Doppler analysis of uterine perfusion and ovarian stromal blood flow in polycystic ovary syndrome

Objective

To investigate blood flow velocity in the ovarian stromal artery and uterine artery in women with polycystic ovary syndrome (PCOS) and to correlate these velocities with clinical and biochemical parameters.

Methods

A prospective study was carried out in 55 patients with PCOS and 42 age-matched women who did not have PCOS. Clinical, biochemical, and hormonal characteristics, and utero-ovarian Doppler ultrasound blood flow parameters were determined, and correlations between the parameters were evaluated.

Results

Ovarian stromal blood flow was higher (P < 0.01) and uterine perfusion was lower (P < 0.01) in women with PCOS compared with women who did not have PCOS. Ovarian stromal artery pulsatility index (PI) was inversely correlated with levels of dehydroepiandrosterone sulfate (DHEAS) and insulin-like growth factor-1, and with the luteinizing hormone/follicle-stimulating hormone ratio. There was a positive correlation between uterine artery PI and DHEAS level.

Conclusion

Doppler analysis of the uterine and intraovarian arteries may provide additional information about the etiopathogenesis of PCOS and partly explain the clinical implications of the condition.     

Three-dimensional power Doppler imaging in the diagnosis of polycystic ovary syndrome

Objective

To determine the role of three-dimensional (3D) power Doppler imaging in the diagnosis of polycystic ovary syndrome (PCOS).

Methods

Pulsatility index (PI) and resistance index (RI) of the uterine artery and ovary were measured by two-dimensional (2D) Doppler imaging, while vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured by 3D power Doppler in 25 patients with PCOS and 25 women with normal menstrual cycles used as a control group.

Results

Uterine artery PI and RI were significantly higher (P < 0.001) and ovarian PI and RI were significantly lower (P < 0.001) in women with PCOS compared with controls. Ovarian VI and VFI were significantly higher in women with PCOS compared with the control group (P < 0.001).

Conclusion

3D power Doppler indices were higher in women with PCOS than in the control group and were positively correlated with 2D color Doppler indices, and clinical and hormonal parameters. High 3D power Doppler indices may be useful as one of the diagnostic criteria for PCOS.     

The antiandrogenic effect of flutamide improves uterine perfusion in women with polycystic ovary syndrome

Objective: To evaluate whether, by blocking androgen action, flutamide can decrease and normalize vascular resistance in the uterine artery in patients with polycystic ovary syndrome (PCOS).

Design: Prospective and controlled study.

Setting: Endocrinological Centre of the Department of Obstetrics and Gynecology of the University of Cagliari, Italy.

Patient(s): Twenty-two patients with PCOS were enrolled in the study and randomly assigned to one of the following two treatments for 3 months: oral administration of flutamide (250 mg twice daily) or placebo.

Intervention(s): Doppler flow measurement of the uterine artery and serum hormone concentration determination during the early follicular phase of the menstrual cycle before treatment and during the third month of treatment.

Main Outcome Measure(s): Pulsatility index (PI) of the uterine artery before and during treatment.

Result(s): The PI of the uterine artery decreased significantly during treatment. No difference was found in patients treated with placebo. Correlation was found only between the PI values of the uterine artery and DHEAS.

Conclusion(s): The low uterine perfusion that characterizes patients with PCOS can be improved by the antiandrogenic effect of flutamide.     

Significance of Doppler ultrasonography in the diagnosis of polycystic ovary syndrome

OBJECTIVE: To investigate the importance of transvaginal color Doppler ultrasonography of uterine and intraovarian arteries in the clinical diagnosis of polycystic ovary syndrome (PCOS). MATERIAL & METHOD: This study was planned as a cohort, controlled, prospective study. A total of 80 participants (40 with PCOS and 40 as a control group) were enrolled in the study. A Doppler system with a 6.0 MHz transvaginal probe was used when performing ultrasonography (USG) and Doppler examinations. Ovarian size and volume, number of follicles and stromal echogenity were evaluated by USG. Doppler flow studies were targeted to uterine and intraovarian arteries and the pulsatility index (PI) was assessed. The concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone (T) and dihydroepiandrostenedione sulphate (DHEAS) were measured by immunometric methods. RESULTS: The mean values of the number of follicles and the ovarian volume of both the right and left ovaries were higher in the group with PCOS than the control group (p < 0.05). The mean PI values of the right and left ovaries, respectively, were 0.84 +/- 0.23 and 1.09 +/- 1.17 in the group with PCOS, and 0.88 +/- 0.14 and 0.92 +/- 0.15 in the control group. The mean PI values of the right and left uterine arteries, respectively, were 3.25 +/- 0.98 and 3.33 +/- 1.12 in the group with PCOS, and 3.17 +/- 0.93 and 3.2 +/- 1.38 in the control group (p > 0.05). The correlation analysis of the ovarian volume, the number of follicles and Doppler parameters revealed that there was a positive correlation and statistically significant difference between the right ovarian volume and right uterine artery PI in the group with PCOS and the left ovarian volume and left uterine artery PI in the control group (p > 0.05). The mean stromal PI of the ovarian and uterine arteries were 0.96 +/- 0.61 and 3.29 +/- 1.02 in the group with PCOS and 0.9 +/- 0.12 and 3.19 +/- 1.14 in the control group, respectively (p > 0.05). In the group with PCOS, the mean ovarian volume and the mean number of follicles were 11.46 +/- 4.43 and 13.91 +/- 4.11, respectively, whereas they were 7.63 +/- 2.44 and 5.55 +/- 2.34 in the control group (p < 0.05). CONCLUSION: It is not beneficial to use color Doppler transvaginal ultrasonography in the clinical diagnosis of patients with PCOS.     

Adrenocortical steroid response to ACTH in different phenotypes of non-obese polycystic ovary syndrome

Background

Adrenal androgen excess is frequently observed in PCOS. The aim of the study was to determine whether adrenal gland function varies among PCOS phenotypes, women with hyperandrogenism (H) only and healthy women.

Methods

The study included 119 non-obese patients with PCOS (age: 22.2?±?4.1y, BMI:22.5?±?3.1?kg/m²), 24 women with H only and 39 age and BMI- matched controls. Among women with PCOS, 50 had H, oligo-anovulation (O), and polycystic ovaries (P) (PHO), 32 had O and H (OH), 23 had P and H (PH), and 14 had P and O (PO). Total testosterone (T), SHBG and DHEAS levels at basal and serum 17-hydroxprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels after ACTH stimulation were measured.

Results

T, FAI and DHEAS, and basal and AUC values for 17-OHP and A4 were significantly and similarly higher in PCOS and H groups than controls (p?<?0.05 for all) whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Three hyperandrogenic subphenotypes (PHO, OH, and PH) compared to non-hyperandrogenic subphenotype (PO) had significantly and similarly higher T, FAI, DHEAS and AUC values for 17-OHP, A4 and DHEA (p?<?0.05). All subphenotypes had similar basal and AUC values for cortisol.

Conclusion

PCOS patients and women with H only have similar and higher basal and stimulated adrenal androgen levels than controls. All three hyperandrogenic subphenotypes of PCOS exhibit similar and higher basal and stimulated adrenal androgen secretion patterns compared to non-hyperandrogenic subphenotype.

     

Short-term metformin treatment for clomiphene citrate-resistant women with polycystic ovary syndrome

Objective

To evaluate the effect of a short-course pretreatment with metformin on hyperandrogenism, insulin resistance, cervical scores, and pregnancy rates in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS).

Methods

Thirty-seven women with CC-resistant PCOS were randomly assigned to be pretreated with 500 mg of metformin or placebo 3 times per day for 2 cycles, and 100 mg of CC was given on days 5 through 9 of the second cycle in both groups. Luteinizing hormone (LH), follicle stimulating hormone (FSH), dehydroepiandrostendione sulfate (DHEAS), total testosterone (T), glucose, and insulin levels were measured at baseline and after the first cycle, as well as body mass index (BMI), cervical score, and pregnancy rate.

Results

After 1 cycle, BMI, total T level, and percentage of participants with insulin resistance were significantly decreased in the metformin group, without any significant decrease in LH, FSH, and DHEAS levels; and in the second cycle, CC treatment resulted in a higher ovulation rate and a thicker endometrium in the metformin group. The pregnancy rate and cervical scores were also higher in that group.

Conclusion

The short-course pretreatment with metformin decreased hyperandrogenism and insulin resistance and improved cervical sores, ovulation rate, and pregnancy rate among women with CC-resistant PCOS.     

The association of body mass index and biochemical hyperandrogenaemia in women with and without polycystic ovary syndrome

Objective

To investigate the association between BMI and different androgen parameters in women with PCOS and normal ovulatory women.

Study design

A cross sectional, observational study was carried out. A total of 286 patients aged 20–44 years were recruited. One hundred and sixty-five women had a diagnosis of PCOS and 121 women were ovulatory with no clinical or biochemical or ultrasound evidence of PCOS. The PCOS and non-PCOS groups were sub-divided into two subgroups based on BMI (BMI ≤ 30 kg/m² and BMI > 30 kg/m²). Androgen parameters measured were testosterone, androstenedione, free androgen index and sex hormone-binding globulin (SHBG). Testosterone and androstenedione were measured using tandem mass spectrometry. Free androgen index (FAI) was calculated using the formula: (testosterone/SHBG) × 100. Spearman rank correlations were used to determine relationship between BMI and androgens.

Results

The PCOS group had a higher BMI compared with the non-PCOS group (28.9 ± 5.8, 24.5 ± 4.1). Total testosterone, androstenedione, and FAI were significantly higher while SHBG was lower in the PCOS group. A correlation between BMI and total testosterone was not observed in either group. Positive correlations were observed between BMI and FAI in both PCOS (p < 0.001) and non-PCOS groups (p = 0.02) while a positive correlation was observed between BMI and androstenedione in the PCOS group (p = 0.001). SHBG correlated negatively with BMI in both groups.

Conclusion

A strong correlation exists between BMI and FAI but not with total testosterone, possibly due to the mediation of SHBG. Hyperandrogenaemia in the form of androstenedione seems to be augmented in PCOS with increasing BMI. A direct causal relationship between BMI and androgenaemia was not established.     

High DHEAS/free testosterone ratio is related to better metabolic parameters in women with PCOS

Abstract

Aims: To demonstrate the effects of DHEAS/free testosterone (DHEAS/FT) ratio on metabolic parameters in women with and without polycystic ovary syndrome (PCOS).

Methods: The data of 91 women with PCOS and 66 women in the control group were collected retrospectively.

Results: DHEAS/FT of the control group was higher than that of PCOS group (684.93?±?300.54 to 517.2?±?300.8, p?<?0.001). DHEAS/FT correlated with BMI (r?=??0.352, p?=?0.001), WHR (r?=??0.371, p?=?0.0219), LDL (r?=??0.227, p?=?0.031), HOMA-IR (r?=??0.36, p?=?0.001) and FAI (r?=??0.639, p?=?0.001) negatively and with HDL (r?=?0.344, p?=?0.001) and SHBG (r?=?0.646, p?=?0.001) positively. In the control group, DHEAS/FT correlated with BMI (r?=??0.334, p?=?0.007), CRP (r?=??0.297, p?=?0.016) and FAI (r?=??0.399, p?=?0.01) negatively.

Conclusions: High DHEAS/FT ratios are related to a better metabolic phenotype in women with PCOS and low levels can be used to detect women with PCOS that have a higher risk of metabolic problems.     

Doppler study of the uterine arteries and ovarian stroma in patients with polycystic ovary syndrome

Doppler analysis of the uterine arteries and ovarian stroma was performed by transvaginal ultrasound in 24 patients with polycystic ovary syndrome (PCOS) and 22 ovulatory women. Vascularization of the ovarian stroma was more abundant in patients with PCOS than in control women, but no significant difference in the mean pulsatility index (PI) was observed between groups (1.14 +/- 0.28 for the PCOS group and 1.05 +/- 0.19 for the control group). The mean PI of the uterine arteries was significantly higher in the PCOS group (PI = 3.7 +/- 0.8) than in the control group (PI = 2.9 +/- 0.4). In the patients with PCOS, no correlation was observed between PI and luteinizing hormone, testosterone or androstenedione levels. Obesity had no effect on uterine artery PI, with no significant differences in this index when the 3 groups were subdivided into obese and non-obese groups.     

The serum protein α2-Heremans-Schmid glycoprotein/fetuin-a concentration and carotid intima-media thickness in women with polycystic ovary syndrome

Objective

To investigate fetuin-A concentrations and its association with metabolic and sonographic cardiovascular markers in women with polycystic ovary syndrome (PCOS) and healthy subjects.

Study design

Thirty-five women with PCOS and 37 healthy control women were matched for body mass index (BMI) and age. Serum fetuin-A concentrations, and reproductive and adrenal hormones were measured, and insulin resistance and carotid intima media thickness (CIMT) were evaluated in both groups. The correlations between cardiovascular risk factors, CIMT and fetuin-A concentrations were tested.

Results

Mean fetuin-A concentrations were significantly elevated in the PCOS group compared with control subjects (101.2 ng/ml ± 33.55 vs. 82.5 ng/ml ± 32.65, P = 0.019). CIMT was also higher in women with PCOS than in control subjects (0.51 ± 0.05 mm vs. 0.44 ± 0.05 mm, P < 0.01). Serum lipid parameters were correlated to serum fetuin-A concentrations in the PCOS group, but no correlation was found between fetuin-A and CIMT (r_PCOS = 0.244, p_PCOS = 0.158; r_control = −0.002, p_control = 0.988).

Conclusion

In this, the first study of fetuin-A concentrations in PCOS, the results showed that fetuin-A concentrations were increased in euglycemic patients with PCOS.     

Modified Ferriman-Gallwey hirsutism score and androgen levels in Turkish women

Objective(s)

To evaluate a modified Ferriman-Gallwey (mFG) scoring system and serum total testosterone (tT) and dehydroepiandrosterone sulfate (DHEAS) levels, in women with polycystic ovary syndrome (PCOS) and in control subjects.

Study design

Women with any gynecological problem who presented to the Kahramanmaras Sutcuimam University Medical Faculty Gynecology and Obstetric Outpatient Clinic in the Mediterranean region of Turkey were assessed prospectively. Oligo-anovulation, clinical and biochemical hyperandrogenism, and PCO appearance on ultrasound that met the 2003 Rotterdam Consensus Criteria were used for PCOS diagnosis. Group 1 consisted of 43 cases with a diagnosis of PCOS and group 2 (control group) consisted of 75 age and BMI matched control subjects without PCOS.

Results

In groups 1 and 2, clinical hyperandrogenism (hirsutism) appearance ratio was 86.0% (37/43) and 18.0% (15/75) (p < 0.001); while biochemical hyperandrogenism (high serum tT or DHEAS level) was 65.1% (28/43) and 36% (27/75) (p < 0.05), respectively. In groups 1 and 2, mean serum tT levels were 115.2 and 73.4 ng/dL (p < 0.001), mean serum DHEAS levels were 256.1 and 177.7 ng/dL (p < 0.001), and mean hirsutism scores were 11.2 and 5.5 (p < 0.001), respectively. Serum mean tT, DHEAS and hirsutism scores for group 1 were significantly higher than those of group 2 (<0.001). No correlation was observed between BMI and the hirsutism scores or the biochemical hyperandrogenism in both groups.

Conclusion(s)

In our study, mean serum androgen levels and hirsutism ratio in the PCOS group were higher than the control group. These values were also substantially higher than those previously published in the literature.     

Efficacy of Combined Cabergoline and Metformin Compared to Metformin Alone on Cycle Regularity in Patients with Polycystic Ovarian Disease with Hyperprolactinemia: A Randomized Clinical Trial

Purpose

Polycystic ovarian syndrome (PCOS) is a common reproductive disorder. Increasing serum prolactin in these patients could be detected in both follicular and luteal phase of the normal and stimulated cycles. Hyperprolactinemia affects the hypothalamic–pituitary–ovarian axis causing anovulation and abnormal uterine bleeding. In this study, the efficacy of combined cabergoline and metformin therapy was compared to metformin therapy alone in patients with PCOS on the body mass index, androgen profile and menstrual cycle regulation.

Methods

Two hundred and fifty patients with polycystic ovarian syndrome (PCOS) with increased serum prolactin were randomly allocated into two groups: group (1) received oral metformin tablet 1000 mg per day and cabergoline 0.5 g tablet weekly for 3 months as a case group, and group (2) received oral metformin tablet 1000 mg per day and a placebo tablet weekly for 3 months as the control group (n = 123). Body mass index (BMI), menstrual cycle regularity, serum testosterone, serum prolactin and dehydroepiandrosterone sulfate (DHEAS) level were compared before and after treatment in both groups.

Results

There was significant decrease in body mass index and improvement of androgenic profile in both groups after treatment. In group (1), there was significant improvement in cycle regularity and significant decrease in serum prolactin level post-treatment.

Conclusions

The use of cabergoline in addition to metformin had more favorable effect on cycle regularity and prolactin level in patients with polycystic ovarian syndrome with hyperprolactinemia than the use of metformin alone.

     

Role of the two-point pull-up technique for treating the uterine arteries during radical hysterectomy and trachelectomy

Objectives

To introduce a safe and reliable method for the management of peripheral vessels around the uterine artery during abdominal radical hysterectomy or abdominal radical trachelectomy.

Study design

From 2007 to 2011, 102 patients with invasive cervical cancer underwent an abdominal radical hysterectomy. In 48 operations in 2007–2009, we performed the conventional radical hysterectomy, in which we ligated and cut the uterine arteries at their origin, and we divided the anterior leaf of the vesico-uterine ligament by blindly inserting scissors into the ureteral tunnel, pushing the ureter laterally from the cervix. In 54 operations in 2009–2011, we pulled up the origin and the bifurcation of the uterine artery using vessel tape, skeletonized the uterine artery and directly divided the superficial uterine vein, superior vesical vein and ureteric branch of the uterine artery. We also performed four radical trachelectomies using the two point pull-up method. We investigated whether this method was useful for the management of peripheral vessels around the uterine artery.

Results

The mean total blood loss in the two point pull-up method group (485 ± 270 ml) was significantly lower than that in the conventional surgery group (686 ± 554 ml) (p < 0.05). The mean length of the operation in the two point pull-up method group (481 ± 53 min) was not significantly different from the conventional surgery group (497 ± 74 min) (p = 0.111). The mean number of dissected lymph nodes in the two point pull-up method group (37.2 ± 11.6) was not significantly different from that in the conventional method group (34.4 ± 10.2) (p = 0.096). The overall survival and progression-free survival were also not substantially different between the two groups. In the radical trachelectomy, the mean blood loss was 377.5 ± 185.6 ml and the mean duration of surgery was 520.0 ± 48.5 min using the two point pull-up method. We were able to preserve both uterine arteries without accidental injury or disruptive bleeding. All four patients were menstruating normally as of the last examination.

Conclusions

The two point pull-up method enabled us to reduce intraoperative blood loss without increasing other complications during abdominal radical hysterectomy or abdominal radical trachelectomy.     

Brachial artery conductance during reactive hyperemia is increased in women with polycystic ovary syndrome

Objective

To examine changes in brachial artery conductance (BAC) during reactive hyperemia in women with polycystic ovary syndrome (PCOS) compared to controls.

Study design

This is a pilot case-control study performed at a single academic medical center. Changes in BAC during reactive hyperemia were evaluated in 31 women with PCOS and 11 healthy control women. Fasting glucose, insulin, lipids and androgen levels were also determined. A mixed-effects model was used to compare the PCOS curve to the control curve for change in BAC from baseline during reactive hyperemia.

Results

Body mass index (BMI) and testosterone levels were significantly increased in the PCOS group compared to controls (P < 0.05). In addition, the PCOS group had higher total and LDL cholesterol levels (P = 0.05 and 0.09, respectively). Change in BAC from baseline during reactive hyperemia was significantly increased in the PCOS group compared to controls even after adjusting for age, BMI and LDL cholesterol levels (P < 0.0001). There were no significant differences between the two groups in age, blood pressure, or fasting glucose or insulin levels.

Conclusions

Brachial artery conductance during reactive hyperemia is significantly increased in women with PCOS compared to controls and may be a novel early indicator of increased cardiovascular risk in women with PCOS.     

Obesidad como factor pronóstico reproductivo en ciclos de fecundación in vitro-inyección espermática intracitoplasmática

Objective

To compare reproductive outcomes in our in vitro fertilization (IVF) program according to women's body mass index (BMI).

Subjects and methods

We included a total of 863 IVF-intracytoplasmic sperm injection (ICSI) cycles with controlled ovarian stimulation with GnRH antagonists.

Results

Patient age differed among the BMI groups but this difference was not clinically relevant (± 1 year). No significant differences were found among BMI groups in the duration of ovarian stimulation or in the total follicle-stimulating hormone dose used. However, there were significantly fewer selected follicles, retrieved oocytes, mature oocytes and transferred embryos at higher BMIs. Rates of pregnancy and live births were progressively and significantly reduced as BMI increased (group i: 41.4%, group i: 32.5%, group iii: 29.6%; P<.05).

Conclusions

Female overweight and obesity impair IVF outcomes. Pregnancy and live birth rates were progressively reduced as BMI increased.     

Anti-Mullerian hormone and insulin resistance in polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is a prevalent disease affecting women of reproductive age. It may be associated with metabolic disorders such as insulin resistance (IR) and obesity. The anti-Mullerian hormone (AMH) levels seem to be higher in patients with PCOS.

Objective: The present study was designed to evaluate the association between AMH and insulin in women with PCOS with and without IR.

Methods: Cross-sectional study, including 86 patients, selected and divided into three groups: Group A: 26 women with PCOS and IR; Group B: 30 women with PCOS and without IR; and Group C: 30 controls without PCOS.

Results: We found significant difference between serum AMH levels in the group of women with PCOS and without IR when compared to the control group, thus showing that PCOS and IR play an important role in elevating the levels of this hormone. When the groups were compared with each other following adjustment for BMI, serum AMH levels were significantly higher in the group of women with PCOS and IR.

Conclusion: AMH levels are significantly higher in patients with PCOS, particularly in those women with PCOS and IR. Nevertheless, larger samples are required to confirm these findings.     

Effect of body mass index on clinical manifestations in patients with polycystic ovary syndrome

Objective

To determine whether there is a correlation between body mass index (BMI) and blood pressure or clinical features such as hirsutism in women with polycystic ovary syndrome (PCOS).

Method

In this cross-sectional study, 62 women with PCOS were allocated to one of 3 groups according to a BMI range defining normal weight, overweight, or obesity. Blood pressure, waist-to-hip ratio, Ferriman and Gallwey hirsutism score, and presence of acne were recorded for each participant and the means were compared among groups.

Results

The overall mean age was 35.85 ± 5.03 years; BMI, 31.91 ± 6.40; systolic and diastolic blood pressure, 113.02 ± 16.10 mm Hg and 71.79 ± 10.04 mm Hg; waist-to-hip ratio, 0.82 ± 0.07; and hirsutism score, 3.63 ± 4.35. Acne was present in 24 participants. Of these, 8 (33.3%) were overweight and 13 (54.2%) obese. When groups were compared, a progressive and significant increase in systolic and diastolic blood pressure was observed from the normal weight to the obese group.

Conclusion

We observed a significant and progressive correlation between BMI and both blood pressure and clinical features in women with PCOS.     

Heterogenous origins of hyperandrogenism in the polycystic ovary syndrome in relation to body mass index and insulin resistance

Background: Insulin resistance and obesity are not universal features of polycystic ovary syndrome (PCOS). We planned to assess the differences between patients with nonobese /insulin-sensitive phenotype vs. obese/ insulin-resistant phenotype in terms of the potential mechanisms underlying their hyperandrogenism.

Materials and methods: A total of 52 women satisfying Androgen Excess Society (AES) criteria were included. Hormonal and metabolic profile including prolactin, dehydroepiandrosterone sulfate (DHEAS), free testosterone, sex hormone binding globulin (SHBG), fasting plasma glucose and insulin were measured in follicular phase.

Results: DHEAS was found to be higher in the nonobese patients as compared to the obese (p?=?0.01). There was also a strong trend for a higher DHEAS among patients with lower insulin resistance by homeostatic model assessment (HOMA-IRp?=?.06).While the total testosterone (p?=?.044) and SHBG (p?=?.007) were found to be lower in the more insulin-resistant group (HOMA-IR ≥ 2.3), the free testosterone levels were similar. However, the percentage of free testosterone was higher in the more insulin-resistant group (p?=?.005).

Conclusions: The hyperandrogenic state in PCOS appears to have heterogenous origins. Nonobese patients with PCOS have adrenal hyperandrogenism as the underlying mechanism while their obese/ insulin-resistant counterparts have low SHBG and hence an increased fraction of free testosterone.     

Antithyroid Peroxidase Antibodies in Women with Polycystic Ovary Syndrome

Objective

To find the prevalence of thyroid autoimmunity in PCOS women of reproductive age group.

Methods

Study design: Observational study was done at ESIMC and PGIMSR K.K. Nagar March 2013–Feb 2014. Ninety cases of women with PCOS based on Rotterdam’s criteria and an equal number of age-matched controls (women without PCOS) were included in the study. Thyroid profile, antithyroid peroxidase titre, serum progesterone, testosterone and fasting blood sugar were estimated using standardised techniques.

Results

Menstrual irregularity (oligomenorrhoea and amenorrhoea) was the most common abnormality found in patients with PCOS compared with non-PCOS (p < 0.0001). Hyperandrogenism was the second most common manifestation present in PCOS of our study group. Hirsutism was the striking hyperandrogenic feature that was present in study group. PCOS patients had higher BMI compared to controls (p < 0.0001). The prevalence of thyroid dysfunction was not significantly different in both the groups (p < 0.80). Anti-TPO titre was higher in PCOS patients (25.8 ± 2.9 IU/ml) compared to the controls (14.5 ± 2.3 IU/ml) (p < 0.009).

Conclusion

The present study shows that PCOS was associated with increased anti-TPO titres, thus emphasising the importance of screening all PCOS patients for anti-TPO along with routine thyroid profile.

     

Gynecology: Low-Dose Aspirin for Infertile Women with Thin Endometrium Receiving Intraeuterine Insemination: A Prospective, Randomized Study

Purpose: The objective was to evaluate the effect of aspirinon infertile women with thin endometrium. Methods: Patients who had thin endometrium ( 8 mm)and intrauterine insemination were divided into the aspirinand nonaspirin groups. Endometrial pattern (trilaminar andnontrilaminar) and thickness, the pulsatility index (PI) andresistance index (RI) of the uterine artery, spiral artery, andovarian dominant follicles, and pregnancy rates of bothgroups were measured. Results: A total of 114 and 122 women were included inthe aspirin and nonaspirin groups, respectively. There weresignificantly higher percentages of trilaminar endometrium(46.5% vs. 26.2%) and pregnancy rate (18.4% vs. 9.0%)after aspirin therapy. There was nonsignificant differencein the endometrial thickness, and PI/RI values of the uterineartery, spiral artery, and ovarian dominant follicle betweenboth groups. Conclusions: Higher pregnancy rate and better endometrialpattern were achieved in patients with thin endometriumafter aspirin administration. Aspirin therapy could notsignificantly increase the endometrial thickness and theresistance of uterine and ovarian flow.