Disorder In Women Of Reproductive Age Research Articles

Body composition of lean women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine and metabolic disorders in reproductive age women, and it is related to changes in body size, shape and composition. Anthropometric somatotype is a quantitative description of the individual’s body shape and composition classified as endomorphy, mesomorphy or ectomorphy. Since PCOS somatotype has never previously been studied, here we evaluate body shape and composition phenomena in lean women with polycystic ovary syndrome and assess relationships with metabolic parameters. The study of 20–35 year-old women was carried out at the Department of Anatomy, Histology and Anthropology at Vilnius University. Standard anthropometric instruments and methods were used, and J. Matiegka’s equations calculated skeletal mass, skin and subcutaneous adipose tissue and muscles and internal organs. In addition, Heath – Carter’s somatotypes were computed, and the participants’ glucose, insulin, testosterone, sex hormone-binding globulin and lipid levels were established. We analysed data from 120 women with a mean age of 27.30 ± 3.68 years. Lean women with PCOS had greater skeletal mass by 0.47 kg (p<0.05, Cohen’s d=1.14), greater skin and subcutaneous adipose tissue mass by 2.79 kg (p<0.05, Cohen’s d=6.07) and lower muscle mass by 1.47 kg (p<0.05, Cohen’s d=2.84) compared to control women (p<0.05). The mean PCOS somatotype ratio was 4.96–4.38–3.00 (SD 1.50–1.26–1.11). This classified women with PCOS as mesomorphic endomorphs, in contrast to healthy women who were endomorphic mesomorphs. The PCOS subjects’ skin and subcutaneous adipose tissue and endomorphy/mesomorphy somatotype positively correlated with insulin levels and the HOMA-IR. It was established that lean women with polycystic ovary syndrome had a mesomorphic endomorph somatotype and higher skin and subcutaneous adipose tissue mass, but less muscle mass than healthy lean women. In addition, skin and subcutaneous adipose tissue positively correlated with insulin level and HOMA-IR in lean PCOS women.

Genetic factors modulate the impact of pubertal androgen excess on insulin sensitivity and fertility.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive age women. The syndrome is caused by a combination of environmental influences and genetic predisposition. Despite extensive efforts, the heritable factors contributing to PCOS development are not fully understood. The objective of this study was to test the hypothesis that genetic background contributes to the development of a PCOS-like reproductive and metabolic phenotype in mice exposed to excess DHEA during the pubertal transition. We tested whether the PCOS phenotype would be more pronounced on the diabetes-prone C57BL/6 background than the previously used strain, BALB/cByJ. In addition, we examined strain-dependent upregulation of the expression of ovarian and extra-ovarian candidate genes implicated in human PCOS, genes containing known strain variants, and genes involved with steroidogenesis or insulin sensitivity. These studies show that there are significant strain-related differences in metabolic response to excess androgen exposure during puberty. Additionally, our results suggest the C57BL/6J strain provides a more robust and uniform experimental platform for PCOS research than the BALB/cByJ strain.

An interleukin-6 gene promoter polymorphism is associated with polycystic ovary syndrome in South Indian women

Polycystic ovary syndrome (PCOS) is a most common endocrine disorder of reproductive age women. Interleukin-6 is involved in the pathophysiological characteristics associated with polycystic ovary syndrome (PCOS). The-174 G/C IL-6 gene promoter region single nucleotide polymorphism (SNP) may influence or modulate gene function and/or transcriptional efficiency. The current study was aimed to evaluate the association between IL-6 gene -174 G/C promoter polymorphism and Polycystic Ovary Syndrome in South Indian women. In the present study, we examined the genotypic and allele distribution among the PCOS patients (n = 104) and controls (n = 156). The genotypes of IL-6 -174 G/C SNP were analyzed by polymerase chain reaction (PCR) and sequencing analysis. The allele frequency and genotype distributions of cases and controls were analyzed using Fisher's exact test. The genotype frequencies observed among the 104 cases and 156 controls were G/G 66.3% and 49.4%, G/C 29.8% and 46.8%, and C/C 3.8% and 3.8% (OR: 1.6226, CI: 1.0574-2.4899). The G and C allele frequencies were 81.25% and 72.8%, and 18.75% and 27.2%, respectively. The genotype and allele distribution revealed significant differences between PCOS patients and controls (all P values < 0.05). Our findings showed a significant statistical association between IL-6 -174 G/C SNP and PCOS risk in South Indian women. The 'G' allele frequency influences significantly higher in PCOS patients than controls. However, the exact mechanism by which 'G' allele frequency influence PCOS patients is yet to be determined.

Effects of tanshinone on hyperandrogenism and the quality of life in women with polycystic ovary syndrome: protocol of a double-blind, placebo-controlled, randomised trial

IntroductionPolycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in reproductive-age women. Chinese herbal medicine has been used for the treatment of PCOS, but the evidence for...

A STUDY OF THE ROLE PLAYED BY THE POLYMORPHISM OF GENES ENCODING CYTOKINES IN THE DEVELOPMENT OF COMPLICATIONS OF THE UROGENITAL CHLAMYDIA INFECTION IN WOMEN

The author describes the results of a study of the polymorphism of genes encoding cytokines IL-6, IL-10, TnF-α, IFN-γ, TGF-β 1 and MBL2 in women suffering from the urogenital chlamydia infection (40 subjects), women with secondary infertility caused by the Chlamydia infection in the medical history (20 subjects) and clinically healthy women of childbearing potential (control group, 20 subjects). The SnapShot multiplex molecular and genetic method was used to study the polymorphism of genes. As a result of the study, the most frequent genotypes were revealed for each polymorphism of cytokine genes. reliable associations (0.01 &lt; р &lt; 0.001) were established between the frequency of individual genotypes (IL6*-174C/C, IL-10*-1082G/A, TGF-β 1*-915G/C, TGF-β 1*-869T/C and MBL2*-204G/G) and the onset of complications of the urogenital chlamydia infection, which makes it possible to exam ine these variants of genotypes as markers of an increased risk for the complicated course of the urogenital chlamydia infection resulting in reproductive disorders in women.

Cardiovascular and metabolic risks associated with PCOS

Polycystic ovary syndrome, the most common endocrine disorder of reproductive age women, is often associated with insulin resistance and associated disorders. The frequency of type 2 diabetes, hyperlipidemia, cardiac risk markers, structural vascular disease, and clinical disease events are increased in this population of women. PCOS, however, represents a broad spectrum of clinical presentations, as defined by different criteria proposed in Europe and the United States. The role of insulin resistance and hence the risk of cardiometabolic disorders may in part be determined by the definition of PCOS used. Epidemiologic studies and clinical trials support the need to identify women with PCOS to determine their risk of cardiometabolic disorders to prevent and/or treat their serious consequences.

A prospective study of GnRH long agonist versus flexible GnRH antagonist protocol in PCOS: Indian experience

BACKGROUND:Polycystic ovarian syndrome is a common endocrine disorder of reproductive age women. Many controlled ovarian stimulation (COS) strategies have been offered for the treatment of patients with PCOS undergoing in vitro fertilization, but the optimal protocol is still a controversy. There is no compelling evidence for the advantage of one stimulation protocol over the other.MATERIALS AND METHODS:This is a single-center prospective controlled study comparing long agonist and antagonist protocol in PCOS women.RESULTS:There was no significant difference in live birth rate and clinical pregnancy rate. Rate of ovarian hyperstimulation syndrome was significantly higher in the agonist group. Number of oocytes retrieved, number of follicles and peak estradiol levels were significantly more in the agonist group.CONCLUSION:The GnRH antagonist protocol is an equally effective but safer protocol in PCOS patients compared with the long agonist protocol.

Evaluation of the association between GHR exon 3 polymorphism and polycystic ovary syndrome among Han Chinese women

Background Polycystic ovary syndrome (PCOS) and type 2 diabetes (T2D) are two common metabolic disorders in reproductive-aged women, and both are associated with insulin resistance. Evidence has indicated that the growth hormone receptor (GHR) exon 3 polymorphism is associated with T2D and the GHRd3 allele may have the preventive effect on the disease. However, the genetic effect of this polymorphism on PCOS is unknown. The present study thus aims to evaluate the association between the GHR exon 3 polymorphism and PCOS. Design A total of 432 patients with PCOS and 441 healthy control subjects were included. All of them were Han Chinese women and well characterized. Genotyping experiments of GHR exon 3 polymorphism were performed with a standard protocol of PCR and gel electrophoresis. Results GHRd3 allele frequency in PCOS patients was significantly higher compared to the control subjects (19.1% vs. 14.3%; P = 0.007, OR = 1.416; 95% CI = 1.099–1.825). Further analyses indicated that the GHRd3 allele was associated with increased waist and hip circumstance in healthy women ( P = 0.016; 0.003), and also with 1-h, 2-h and area under the curve (AUC) plasma glucose levels among PCOS patients (all P < 0.05). But, no association of GHR exon 3 polymorphism with insulin resistance in the patients was observed. Conclusions The present study provides the first evidence that GHR exon 3 polymorphism is associated with PCOS in Han Chinese women. The GHRd3 allele may contribute to an impact of glucose metabolism but not insulin resistance.

Treatment for Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women, affecting approximately 6% of the population. 1 Setji TL Brown AJ Polycystic ovary syndrome: diagnosis and treatment. Am J Med. 2007; 120: 128-132 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar

Premenstrual Mood Exacerbation Linked to Severe Bipolar Symptoms

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPremenstrual Mood Exacerbation Linked to Severe Bipolar SymptomsMark MoranMark MoranSearch for more papers by this authorPublished Online:18 Mar 2011https://doi.org/10.1176/pn.46.6.psychnews_46_6_17_2AbstractPremenstrual mood exacerbation may be a clinical marker predicting a worse presentation and course of bipolar disorder in reproductive-age women. Women who have bipolar disorder and also experience premenstrual mood exacerbation appear to have a worse course of illness, a shorter time to relapse, and greater symptom severity than women with bipolar disorder who do not experience premenstrual mood exacerbation, according to a report that was published February 15 online in AJP in Advance."Mood exacerbation" was defined in the study as syndromal—corresponding to the DSM-IV mood states (depression, mania, hypomania, mixed)—or subsyndromal, not meeting criteria for any of these states but having three or four depression and/or mania symptoms. "Although time to relapse to a syndromal episode did not differ between women with premenstrual exacerbation and those without during follow-up, time to relapse in those with premenstrual exacerbation was half that of those without when relapse was defined more broadly as a syndromal or subsyndromal episode," wrote lead author Rodrigo Dias, M.D., and colleagues at Massachusetts General Hospital. "Women with premenstrual exacerbation also had more severe depressive and mood elevation symptoms during follow-up, reflecting greater symptom burden. Taken together, these findings suggest that premenstrual exacerbation may be a marker for a more recurrent and symptomatic course of illness among premenopausal women with bipolar disorder." In the study, 932 women aged 18 to 40 who were enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) responded to two questions about premenstrual mood changes: "Currently, do you typically experience depression symptoms around your menstrual period?" and "Currently, do you experience mood swings around your menstrual period?" Women who provided a positive response to one or both of these questions were categorized as having premenstrual exacerbation. After exclusion of women with previous unspecified gynecological surgeries and women for whom information was lacking about whether they had menstrual cycles, a total of 293 women—191 women with premenstrual exacerbation and 102 women without—were followed prospectively for one year. During follow-up, women with premenstrual exacerbation had more mood episodes overall than those without, including more depressive episodes, though the women did not have more episodes of mania or hypomania. Differences remained when episode frequency was categorized; women reporting premenstrual exacerbation were more likely to have one to three episodes a year (73.8 percent compared with 55.9 percent) and less likely to have no episodes (24.1 percent compared with 42.2 percent) during follow-up. Time to relapse was compared among 129 women (66 with premenstrual exacerbation and 63 without) who were in recovered status at baseline and had at least one additional assessment during the follow-up period. No significant difference was seen between groups in time to relapse to a syndromal episode; however, when the analysis included subsyndromal episodes as part of a broader definition of relapse, women with premenstrual exacerbation relapsed sooner on average than did those without, according to the report. Using this broader definition of relapse, the median time to relapse was 4.5 months in the group with premenstrual mood exacerbation, compared with 8.5 months in the group without it, a statistically significant difference. (No significant differences between groups were seen in the proportion of women changing medications before they relapsed.) Finally, statistical analysis of severity of symptoms as reported by women indicated that premenstrual exacerbation adversely affects the severity of both depression and mood elevation symptoms. Dias told Psychiatric News that the results suggest that clinicians treating women with bipolar disorder should follow the menstrual cycles of patients during appointments and ask them to make notes about the mood changes between appointments. "In the last five years, the scientific literature has been paying more attention to the subsyndromal mood states in depression and in bipolar disorder," he told Psychiatric News. "This kind of mood state, wherein the patient has mood symptoms but does not meet criteria for a mood episode, has been linked with poor functionality and more relapses of mood episodes. "In our study, we observed that women with premenstrual exacerbation spend more time in that kind of mood state and have more residual symptoms suggesting that they could be considered a group of patients who will have a more severe course of bipolar disorder." "Longitudinal Follow-Up of Bipolar Disorder in Women With Premenstrual Exacerbation: Findings From STEP-BD" is posted at <http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2010.09121816v1>. ISSUES NewArchived

GnRH Pulsatility, the Pituitary Response and Reproductive Dysfunction

GnRH plays an essential role in neuroendocrine control of reproductive function. In mammals, the pattern of gonadotropin secretion includes both pulse and surge phases, which are regulated independently. The pulsatile release of GnRH and LH plays an important role in the development of sexual function and in the normal regulation of the menstrual cycle. The importance of GnRH pulsatility was established in a series of classic studies. Fertility is impaired when GnRH pulsatility is inhibited by chronic malnutrition, excessive caloric expenditure, or aging. A number of reproductive disorders in women with including hypogonadotropic hypogonadism, hypothlamic amenorrhea, hyperprolactinemia and polycystic ovary syndrome (PCOS) are also associated with disruption of the normal pulsatile GnRH secretion. Despite these findings, the molecular mechanisms of this pulsatile GnRH regulation are not well understood. Here, we review recent studies about GnRH pulsatility, signaling and transcriptional response, and its implications for disease.

Dietary Approaches and Alternative Therapies for Polycystic Ovary Syndrome

Abstract: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in reproductive age women. PCOS is characterized by the absence of menstruation or irregular and abnormal menstruation, excessive amounts of body hair, excessive body weight, and infertility. Women with PCOS often have multiple ovarian cysts, high levels of androgen hormones, insulin resistance and metabolic syndrome. This review is focused on the dietary approaches and alternative therapies which have been proved to play major roles in the treatment of PCOS. The ideal diet for PCOS is one that promotes weight loss and then weight maintenance. In addition, some of the essential nutrients may improve associated risk factors of PCOS. Among them are chromium, omega 3 fattyacids, antioxidants, phytosterols, magnesium, calcium, potassium and other essential vitamins and minerals. The most important aspect of treatment is managing cardiovascular risks, such as obesity, high blood cholesterol, diabetes and high blood pressure. Early recognition and aggressive lifestyle interventions are the cornerstones of PCOS treatment. Treating individual risk factors might help to reduce overall risk of PCOS. Some of the PCOS risk factors are modifiable. Aggressive medical nutritional therapy may be appropriate in early conditions than advanced stages.

Determining the time androgens and sex hormone-binding globulin take to return to baseline after discontinuation of oral contraceptives in women with polycystic ovary syndrome: a prospective study

In this study, discontinuation of oral contraceptive pills in women with polycystic ovary syndrome was followed by the return of all measured androgens and sex hormone-binding globulin levels to basal values after 8 weeks. These observations are pertinent to the measurement of androgens and sex hormone-binding globulin levels in subjects who currently are taking oral contraceptive pills and have symptoms that are related to polycystic ovary syndrome.

Ovarian follicle development and transgenic mouse models

Ovarian follicle development is a complex process that begins with the establishment of what is thought to be a finite pool of primordial follicles and culminates in either the atretic degradation of the follicle or the release of a mature oocyte for fertilization. This review highlights the many advances made in understanding these events using transgenic mouse models. Specifically, this review describes the ovarian phenotypes of mice with genetic mutations that affect ovarian differentiation, primordial follicle formation, follicular growth, atresia, ovulation and corpus luteum (CL) formation. In addition, this review describes the phenotypes of mice with mutations in a variety of genes, which affect the hormones that regulate folliculogenesis. Because studies using transgenic animals have revealed a variety of reproductive abnormalities that resemble many reproductive disorders in women, it is likely that studies using transgenic mouse models will impact our understanding of ovarian function and fertility in women.

Polycystic Ovarian Syndrome and Insulin Resistance: Implications for Estrogen Use in Premenopausal and Postmenopausal Women

Polycystic ovarian syndrome (PCOS) is the most frequent endocrine disorder of reproductive age women, affecting an estimated 8-10% of all women in this age group or approximately six million women. Further, women with PCOS continue to manifest the metabolic alterations inherent in the insulin resistance syndrome after menopause, rendering them more susceptible to type 2 diabetes and cardiovascular disease. Aging and obesity further contribute to these risks. Since estrogen-containing therapy is commonly used for menstrual regulation in premenopausal women with PCOS, it is important to evaluate the possible consequences of hormonal therapy on subsequent metabolic and cardiovascular risk. In postmenopausal women, a consensus regarding the appropriate role of estrogen replacement therapy is currently in evolution. By examining the effects of estrogen with or without progesterone on insulin resistance, insight may be gained about the risk/benefit ratio of this therapy in the subset of women with insulin resistance, PCOS, and type 2 diabetes. The goal of this review, then, is to examine the known effects of estrogen on insulin sensitivity and its implications for cardiovascular and metabolic risk.

Successful three-dimensional culture of human secretory phase endometrium as an in vitro model for endometriosis

Endometriosis is a common disorder in reproductive-age women characterized by presence of endometrial-like tissue outside of the uterus, most commonly on the ovary and pelvic peritoneum. The etiology of endometriosis remains poorly understood but it is generally considered that retrograde menstruation is required. The aim of this study was to determine whether secretory phase endometrium could recapitulate the early stages of endometriosis in vitro in a 3-D fibrin matrix model system that we have previously described (Fertil Steril 80(5):1137–43, 2003).

Procena kardiovaskularnih faktora rizika u bolesnica sa sindromom policističnih ovarijuma

Polycystic ovary syndrome (PCOS) is the most frequent reproductive disorder in women. PCOS is considered a metabolic disorder closely related to obesity, insulin resistance, hyperinsulinism and unfavourable lipid profile, and all together increases the risk of cardiovascular diseases. The objective of the study was to estimate the concentration of individual lipid fractions in obese PCOS patients as well as to examine the possible connection of changes in lipid fractions regarding the age of the patients. There were 59 obese patients with PCOS examined, who were divided into two groups: < 20 years (group A, n=22) and > 20 years (group B, n=37). The results of these groups were compared with the corresponding from the control groups (groups C and D). Basal values of cholesterol, HDL, LDL, triglycerides, oxidated LDL, Apo AI, Apo AII, Apo V, Apo E and atherogenic indices Apo B/Apo AI and LDL/HDL were analysed. A statistically significant difference between the groups A and V for the total cholesterol (4,20 vs. 5,02 mmol/L), LDL-cholesterol (2,79 vs. 3,42 mmol/L), triglycerides (1,27 vs. 1,50 mmol/L), oxidatedLDL (56,35 vs. 65,17 U/L), Apo V (0,87 vs. 1,03 g/L), Apo B / Apo AI (0,55 vs. 0,68) and LDL / HDL (2,37 vs. 3,06) was determined. It was conformed that in the obese patients with PCOS there was significantly higher level of almost all analysed lipid fractions and atherogenic indices with extremely high oxidation of LDL cholesterol. The PCOS patients have significantly higher atherogenic potential with ageing.

Integrin receptors: the dynamic modulators of endometrial function

Cell–cell and cell–extracellular matrix (ECM) interactions play a critical role in various developmental processes, including differentiation, proliferation and migration of cells. ECM proteins can influence cellular function thus creating a complex feedback mechanism. The adhesion of cells to each other, their ECM proteins and endothelial surfaces is mediated by a variety of membrane proteins collectively known as adhesion molecules. Adhesion molecules have been further divided into five subfamilies, the integrins, the selectins, the cadherins, the mucins and the immunoglobulin superfamily. Members of the integrin family of cell surface adhesion receptors are important mediators of cell–ECM contact. Integrin receptors are αβ heterodimers with a transmembrane segment, a short cytoplasmic domain and a large extracellular domain. The role of integrins in reproduction has been established. Several reasons make these molecules very attractive due to their constant involvement from egg to birth. They participate in sperm–egg interaction, fertilization, implantation and placentation in many species including humans. Integrins provide signals to individual cells essential for growth and development of different tissues. In the present review, we describe (1) the regulatory pathways for controlling expression of integrins in the endometrium, (2) various biomarkers and their role in endometrial function, (3) reproductive disorders in women related to aberrant integrin expression in the endometrium and (4) the functional significance of integrins available from gene knockout studies.

Obesity and reproductive disorders in women.

Obesity, particularly the abdominal phenotype, is associated with several reproductive disturbances. Whereas mechanisms by which obesity affect fertility are complex and still not completely understood, an important role appears to be played by the presence of a condition of functional hyperandrogenism and hyperinsulinaemia, which accompanies the insulin-resistant state. In women with the polycystic ovary syndrome, abdominal obesity may be co-responsible for the development of hyperandrogenism and associated chronic anovulation, through mechanisms primarily involving the insulin-mediated overstimulation of ovarian steroidogenesis and decreased sex hormone-binding globulin blood concentrations. By these mechanisms, obesity may also favour resistance to clomiphene and gonadotrophin-induced ovulation and reduce outcomes of IVF/ICSI procedures. Due to the beneficial effects of weight loss, lifestyle intervention programmes should represent the first-line approach in the treatment of infertile obese women. Insulin-sensitizing agents may add further benefits, particularly if administered in combination with hypocaloric dieting. Therefore, individualized pharmacological support aimed at favouring weight loss and improving insulin resistance should be widely extended in clinical practice in obese infertile patients. This may be beneficial even during pregnancy, thereby permitting favourable physiological delivery and healthy babies.

Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder of reproductive age women characterized in its broadest definition by the presence of oligoamenorrhea and hyperandrogenism and the absence of other disorders. Defects of gonadotropin secretion, including an elevated LH level, elevated LH to FSH ratio, and an increased frequency and amplitude of LH pulsations have been described, but the prevalence of these defects in a large, unbiased population of PCOS patients has not been determined. Sixty-one women with PCOS defined by oligomenorrhea and hyperandrogenism and 24 normal women in the early follicular phase had LH samples obtained every 10 min for 8-12 h. Pool LH levels from the frequent sampling studies were within the normal range in the 9 PCOS patients (14.8%) who were studied within 21 days after a documented spontaneous ovulation. Excluding these post-ovulatory patients, 75.0% of the PCOS patients had an elevated pool LH level (above the 95th percentile of the normal controls), and 94% had an elevated LH to FSH ratio. In the anovulatory PCOS patients, pool LH correlated positively with 17-OH progesterone (R = 0.30, P = 0.03), but not with estradiol, estrone, testosterone, androstenedione, or DHEA-S. Pool LH and LH to FSH ratio correlated positively with LH pulse frequency (R = 0.40, P = 0.004 for pool LH, and R = 0.39; P = 0.005 for LH/FSH). There was also a strong negative correlation between pool LH and body mass index (BMI) (R = -0.59, P < 10(-5)). The relationship between BMI and LH secretion in the PCOS patients appeared to be strongest with body fatness, as pool LH was correlated inversely with percent body fat, whether measured by skinfolds (R = -0.61, P < 10(-5)), bioimpedance (R = -0.55, P < 10(-4)), or dual energy x-ray absorptiometry (DEXA) (R = -0.70, P = 0.001; n = 18 for DEXA only). By DEXA, the only body region that was highly correlated with pool LH was the trunk (R = -0.71, P = 0.001). The relationship between body fatness and LH secretion occurred via a decrease in LH pulse amplitude (R = -0.63, P < 10(-5) for BMI; R = -0.58, P < 10(-4) for bioimpedance; and R = -0.64, P = 0.004 for whole body DEXA), with no significant change in pulse frequency with increasing obesity (R = -0.17, P = 0.23 for BMI). 1) the prevalence of gonadotropin abnormalities is very high in women with PCOS selected on purely clinical grounds, but is modified by recent spontaneous ovulation; 2) the positive relationship between LH pulse frequency and both pool LH and LH to FSH ratio supports the hypothesis that a rapid frequency of GnRH secretion may play a key etiologic role in the gonadotropin defect in PCOS patients; 3) pool LH and LH pulse amplitude are inversely related to body mass index and percent body fat in a continuous fashion; and 4) the occurrence of a continuous spectrum of gonadotropin abnormalities varying with body fat suggests that nonobese and obese patients with PCOS do not represent distinct pathophysiologic subsets of this disorder.