obesity, (both PCOS and non-PCOS) with diminished serum concentration of anti-inflammatory cytokines, and increased serum concentration of pro-inflammatory cytokines had IR/HI and dyslipidemia. Pregnant patients with gynoid obesity, (both PCOS and non-PCOS) with normal serum concentration of anti- and pro-inflammatory cytokines had NIS and normal lipid profile.
• 4.In pregnancy with android obesity patients had reduced plasma concentration of IL-10 and increased concentration of IL-6 which may impair the development of the placenta with increased risk of PTL.
• 5.Neonatal complications and perinatal mortality were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity.

     

Effect of 25-hydroxyvitamin D on metabolic parameters and insulin resistance in patients with polycystic ovarian syndrome

ObjectivesTo investigate the correlation between the levels of 25-hydroxyvitamin D and insulin resistance in patients with polycystic ovarian syndrome (PCOS).Patients and methodsIn 30 untreated PCOS patients and 15 control subjects, levels of 25-hydroxyvitamin D were measured. In addition, endocrine and metabolic variables were evaluated and a glucose tolerance test was performed to assess indices of insulin resistance.ResultsObese PCOS women (n = 15) had lower 25-hydroxyvitamin D levels than lean PCOS women (n = 15) and control subjects (8.9 ± 3.1 vs 26.5 ± 6.4 vs 79.2 ± 19.1 nmol/l respectively; P < 0.001). In the entire cohort, 25-hydroxyvitamin D levels were negatively correlated with body mass index (r = ?0.390), fasting insulin (r = ?0.707), HOMA-β (r = ?0.705), and HOMA-IR (r = ?0.635), and positively correlated with QUICKI (r = 0.723) (all P < 0.001).ConclusionIn PCOS women, low 25-hydroxyvitamin D levels are associated with obesity and insulin resistance.     

Insulin Resistance and Adolescent Girls with Polycystic Ovary Syndrome

Study ObjectivesTo estimate (1) the prevalence of insulin resistance (IR), by fasting glucose: insulin ratio (G:I < 7.0) in adolescent girls with polycystic ovary syndrome (PCOS), (2) to compare the clinical and biochemical parameters between insulin-resistant and non-insulin resistant groups.DesignCase series.SettingClinic based.Participants49 adolescent girls with complaints of oligomenorrhoea with hirsutism and or acne.InterventionsForty-nine adolescent girls diagnosed to have PCOS (Rotterdam 2003 criteria) were studied. Body mass index (BMI), abdominal circumference (AC), hirsutism (Ferriman Gallway score ≥ 6), presence of acne, acanthosis nigricans (AN) were noted in each case. Serum testosterone, sex hormone binding globulin (SHBG), fasting plasma glucose and insulin levels were measured. Free androgen index (FAI) was calculated.Results69.4% of these girls were found to have IR. There were no differences in age, BMI, AC, serum testosterone, FAI and fasting glucose levels between insulin resistant and non-insulin resistant girls. But there were significant differences in frequencies of hirsutism, acne, AN, and serum levels of SHBG and fasting insulin between the two groups.ConclusionAdolescent girls with PCOS and IR are more hirsute and have more AN and lower SHBG and higher fasting insulin levels compared to non-insulin resistant girls.     

L’insulinorésistance biologique chez la femme congolaise avec syndrome des ovaires polymicrokystiques (SOPK)

ObjectivesMetabolic features of polycystic ovary syndrome (PCOS) have been poorly investigated in African women where environmental factors are different from those occurring in developed countries. This study aimed to determine the frequency and features of insulin resistance (IR) in Congolese women affected by polycystic ovary syndrome (PCOS).Patients and methodsThis was a case-control study conducted in women received in three hospital institutions in Kinshasa from 2006–2007. Blood samples were taken to measure HDL and LDL cholesterol, triglycerides, fasting insulin and glucose levels, and the homeostatic model (HOMA-IR) was used to assess IR under basal conditions.ResultsFifty-five Congolese women with PCOS and forty-four normal women (mean age 24 ± 6.8 years) were included in the study. Although body mass index was not statistically different between PCOS and control women, IR evaluated by the HOMA-IR was detected in 39.3% of PCOS women. Fasting insulin level was the most significant determinant of IR in the Congolese women with PCOS (OR 2.134 [1.360–3.348]; P < 0.001).ConclusionsNearly one in two women from Congo affected by PCOS is IR and this feature is independent of overweight and central fat distribution. HOMA-IR is the most suitable index than the clinical parameters for detecting IR in these women.     

PCOS and Urethrovaginal Space: 3-D Volumetric and Vascular Analysis

IntroductionThe vaginal orgasm seems to be evocated by the stimulation of the G-spot: a highly sensitive area on the anterior wall of the human vagina. However, the existence of such a spot is controversial.AimTo evaluate, by the use of three-dimensional (3-D) ultrasonography, the anatomic structures of the urethrovaginal space both in polycystic ovarian syndrome (PCOS) patients and eumenorrheic non-hirsute controls.MethodsTwenty-three (Group I) PCOS patients and 25 eumenorrheic young women (Group II) were submitted to two-dimensional (2-D) and 3-D ultrasonography and color Doppler analysis of the urethrovaginal space and of the clitoris.Main Outcome Measures2-D ultrasonographic evaluation of the ovaries and of the urethrovaginal space; color Doppler evaluation of the ovarian stromal arteries, urethrovaginal main feeding artery, and dorsal clitoral arteries; 3-D volume calculation of the urethrovaginal space, and 3-D power Doppler analysis of the vascularization index; flow index; and vascularization flow index; hormonal evaluation.ResultsThe vaginal orgasm was present in 13/23 (56%) patients in PCOS Group and in 13/25 (52%) in the controls. The 3-D reconstruction of the urethrovaginal space demonstrated a gland-like aspect with small feeding vessels: “female prostate.” The 3-D mean volume of the “female prostate” was significantly higher in Group I (0.48 ± 0.21 mL) than in Group II (0.39 ± 0.19 mL; P = 0.044). The Virtual Organ Computer-aided AnaLys (VOCAL) built mean volume of the “female prostate” was positively correlated with the time since intercourse (r = 0.486; P = 0.032), with the total length of the urethrovaginal space (r = 0.616; P = 0.025) and with the testosterone (r = 0.424; P = 0.048) circulating values.ConclusionsThe presence of the G-spot and its role in vaginal orgasm remains controversial. In Italians, and normal weight PCOS patients the hyperandrogenism seems to result in ovarian stromal and “female prostate” hyperplasia. Battaglia C, Nappi RE, Mancini F, Alvisi S, Del Forno S, Battaglia B, Venturoli S. PCOS and urethrovaginal space: 3-D volumetric and vascular analysis.     

Women's Perceptions of Polycystic Ovary Syndrome Following Participation in a Clinical Research Study: Implications for Knowledge,Feelings, and Daily Health Practices

ObjectivePolycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects 6% to 10% of reproductive aged women. It is a poorly understood and often undiagnosed condition that has implications for the health of affected women. We assessed changes in knowledge, feelings, and daily health practices related to PCOS in clinical research study participants.MethodsSixty-eight women who had received counselling and education about PCOS while participating in a clinical research study were invited to complete an online survey that assessed levels of concern, knowledge, healthy dieting, active living, and health care satisfaction before and after the study. Differences and associations between scores were analyzed by paired t tests and Pearson correlation.ResultsForty-three women (63%) completed the survey. After taking part in a clinical research study, participants believed they had increased knowledge of (P < 0.001) and concern about (P = 0.029) the etiology and health consequences of PCOS, better lifestyle practices (P < 0.001), and improved health care satisfaction (P = 0.045). Enhanced knowledge of PCOS was positively associated with changes in concern (P = 0.045), healthy dietary habits (P = 0.04), activity levels (P = 0.003), and health care satisfaction (P < 0.001). After the study, women felt empowered to participate in the management of their condition and communicate with their primary care providers.ConclusionWomen with PCOS felt that they had more knowledge and motivation to implement preventive health strategies after participating in a clinical research study. Education about how PCOS affects their immediate and long-term health enabled women with PCOS to feel physical and psychological benefits and to engage more with their health care providers.     

Cardiovascular and metabolic characteristics of infertile Chinese women with PCOS diagnosed according to the Rotterdam consensus criteria

Polycystic ovary syndrome (PCOS) is strongly associated with metabolic abnormalities in Western women. However, data from other populations and geographical regions are scarce. This study evaluated cardiovascular and metabolic risk factors in Chinese infertile women diagnosed with PCOS using the 2003 Rotterdam consensus criteria. A total of 615 women representing the four PCOS phenotypes (oligo- or anovulation (AO) + hyperandrogenism (HA) + polycystic ovaries (PCO), AO + HA, AO + PCO and HA + PCO) underwent standardized metabolic screening including a 75 g oral glucose tolerance test. All groups presented with similar reproductive characteristics, with the only difference being a significantly higher Ferriman–Gallwey score for hirsutism (P = 0.01) in the subgroup characterized by HA + PCO. Overall, the prevalence of metabolic syndrome was 6.4%, with no difference among the four groups (range of 2.3–12.2%). Metabolic syndrome was associated with body mass index (P < 0.001), waist/hip ratio (P = 0.002), index of insulin resistance (P = 0.005) and fasting insulin (P = 0.009) in multivariate analysis. Compared with Caucasians and Chinese women in Westernized societies, mainland Chinese women with PCOS have a low risk of metabolic syndrome and its presence does not vary across the specific PCOS phenotypes.Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is diagnosed if at least two of three of the following characteristics are present: lack of ovulation (oligo- or anovulation), specific ultrasound characteristics of the ovaries (enlarged ovary and/or increased number of antral follicles), and increased production of androgen hormones and/or its clinical manifestations such as hirsutism and acne. Therefore, four presentations of PCOS can be distinguished. PCOS is also associated with the metabolic syndrome, a clustering of from three to five risk factors of cardiovascular disease. Unfortunately, knowledge about PCOS and its metabolic associations for the Asian region is scarce. The objective of this study was to evaluate cardiovascular and metabolic risk factors in a group of 615 Chinese infertile women with PCOS representing the four PCOS subgroups, from mainland China. Overall, women in the four PCOS subgroups had similar physical, hormonal and biochemical characteristics, with only more hirsutism in the subgroup characterized by overproduction of androgen hormones and ovarian ultrasound characteristics. Of the total group, 6.4% had metabolic syndrome with no differences among subgroups (range 2.3–12.2%). We found that the presence of metabolic syndrome was associated with higher body mass index, higher waist/hip ratio, and a higher index of insulin resistance (HOMA-IR) and higher fasting insulin concentrations. We conclude that in contrast to Caucasians and Chinese women in Westernized societies, mainland Chinese women with PCOS have a low risk of metabolic syndrome and that its presence does not vary among the four PCOS phenotypes.     

Elevated concentrations of serum ischaemia-modified albumin in PCOS,a novel ischaemia marker of coronary artery disease

This prospective case–control study comprised 41 consecutive patients with PCOS and 41 non-PCOS control patients matched for body mass index (BMI) and age (mean age, 22.17 ± 4.45 and 23.29 ± 3.11 years, respectively). Serum IMA, fasting glucose, fasting insulin, homeostatic model assessment insulin resistance index (HOMA-IR), prolactin, thyroid-stimulating hormone, LH, FSH, oestradiol, total testosterone, dehydroepiandrosterone sulphate, high-density lipoprotein (HDL) cholesterol, triglyceride, 17-α-hydroxyprogesterone and cortisol concentrations were measured. Compared with the control group, women with PCOS had significantly higher concentrations of LH (P < 0.001), LH/FSH ratio (P < 0.001), fasting insulin (P < 0.001), HOMA (P < 0.001) and total testosterone (P = 0.031). Serum IMA concentrations in PCOS women were significantly higher than control group (0.63 ± 0.26 versus 0.49 ± 0.16 absorbance units, respectively, P = 0.003, 95% CI 0.05–0.24). Bivariate analysis revealed that serum IMA concentrations were only well correlated with the Ferriman–Gallwey score (r = 0.416, P = 0.007), total testosterone (r = 0.357, P = 0.022) and BMI (r = 0.3751, P = 0.016) in PCOS group. Serum IMA, which has recently been developed as a clinical marker of ongoing myocardial ischaemia, appears to be elevated in PCOS. This may be due to increased androgen concentrations observed in PCOS.     

The Role of Serum Testosterone in Early Pregnancy Outcome: A Comparison in Women With and Without Polycystic Ovary Syndrome

ObjectiveHyperandrogenic conditions in women are associated with increased rates of miscarriage. However, the specific role of maternal testosterone in early pregnancy and its association with pregnancy outcome is unknown. The purpose of this study was to compare serum testosterone levels during early pregnancy in women with and without polycystic ovary syndrome (PCOS) who either had successful pregnancies or miscarried.MethodWe collected serum samples from women attending a university-based fertility centre at the time of their first positive serum beta human chorionic gonadotropin pregnancy test. The samples were subsequently assayed for total testosterone level. We used logistical regression modelling to control for PCOS diagnosis, BMI, and age.ResultsTotal testosterone levels were available for 346 pregnancies, including 286 successful pregnancies and 78 first trimester miscarriages. We found no difference in total testosterone levels between women who subsequently had an ongoing pregnancy (mean concentration 3.6 ± 2.6 nmol/L) and women with a miscarriage (mean 3.6 ± 2.4 nmol/L). Using the Rotterdam criteria to identify women with PCOS, we also found no differences in serum testosterone between women who had ongoing pregnancies or miscarriages, either with PCOS (P = 0.176) or without PCOS (P = 0.561).ConclusionsOur findings show that early pregnancy testosterone levels do not predict pregnancy outcome, and they call into question the role of testosterone in causing miscarriage in populations of women with PCOS. Further research is needed to elucidate the normal progression of testosterone levels during pregnancy and to investigate further the relationship between PCOS and miscarriage.     

Weight loss and vascular inflammatory markers in overweight women with and without polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular disease risk. The effect of weight loss on the vascular inflammatory markers plasminogen activator inhibitor-1 (PAI-1), asymmetric dimethylarginine (ADMA), soluble vascular cell adhesion molecule-1 (sVCAM-1) and intracellular adhesion molecule-1 (sICAM-1) is unknown. Overweight women with (n = 14) and without (n = 13) PCOS of comparable age and body mass index undertook an 8-week weight-loss programme. Women with PCOS had elevated PAI-1, sVCAM-1 and sICAM-1 before and after weight loss compared with the controls. For all women, sVCAM-1 (P = 0.026) and sICAM-1 (P = 0.04) decreased with weight loss. Women with PCOS have elevated inflammatory markers, which are partially reduced by weight loss.     

Quality of Life and Body Mass Index in Overweight Adult Women with Polycystic Ovary Syndrome During a Lifestyle Modification Program

ObjectiveTo evaluate changes in body mass index (BMI) and health-related quality of life (HRQoL), including an acne parameter, of overweight adult women with polycystic ovary syndrome (PCOS) during a lifestyle modification program. Design: Prospective longitudinal within-patient study.DesignProspective longitudinal within-patient study.SettingDepartment of Reproductive Medicine of the Ghent University Hospital (Belgium).ParticipantsThirty-three overweight (BMI > 25 kg/m²) women with PCOS between age 18 and 43 years.MethodsParticipants followed a 24-week lifestyle modification program consisting of a diet, exercise, and psychological subprogram. BMI was assessed at Weeks 0, 8, 16, and 24 of the program. The HRQoL was measured at Week 0, 12, and 24 of the program using the PolyCystic Ovary Syndrome Questionnaire (PCOSQ) and a Visual Analogue Scale (VAS) to evaluate the influence of acne on HRQoL.ResultsDuring a 24-week period no significant decrease in BMI occurred (mean difference = 1.71, 95% confidence interval [CI] [-1.38, 4.81]. During that period, there was a significant positive evolution of the total PCOSQ score, F(2, 37.5) = 23.7, the emotions, F(2, 37.9) = 4.2, weight, F(2, 42.1) = 24.8, body hair, F(2, 35.6) = 3.3, and infertility problems domain scores, F(2, 43.1) = 15.64, of the PCOSQ, as well as of the acne VAS score, F(2, 29.3) = 4.2. These effects primarily occurred during the first 12 weeks.ConclusionIn spite of no significant changes in BMI, the HRQoL of overweight adult women with PCOS significantly improved during a 24-week lifestyle modification program.     

Combined pioglitazone–metformin and clomiphene citrate versus metformin and clomiphene citrate in induction of ovulation in women with clomiphene citrate-resistant polycystic ovary syndrome

ObjectiveTo compare the efficacy of pioglitazone + metformin and clomiphene citrate (CC) with metformin and CC in women with CC-resistant polycystic ovary syndrome (PCOS).DesignRandomized clinical trial (RCT).SettingA university teaching hospital in Cairo, Egypt.PatientsOne hundred women with CC-resistant PCOS.MethodsFifty women received pioglitazone 15 mg + metformin 850 mg once daily from the first day of the cycle for 10 days, and 50 women received metformin (500 mg three times daily). Clomiphene citrate 100 mg from the third day of the cycle for 5 days was added to each group. Treatment was continued for three cycles.Main outcome measure(s)Ovulation rate and pregnancy rate.ResultsOvulation rate was significantly higher in the pioglitazone + metformin and CC group than the metformin and CC group (69.8% versus 48.8%) (p: 0.002). Significantly higher serum E₂ on day 12 and thicker endometrium were found in the pioglitazone + metformin and CC group in the three follow up cycles. Also, cummulative pregnancy rate was significantly higher in the pioglitazone + metformin and CC group than the metformin and CC group (58% versus 34%) (P: 0.027).ConclusionThe use of pioglitazone/metformin and CC is more effective than metformin and CC as regards ovulation and pregnancy rates in anovulatory women with CC-resistant PCOS.     

Role of some biomarkers in chronic pelvic pain for early detection of endometriosis in infertile women

ObjectiveDiagnosis of endometriosis in infertile women with chronic pelvic pain depends mainly on laparoscopy, but it has many risks. The aim of this study was to evaluate the value of some biomarkers as a reliable non-invasive method for the diagnosis of early stages of endometriosis in infertile women with chronic pelvic pain.Materials and methodsA total of 95 women who underwent laparoscopy were divided into two groups: control cases (30 cases) with no pathologic findings; and endometriosis patients (65 cases) {subdivided into stages 1–2 or minimal–mild (MM) and stages 3–4 or moderate–severe (MS) cases}. Blood was drawn on cycle days 6–10 and stored at ?70 °C for subsequent analysis of IL-6, CA-125, TNF-α, HsCRP and VEGF levels.ResultsHigh levels of serum IL-6 and serum TNF-α were observed in MM endometriosis as compared to controls (P < 0.001) and to MS endometriosis (P < 0.05). Levels of serum CA-125, Hs-CRP & VEGF were significantly elevated in MS endometriosis when compared with MM endometriosis and controls (P < 0.001, P < 0.001 & P < 0.008 respectively).ConclusionSerum IL-6 and TNF-α levels are reliable non-invasive biomarkers for the diagnosis of early stages of endometriosis because they increased significantly in early cases than in late cases. CA125, Hs-CRP & VEGF are significantly increased in late cases, so they cannot be used for early diagnosis.     

Clomiphene citrate alone,in combination with metformin or in combination with pioglitazone as first line therapy in induction of ovulation in infertile women with polycystic ovary syndrome,a randomized controlled trial

Study objectiveTo compare the efficacy of clomiphene citrate (CC) alone, combined CC and metformin and combined CC and pioglitazone as first line therapy for induction of ovulation and achievement of pregnancy in overweight and obese infertile women due to polycystic ovary syndrome (PCOS).DesignA randomized controlled trial.SettingThe infertility clinic of Ain Shams University maternity hospital.Materials and methods106 overweight and obese women complaining of infertility due to PCOS were randomly assigned to receive ovulation induction using CC, 100 mg daily for 5 days beginning on the third day of spontaneous or induced menses, either alone (Group 1) in combination with metformin, 850 mg twice daily, (Group 2) or in combination with pioglitazone, 30 mg daily, (Group 3). Folliculometry was started from cycle day 9 and repeated every 2 days. hCG (10000 IU) was given intramuscular when at least one follicle ?18 mm was formed. Serum β-hCG was measured 16 days after hCG injection to diagnose pregnancy.Main outcome measureBiochemical pregnancy rate.ResultsThere were no statistically significant differences between the three study groups regarding the biochemical pregnancy rates (7.4% (2/27), 11.1% (3/27) and 18.5% (5/27) for groups 1, 2 and 3, respectively) and the number of women who succeeded to have mature follicles (74.1% (20/27), 74.1% (20/27) and 81.5% (22/27) for groups 1, 2 and 3, respectively).ConclusionThere is no potential benefit from adding pioglitazone or metformin to CC while inducing ovulation in overweight and obese women complaining of infertility due to PCOS. Further larger extended trials are needed to assess using insulin sensitizers for longer duration which could give a better chance to evaluate the cumulative effect of these drugs.     

Evaluation of ultrasonographic and Anti-Müllerian Hormone (AMH) changes as predictors for ovarian reserve after laparoscopic ovarian drilling for women with polycystic ovarian syndrome

Background and aim of the studyLaparoscopic ovarian drilling (LOD) is considered one of the effective tools for treatment of women with polycystic ovarian syndrome. The aim of this work was to evaluate the effects of laparoscopic ovarian drilling on ovarian reserve assessed by Anti-Müllerian hormone assay and ultrasonography.Study designThe current prospective controlled study included 70 (n = 70) primary anovulatory women with PCOS who are allocated to undergo LOD (n = 40), who are clomiphene citrate (CC) resistant, and another group receiving incremental doses (50–150 mg) of CC (n = 30) and 20 healthy age-matched women with a regular menstrual cycle and normal ovaries (confirmed with ultrasound examination) as the control group.Materials and methodsFor the LOD group, standard laparoscopy ovarian drilling was done just after the end of the menstruation using a monopolar electrocautery needle. For the CC group, clomiphene citrate was given in incremental doses (50–150 mg) for up to six cycles from days 2–6 of a menstrual cycle or after a progestin withdrawal bleeding. Evaluation for the ovarian reserve was done using the following tests: (1) AMH level in the third cycle day, (2) antral follicle count (AFC) by TVS, and (3) summed ovarian volume (SOV) by transvaginal ultrasound examination (TVS).ResultsIn the current study, among the (40) PCOS women having LOD, 30/40 (75%) had regular cycles in the 6-month period after LOD, while the ovulation rate was 24/40 (60%) and the pregnancy rate was 11/40 (27.5%) in the 6-month period after LOD. Those rates were not statistically different in the PCO women group treated with CC. There were statistically significant differences between AMH levels and antral follicle count before and after LOD (p = 0.001 and 0.009 respectively) and this might indicate a possible diminished ovarian reserve.ConclusionAMH and AFC are reliable markers for assessment of the ovarian reserve and measuring them for women with anovulatory PCOS undergoing LOD may provide a useful tool in evaluating the outcome of LOD.     

Comparison between two clomiphene citrate protocols for induction of ovulation in clomiphene resistant polycystic ovary syndrome

ObjectiveTo compare two protocols of CC therapy for induction of ovulation in a group CC resistant PCOS women.Study designDouble blind randomized controlled trial.Subjects and methods260 nulliparous CC resistant PCOS women randomized between two groups; In the first group each patient received 200 mg/day for 5 days while the second group received 100 mg/day for 10 days, both starting on day 3 of progestin induced withdrawal bleeding.Main outcome measuresOvulation defined as at least one follicle reaching ⩾14 mm diameter, and confirmed by timed serum progesterone. Secondary outcome measures included; number of dominant follicles, endometrial thickness, clinical pregnancy rate, and live birth rate.ResultsThe extended protocol resulted in significantly higher ovulation, pregnancy, and live-birth rates than the high dose protocol (p 0.001). Serum FSH levels on day 6 of treatment were comparable between the two groups while the level on day 11 was significantly higher in the second group (p 0.02). Serum LH levels were comparable both on days 6 and 11. Patients on longer protocol (group II) required a longer time to ovulate (18 ± 4.4 versus 14 ± 3.6 days) but had a significantly higher endometrial thickness at the time of ovulation. (p 0.02) FSH and LH levels were comparable between responders and non-responders in both groups.ConclusionsThe current study reports significantly higher ovulation and pregnancy rates with the longer lower dose protocol probably because of prolonged FSH rise. Study web address: ACTRN12611000639921.     

Follicular fluid antimullerian hormone (AMH) does not predict IVF outcomes in polycystic ovary syndrome patients

IntroductionAMH, is a member of the transforming growth factor (TGF-β) produced by granulosa cells with the highest expression being in small antral follicles. Our objective is to evaluate the predictive value of follicular AMH levels as an indicator of IVF outcomes in PCOS patients.Material and methodsA total of 63 patients undergoing the IVF trail were recruited for this prospective case-control study. The patients were classified into three groups: Group I: 43 patients with Polycystic ovary syndrome (PCOS). Group II: 20 normo-ovulatory patients were recruited for the IVF trail because of the male infertility factor (control group). Group III: consists of 33 patients from group I recruited to determine the effect of controlled ovarian hyperstimulation (COH) on serum AMH levels. Serum AMH levels were performed on day 3 of the menstrual cycle whereas the follicular fluid AMH level has been evaluated at the time of oocyte retrieval by enzyme linked immune-sorbent assay (AMH Gen II ELISA kit, Beckman Coulter, Inc. USA). AMH concentrations were adjusted to its protein content, to avoid possible bias due to FF volume variability. The relationship between follicular fluid AMH (FF AMH) levels and the number of oocytes retrieved, number of mature oocytes, number of embryos, fertilization and clinical pregnancy rate were assessed. The demographic data were similar between two groups as regards age and BMI.ResultsBoth serum AMH levels and FF AMH levels were significantly higher in PCOS patients than in the controls, the values for serum levels were (5.07 ± 3.39 ng/ml, 3.07 ± 2.09 ng/ml) respectively and for follicular fluid levels were (67 ± 50.7 ng/g¹, 38.5 ± 44.4 ng/g) respectively. Serum AMH levels showed a positive correlation with oocytes retrieved and mature oocyte number, but there was no significant correlation with good quality embryo number, fertilization rate or clinical pregnancy rate in PCOS patients. On the other hand FF AMH levels do not show correlation with any of the IVF outcomes mentioned above in PCOS patients. Interestingly, the interval change in serum AMH levels between baseline AMH levels and levels after COH had a significant predictive value of pregnancy.ConclusionsSerum AMH levels can predict the number of the retrieved oocytes and mature oocytes, whereas FF AMH may not be a valuable predictor for IVF outcomes in PCOS patients.     

Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy

ObjectiveTo evaluate the effect of normal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and obesity on clinical results among patients who underwent total laparoscopic hysterectomy (TLH).MethodsIn a prospective study at the Civil Hospital of Culiacan in Sinaloa State, Mexico, data were compared from 209 patients who underwent TLH between July 6, 2009, and December 30, 2011. The following primary variables were analyzed for 77 normal BMI patients, 82 overweight patients, and 50 obese patients: procedure duration, operative bleeding, major and minor trans-operative complications, length of hospital stay, and postoperative pain.ResultsThe mean duration of surgical procedure (P < 0.001) and operative bleeding (P = 0.002) were lower for patients with normal BMI compared with the other 2 groups. The rate of conversion to laparotomy was similar among the 3 groups. Overall, the frequency of complications was 6.2% (n = 13/209); the frequency of complications by study group was 2.6%, 4.8%, and 14% for the normal BMI, overweight and obesity groups, respectively (P < 0.05). Major complications were more frequent among patients with obesity (P = 0.010).ConclusionThe duration of surgical procedure and operative morbidity were found to increase, mainly owing to major complications, among patients with obesity (BMI ≥ 30).     

Delivery by Caesarean Section and Infant Cardiometabolic Status at One Year of Age

ObjectiveDisruption of the gut microbiome has been associated with overweight/obesity, insulin resistance, and type 2 diabetes. Recently, it has been reported that Caesarean section disrupts the normal gut microbiome of neonates. As such, these data have raised the intriguing possibility that CS could lead to an adverse cardiometabolic risk profile early in life. Thus, we sought to compare the cardiometabolic status of infants delivered by CS to that of infants delivered vaginally.MethodsIn this prospective observational cohort study, 104 women underwent cardiometabolic evaluation in pregnancy followed by similar assessment of their infants at one year of age, thereby enabling comparison of infants delivered vaginally (n = 74) to those delivered by CS (n = 30). Infant assessment included anthropometric evaluation and measurement of variables associated with cardiometabolic risk.ResultsAt one year of age, there were no differences between infants delivered vaginally and those delivered by CS with respect to mean BMI, sum of skinfolds, fasting glucose, insulin resistance, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, C-reactive protein, leptin, and adiponectin, both before and after covariate adjustment. Of note, maternal and infant levels of adiponectin (r = 0.31, P = 0.007) and of total cholesterol, LDL-cholesterol, and HDL-cholesterol (all r ≥ 0.23, P < 0.05) were associated in the vaginal delivery group only, whereas the analogous association for leptin was observed only in the CS group (r = 0.44, P = 0.02).ConclusionCaesarean section was not found to be associated with an adverse infant cardiometabolic risk profile at one year of age, although it potentially may affect the impact of maternal determinants of this profile.