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Zhao H, Zhang J, Xing C, Cheng X, He B. Metformin versus metformin plus pioglitazone on gonadal and metabolic profiles in normal-weight women with polycystic ovary syndrome: a single-center, open-labeled prospective randomized controlled trial. J Ovarian Res 2024; 17:42. [PMID: 38374053 PMCID: PMC10875752 DOI: 10.1186/s13048-024-01367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To investigate the effects of metformin (MET) monotherapy and pioglitazone plus MET (PIOMET) therapy on gonadal and metabolic profiles in normal-weight women with polycystic ovary syndrome (PCOS). METHODS Sixty normal-weight women with PCOS were recruited between January and September 2022 at the Shengjing Hospital of China Medical University. They were randomly assigned to the MET or PIOMET groups for 12 weeks of MET monotherapy or PIOMET therapy. Anthropometric measurements, menstrual cycle changes, gonadal profiles, and the oral glucose insulin-releasing test (OGIRT) were performed at baseline and after the 12-week treatment. RESULTS Thirty-six participants completed the trial. MET and PIOMET therapies improved menstrual cycles after the 4- and 12-week treatments; however, there was no statistical difference between the two groups. PIOMET therapy improved luteinizing hormone (LH), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio, and free androgen index (FAI) levels after the 4-week treatment, whereas MET monotherapy only improved total testosterone (TT) levels compared to baseline (P < 0.05). Both MET and PIOMET therapies improved TT and anti-Mullerian hormone (AMH) levels after the 12-week treatment (P < 0.05). In addition, only PIOMET therapy significantly improved sex hormone-binding globulin (SHBG), FAI, and androstenedione (AND) levels than the baseline (P < 0.05). PIOMET therapy improved SHBG and AMH levels more effectively than MET monotherapy (P < 0.05). Furthermore, PIOMET treatment was more effective in improving blood glucose levels at 120 and 180 min of OGIRT compared to MET monotherapy (P < 0.05). CONCLUSIONS In normal-weight women with PCOS, PIOMET treatment may have more benefits in improving SHBG, AMH, and postprandial glucose levels than MET monotherapy, and did not affect weight. However, the study findings need to be confirmed in PCOS study populations with larger sample sizes.
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Affiliation(s)
- Han Zhao
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Wuxi, Jiangsu, 214000, PR China
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110000, PR China
| | - Jiaqi Zhang
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110000, PR China
| | - Chuan Xing
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110000, PR China
| | - Xiangyi Cheng
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110000, PR China
| | - Bing He
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110000, PR China.
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Kabakchieva P, Gateva A, Velikova T, Georgiev T, Kamenov Z. Anandamide is associated with waist-to-hip ratio but not with Body Mass Index in women with polycystic ovary syndrome. Minerva Endocrinol (Torino) 2023; 48:150-159. [PMID: 35195378 DOI: 10.23736/s2724-6507.21.03336-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The endocannabinoid system is involved in the regulation of energy balance and ovarian function and may be implicated in the pathogenesis of polycystic ovary syndrome (PCOS). The purpose of the present study is to determine anandamide (AEA) levels in PCOS patients and controls and to analyze its association with metabolic and hormonal disturbances in women with PCOS. METHODS The study included 88 women - 58 patients with PCOS (25.9±5.2 years) and 30 healthy controls (27.6±5.2 years). Further, patients were divided into two subgroups according to their waist-to-hip ratio (WHR): android type PCOS (WHR≥0.85; N.=26) and gynoid type PCOS (WHR<0.85; N.=32). Detailed anthropometric measurements, hormonal and biochemical tests and pelvic ultrasound were obtained between the 3rd and 5th day of a menstrual cycle. AEA was examined by ELISA kits. RESULTS Patients with PCOS and healthy controls did not differ in anthropometric, metabolic parameters, AEA, and sex hormone-binding globulin (SHBG) levels. The PCOS group had increased total testosterone, FAI, DHEAS, androstenedione, and 17-OH-progesterone levels (P<0.001) and elevated LH/FSH ratio (P=0.023). A negative correlation between AEA levels was found with glycaemia at 120 minutes (r=-0.304, P=0.020) and WHR (r=-0.266, P=0.044). In the subanalysis of patients, the gynoid type group had significantly higher levels of AEA than the android type PCOS (5.4 [2.3;8.8] vs. 2.5 [1.8;5.1]; P=0.020). CONCLUSIONS AEA did not differ between healthy women and patients, but a significant difference in its levels was found in PCOS patients divided according to their body constitution type.
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Affiliation(s)
- Plamena Kabakchieva
- Department of Internal Medicine, Faculty of Medicine, Clinic of Endocrinology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria -
- Clinic of Internal Diseases, Military Medical Academy, Naval Hospital, Varna, Bulgaria -
| | - Antoaneta Gateva
- Department of Internal Medicine, Faculty of Medicine, Clinic of Endocrinology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Tsvetelina Velikova
- Laboratory of Clinical Immunology, Faculty of Medicine, Lozenetz University Hospital, St. Kliment Ohridski University, Sofia, Bulgaria
| | - Tsvetoslav Georgiev
- First Department of Internal Medicine, Faculty of Medicine, St. Marina of University Hospital, Medical University, Varna, Bulgaria
| | - Zdravko Kamenov
- Department of Internal Medicine, Faculty of Medicine, Clinic of Endocrinology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
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Motahari Rad H, Mowla SJ, Ramazanali F, Rezazadeh Valojerdi M. Characterization of altered microRNAs related to different phenotypes of polycystic ovarian syndrome (PCOS) in serum, follicular fluid, and cumulus cells. Taiwan J Obstet Gynecol 2022; 61:768-779. [PMID: 36088043 DOI: 10.1016/j.tjog.2022.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Polycystic ovarian syndrome (PCOS) is a metabolic syndrome in which steroidogenesis, folliculogenesis, and cellular adhesion play crucial roles in its prognosis. These pathways are controlled and regulated by some small non-coding RNAs called microRNAs (miRs). Several miRs have differential expression in PCOS compared to healthy women, and their dysregulation suggests important roles of miRs in PCOS pathophysiology. However, the role of miRs is still unclear, especially in various phenotypes of PCOS. MATERIALS AND METHODS This study was conducted to evaluate the diagnostic potential of miR-212-3p, miR-490-5p, miR-647, and miR-4643 in different subtypes of PCOS. Accordingly, nineteen PCOS patients with different subtypes based on Rotterdam criteria (A: 8, B: not detected in this study, C: 5, and D: 6 patients) and six control age and BMI matched women under ICSI treatment were selected. The relative expression of miRs was then measured in blood serum before hormonal treatment (S1) and before ovum pickup (S2), follicular fluid (FF), and cumulus cells (CC) in all subjects. Also, the expression of miRs predicted target genes (AMH, AR, CYP11A1, CYP17A1, CYP19A1, GDF9, and HSD17B12) were done in the CC of understudy groups. RESULTS In general, the results indicated that PCOS significantly increased the expression of miR-212-3p, miR-490-5p, and miR-4643 in FF and CCs compared to control. Although these miRs tend to increase in serum 1 of the PCOS patients, the differences were insignificant. However, there was a significant reduction in the expression of miR-647 in FF and CCs between PCOS vs. control. In addition, the miRs had significantly different expressions in various phenotypes of PCOS. For example, high levels of miR-647 in S2 and low levels of miR-490 in FF and miR-212 in CC can differentiate phenotype A from the other. Also, upregulation of miR-212 in FF and miR-4643 in S1 and low levels of this miR in FF can specifically differentiate subtype A from D. On the other hand, high levels of miR-4643 in FF and miR-490 in CC and lower titter of miR-647 can distinguish subtype C from the other. On the other hand, high levels of AMH, AR, CYP11, CYP17, and HSD17 in the hyperandrogenic PCOS and upregulation of CYP19A1 in the hypoandrogenic group can validate the role of selected miRs in the prognosis of PCOS. CONCLUSION Characterization of altered microRNAs in serum, FF, and CCs and their targets in CC showed that the miRs might play critical roles in steroidogenesis and folliculogenesis. These miRs may be used for molecular classification of PCOS subtypes and as biomarkers for PCOS diagnosis.
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Affiliation(s)
- Hanieh Motahari Rad
- Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Javad Mowla
- Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Fariba Ramazanali
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mojtaba Rezazadeh Valojerdi
- Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
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Coyle CS, Prescott M, Handelsman DJ, Walters KA, Campbell RE. Chronic androgen excess in female mice does not impact luteinizing hormone pulse frequency or putative GABAergic inputs to GnRH neurons. J Neuroendocrinol 2022; 34:e13110. [PMID: 35267218 PMCID: PMC9286661 DOI: 10.1111/jne.13110] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
Polycystic ovary syndrome (PCOS) is associated with androgen excess and, frequently, hyperactive pulsatile luteinizing hormone (LH) secretion. Although the origins of PCOS are unclear, evidence from pre-clinical models implicates androgen signalling in the brain in the development of PCOS pathophysiology. Chronic exposure of female mice to dihydrotestosterone (DHT) from 3 weeks of age drives both reproductive and metabolic impairments that are ameliorated by selective androgen receptor (AR) loss from the brain. This suggests centrally driven mechanisms in hyperandrogen-mediated PCOS-like pathophysiology that remain to be defined. Acute prenatal DHT exposure can also model the hyperandrogenism of PCOS, and this is accompanied by increased LH pulse frequency and increased GABAergic innervation of gonadotrophin-releasing hormone (GnRH) neurons. We aimed to determine the impact of chronic exposure of female mice to DHT, which models the hyperandrogenism of PCOS, on pulsatile LH secretion and putative GABAergic input to GnRH neurons. To do this, GnRH-green fluorescent protein (GFP) female mice received either DHT or blank capsules for 90 days from postnatal day 21 (n = 6 or 7 per group). Serial tail-tip blood sampling was used to measure LH dynamics and perfusion-fixed brains were collected and immunolabelled for vesicular GABA transporter (VGAT) to assess putative GABAergic terminals associated with GFP-labelled GnRH neurons. As expected, chronic DHT resulted in acyclicity and significantly increased body weight. However, no differences in LH pulse frequency or the density of VGAT appositions to GnRH neurons were identified between ovary-intact DHT-treated females and controls. Chronic DHT exposure significantly increased the number of AR expressing cells in the hypothalamus, whereas oestrogen receptor α-expressing neuron number was unchanged. Therefore, although chronic DHT exposure from 3 weeks of age increases AR expressing neurons in the brain, the GnRH neuronal network changes and hyperactive LH secretion associated with prenatal androgen excess are not evident. These findings suggest that unique central mechanisms are involved in the reproductive impairments driven by exposure to androgen excess at different developmental stages.
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Affiliation(s)
- Chris S. Coyle
- Centre for Neuroendocrinology and Department of PhysiologySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Melanie Prescott
- Centre for Neuroendocrinology and Department of PhysiologySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - David J Handelsman
- Andrology LaboratoryANZAC Research InstituteConcord HospitalUniversity of SydneySydneyNSWAustralia
| | - Kirsty A. Walters
- Fertility and Research CentreSchool of Women’s and Children’s HealthUniversity of New South WalesSydneyNSWAustralia
| | - Rebecca E. Campbell
- Centre for Neuroendocrinology and Department of PhysiologySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
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Silva MSB, Campbell RE. Polycystic Ovary Syndrome and the Neuroendocrine Consequences of Androgen Excess. Compr Physiol 2022; 12:3347-3369. [PMID: 35578968 DOI: 10.1002/cphy.c210025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a major endocrine disorder strongly associated with androgen excess and frequently leading to female infertility. Although classically considered an ovarian disease, altered neuroendocrine control of gonadotropin-releasing hormone (GnRH) neurons in the brain and abnormal gonadotropin secretion may underpin PCOS presentation. Defective regulation of GnRH pulse generation in PCOS promotes high luteinizing hormone (LH) pulsatile secretion, which in turn overstimulates ovarian androgen production. Early and emerging evidence from preclinical models suggests that maternal androgen excess programs abnormalities in developing neuroendocrine circuits that are associated with PCOS pathology, and that these abnormalities are sustained by postpubertal elevation of endogenous androgen levels. This article will discuss experimental evidence, from the clinic and in preclinical animal models, that has significantly contributed to our understanding of how androgen excess influences the assembly and maintenance of neuroendocrine impairments in the female brain. Abnormal central gamma-aminobutyric acid (GABA) signaling has been identified in both patients and preclinical models as a possible link between androgen excess and elevated GnRH/LH secretion. Enhanced GABAergic innervation and drive to GnRH neurons is suspected to contribute to the pathogenesis and early manifestation of neuroendocrine derangement in PCOS. Accordingly, this article also provides an overview of GABA regulation of GnRH neuron function from prenatal development to adulthood to discuss possible avenues for future discovery research and therapeutic interventions. © 2022 American Physiological Society. Compr Physiol 12:3347-3369, 2022.
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Affiliation(s)
- Mauro S B Silva
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca E Campbell
- Centre for Neuroendocrinology, Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Ievleva KD, Danusevich IN, Suturina LV. [Role of leptin and nuclear receptor PPARγ in PCOS pathogenesis]. ACTA ACUST UNITED AC 2020; 66:74-80. [PMID: 33481370 DOI: 10.14341/probl12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/18/2020] [Accepted: 12/06/2020] [Indexed: 11/06/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of female endocrine infertility. Insulin resistanсе is supposed to be one of the essential factors of this disease pathways. At the same time, the mechanisms of PCOS development in insulin-resistant patients have not been completely established. Leptin and Peroxisome Proliferator-Activated Receptor γ(PPARγ) are involved in carbohydrate metabolism and reproduction function regulation. It indicates that leptin and PPARγ possibly play a role in the pathways of PCOS. This article is a review of publications on this issue. The purpose of this review was to systematize the available information on the molecular mechanisms that determine the role of leptin and PPARγ in the development of PCOS. The literature search was carried out from 04/05/2020 to 05/17/2020 using the scientific literature databases: NCBI PubMed (foreign sources) and Cyberleninka (domestic sources). We analyzed publications for the period 1990-2020.The review presents the current understanding of the possible role of leptin and PPARγ in the regulation of endocrine, immune systems, and reproductive function, as well as in the development of PCOS. Currently, no studies cover the mechanisms of interaction between leptin and PPARγ in the pathways of this syndrome. The available studies indicating the individual contribution and association of leptin and PPARγ with PCOS are conflicting and have many limitations. Therefore, more studies of direct and indirect interaction of leptin and PPARγ, as well as their role in PCOS pathways, are needed.
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Affiliation(s)
- K D Ievleva
- Scientific Сentre for Family Health and Human Reproduction Problems
| | - I N Danusevich
- Scientific Сentre for Family Health and Human Reproduction Problems
| | - L V Suturina
- Scientific Сentre for Family Health and Human Reproduction Problems
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Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause 2019; 25:1046-1055. [PMID: 29738413 DOI: 10.1097/gme.0000000000001116] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. This systematic review and meta-analysis was conducted to investigate the associations in reproductive-aged women. METHODS PubMed and Scopus were searched up to December, 2016. Original studies on the association of BMI with ovarian reserve markers, anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin β, and antral follicle count (AFC), either according to BMI categories or a continuous variable, were selected. Analyses were stratified into three groups based on polycystic ovary syndrome (PCOS) and fertility status of women. RESULTS Of 4,055 records identified, 45 studies were eligible for inclusion. Comparing the obese with nonobese, the pooled mean differences (MDs) and 95% confidence intervals (CIs) were -1.08 (95% CIs -1.52, -0.63) ng/mL for AMH, -0.22 (95% CIs -0.39, -0.06) mIU/mL for FSH, -0.09 (95% CIs -0.60, 0.42) for AFC, and -21.06 (95% CIs -41.18, -0.85) pg/mL for inhibin β in overall populations. The MDs were significant for AMH in fertile non-PCOS and PCOS women, and for FSH only in PCOS women. Fisher's Z showed significant correlations of BMI with AMH in the overall populations (-0.15 [95% CIs -0.20, -0.11]) and in all subgroups, and with FSH in the fertile non-PCOS women (-0.16 [95% CIs -0.28, -0.04]). CONCLUSION Ovarian reserve markers of AMH and FSH are significantly lower in obese than in nonobese women, and BMI is negatively correlated with AMH in all study populations, and with FSH in fertile non-PCOS subgroups. PCOS and fertility status do not appear to affect the associations.
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Yang PK, Hsu CY, Chen MJ, Lai MY, Li ZR, Chen CH, Chen SU, Ho HN. The Efficacy of 24-Month Metformin for Improving Menses, Hormones, and Metabolic Profiles in Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2018; 103:890-899. [PMID: 29325133 DOI: 10.1210/jc.2017-01739] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023]
Abstract
CONTEXT The long-term effects of metformin in women with polycystic ovarian syndrome (PCOS) are inadequately studied. OBJECTIVE The effects of metformin on women with PCOS during 24 months with respect to menses, hormones, and metabolic profiles are assessed. DESIGN Prospective cohort. SETTING A reproductive endocrinology clinic in a university-affiliated medical center. PATIENTS One hundred nineteen women with PCOS, defined by the Rotterdam criteria, were enrolled. INTERVENTION Metformin was given daily for 24 months. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients with regular menstruation during treatment. Changes in anthropometric, hormonal, and metabolic parameters were also assessed. Analyses were performed using segmented regression analysis with a generalized estimating equation methodology. Outcomes are expressed as magnitude of change from the baseline. RESULTS Both overweight (OW) and normal-weight (NW) women with PCOS had increased menstrual frequency and decreased body mass index (BMI), testosterone, and luteinizing hormone levels in the first 6 months. Further stratification showed that NW women exhibiting elevated testosterone at baseline had the largest magnitude of improvement at 6 months [odds ratio (OR), 7.21; 95% confidence interval (CI), 2.35 to 22.17], whereas OW patients with normal testosterone were most likely to achieve normal menses at 12 months (OR, 0.63; 95% CI, 0.47 to 0.77). CONCLUSIONS Metformin was associated with improvements in the menstrual cycle and most hormonal profiles in OW and NW women with PCOS during 24 months of treatment. Most parameters reached maximal response and steady-state after 6 months. Phenotypic differences in baseline BMI and testosterone level can be used as patient selection criteria or treatment prognostics.
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Affiliation(s)
- Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yuan Hsu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Yu Lai
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Zheng-Rong Li
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chen-Hsin Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Nerng Ho
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
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Xu J, Bao X, Peng Z, Wang L, Du L, Niu W, Sun Y. Comprehensive analysis of genome-wide DNA methylation across human polycystic ovary syndrome ovary granulosa cell. Oncotarget 2017; 7:27899-909. [PMID: 27056885 PMCID: PMC5053696 DOI: 10.18632/oncotarget.8544] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/28/2016] [Indexed: 01/11/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) affects approximately 7% of the reproductive-age women. A growing body of evidence indicated that epigenetic mechanisms contributed to the development of PCOS. The role of DNA modification in human PCOS ovary granulosa cell is still unknown in PCOS progression. Global DNA methylation and hydroxymethylation were detected between PCOS’ and controls’ granulosa cell. Genome-wide DNA methylation was profiled to investigate the putative function of DNA methylaiton. Selected genes expressions were analyzed between PCOS’ and controls’ granulosa cell. Our results showed that the granulosa cell global DNA methylation of PCOS patients was significant higher than the controls’. The global DNA hydroxymethylation showed low level and no statistical difference between PCOS and control. 6936 differentially methylated CpG sites were identified between control and PCOS-obesity. 12245 differential methylated CpG sites were detected between control and PCOS-nonobesity group. 5202 methylated CpG sites were significantly differential between PCOS-obesity and PCOS-nonobesity group. Our results showed that DNA methylation not hydroxymethylation altered genome-wide in PCOS granulosa cell. The different methylation genes were enriched in development protein, transcription factor activity, alternative splicing, sequence-specific DNA binding and embryonic morphogenesis. YWHAQ, NCF2, DHRS9 and SCNA were up-regulation in PCOS-obesity patients with no significance different between control and PCOS-nonobesity patients, which may be activated by lower DNA methylaiton. Global and genome-wide DNA methylation alteration may contribute to different genes expression and PCOS clinical pathology.
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Affiliation(s)
- Jiawei Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Xiao Bao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Zhaofeng Peng
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Linlin Wang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Linqing Du
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Wenbin Niu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
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Phoenixin-14 concentrations are increased in association with luteinizing hormone and nesfatin-1 concentrations in women with polycystic ovary syndrome. Clin Chim Acta 2017. [DOI: 10.1016/j.cca.2017.06.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rezaee M, Asadi N, Pouralborz Y, Ghodrat M, Habibi S. A Review on Glycosylated Hemoglobin in Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2016; 29:562-566. [PMID: 27593259 DOI: 10.1016/j.jpag.2016.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 12/17/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders among women of reproductive age, with a variety of complications and consequences mostly due to hyperandrogenism and insulin resistance (IR). PCOS patients with IR are at risk for metabolic syndrome and diabetes mellitus (DM) along with its complications such as cardiovascular events. There are several methods for screening IR in patients with PCOS to predict DM and other complications. Fasting plasma glucose test, oral glucose tolerance test, and insulin and glycosylated hemoglobin (HbA1c) levels are some available screening tools for IR. The American Diabetes Association recommended HbA1c to screen for DM because HbA1c is not affected by day-to-day plasma glucose levels and reflects the plasma glucose status during 2-3 months before measurement. Some studies have evaluated the role of HbA1c as a screening method to predict DM in PCOS patients, however, there are still controversies in this matter. Also some studies reported that HbA1c has a correlation with complications of PCOS such as metabolic syndrome and cardiovascular events. We found that HbA1c could be a suitable screening test for IR in PCOS patients but more studies are recommended, omitting confounding factors that could affect IR in patients with PCOS, such as antihyperglycemic agents like metformin, or lifestyle modification, which can be effective in reducing IR in patients with PCOS.
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Affiliation(s)
- Mohsen Rezaee
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yasna Pouralborz
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.
| | - Mahshid Ghodrat
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Shaghayegh Habibi
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
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Li C, Chen L, Zhao Y, Chen S, Fu L, Jiang Y, Gao S, Liu Z, Wang F, Zhu X, Rao J, Zhang J, Zhou X. Altered expression of miRNAs in the uterus from a letrozole-induced rat PCOS model. Gene 2016; 598:20-26. [PMID: 27777110 DOI: 10.1016/j.gene.2016.10.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Polycystic ovary syndrome (PCOS) causes female subfertility with ovarian disorders and may be associated with increased rate of early-pregnancy failure. Rat PCOS models were established using letrozole to understand the uterine pathogenesis of PCOS. The differential expression of microRNAs (miRNAs) was observed in rat uterus with PCOS. After estrous cycles were disrupted, significantly abnormal ovarian morphology and hormone level were observed in rats with PCOS. A total of 148 miRNAs differentially expressed were identified in the uterus from the letrozole-induced rat model compared with the control. These miRNAs included 111 upregulated miRNAs and 37 downregulated miRNAs. The differential expression of miR-484, miR-375-3p, miR-324-5p, and miR-223-3p was further confirmed by quantitative reverse transcription polymerase chain reaction. Bioinformatic analysis showed that these four miRNAs were predicted to regulate a large number of genes with different functions. Pathway analysis supported that target genes of miRNAs were involved in insulin secretion and signaling pathways, such as wnt, AMPK, PI3K-Akt, and Ras. These data indicated that miRNAs differentially expressed in rat uterus with PCOS may be associated with PCOS pathogenesis in the uterus. Our findings can help clarify the mechanism of uterine defects in PCOS.
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Affiliation(s)
- Chunjin Li
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Lu Chen
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Yun Zhao
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Shuxiong Chen
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Lulu Fu
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Yanwen Jiang
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Shan Gao
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Zhuo Liu
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Fengge Wang
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Xiaoling Zhu
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Jiahui Rao
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Jing Zhang
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China
| | - Xu Zhou
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun, Jilin 130062, People's Republic of China.
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Nehir Aytan A, Bastu E, Demiral I, Bulut H, Dogan M, Buyru F. Relationship between hyperandrogenism, obesity, inflammation and polycystic ovary syndrome. Gynecol Endocrinol 2016; 32:709-713. [PMID: 26951881 DOI: 10.3109/09513590.2016.1155208] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This prospective study aimed to determine the status of circulating levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α), IL-27, IL-35, IL-37, α-1 acid glycoprotein in patients with polycystic ovary syndrome (PCOS) compared with controls and to evaluate their relation with hyperandrogenism and obesity. Forty-eight patients with PCOS (29 obese, 19 lean) and 40 healthy controls (20 obese, 20 lean) were enrolled. CRP, TNF-α, IL-27, IL-35, IL-37, α-1 acid glycoprotein, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S) levels were measured. Levels of total testosterone, A4, DHEA-S were significantly higher in patients with PCOS than in controls both in the obese and lean groups, while levels of SHBG were significantly lower in all patients with PCOS than in all (p < 0.05). Free androgen index (FAI) values were significantly higher in all patients with PCOS than in all controls (all p < 0.05). Levels of CRP, TNF-α, α-1 acid glycoprotein were significantly increased in all patients with PCOS compared with all controls (all p < 0.001). FAI had a positive correlation with CRP, TNF-α, α-1 acid glycoprotein, a negative correlation with IL-27, IL-25, IL-37 (all p < 0.01). Body mass index had a negative correlation with IL-27, IL-35, IL-37, a positive correlation with α-1 acid glycoprotein, FAI (p < 0.05). The findings confirm the proinflammatory state of PCOS. Moreover, obesity along with PCOS significantly elevates the inflammatory status and hyperandrogenism.
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Affiliation(s)
- Asli Nehir Aytan
- a Department of Obstetrics and Gynecology , Istanbul University School of Medicine , Istanbul , Turkey and
| | - Ercan Bastu
- a Department of Obstetrics and Gynecology , Istanbul University School of Medicine , Istanbul , Turkey and
| | - Irem Demiral
- a Department of Obstetrics and Gynecology , Istanbul University School of Medicine , Istanbul , Turkey and
| | - Huri Bulut
- b Department of Biochemistry , Bezmialem Foundation University, Faculty of Science , Istanbul , Turkey
| | - Murat Dogan
- a Department of Obstetrics and Gynecology , Istanbul University School of Medicine , Istanbul , Turkey and
| | - Faruk Buyru
- a Department of Obstetrics and Gynecology , Istanbul University School of Medicine , Istanbul , Turkey and
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14
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Abstract
Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.
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15
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Ayonrinde OT, Adams LA, Doherty DA, Mori TA, Beilin LJ, Oddy WH, Hickey M, Sloboda DM, Olynyk JK, Hart R. Adverse metabolic phenotype of adolescent girls with non-alcoholic fatty liver disease plus polycystic ovary syndrome compared with other girls and boys. J Gastroenterol Hepatol 2016; 31:980-7. [PMID: 26589977 DOI: 10.1111/jgh.13241] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) share risk associations of adiposity and insulin resistance. We examined the impact of a PCOS diagnosis on the metabolic phenotype of adolescent girls with NAFLD and compared this to girls without PCOS or NAFLD and to age-matched boys. METHODS Community-based adolescents from the Raine Cohort participated in assessments for NAFLD (572 girls and 592 boys) and PCOS (244 girls). One hundred and ninety-nine girls attended both assessments. RESULTS Amongst the 199 girls, PCOS was diagnosed in 16.1% and NAFLD in 18.6%. NAFLD was diagnosed in 10.1% of the boys. NAFLD was more prevalent in girls with PCOS than girls without PCOS (37.5% vs 15.1%, P = 0.003). Girls with NAFLD plus PCOS had greater adiposity (waist circumference, body mass index, suprailiac skinfold thickness [SST], serum androgens, high-sensitivity C-reactive protein, ferritin, homeostasis model assessment for insulin resistance (HOMA-IR), and lower serum sex hormone binding globulin levels than girls with NAFLD without a PCOS diagnosis (all P < 0.05). Girls with NAFLD plus PCOS had similar adiposity, HOMA-IR, and adiponectin levels to boys with NAFLD, but more adiposity, serum leptin and HOMA-IR than both girls and boys without NAFLD. PCOS (odds ratios 2.99, 95% confidence intervals 1.01-8.82, P = 0.048) and SST (odds ratios 1.14, 95% confidence intervals 1.08-1.20, P < 0.001) independently predicted NAFLD in adolescent girls, however, serum androgens and HOMA-IR levels did not. CONCLUSIONS Adolescent girls with NAFLD plus PCOS have a similar metabolic phenotype to boys with NAFLD. Increasing SST and pre-existing PCOS independently predict NAFLD in adolescent girls.
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Affiliation(s)
- Oyekoya T Ayonrinde
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Leon A Adams
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.,Liver Transplantation Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Dorota A Doherty
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Trevor A Mori
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Lawrence J Beilin
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Wendy H Oddy
- Centre for Child Health Research, Telethon Institute for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Deborah M Sloboda
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John K Olynyk
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Murdoch University, Perth, Western Australia, Australia
| | - Roger Hart
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia
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16
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Ramezanali F, Khalili G, Arabipoor A, Bagheri Lankarani N, Moini A. Relationships between Serum Luteinizing Hormone Level, Endometrial Thickness and Body Mass Index in Polycystic Ovary Syndrome Patients with and without Endometrial Hyperplasia. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:36-41. [PMID: 27123198 PMCID: PMC4845527 DOI: 10.22074/ijfs.2016.4766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 08/03/2015] [Indexed: 11/20/2022]
Abstract
Background The endometrial hyperplasia measured by ultrasound in polycystic ovary
syndrome (PCOS) women is strongly related to pathologic endometrial thickness, but
there is no consensus on the relation between serum luteinizing hormone (LH) and either
of these factors: pathologic endometrial hyperplasia and body mass index (BMI). Materials and Methods In this observational cross-sectional study, three hundred fifty
infertile PCOS women were involved in this research. An endometrial biopsy was taken
by using a pipelle instrument, regardless of menstrual cycle’s day and all samples were
reported by the same pathologist. Basal serum LH level was compared between two
subgroups (hyperplasia and non-hyperplasia). The intended population was divided into
three groups according to BMI and basal serum LH, later on the comparison was made in
three groups. Chi-square test was applied to compare nominal variables between groups.
Mann-Whitney U, and one way ANOVA tests were used to compare means on the basis
of the result of normality test. Results The frequency of endometrial hyperplasia was 2.6%. Endometrial thickness
in the patients with endometrial hyperplasia was significantly higher than that of a
normal endometrium (10.78 ± 3.70 vs. 7.90 ± 2.86 respectively, P=0.020). There was
no relation between endometrial hyperplasia and serum LH (P=0.600). The ANOVA
test showed serum LH levels were not the same among three BMI groups (P=0.007).
Post hoc test was also performed. It showed that the LH level in normal BMI group
was significantly higher than those of other groups (P=0.005 and P=0.004), but there
was no statistical difference between overweight and obese groups (P=0.8). We found
no relationship between BMI and endometrial thickness in PCOS patients (P=0.6). Conclusion Sonographic endometrial stripe thickness is predictive for endometrial hyperplasia in PCOS women. We could not find out any relationship between serum LH level and BMI with endometrial thickness in PCOS patients. However, our study confirmed a
diverse relationship between serum LH level and BMI in PCOS patients.
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Affiliation(s)
- Fariba Ramezanali
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Gholamreza Khalili
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Narges Bagheri Lankarani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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17
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Zhang H, Yi M, Zhang Y, Jin H, Zhang W, Yang J, Yan L, Li R, Zhao Y, Qiao J. High-fat diets exaggerate endocrine and metabolic phenotypes in a rat model of DHEA-induced PCOS. Reproduction 2016; 151:431-41. [PMID: 26814210 DOI: 10.1530/rep-15-0542] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/26/2016] [Indexed: 01/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder with unclear etiology and unsatisfactory management. Effects of diets on the phenotype of PCOS were not fully understood. In the present study, we applied 45 and 60% high-fat diets (HFDs) on a rat model of PCOS induced by postnatal DHEA injection. We found that both DHEA and DHEA+HFDs rats exhibited reproductive abnormalities, including hyperandrogenism, irregular cycles and polycystic ovaries. The addition of HFDs, especially 60% HFDs, exaggerated morphological changes of ovaries and a number of metabolic changes, including increased body weight and body fat content, impaired glucose tolerance and increased serum insulin levels. Results from qPCR showed that DHEA-induced increased expression of hypothalamic androgen receptor and LH receptor were reversed by the addition of 60% HFDs. In contrast, the ovarian expression of LH receptor and insulin receptor mRNA was upregulated only with the addition of 60% HFDs. These findings indicated that DHEA and DHEA+HFDs might influence PCOS phenotypes through distinct mechanisms: DHEA affects the normal function of hypothalamus-pituitary-ovarian axis through LH, whereas the addition of HFDs exaggerated endocrine and metabolic dysfunction through ovarian responses to insulin-related mechanisms. We concluded that the addition of HFDs yielded distinct phenotypes of DHEA-induced PCOS and could be used for studies on both reproductive and metabolic features of the syndrome.
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Affiliation(s)
- Haolin Zhang
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Ming Yi
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Yan Zhang
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Hongyan Jin
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Wenxin Zhang
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Jingjing Yang
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Liying Yan
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Rong Li
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Yue Zhao
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China Department of Obstetrics and GynaecologyCenter for Reproductive Medicine, Peking University Third Hospital, No. 49, North Huayuan Road, Haidian District, Beijing 100191, ChinaKey Laboratory of Assisted ReproductionMinistry of Education, Beijing, ChinaBeijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive TechnologyBeijing, ChinaNeuroscience Research InstitutePeking University, Beijing, China
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18
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Johnson LK, Holven KB, Nordstrand N, Mellembakken JR, Tanbo T, Hjelmesæth J. Fructose content of low calorie diets: effect on cardiometabolic risk factors in obese women with polycystic ovarian syndrome: a randomized controlled trial. Endocr Connect 2015; 4:144-54. [PMID: 26138702 PMCID: PMC4488759 DOI: 10.1530/ec-15-0047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We aimed to examine whether a whole-grain crispbread (CB) low-fructose, low-calorie diet (LCD) might be superior to a traditional LCD based on fructose-rich liquid meal replacements (LMRs) with respect to improvement of various cardiometabolic risk factors and reproductive hormones. Parallel-group randomised controlled clinical trial. Morbidly obese women with polycystic ovarian syndrome (PCOS) were randomised to either an 8-week CB-LCD or LMR-LCD (900-1100 kcal/day, fructose 17 g/day or 85 g/day). A total of 51 women completed the study. Body weight, fat mass and waist circumference reduced by mean (s.d.) 10.0 (4.8) kg, 7.4 (4.2) kg and 8.5 (4.4) cm, with no significant differences between groups. Total-cholesterol, HDL-cholesterol and Apo-A1 were significantly reduced within both groups (all P values <0.01), with no significant between-group differences. The triacylglycerol and LDL-cholesterol levels were reduced within the LMR group only, with no significant between-group differences. Blood pressure and most measures of glucose metabolism improved significantly in both diet groups, with no significant between-group difference. Uric acid levels rose by 17.7 (46.4) and 30.6 (71.5) μmol/l in the CB and LMR group, respectively, with no significant difference between groups. Gastrointestinal discomfort was significantly and equally reduced in both intervention groups. Free testosterone index was reduced in both groups, with no significant difference between groups. Morbidly obese women with PCOS who underwent either an 8-week low or high-fructose LCD-diet had similar changes in various cardiometabolic risk factors and reproductive hormones. Registration at ClinicalTrials.gov: NCT00779571.
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Affiliation(s)
- Line K Johnson
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Kirsten B Holven
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Njord Nordstrand
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Jan R Mellembakken
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Tom Tanbo
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway Morbid Obesity CentreVestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, NorwayDepartment of NutritionInstitute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317 Oslo, NorwayNorwegian National Advisory Unit on Familial HypercholesterolemiaDepartment of Endocrinology, Morbid Obesity and Preventive MedicineDepartment of GynecologyOslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, NorwayInstitute of Clinical MedicineDepartment of EndocrinologyMorbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
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Sjaarda LA, Schisterman EF, Schliep KC, Plowden T, Zarek SM, Yeung E, Wactawski-Wende J, Mumford SL. Dietary Carbohydrate Intake Does Not Impact Insulin Resistance or Androgens in Healthy, Eumenorrheic Women. J Clin Endocrinol Metab 2015; 100:2979-86. [PMID: 26066675 PMCID: PMC4524988 DOI: 10.1210/jc.2015-1957] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Diet is proposed to contribute to androgen-related reproductive dysfunction. OBJECTIVE This study evaluated the association between dietary macronutrient intake, carbohydrate fraction intake, and overall diet quality on androgens and related hormones, including anti-Müllerian hormone (AMH) and insulin, in healthy, regularly menstruating women. DESIGN This was a prospective cohort study from 2005 and 2007. SETTING The study was conducted at the University at Buffalo, western New York State, USA. PARTICIPANTS Participants were 259 eumenorrheic women without a self-reported history of infertility, polycystic ovary syndrome (PCOS), or other endocrine disorder. MAIN OUTCOME MEASURES A 24-hour dietary recall was administered 4 times per menstrual cycle, and hormones were measured 5 to 8 times per cycle for 1 (n = 9) or 2 (n = 250) cycles per woman (n = 509 cycles). Associations between the dietary intake of carbohydrates (starch, sugar, sucrose, and fiber), macronutrients, overall diet quality and hormones (insulin, AMH, and total and free testosterone), as well as the relationship of dietary intake with occurrences of high total testosterone combined with high AMH (fourth quartile of each), ie, the "PCOS-like phenotype," were assessed. RESULTS No significant relationships were identified between dietary intake of carbohydrates, percent calories from any macronutrient or overall diet quality (ie, Mediterranean diet score) and relevant hormones (insulin, AMH, and total and free testosterone). Likewise, no significant relationships were identified between dietary factors and the occurrence of a subclinical PCOS-like phenotype. CONCLUSIONS Despite evidence of a subclinical continuum of a PCOS-related phenotype of elevated androgens and AMH related to sporadic anovulation identified in previous studies, dietary carbohydrate and diet quality do not appear to relate to these subclinical endocrine characteristics in women without overt PCOS.
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Affiliation(s)
- Lindsey A Sjaarda
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Enrique F Schisterman
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Karen C Schliep
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Torie Plowden
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Shvetha M Zarek
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Edwina Yeung
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Jean Wactawski-Wende
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
| | - Sunni L Mumford
- Division of Intramural Population Health Research (L.A.S., E.F.S., K.C.S., T.P., S.M.Z., E.Y., S.L.M.) and Program of Reproductive and Adult Endocrinology (T.P., S.M.Z.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Department of Epidemiology and Environmental Health (J.W.W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
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Ressler IB, Grayson BE, Ulrich-Lai YM, Seeley RJ. Diet-induced obesity exacerbates metabolic and behavioral effects of polycystic ovary syndrome in a rodent model. Am J Physiol Endocrinol Metab 2015; 308:E1076-84. [PMID: 26078189 PMCID: PMC4469809 DOI: 10.1152/ajpendo.00182.2014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/09/2015] [Indexed: 01/13/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age. Although a comorbidity of PCOS is obesity, many are lean. We hypothesized that increased saturated fat consumption and obesity would exacerbate metabolic and stress indices in a rodent model of PCOS. Female rats were implanted with the nonaromatizable androgen dihydrotestosterone (DHT) or placebo pellets prior to puberty. Half of each group was maintained ad libitum on either a high-fat diet (HFD; 40% butter fat calories) or nutrient-matched low-fat diet (LFD). Irrespective of diet, DHT-treated animals gained more body weight, had irregular cycles, and were glucose intolerant compared with controls on both diets. HFD/DHT animals had the highest levels of fat mass and insulin resistance. DHT animals demonstrated increased anxiety-related behavior in the elevated plus maze by decreased distance traveled and time in the open arms. HFD consumption increased immobility during the forced-swim test. DHT treatment suppressed diurnal corticosterone measurements in both diet groups. In parallel, DHT treatment significantly dampened stress responsivity to a mild stressor. Brains of DHT animals showed attenuated c-Fos activation in the ventromedial hypothalamus and arcuate nucleus; irrespective of DHT-treatment, however, all HFD animals had elevated hypothalamic paraventricular nucleus c-Fos activation. Whereas hyperandrogenism drives overall body weight gain, glucose intolerance, anxiety behaviors, and stress responsivity, HFD consumption exacerbates the effect of androgens on adiposity, insulin resistance, and depressive behaviors.
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Affiliation(s)
- Ilana B Ressler
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Cincinnati, Cincinnati, Ohio
| | - Bernadette E Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Yvonne M Ulrich-Lai
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio; and
| | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Jamilian M, Razavi M, Fakhrie Kashan Z, Ghandi Y, Bagherian T, Asemi Z. Metabolic response to selenium supplementation in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Clin Endocrinol (Oxf) 2015; 82:885-91. [PMID: 25510442 DOI: 10.1111/cen.12699] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/03/2014] [Accepted: 12/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We are aware of no study examining the effects of selenium supplementation on metabolic profiles of patients with polycystic ovary syndrome (PCOS). This study was conducted to evaluate the effects of selenium supplementation on glucose homeostasis parameters and lipid concentrations in women with PCOS. DESIGN, PATIENTS AND MEASUREMENTS This randomized, double-blind, placebo-controlled trial was conducted among 70 women diagnosed with PCOS and aged 18-40 years old. Participants were randomly divided into two groups to receive 200 μg per day selenium supplements (N = 35) or placebo (N = 35) for 8 weeks. Fasting blood samples were taken at baseline and after 8 weeks intervention to quantify glucose, insulin and lipid concentrations. RESULTS After 8 weeks of intervention, subjects who received selenium supplements had significantly decreased serum insulin levels (-29·83 ± 47·29 vs +9·07 ± 77·12 pmol/l, P = 0·013), homeostasis model of assessment-insulin resistance (HOMA-IR) (-1·15 ± 1·81 vs +0·42 ± 3·09, P = 0·011), homeostatic model assessment-beta-cell function (HOMA-B) (-19·06 ± 30·95 vs +4·55 ± 47·99, P = 0·017) and increased quantitative insulin sensitivity check index (QUICKI) (+0·03 ± 0·04 vs +0·0009 ± 0·05, P = 0·032) compared with placebo. In addition, supplementation with selenium resulted in a significant reduction in serum triglycerides (-0·14 ± 0·55 vs +0·11 ± 0·30 mmol/l, P = 0·025) and VLDL-C concentrations (-0·03 ± 0·11 vs +0·02 ± 0·06 mmol/l, P = 0·025) compared with placebo. CONCLUSIONS In conclusion, 200 microgram per day selenium supplementation for 8 weeks among PCOS women had beneficial effects on insulin metabolism parameters, triglycerides and VLDL-C levels; however, it did not affect FPG and other lipid profiles.
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Affiliation(s)
- Mehri Jamilian
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, I.R. Iran
| | - Maryamalsadat Razavi
- Department of Gynecology and Obstetrics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, I.R. Iran
| | - Zohreh Fakhrie Kashan
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Yasser Ghandi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Tayebeh Bagherian
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
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22
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Orief YI, El-agwany AS, Darwish EAE, Rahman AHA, Ghazal SM. Relationship between ultrasound parameters and intra cytoplasmic sperm injection outcome in polycystic ovarian syndrome treated by non agonist step up stimulation protocol. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Arduc A, Sarıcam O, Dogan BA, Tuna MM, Tutuncu YA, Isik S, Berker D, Sennaroglu E, Guler S. Should insulin resistance be screened in lean hirsute women? Gynecol Endocrinol 2015; 31:291-5. [PMID: 25561024 DOI: 10.3109/09513590.2014.994598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The role of insulin resistance (IR) is well-documented in obese women with polycystic ovary syndrome (PCOS). Controversies exist concerning the presence of IR in idiopathic hirsutism (IH) or if it is a manifestation of high body mass index (BMI). We aimed to investigate the presence/absence of IR in lean hirsute women. One-hundred fifty-one lean women with hirsutism [96 PCOS (group 1) and 55 IH (group 2)] and 58 age-and BMI-matched healthy controls (group 3) were recruited in the study (mean age 25.21 ± 6.1 versus 26.26 ± 4.6years; BMI 21.79 ± 1.7 versus 22.02 ± 2.2 kg/m(2), respectively). Significantly higher insulin and HOMA-IR, and significantly lower fasting glucose insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), reciprocal insulin, and Raynaud index were detected in groups 1 and 2 than in group 3 (p < 0.05). These IR indices were similar between groups 1 and 2. The number of patients with IR (HOMA-IR > 2, FGIR < 7.2, or QUICKI < 0.357) was significantly higher in groups 1 and 2 than in group 3, but was similar between groups 1 and 2. A higher frequency of IR occurs in lean hirsute women regardless of they having PCOS or IH. IR may contribute to aetiopathogenesis of IH, or may cause some metabolic abnormalities in these patients.
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Affiliation(s)
- Ayse Arduc
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrine and Obesity Branch, National Institutes of Health , Bethesda, MD , USA
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Yılmaz SA, Altınkaya SÖ, Kebabçılar A, Seçilmiş Kerimoğlu Ö, Tazegül Pekin A, Abuşoğlu S, Çelik Ç, Ünlü A. The relationship between Polycystic ovary syndrome and vitamin D levels. Turk J Obstet Gynecol 2015; 12:18-24. [PMID: 28913035 PMCID: PMC5558399 DOI: 10.4274/tjod.76148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/17/2014] [Indexed: 12/28/2022] Open
Abstract
Objective: The main aim of this study was to determine the association of serum 25-hydroxyvitamin D (25-OH D) levels with hormonal, clinical and metabolic profile in patients with and without Polycystic ovary syndrome (PCOS). Materials and Methods: Forty-eight normal-weight (body mass index (BMI) of 19-24.99 kg/m2) women with PCOS, 36 overweight (BMI of 25-29.9 kg/m2) women with PCOS and 56 normal-weight controls participated in the study. Blood samples were collected in the early follicular phase (between day 2 and day 5 of the menstrual cycle) at 9:00 am after an overnight fast. Circulating concentrations of 25-OH D, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, TSH, free testosterone, dehydroepiandrosterone sulphate (DHEA-SO4), 17-hydroxyprogesterone, sex hormone-binding globulin (SHBG), fasting insulin, fasting glucose, and lipid profile were assessed. Results: Normal weight (BMI 19-24.99 kg/m2) and overweight (BMI 25-29.99 kg/m2) women with PCOS were compared with normal-weight controls and lower 25-OH D levels were found in both PCOS groups (p<0.05 and p<0.01, respectively 25-OH D significantly negatively correlated with waist circumference (WC), waist-to-hip ratio (WHR), free testosterone and modified Ferriman-Gallwey scores, however, there was a positive correlation between 25-OH D and SHBG levels (p<0.05). Conclusion: Our findings suggest that PCOS is associated with hypovitaminosis D.
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Affiliation(s)
- Setenay Arzu Yılmaz
- Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Sündüz Özlem Altınkaya
- Adnan Menderes University Faculty of Medicine, Department of Obstetrics and Gynecology, Aydın, Turkey
| | - Ayşegül Kebabçılar
- Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | | | - Aybike Tazegül Pekin
- Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Sedat Abuşoğlu
- Selçuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
| | - Çetin Çelik
- Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Ali Ünlü
- Selçuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
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Moran C, Arriaga M, Arechavaleta-Velasco F, Moran S. Adrenal androgen excess and body mass index in polycystic ovary syndrome. J Clin Endocrinol Metab 2015; 100:942-50. [PMID: 25514100 DOI: 10.1210/jc.2014-2569] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Adrenal hyperandrogenism affects approximately 25% of polycystic ovary syndrome (PCOS) patients but its relation to obesity is not totally understood. OBJECTIVE This study aimed to assess dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) levels in relation to body mass index (BMI) in PCOS. DESIGN AND SETTING This was a prospective observational study at an institutional practice at an obstetrics/gynecology hospital. PARTICIPANTS The study included 136 PCOS patients, 20-35 years old, and 42 age-matched control women. The participants were classified with the BMI cutoff value of 27 kg/m(2) as follows: 1) high-BMI PCOS patients; 2) low-BMI PCOS patients; 3) high-BMI control women; and 4) low-BMI control women. The data were reanalyzed with the BMI cutoff value of 30 kg/m(2) to corroborate the findings in obese and nonobese patients. MAIN OUTCOME MEASURE(S) Blood samples were taken and LH, FSH, insulin, T, androstenedione (A4), DHEA, DHEAS, and glucose levels were determined. Homeostatic model assessment was calculated. Pelvic and abdominal ultrasound for ovarian morphology and adipose tissue, respectively, were performed. RESULTS Obese PCOS patients presented significantly more insulin resistance than nonobese PCOS patients. The LH levels and LH/FSH ratio were significantly higher in low-BMI than in high-BMI PCOS patients. The A4 and DHEAS levels were significantly higher in nonobese than in obese PCOS patients. A significant correlation between LH and A4 in nonobese PCOS patients was observed. The frequency of hyperandrogenism by increased A4, and DHEA along with DHEAS was significantly higher in low-BMI PCOS patients compared with high-BMI PCOS patients. Some findings observed with the BMI cutoff value of 27 kg/m(2) changed with the cutoff value of 30 kg/m(2). CONCLUSIONS Low BMI more so than high BMI is associated with increased LH, high A4, DHEA, and DHEAS levels in PCOS patients. The BMI cutoff value of 27 kg/m(2) classified better than 30 kg/m(2) for hormonal and metabolic characteristics.
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Affiliation(s)
- Carlos Moran
- Research Unit of Reproductive Medicine (C.M., F.A.-V.), Health Research Council, Mexican Institute of Social Security, Mexico City, Mexico; Medical Unit of High Specialty (M.A.), Gynecology and Obstetrics Hospital No. 4 Luis Castelazo Ayala, Mexican Institute of Social Security, Mexico City, Mexico; and Research Unit of Clinical Epidemiology (S.M.), Health Research Council, Mexican Institute of Social Security, Mexico City, Mexico
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Rizk NM, Sharif E. Leptin as well as Free Leptin Receptor Is Associated with Polycystic Ovary Syndrome in Young Women. Int J Endocrinol 2015; 2015:927805. [PMID: 26180527 PMCID: PMC4477211 DOI: 10.1155/2015/927805] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/07/2015] [Indexed: 02/07/2023] Open
Abstract
Background and Aim. Leptin has two forms in the circulation: free and bound forms. The soluble leptin receptor (sOB-R) circulates in the blood and can bind to leptin. The aim of this study is to assess the concentrations of the leptin and the sOB-R in PCOS and its relation to adiposity, insulin resistance, and androgens. Methods. A cross-sectional study included 78 female students aged 17-25 years. Fasting serum leptin and sOB-R concentrations were measured. The anthropometric variables and the hormonal profile such as insulin, female and male sex hormones, and prolactin were assessed. Results. In PCOS, leptin level (ng/ml) and free leptin index (FLI) increased significantly while sOB-R (ng/ml) significantly decreased compared to control subjects. In age-matched subjects, obese PCOS had increased leptin level in ng/ml (median level with interquartile levels) of 45.67 (41.98-48.04) and decreased sOB-R in ng/ml 11.47 (7.59-16.44) compared to lean PCOS 16.97 (10.60-45.55) for leptin and 16.62 (11.61-17.96) for sOB-R with p values 0.013 and 0.042, respectively. However, body mass index (BMI) is significantly correlated with leptin and s-OBR, while no significant correlations with parameters of insulin resistance were detected. Conclusion. PCOS is associated with hyperleptinemia and increased free leptin index. Decreased sOB-R could be a compensatory mechanism for the defective action of leptin.
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Affiliation(s)
- Nasser M. Rizk
- Health Sciences Department, CAS, Qatar University, P.O. Box 2713, Doha, Qatar
- *Nasser M. Rizk:
| | - Elham Sharif
- Health Sciences Department, CAS, Qatar University, P.O. Box 2713, Doha, Qatar
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Genetic variation in the vitamin D receptor gene and vitamin D serum levels in Egyptian women with polycystic ovary syndrome. Mol Biol Rep 2014; 40:6063-73. [PMID: 24078159 DOI: 10.1007/s11033-013-2716-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 09/14/2013] [Indexed: 01/13/2023]
Abstract
Obesity, insulin resistance, and hyperandrogenism are considered crucial parameters of polycystic ovary syndrome (PCOS) which might be related to vitamin D metabolism. The aim of this study was to investigate the associations between polymorphisms (TaqI and ApaI) in the vitamin D receptor gene (VDR) and PCOS among Egyptian women. We aimed also to elucidate the impact of these polymorphisms on vitamin D level, hormonal and metabolic parameters of PCOS. One hundred and fifty Egyptian women with PCOS and 150 unrelated controls were enrolled in this study. Polymorphisms of VDR Taq-I T/C (rs731236) and Apa-I A/C (rs7975232) gene were genotyped using polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP). Serum 25 hydroxy vitamin D [25(OH) D] levels were measured by high-performance liquid chromatography. PCOS women had significantly lower levels of 25(OH) D compared to healthy women. Our results revealed that Taq-I CC genotype and C allele were associated with increased risk of PCOS, while the Apa-I polymorphism was not. Haplotype Taq-I C/ Apa-I C was associated with a higher PCOS risk more than controls. Moreover, there was a significant decrease of 25(OH) D levels in carriers of haplotype Taq-I C/ Apa-I C (with variant alleles) compared to the non-carriers. Results showed also that there was an obesity- VDR Taq-I genotypes interactions. These results suggested that, VDR Taq-I gene polymorphism is associated with increased risk of PCOS in Egyptian women.
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Guler I, Himmetoglu O, Turp A, Erdem A, Erdem M, Onan MA, Taskiran C, Taslipinar MY, Guner H. Zinc and homocysteine levels in polycystic ovarian syndrome patients with insulin resistance. Biol Trace Elem Res 2014; 158:297-304. [PMID: 24664271 DOI: 10.1007/s12011-014-9941-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/09/2014] [Indexed: 01/03/2023]
Abstract
In this study, our objective was to evaluating the value of serum zinc levels as an etiologic and prognostic marker in patients with polycystic ovarian syndrome. We conducted a prospective study, including 53 women with polycystic ovarian syndrome and 33 healthy controls. We compared serum zinc levels, as well as clinical and metabolic features, of the cases. We also compared serum zinc levels between patients with polycystic ovarian syndrome with insulin resistance. Mean zinc levels were found to be significantly lower in patients with polycystic ovarian syndrome than healthy controls. Multiple logistic regression analysis of significant metabolic variables between polycystic ovarian syndrome and control groups (serum zinc level, body mass index, the ratio of triglyceride/high-density lipoprotein cholesterol, and homocysteine) revealed that zinc level was the most significant variable to predict polycystic ovarian syndrome. Mean serum zinc levels tended to be lower in patients with polycystic ovarian syndrome with impaired glucose tolerance than patients with normal glucose tolerance, but the difference was not statistically significant. In conclusion, zinc deficiency may play a role in the pathogenesis of polycystic ovarian syndrome and may be related with its long-term metabolic complications.
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Affiliation(s)
- Ismail Guler
- Department of Obstetrics & Gynecology, Faculty of Medicine, Gazi University, 06500 Besevler, Ankara, Turkey,
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Sjaarda LA, Mumford SL, Kissell K, Schliep KC, Hammoud AO, Perkins NJ, Weck J, Wactawski-Wende J, Schisterman EF. Increased androgen, anti-Müllerian hormone, and sporadic anovulation in healthy, eumenorrheic women: a mild PCOS-like phenotype? J Clin Endocrinol Metab 2014; 99:2208-16. [PMID: 24606085 PMCID: PMC4037725 DOI: 10.1210/jc.2013-3781] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Hyperandrogenism is a hallmark of polycystic ovary syndrome (PCOS) in women with irregular menses, yet the relationship between androgens and ovarian dysfunction remains poorly understood in eumenorrheic women. OBJECTIVE The objective of the study was to evaluate whether sporadic anovulation was associated with higher T and anti-müllerian hormone (AMH; marker of ovarian follicle count) concentrations in eumenorrheic women. DESIGN This was a prospective cohort study from 2005 to 2007. SETTING The study was conducted at the University of Buffalo in western New York state. PARTICIPANTS A total of 259 eumenorrheic women without a self-reported history of infertility, PCOS, or other endocrine disorder participated in the study. MAIN OUTCOME MEASURES Total T and AMH were measured five to eight times per cycle for one (n = 9) or two (n = 250) cycles per woman (n = 509 cycles) with timing of menstrual cycle phase assisted by fertility monitors. Anovulatory cycles were defined biochemically by progesterone and LH concentrations. Repeated-measures ANOVA was conducted on log-transformed data with adjustment for age. RESULTS Compared with ovulatory cycles (n = 467), sporadic anovulatory cycles (n = 42) had marginally higher total and significantly higher free T [mean 23.7 ng/dL (95% confidence interval [CI] 21.4-26.3) vs 21.6 ng/dL (95% CI 20.9-22.3), P = .08, and 0.36 ng/dL (95% CI 0.33-0.40) vs 0.32 ng/dL (95% CI 0.31-0.33), P = .02, respectively] during menses and also throughout the luteal phase (P < .01 for all). Women with higher T had elevated AMH concentrations, increased reporting of a history of acne requiring medical treatment, but not increased hirsutism. CONCLUSIONS Mechanisms of androgen-related ovulatory dysfunction that characterize PCOS in women with menstrual disturbances may occur across a continuum of T concentrations, including in eumenorrheic women without clinical hyperandrogenism.
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Affiliation(s)
- Lindsey A Sjaarda
- Division of Intramural Population Health Research (L.A.S., S.L.M., K.K., K.C.S., N.J.P., J.W., E.F.S.) and Program of Reproductive and Adult Endocrinology (K.K.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; Division of Reproductive Endocrinology and Infertility (A.O.H.), Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132; and Department of Social and Preventive Medicine (J.W.-W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214
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Elevated diastolic blood pressure in insulin-resistant polycystic ovarian syndrome patients. Arch Gynecol Obstet 2013; 289:119-22. [DOI: 10.1007/s00404-013-2953-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Chang EM, Han JE, Seok HH, Lee DR, Yoon TK, Lee WS. Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation-in vitro fertilization-embryo transfer cycle. Clin Endocrinol (Oxf) 2013; 79:93-9. [PMID: 23176069 DOI: 10.1111/cen.12099] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Although extensive evidence indicates the hyperinsulinemia directly contributes to reproductive dysfunction in polycystic ovarian syndrome (PCOS), influence of insulin resistance (IR) on assisted reproductive technology outcomes is poorly understood. In this study we aimed to evaluate the effects of IR on in vitro maturation-in vitro fertilization-embryo transfer (IVM-IVF-ET) in patients with PCOS. DESIGN Prospective observational study. PATIENTS Women with PCOS (n = 115) commencing IVM. MEASURMENTS IR (n = 51) and non-IR (n = 64) women with PCOS ready to commence an IVM cycle were recruited. IR was diagnosed using the glucose tolerance test (GTT) and homeostasis model assessment (HOMA) index. Patients with an abnormal GTT and/or HOMA index >2·4 were considered IR. Patients underwent 115 cycles of unstimulated hCG-primed IVM. RESULTS Maturation, fertilization, cleavage rates, the number of good-quality embryo, and blastocyst formation rates were not significantly different between groups. However, implantation (11·6% vs 28·7%, P = 0·001, respectively), clinical pregnancy (23·5% vs 53·1%, P = 0·002, respectively), and ongoing pregnancy rates (21·6% vs 46·9%. P = 0·006, respectively) were significantly decreased in the IR group. The negative effect of IR on pregnancy outcomes remained after controlling for age, body mass index (BMI) and lipid profiles (OR 4·928, 95% CI 1·735-13·991, P = 0·003). CONCLUSIONS Pregnancy rate after IVM is impaired in IR patients with PCOS. Oocyte development and embryo quality are not affected, suggesting that the effects of hyperinsulinemia on endometrial function and implantation process underlie the decreased pregnancy rate.
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Affiliation(s)
- Eun M Chang
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul, 135-081, Republic of Korea
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Kashani L, Omidvar T, Farazmand B, Modabbernia A, Ramzanzadeh F, Tehraninejad ES, Ashrafi M, Tabrizi M, Akhondzadeh S. Does pioglitazone improve depression through insulin-sensitization? Results of a randomized double-blind metformin-controlled trial in patients with polycystic ovarian syndrome and comorbid depression. Psychoneuroendocrinology 2013; 38:767-776. [PMID: 22999261 DOI: 10.1016/j.psyneuen.2012.08.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 12/28/2022]
Abstract
Thiazolidinediones have shown beneficial effects in short-term treatment of depression. However, it is unclear whether the antidepressant efficacy of these agents is related to their insulin-sensitizing action. We conducted the present study to compare the antidepressant efficacy of pioglitazone with another insulin-sensitizer, metformin, in obese patients with concomitant polycystic ovarian syndrome (PCOS) and major depressive disorder (MDD). In a six-week double-blind study, 50 patients with PCOS and MDD (DSM-IV-TR criteria) with Hamilton depression rating scale (HDRS) score of <20, randomly received pioglitazone (15 mg twice daily; PO) or metformin (750 mg twice daily; PO). Assessment was done using HDRS (weeks 0, 3, 6) together with fasting Insulin, glucose, and lipid profile, liver enzymes, homeostatic model assessment of insulin resistance (HOMA-IR), anthropometric measures, and serum androgens (weeks 0 and 6). Pioglitazone was superior to metformin in reducing HDRS scores at the end of the study [38.3% versus 8.3% reduction from baseline scores, F(1, 37) = 73.513, P<0.001]. Changes from baseline in HOMA-IR values at week 6 were not significantly different between the two groups (P = 0.888). Baseline (but not follow-up) HDRS and HOMA-IR values were significantly correlated (r = 0.393, P = 0.012). In multiple regression analysis, treatment with pioglitazone independent of HOMA-IR values predicted greater score reduction on HDRS at week 6 (standardized beta = 0.801, P<0.001). Biochemical and hormonal profile did not differ between the two groups at week 6. Metformin was associated with higher frequency of gastrointestinal side effects (P = 0.014). In summary, we showed that pioglitazone improved depression with mechanisms largely unrelated to its insulin-sensitizing action (registration number: IRCT201106081556N23).
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Affiliation(s)
- Ladan Kashani
- Infertility Ward, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Mormandi EA, Otero P, Bertone AL, Calvo M, Astarita G, Kogovsek N, Levalle O. [Body weight increase and quality of semen: a controversial association]. ACTA ACUST UNITED AC 2013; 60:303-7. [PMID: 23562378 DOI: 10.1016/j.endonu.2013.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/04/2012] [Accepted: 01/04/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infertility is a public health disorder affecting 10% of the population worldwide. Research on the impact of body mass index (BMI) on male fertility is very limited as compared to the multiple studies evaluating the impact of overweight in women's fertility. Although 25%-30% of the cases of couples consulting for infertility are attributable to male factors, studies evaluating the association between semen parameters and BMI are controversial. OBJECTIVE To assess the impact of BMI on semen parameters in a selected group of men with unexplained infertility. METHOD A retrospective analysis of 168 patients during the 2008-2010 period. They all had at least one semen analysis and related studies to rule out known causes of infertility. Median age of patients was 35 years (22-55), and they were divided into three groups: normal weight (BMI: 20-24.9kg/m(2)), overweight (BMI 25-29.9kg/m(2)), and obese (BMI ≥30kg/m(2)). RESULTS There were no significant differences in semen parameters evaluated between the three groups, and no significant correlation was found between the same parameters and BMI. CONCLUSIONS There was no significant association between BMI and conventional semen parameters, but we cannot exclude an impairment in other semen parameters that are not routinely assessed, which could result in a lower potential fertility in these individuals.
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Affiliation(s)
- Eduardo Alejandro Mormandi
- Laboratorio de Endocrinología, División de Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina.
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Sinawat S, Buppasiri P, Lumbiganon P, Pattanittum P. Long versus short course treatment with metformin and clomiphene citrate for ovulation induction in women with PCOS. Cochrane Database Syst Rev 2012; 10:CD006226. [PMID: 23076922 PMCID: PMC7264991 DOI: 10.1002/14651858.cd006226.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women. Apart from infertility, women with PCOS often have other endocrine disorders, including insulin resistance, hyperinsulinaemia and hyperandrogenism. Metformin,combined with clomiphene citrate (CC), has been shown to be more effective in ovulation induction when compared with clomiphene citrate alone. The optimal duration for metformin pretreatment before initiation of clomiphene citrate, however, is unknown. OBJECTIVES To determine the effectiveness of short-course (less than four weeks) metformin plus CC versus long-course (four weeks or more) metformin plus CC with regard to ovulation and achievement of pregnancy in infertile women with PCOS. SEARCH METHODS We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE and PsycINFO (all from inception to 1 February 2012). SELECTION CRITERIA Randomised controlled trials comparing short-course (less than four weeks) metformin plus CC versus long-course (four weeks or more) metformin plus CC for ovulation or achievement of pregnancy in infertile women with PCOS. DATA COLLECTION AND ANALYSIS No trials were found that met the selection criteria. MAIN RESULTS No randomised controlled trials were identified. AUTHORS' CONCLUSIONS There are insufficient data to determine whether short-course metformin pretreatment is as effective as the conventional long-course metformin pretreatment before initiation of clomiphene citrate for ovulation induction in infertile women with PCOS. A well-designed randomised controlled trial is needed to answer this important clinical question.
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Affiliation(s)
- Supat Sinawat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Cebeci F, Onsun N, Mert M. Insulin resistance in women with hirsutism. Arch Med Sci 2012; 8:342-6. [PMID: 22662009 PMCID: PMC3361048 DOI: 10.5114/aoms.2012.28563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 10/10/2010] [Accepted: 10/20/2010] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION There are still not enough data showing whether patients with idiopathic hirsutism (IH) also have insulin resistance. The association between polycystic ovary syndrome (PCOS) and insulin resistance is well documented in the literature, but the Rotterdam Consensus has concluded that principally obese women with PCOS should be screened for the metabolic syndrome. We intended to investigate the presence/absence of insulin resistance in non-obese women with hirsutism. MATERIAL AND METHODS Twenty-eight women with PCOS (14 non-obese and 14 obese), 12 non-obese with IH, and 16 non-obese healthy women were included in the study. The presence of insulin resistance was investigated by using basal insulin levels and the homeostasis model assessment (HOMA) score in the study group. RESULTS Patients with obese and nonobese PCOS had significantly (p < 0.05) higher basal insulin levels and HOMA scores than IH and control subjects. Insulin levels and HOMA scores did not differ between obese and non-obese PCOS patients. Patients with IH did not show any difference from the control group. CONCLUSIONS Insulin resistance exists in non-obese women with PCOS as well as obese women with PCOS. The PCOS is associated with insulin resistance independent of obesity. Insulin resistance should be assessed in all hirsute women with PCOS regardless of their body mass index. More studies in larger numbers of patients should be performed to investigate the role of insulin resistance in women with IH.
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Affiliation(s)
- Filiz Cebeci
- Department of Dermatology, Vakif Gureba Teaching Hospital, Istanbul, Turkey
| | - Nahide Onsun
- Department of Dermatology, Vakif Gureba Teaching Hospital, Istanbul, Turkey
| | - Meral Mert
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Medical Faculty, Istanbul University, Turkey
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Gören K, Sağsöz N, Noyan V, Yücel A, Cağlayan O, Bostancı MS. Plasma apelin levels in patients with polycystic ovary syndrome. J Turk Ger Gynecol Assoc 2012; 13:27-31. [PMID: 24627671 DOI: 10.5152/jtgga.2011.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/07/2011] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of the study was to evaluate plasma apelin levels in patients with polycystic ovary syndrome (PCOS) and healthy controls. MATERIAL AND METHODS Plasma apelin levels, serum lipid levels, serum hormone levels, and homeostasis model assessment-insulin resistance (HOMA-IR) values of 32 patients with PCOS and 31 healthy women forming the control group were checked. RESULTS Plasma apelin levels of the PCOS group (0.350±0.083 ng/ml) were significantly higher than those of the control group (0.246±0.045 ng/ml) (p<0.001). No significant correlation was detected between apelin levels and biochemical or clinical data in PCOS group. CONCLUSION Plasma apelin levels were significantly higher in PCOS patients.
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Affiliation(s)
- Kıvılcım Gören
- Department of Gynecology and Obstetrics, Haci Hidayet Dogruer State Hospital, Specialist of Obstetric and Gynecology, Kırıkkale, Turkey
| | - Nevin Sağsöz
- Department of Gynecology and Obstetrics, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Volkan Noyan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Aykan Yücel
- Department of Gynecology and Obstetrics, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Osman Cağlayan
- Department of Biochemistry, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Mehmet Sühha Bostancı
- Specialist of Obstetric and Gynecology, Sakarya Education and Research Hospital, Sakarya, Turkey
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Moran C, Arriaga M, Rodriguez G, Moran S. Obesity differentially affects phenotypes of polycystic ovary syndrome. Int J Endocrinol 2012; 2012:317241. [PMID: 22829818 PMCID: PMC3399368 DOI: 10.1155/2012/317241] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/13/2012] [Accepted: 04/17/2012] [Indexed: 11/17/2022] Open
Abstract
Obesity or overweight affect most of patients with polycystic ovary syndrome (PCOS). Phenotypes are the clinical characteristics produced by the interaction of heredity and environment in a disease or syndrome. Phenotypes of PCOS have been described on the presence of clinical hyperandrogenism, oligoovulation and polycystic ovaries. The insulin resistance is present in the majority of patients with obesity and/or PCOS and it is more frequent and of greater magnitude in obese than in non obese PCOS patients. Levels of sexual hormone binding globulin are decreased, and levels of free androgens are increased in obese PCOS patients. Weight loss treatment is important for overweight or obese PCOS patients, but not necessary for normal weight PCOS patients, who only need to avoid increasing their body weight. Obesity decreases or delays several infertility treatments. The differences in the hormonal and metabolic profile, as well as the different focus and response to treatment between obese and non obese PCOS patients suggest that obesity has to be considered as a characteristic for classification of PCOS phenotypes.
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Affiliation(s)
- Carlos Moran
- Direction of Health Research and Training, Medical Unit of High Specialty, Gynecology and Obstetrics Hospital No. 4 Luis Castelazo Ayala, Mexican Institute of Social Security, Mexico City, DF 01090, Mexico
- Health Research Council, Mexican Institute of Social Security, Mexico City, DF 06725, Mexico
- *Carlos Moran:
| | - Monica Arriaga
- Direction of Health Research and Training, Medical Unit of High Specialty, Gynecology and Obstetrics Hospital No. 4 Luis Castelazo Ayala, Mexican Institute of Social Security, Mexico City, DF 01090, Mexico
| | - Gustavo Rodriguez
- General Hospital of Zone No. 8, Mexican Institute of Social Security, Mexico City, DF 01090, Mexico
| | - Segundo Moran
- Health Research Council, Mexican Institute of Social Security, Mexico City, DF 06725, Mexico
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Ozgen IT, Aydin M, Guven A, Aliyazicıoglu Y. Characteristics of polycystic ovarian syndrome and relationship with ghrelin in adolescents. J Pediatr Adolesc Gynecol 2010; 23:285-9. [PMID: 20537572 DOI: 10.1016/j.jpag.2010.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 01/19/2010] [Accepted: 02/26/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Some points of pathogenesis in polycystic ovarian syndrome (PCOS) are still unknown. In this study we evaluated the characteristics of this disease and its relationship with ghrelin in adolescence. DESIGN A prospective case control study was designed. Four groups: obese PCOS (n = 13), lean PCOS (n = 13), obese control (n = 10) and lean control (n = 10) were formed. Oral glucose tolerance tests (OGTT) were performed on all subjects. Laboratory and clinical features of groups were compared. SETTING University pediatric endocrinology clinic. PARTICIPANTS Adolescents with PCOS. INTERVENTIONS None. MAIN OUTCOME MEASURES Insulin resistance, ghrelin, delta ghrelin (difference of ghrelin between basal and 120(th) minute after OGTT), androgens RESULTS Insulin resistance ratios were 93.3%, 46.6%, 50% in obese PCOS, lean PCOS and obese controls respectively. Ghrelin levels were lower in obese PCOS group but statistically different only between obese and lean PCOS groups. Ghrelin was correlated negatively with HOMA-IR (P < 0.001), 17 OH progesterone (P = 0.05), total (P = 0.015) and free testosterone (P = 0.013). Ghrelin suppression was blunted in PCOS groups. Ghrelin suppression ratios after glucose load were 24.4%, 28.7%, 36%, 35% obese PCOS, lean PCOS, obese control and lean control groups respectively. CONCLUSION Low ghrelin levels in obese PCOS patients, correlations between insulin resistance, androgens and ghrelin, blunted suppression of ghrelin after glucose load in PCOS have been considered as evidences of ghrelin role in pathogenesis of this syndrome.
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Affiliation(s)
- I T Ozgen
- Department of Pediatrics, Division of Pediatric Endocrinology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey.
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Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Arch Gynecol Obstet 2009; 280:559-63. [DOI: 10.1007/s00404-009-0958-7] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 01/20/2009] [Indexed: 02/07/2023]
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Kenigsberg S, Bentov Y, Chalifa-Caspi V, Potashnik G, Ofir R, Birk OS. Gene expression microarray profiles of cumulus cells in lean and overweight-obese polycystic ovary syndrome patients. Mol Hum Reprod 2009; 15:89-103. [PMID: 19141487 DOI: 10.1093/molehr/gan082] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this work was to study gene expression patterns of cultured cumulus cells from lean and overweight-obese polycystic ovary syndrome (PCOS) patients using genome-wide oligonucleotide microarray. The study included 25 patients undergoing in vitro fertilization and intra-cytoplasmic sperm injection: 12 diagnosed with PCOS and 13 matching controls. Each of the groups was subdivided into lean (body mass index (BMI) < 24) and overweight (BMI > 27) subgroups. The following comparisons of gene expression data were made: lean PCOS versus lean controls, lean PCOS versus overweight PCOS, all PCOS versus all controls, overweight PCOS versus overweight controls, overweight controls versus lean controls and all overweight versus all lean. The largest number of differentially expressed genes (DEGs), with fold change (FC) |FC| >or= 1.5 and P-value < 0.01, was found in the lean PCOS versus lean controls comparison (487) with most of these genes being down-regulated in PCOS. The second largest group of DEGs originated from the comparison of lean PCOS versus overweight PCOS (305). The other comparisons resulted in a much smaller number of DEGs (174, 109, 125 and 12, respectively). In the comparison of lean PCOS with lean controls, most DEGs were transcription factors and components of the extracellular matrix and two pathways, Wnt/beta-catenin and mitogen-activated protein kinase. When comparing overweight PCOS with overweight controls, most DEGs were of pathways related to insulin signaling, metabolism and energy production. The finding of unique gene expression patterns in cumulus cells from the two PCOS subtypes is in agreement with other studies that have found the two to be separate entities with potentially different pathophysiologies.
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Affiliation(s)
- Shlomit Kenigsberg
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev, Ben-Gurion University, Beer-Sheva, Israel
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Yildizhan R, Adali E, Kolusari A, Kurdoglu M, Yildizhan B, Sahin HG, Kamaci M. Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone. J Int Med Res 2008; 36:1197-204. [DOI: 10.1177/147323000803600605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sixty-seven infertile women with polycystic ovary syndrome (PCOS) were divided into two groups, obese and non-obese, according to their body mass index. Waist-to-hip ratio, insulin resistance, total testosterone and dehydroepiandrosterone sulphate levels were significantly elevated in obese, compared with non-obese, patients. Both groups were treated with a low-dose step-up protocol of recombinant follicle-stimulating hormone (rFSH) with a starting dose of 50 IU/day and, every third day, a 25-IU increase in the dose until the appropriate dose was achieved for each individual, up to a maximum of 175 IU/day. In the obese group only, repeat therapy commenced in the second ovulatory cycle in women who had not become pregnant, however a starting dose of 75 IU/day was then used, with incremental and maximum dose as before. The results of the starting dose of 75 IU/day rFSH were compared with the results of a 50 IU/day rFSH starting dose in the obese group. A starting dose of 50 IU/day rFSH in a low-dose step-up regimen was found to be effective, safe and well-tolerated for inducing follicular development in non-obese infertile women with PCOS. However, for obese PCOS patients, a starting dose of 75 IU/day rFSH is recommended.
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Affiliation(s)
- R Yildizhan
- Department of Obstetrics and Gynaecology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - E Adali
- Department of Obstetrics and Gynaecology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - A Kolusari
- Department of Obstetrics and Gynaecology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - M Kurdoglu
- Department of Obstetrics and Gynaecology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - B Yildizhan
- Department of Obstetrics and Gynaecology, Medical Faculty, Marmara University, Istanbul, Turkey
| | - HG Sahin
- Department of Obstetrics and Gynaecology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - M Kamaci
- Department of Obstetrics and Gynaecology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
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Affiliation(s)
- Suhail A R Doi
- Division of Endocrinology, Mubarak Al-Kabeer Hospital and Kuwait University, Kuwait.
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Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including polycystic ovary syndrome. Med Clin North Am 2008; 92:1163-92, xi. [PMID: 18721657 DOI: 10.1016/j.mcna.2008.04.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infertility in women has many possible causes and must be approached systematically. The most common cause of medically treatable infertility is the polycystic ovary syndrome (PCOS). This syndrome is common in young women and is the cause of anovulatory infertility in 70% of cases. It is therefore an important condition to screen and manage in primary care medical settings. In the past 10 years, insulin sensitization with weight loss or metformin has been shown to be a safe and effective treatment for PCOS infertility that eliminates the risk of multiple pregnancy and may reduce the risk of early pregnancy loss as compared with ovulation-inductor drugs. The authors believe metformin should be considered as first-line therapy because it has the advantage to allow for normal single ovulation, for reduced early pregnancy loss, and, most importantly, lifestyle modifications and weight loss before pregnancy. Losing weight not only improves fertility but also reduces adverse pregnancy outcomes associated with obesity.
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Affiliation(s)
- Maryse Brassard
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, 3001, 12th North Avenue, Sherbrooke, QC J1H 5N4, Canada
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Sinawat S, Buppasiri P, Lumbiganon P, Pattanittum P. Long versus short course treatment with Metformin and Clomiphene Citrate for ovulation induction in women with PCOS. Cochrane Database Syst Rev 2008:CD006226. [PMID: 18254096 DOI: 10.1002/14651858.cd006226.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women. Apart from infertility, women with PCOS often have other endocrine disorders, including insulin resistance,hyperinsulinaemia and hyperandrogenism. Metformin,combined with clomiphene citrate (CC), has been shown to be more effective in ovulation induction when compared with clomiphene citrate alone. The optimal duration for metformin pretreatment before initiation of clomiphene citrate, however, is unknown. OBJECTIVES To determine the effectiveness of short-course (less than four weeks) metformin plus CC versus long-course (four weeks or more) metformin plus CC with regard to ovulation and achievement of pregnancy in infertile PCOS women. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, 2006 issue 4), MEDLINE (1950 to 7 January 2007), CINAHL (1982 to December 2006) and EMBASE (1980 to 7 January 2007). SELECTION CRITERIA Randomised controlled trials comparing short-course (less than four weeks) metformin plus CC versus long-course (four weeks or more) metformin plus CC for ovulation or achievement of pregnancy in infertile PCOS women. DATA COLLECTION AND ANALYSIS No trials were found that met the selection criteria. MAIN RESULTS No randomised controlled trials were identified. AUTHORS' CONCLUSIONS There are insufficient data to determine whether short-chouse metformin pretreatment is as effective as the conventional long-course metformin pretreatment before initiation of clomiphene citrate for ovulation induction in infertile PCOS patients. A well-designed randomised controlled trial is needed to answer this important clinical question.
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Affiliation(s)
- S Sinawat
- Khon Kaen Universtity, Obstetrics and Gynaecology, Kohn Kaen, Thailand, 40002.
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Moran C, Renteria JL, Moran S, Herrera J, Gonzalez S, Bermudez JA. Obesity differentially affects serum levels of androstenedione and testosterone in polycystic ovary syndrome. Fertil Steril 2007; 90:2310-7. [PMID: 18163993 DOI: 10.1016/j.fertnstert.2007.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 09/07/2007] [Accepted: 09/07/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess androstenedione (A) and T levels in obese and nonobese patients with polycystic ovary syndrome (PCOS) after GnRH and oral glucose tolerance tests (OGTT). DESIGN Cross sectional study. SETTING Clinical research center. PATIENT(S) Thirty patients with PCOS, of whom 15 were obese and 15 were nonobese, and 7 women without PCOS were included in the study. INTERVENTION(S) The GnRH test and OGTT were performed in all subjects. MAIN OUTCOME MEASURE(S) Basal and stimulated levels of LH, FSH, insulin, A, and total T were measured. Areas under the curve (AUCs) and AUC change after stimulation for these hormones were calculated. RESULT(S) The basal T levels were significantly higher in obese than in nonobese patients with PCOS. In contrast, the basal levels of A were similar in obese and nonobese patients with PCOS. The T(AUC) after GnRH was significantly greater in obese than in nonobese patients with PCOS but was not significantly different after OGTT. The A(AUC) after GnRH and OGTT was significantly greater in nonobese than in obese patients with PCOS. However, there were no significant differences in T(AUC) and A(AUC) changes after GnRH and OGTT. CONCLUSION(S) A different pattern in the levels of T and A with respect to obesity in PCOS was observed, suggesting a shift in ovarian enzymatic function.
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Affiliation(s)
- Carlos Moran
- Health Research Council, Mexican Institute of Social Security, Mexico City, Mexico.
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Association of increased total antioxidant capacity and anovulation in nonobese infertile patients with clomiphene citrate–resistant polycystic ovary syndrome. Fertil Steril 2007; 88:418-24. [DOI: 10.1016/j.fertnstert.2006.11.172] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 11/27/2006] [Accepted: 11/27/2006] [Indexed: 12/13/2022]
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Moran LJ, Brinkworth G, Noakes M, Norman RJ. Effects of lifestyle modification in polycystic ovarian syndrome. Reprod Biomed Online 2006; 12:569-78. [PMID: 16790100 DOI: 10.1016/s1472-6483(10)61182-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a common endocrine condition with reproductive and metabolic consequences, including anovulation, infertility and an increased prevalence of diabetes mellitus. Obesity, central obesity and insulin resistance are strongly implicated in its aetiology. Dietary weight loss is recommended as the primary treatment strategy; however, effective means of achieving and maintaining weight loss and reproductive and metabolic improvements are unknown. Lifestyle modification programmes with an emphasis on behavioural management and dietary and exercise interventions have been successful in the general population in reducing the risk of diabetes and the metabolic syndrome, and have had some initial success in improving fertility outcomes in PCOS. However, the literature on effective diet and exercise programmes for PCOS has been sparse, and structured advice for implementing components of lifestyle modification programmes should be assessed in this population.
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Affiliation(s)
- Lisa J Moran
- CSIRO Human Nutrition, PO Box 10041 BC, Adelaide, South Australia, Australia, 5000.
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Moran LJ, Noakes M, Clifton PM, Wittert GA, Williams G, Norman RJ. Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome. Am J Clin Nutr 2006; 84:77-87. [PMID: 16825684 DOI: 10.1093/ajcn/84.1.77] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS), a common condition in women, improves with weight loss. Meal replacements in short-term weight loss and strategies for weight maintenance have not been investigated in PCOS. OBJECTIVE We compared in overweight women with PCOS the effects of meal replacements in short-term weight-loss and longer-term carbohydrate- or fat-restriction strategies on weight maintenance and improvements in reproductive and metabolic variables. DESIGN Overweight women with PCOS (n = 43; x +/- SD age: 32.1 +/- 5.2 y; weight: 96.1 +/- 18.4 kg) followed an 8-wk weight-loss regimen (2 meal replacements/d, 4904.4 +/- 127 kJ; phase 1) and then a 6-mo weight-maintenance carbohydrate- (<120 g/d) or fat- (<50 g/d) restriction regimen (phase 2). RESULTS Thirty-four women completed phase 1, and 23 women completed phase 2; the proportion of dropouts was similar in the 2 groups. During phase 1, significant (P < 0.05) reductions in weight (5.6 +/- 2.4 kg), waist circumference (6.1 +/- 2.5 cm), body fat (4.1 +/- 2.2 kg), insulin (2.8 +/- 1.1 mU/L), total testosterone (0.3 +/- 0.7 nmol/L), and free androgen index (3.1 +/- 4.6) occurred; these changes were sustained during phase 2. No significant differences between diet groups were seen for any variables. At 6 mo, both approaches resulted in a net weight loss of 4.7 +/- 4.6 kg. Improvements in menstrual cyclicity occurred for 16 (57.1%) of 28 subjects. CONCLUSIONS Meal replacements are an effective strategy for the short-term management of PCOS. Advice on moderate fat or carbohydrate restriction was equally effective in maintaining weight reduction and improving reproductive and metabolic variables.
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Affiliation(s)
- Lisa J Moran
- Discipline of Obstetrics and Gynaecology (Research Centre for Reproductive Health), School of Paediatrics and Reproductive Health, Adelaide, Australia.
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Lord J, Thomas R, Fox B, Acharya U, Wilkin T. The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome. BJOG 2006; 113:1203-9. [PMID: 16753044 DOI: 10.1111/j.1471-0528.2006.00973.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To establish whether visceral fat mass is the most significant variable correlating with insulin resistance and other metabolic parameters in women with polycystic ovary syndrome (PCOS). DESIGN Prospective cross-sectional trial. SETTING Reproductive medicine clinic. POPULATION Forty women with anovulatory PCOS. METHODS Measurements were taken at recruitment, and analysis was performed to define correlations between the outcome measures and the explanatory variables. MAIN OUTCOME MEASURES Visceral and subcutaneous fat by computed tomography scan, insulin resistance, anthropometric measures, markers of the metabolic syndrome and androgens. RESULTS Strong linear correlation of visceral fat to insulin resistance (r = 0.68, P < 0.001) was observed. There were also statistically significant correlations with fasting insulin (r = 0.73, P < 0.001), homeostasis model assessment beta-cell function (r = 0.50, P = 0.007), triglycerides (r = 0.45, P = 0.003), high-density lipoprotein cholesterol (r = -0.42, P = 0.007), urate (r = 0.47, P = 0.002), Sex hormone binding globulin (r = -0.39, P = 0.01) and luteinising hormone (r = -0.32, P = 0.02). There were no significant correlations of testosterone with fat distribution or metabolic parameters. Insulin resistance showed closest correlation to visceral fat mass (r = 0.68, P < 0.001), then to waist circumference (r = 0.62, P < 0.001), with the weakest correlation being waist:hip ratio (r = 0.36, P = 0.01). The best regression model for predicting insulin resistance is with visceral fat mass and triglycerides as the explanatory variables (r = 0.72, P < 0.001). CONCLUSIONS Visceral fat is the most significant variable correlating with metabolic dysfunction in women with PCOS. Our data support the hypothesis that visceral fat either causes insulin resistance or is a very early effect of it. It also implies that reducing visceral fat should reduce insulin resistance which may account for the observations that exercise and weight loss appear to be more effective interventions than pharmacological treatments. The best anthropometric measure of insulin resistance is waist circumference.
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Affiliation(s)
- J Lord
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital, Truro, Cornwall, UK.
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Peterson NB, Trentham-Dietz A, Newcomb PA, Chen Z, Gebretsadik T, Hampton JM, Stampfer MJ, Willett WC, Egan KM. Relation of Anthropometric Measurements to Ovarian Cancer Risk in a Population-based Case–control Study (United States). Cancer Causes Control 2006; 17:459-67. [PMID: 16596298 DOI: 10.1007/s10552-005-0416-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Accepted: 11/16/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between anthropometric measures and ovarian cancer by menopausal status. METHODS We analyzed data from a population-based case-control study comprised of 700 incident cases of epithelial ovarian cancer and 5,943 population controls from Massachusetts and Wisconsin enrolled between 1993 and 2001. In a telephone interview, information was gathered on established ovarian cancer risk factors, as well as adult height and age-specific body weight. Logistic regression was used to estimate multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for body mass index (BMI) throughout life. RESULTS Recent BMI had no significant association with ovarian cancer risk (P-trend 0.14 for continuous BMI), after adjustment for age and other ovarian cancer risk factors. However, a non-significant positive association (overall P-trend 0.08) was observed for BMI at age 20; the risk estimate comparing a body mass of >25 kg/m2 to the lowest quintile (<or=18.88 kg/m2) was moderately but non-significantly elevated (OR 1.46; 95% CI 0.92, 2.31). CONCLUSION Results of this study suggest that maintenance of a lean body mass, particularly in early adult life, may decrease ovarian cancer risk.
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Affiliation(s)
- Neeraja B Peterson
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Medical Center East, Suite 6000, Nashville, TN 37232-8300, USA.
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