[Polycystic ovary syndrome and pregnancy: clinical experience]

Rev Med Chil. 2007 Dec;135(12):1530-8

Authors: Villarroel AC, Echiburú B, Riesco V, Maliqueo M, Cárcamo M, Hitschfeld C, Sánchez F, del Solar MP, Sir-Petermann T

BACKGROUND: Polycystic ovary syndrome (PCOS) is an endocrine metabolic dysfunction closely associated with insulin resistance and obesity, which predisposes to pregnancy complications. AIM: To report a prospective clinical experience in PCOS patients who became pregnant after diet, exercise and metformin treatment intervention, and were followed up during the whole pregnancy. PATIENTS AND METHODS: Seventy pregnant PCOS (PPCOS) women and forty normal pregnant (NP) women of similar age and with singleton pregnancies were included in the study. During gestational ages 10-16 and 22-28 weeks, a 2h, 75 g oral glucose tolerance test (OGTT) was performed with measurement of glucose and insulin in each sample. RESULTS: No differences were found in duration of gestation, weight gain during pregnancy, or systolic and diastolic blood pressure between PPCOS and NP women. There were significant differences in body mass index (BMI) at the initiation and in the third trimester of pregnancy between both groups. The incidence of gestational diabetes was significantly higher (p <0.01) in the PCOS group (35.2%) compared to the control group (5.0%). The prevalence of small for gestational age (SGA) infants tended to be higher (p =0.09) in the PCOS group. During pregnancy, 2h glucose and insulin were significantly higher in PPCOS than in NP women. CONCLUSIONS: PCOS mothers showed a higher prevalence of gestational diabetes and SGA newborns, which cannot be attributed to the weight gain during pregnancy, and seems to be more related to the BMI at the initiation of pregnancy, and to the PCOS condition of the mother.

PMID: 18357353 [PubMed - indexed for MEDLINE]

Endocrine and metabolic differences among phenotypic expressions of polycystic ovary syndrome according to the 2003 Rotterdam consensus criteria.

Am J Obstet Gynecol. 2008 Jun;198(6):670.e1-7; discussion 670.e7-10

Authors: Kauffman RP, Baker TE, Baker VM, DiMarino P, Castracane VD

OBJECTIVE: The Rotterdam criteria extend the phenotypic spectrum of polycystic ovary syndrome (PCOS). We characterized endocrine and metabolic differences among women meeting the National Institutes of Health (NIH) definition for PCOS vs two novel phenotypes established by the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine definition. STUDY DESIGN: Endocrine and metabolic data from a retrospective analysis of 160 age- and weight-matched women with PCOS and 23 controls were compared. Insulin sensitivity indices were correlated with androgens, gonadotropins, and lipids within each phenotype. RESULTS: Ovarian and adrenal androgens were highest in the NIH-defined PCOS group, lowest in the nonhyperandrogenic PCOS group, and intermediate in the hyperandrogenic ovulatory PCOS population. Insulin sensitivity indices, gonadotropins, and lipids were similar across all PCOS phenotypes. The magnitude of insulin resistance correlated with free testosterone only in the NIH-defined group. CONCLUSION: Androgen levels are the major distinguishing endocrine feature differentiating phenotypic expressions of PCOS. Hyperinsulinemia correlates with free testosterone levels only in traditional NIH-defined women with PCOS.

PMID: 18355776 [PubMed - indexed for MEDLINE]

Thrombin-activatable fibrinolysis inhibitor and cardiovascular risk factors in polycystic ovary syndrome.

Exp Clin Endocrinol Diabetes. 2008 Mar;116(3):143-7

Authors: Erdoğan M, Karadeniz M, Alper GE, Tamsel S, Uluer H, Cağlayan O, Saygili F, Yilmaz C

OBJECTIVE: We aimed to assess circulating thrombin activatable fibrinolysis inhibitor (TAFI) levels and carotid intima-media thickness (CIMT) in PCOS patients and control subjects. In this study we aimed to evaluate the relation between the levels of TAFI and homocysteine, high sensitive CRP (hsCRP), fibrinogen and CIMT in PCOS patients carrying a potential risk for developing CVD and diabetes and compared with age- and body mass index-matched controls. RESEARCH DESIGN AND METHODS: We studied 68 PCOS patients and 26 healthy controls. We conducted an observational study examining noninvasive markers of early CV disease in women with PCOS including structural CIMT. Noninvasive markers of early CVD, CIMT were measured in PCOS patients and control subjects. Metabolic parameters included fasting insulin and glucose levels, lipid and androgen levels, TAFI levels, hsCRP. RESULTS: Fasting glucose levels, prolactin, TSH, Total-cholesterol, LDL-cholesterol, triglyceride, estradiol, DHEA-S and age were similar in the two groups, whereas serum insulin, fibrinogen, hs-CRP, 17-OHP, free-testosterone, total testosterone, HOMA-IR, HDL were significantly elevated in PCOS patients in comparison to control subjects (p<0.05). Plasma TAFI levels were similarly in PCOS patients compared with healthy controls. No difference was observed in the combined IMT among the studied groups. CONCLUSIONS: In our study, no significant difference in lipid parameters was determined between patients with PCOS and healthy controls. In our study, we did not observed any difference in CIMT measurements and TAFI levels between patients with PCOS and healthy controls that can be explained by their low ages and short duration of PCOS.

PMID: 18350479 [PubMed - indexed for MEDLINE]

Pioglitazone administration alters ovarian gene expression in aging obese lethal yellow mice.

Reprod Biol Endocrinol. 2008;6:10

Authors: Brannian JD, Eyster KM, Weber M, Diggins M

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are often treated with insulin-sensitizing agents, e.g. thiazolidinediones (TZD), which have been shown to reduce androgen levels and improved ovulatory function. Acting via peroxisome proliferator-activated receptor (PPAR) gamma, TZD alter the expression of a large variety of genes. Lethal yellow (LY; C57BL/6J Ay/a) mice, possessing a mutation (Ay) in the agouti gene locus, exhibit progressive obesity, reproductive dysfunction, and altered metabolic regulation similar to women with PCOS. The current study was designed to test the hypothesis that prolonged treatment of aging LY mice with the TZD, pioglitazone, alters the ovarian expression of genes that may impact reproduction. METHODS: Female LY mice received daily oral doses of either 0.01 mg pioglitazone (n = 4) or an equal volume of vehicle (DMSO; n = 4) for 8 weeks. At the end of treatment, ovaries were removed and DNA microarrays were used to analyze differential gene expression. RESULTS: Twenty-seven genes showed at least a two-fold difference in ovarian expression with pioglitazone treatment. These included leptin, angiopoietin, angiopoietin-like 4, Foxa3, PGE1 receptor, resistin-like molecule-alpha (RELM), and actin-related protein 6 homolog (ARP6). For most altered genes, pioglitazone changed levels of expression to those seen in untreated C57BL/6J(a/a) non-mutant lean mice. CONCLUSION: TZD administration may influence ovarian function via numerous diverse mechanisms that may or may not be directly related to insulin/IGF signaling.

PMID: 18348723 [PubMed - indexed for MEDLINE]

[Preliminary study of protein expression profiling of PCOS on different state]

Zhonghua Yi Xue Za Zhi. 2008 Jan 1;88(1):7-11

Authors: Zhao SY, Qiao J, Li MZ, Zhang XW, Yu JK, Li R

OBJECTIVE: To screen the serum protein expression profiles in patients having polycystic ovary syndrome (PCOS) with or without insulin resistance (IR) and search for discriminatory proteins. METHOD: Fasting serum samples of 30 PCOS patients with IR, 30 PCOS patients without IR, and 30 control individuals from Reproductive Center of Peking University Third Hospital were studied. RESULTS: There were 27 differential protein peaks between PCOS IR patients and controls, 17 between PCOS non-IR patients and controls, and 19 between PCOS IR patients and non-IR patients. Marker proteins from differentially expressed proteins were screened out using support vector machine (SVM), and were used to establish three diagnostic models for PCOS IR, PCOS non-IR, and IR, respectively. CONCLUSIONS: There were significantly different serum proteomic patterns in different types of PCOS. Using Protein Chip combined with SVM, computer diagnostic models for PCOS with and without IR were set up quickly and efficiently. These discriminatory proteins may help us understand the proteomic changes in serum and find out potential biomarkers of PCOS and IR.

PMID: 18346370 [PubMed - indexed for MEDLINE]

Ultrasound-guided transvaginal ovarian needle drilling (UTND) for treatment of polycystic ovary syndrome: A randomized controlled trial.

Fertil Steril. 2008 Mar 13;

Authors: Badawy A, Khiary M, Ragab A, Hassan M, Sherief L

OBJECTIVE: To evaluate the outcome of ovarian needle drilling using transvaginal ultrasound guidance as an alternative to the traditional laparoscopic electrosurgical drilling for patients with polycystic ovary syndrome (PCOS). DESIGN: A randomized controlled study. SETTING: University teaching hospital and private practice setting. PATIENT(S): The study comprised 163 patients with clomiphene-resistant PCOS. INTERVENTION(S): Patients were randomly allocated to either treatment with ultrasound-guided transvaginal needle ovarian drilling (UTND; n = 82) or laparoscopic electrosurgery ovarian drilling (n = 81). MAIN OUTCOME MEASURE(S): Hormonal changes (FSH, LH, T), ovulation and pregnancy. RESULT(S): There were no significant differences between the two groups with regard to body mass index, hormonal profiles, clinical manifestations, and ultrasound findings of PCOS. The duration of UTND was 15.3 +/- 5.61 minutes (10.5-22.3 minutes), while it was 25.6 +/- 8.2 minutes (20.3-38.1 minutes) in laparoscopic drilling, with a statistically significant difference between the two groups. There were no significant differences between the two groups with regard to resumption of normal menstruation, hirsutism, acne, ovulation, and pregnancy. UTND resulted in significant improvement in the ovulation, pregnancy, hirsutism, and acne. There were significant decreases in the serum LH and T levels but not in the FSH or LH/FSH levels after UTND as well. CONCLUSION(S): UTND can be adopted as an outpatient office procedure. The ease of scheduling, reduced costs, and rapid recovery suggest it as a first-line treatment for PCOS cases resistant to clomiphene citrate.

PMID: 18342858 [PubMed - as supplied by publisher]