Overweight Polycystic Ovary Syndrome Research Articles

The effect of Bushenhuoxue nutritional decoction in the treatment of overweight patients with polycystic ovarian syndrome

Objective: To assess the effect of Traditional Chinese Medicine (TCM) nutrition treatment (Bushenhuoxue nutritional decoction) in overweight patients with polycystic ovary syndrome (PCOS). Methods: Retrospective analysis of 96 overweight patients with PCOS who received treatment in our hospital from October 2020 to June 2022 was done. Among them, 46 patients received routine drug treatment and daily dietary intervention (control group), while 50 patients received additional TCM nutrition support in addition to routine treatment (observation group). Glucose and lipid metabolism indicators and hormone levels were compared between the two groups before and after the treatment. Ovulation rate, pregnancy rate, and adverse reactions were compared between both groups one year after the treatment. Results: After treatment, the improvement of glucose and lipid metabolism indicators and hormone levels in the observation group was significantly better than in the control group (P<0.05). After treatment, the TCM syndrome scores of the two groups were lower than that before treatment (P < 0.001), and the TCM syndrome scores of the observation group was lower than that of the control group (P < 0.001).Ovulation and pregnancy rates were significantly higher in the observation group compared to the control group at 1-year follow up (P<0.05), and the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). Conclusions: Combined with conventional drug treatment, TCM nutrition treatment can significantly improve glucose and lipid metabolism, hormone levels, and TCM syndrome of overweight PCOS patients, increase the ovulation and pregnancy rates, and reduce potential adverse reactions. doi: https://doi.org/10.12669/pjms.40.6.9304 How to cite this: Fu J, Chen Y, Huang Z, Wang X. The effect of Bushenhuoxue nutritional decoction in the treatment of overweight patients with polycystic ovarian syndrome. Pak J Med Sci. 2024;40(6):1105-1110. doi: https://doi.org/10.12669/pjms.40.6.9304 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effects of AIDiet intervention to improve diet quality, immuno-metabolic health in normal and overweight PCOS girls: a pilot study

This study was conducted in two groups of girls with PCOS (polycystic ovary syndrome) categorized as slim (group N) and overweight-to-obese (group Ov/Ob). The study's primary outcome was to assess the impact of a 12-week anti-inflammatory diet (AIDiet) intervention, without energy deficit, on daily diet quality improvement, evaluated according to the KIDMED index. The secondary outcome was improving inflammatory, redox, hormonal, and metabolic statuses. In the study, which was completed by 13 girls from the Ov/Ob group and 19 girls from the N group, a significant improvement in the mean KIDMED score was obtained. Moreover, the intervention significantly improves concentration of total antioxidant capacity (TAC), fasting insulin, and the homeostatic model assessment for insulin resistance (HOMA-IR) index, in the Ov/Ob group, while both groups experienced a reduction in the concentration of interleukin (IL)-1 and IL-6, tumour necrosis factor (TNF-α), and androstenedione. The AIDiet intervention effectively improved the quality of the subjects' diets, which was associated with the improvement of hormonal and immuno-metabolic markers. However, these changes in normal-weight patients were observed regardless of body weight reduction. ClinicalTrials.gov Identifier NCT04738409.

Lipid accumulation product is an effective predictor of metabolic syndrome in non-obese women with polycystic ovary syndrome.

To explore the correlation of lipid accumulation product (LAP) with metabolic syndrome (MS) and to assess the predictive value of LAP for MS risk in polycystic ovary syndrome (PCOS) with different body mass index (BMI). A total of 242 PCOS patients and 150 controls were recruited and divided into normal-weight, overweight, and obese groups, then further divided into MS and without MS subgroups. Clinical and anthropometric variables and laboratory results were recorded. LAP was calculated from waist circumference (WC) and triglyceride using sex-specific formulae. Logistic regression analysis and receiver operating characteristic (ROC) curve were applied to determine and analyze the predictive value of LAP for MS. The prevalence of MS among PCOS patients was 45.04%, which was significantly higher than that of the controls (10%). Stratified by BMI, the incidence of MS in the normal-weight, overweight, and obese PCOS groups were 15.58%, 41.43%, and 71.58%, respectively. Logistic regression analysis indicated that LAP was an independent risk factor for MS in both normal-weight and overweight groups; however, the results were not significant in the obese group. ROC curve analysis showed that LAP had an outstanding discrimination index for MS in normal-weight (AUC=0.960, cut-off value=42.5) and overweight (AUC=0.937, cut-off value=47.93) PCOS patients, with a sensitivity of 0.917/0.931 (normal-weight/overweight) and a specificity of 0.969/0.854 (normal-weight/overweight), respectively. Normal-weight and overweight PCOS patients also have a fairly high incidence of MS and should receive as much attention as obese patients. Compared to applying multiple clinical indicators, LAP is more convenient and facilitates acquiring early and accurate diagnoses of MS among non-obese PCOS patients using fewer MS markers.

Association of Neuregulin-4 levels and body mass index with hyperandrogenism in Polycystic Ovary Syndrome patients

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disease that affects approximately 15% of women of childbearing age worldwide. It is one of the causes of infertility and is characterized by hirsutism, acne, persistent or interrupted anovulation, and hyperandrogenemia. Neuregulin-4 (NRG-4) is an adipokine hormone from the protein neuregulin family. Its level is greater in PCOS than in control women, and Neuregulin-4 is linked to body fat percentage and liver fat, as well as insulin resistance (IR). Objectives: To estimate the serum NRG-4 levels in women diagnosed with (PCOS), to compare it with, non-PCOS healthy control and to explore the effect of hyperandrogenism on the obtained result. Patients and Methods: A case-control study was conducted in the Gynecology and the Infertility Clinics in Kut - Zahraa Hospital, Medical City, from September to December 2022. The study included 120 women aged (18-42) years, 60 of whom were diagnosed with polycystic ovaries, and the other 60 were in the control group. Results: Women with PCOS had a significantly higher NRG-4, LH, LH/FSH ratio, testosterone, free testosterone, and Dehydroepiandrosterone sulfate (DHEA-S) than the control groups. In this study, NRG-4 was significantly higher in obese and overweight PCOS women than in normal-weight women. Conclusion: The mean serum NGR-4 concentration is significantly increased in women with PCOS and could be a part of metabolic syndrome. NGR-4 levels were associated with obesity, hyperandrogenism (testosterone, free testosterone, and DHAES) and may have a role in the development of PCOS. Received: May,, 2022 Accepted: Oct, 2023 Published: Jan.2024

Differences in the Characteristics and Factors Associated with Insulin Resistance in Normal Weight and Overweight Polycystic Ovary Syndrome Women

OBJECTIVE This research aimed to compare clinical and biochemical parameters between normal and overweight-obese polycystic ovary syndrome (PCOS) patients, and to determine the association between insulin resistance (HOMA-IR) and anthropometric, biochemical and hormo-nal factors in both groups of PCOS. METHODS This study was of a cross sectional design. PCOS was diagnosed using the Revised Rotterdam Criteria 2003. Participants underwent history taking and physical examination. Blood samples were collected for FPG, insulin, lipid profiles, TSH, FSH, LH, SHBG, total testosterone, and free androgen index (FAI). Insulin resistance index was calculated by homeostatic model assessment (HOMA-IR). Clinical and biochemical parameters were compared between both groups of PCOS. Associations between HOMA-IR and anthropometry, biochemistry and hormonal para-meters between groups were determined separately. RESULTS Sixty-four female with PCOS were enrolled. Comparison of biochemical analyses found that the free androgen index was higher and that LH and SHBG were lower in the overweight-obese group. HOMA-IR was greater in the overweight-obese group. In the overweight-obese group, there were statistically significant correlations between the HOMA-IR with the measured BMI, waist circumference, waist-height ratio, HDL, triglycerides, SHBG and the free androgen index. Interestingly, in the normal weight group, only the triglycerides, SHBG and the free androgen indix had a statistically significant correlation with HOMA-IR. CONCLUSIONS There were clear differences in the parameters related to insulin resistance between overweight-obese and normal weight PCOS; however, triglycerides, SHBG, and the free androgen index played a significant role in insulin resistance in both groups of PCOS. KEYWORDS homeostasis model assessment (HOMA-IR), insulin resistance, polycystic ovary syndrome

Changes of biochemical parameters in normal weight and overweight/obese women with polycystic ovary Syndrome

Objectives: Polycystic ovary syndrome (PCOS) is an endocrine disease in reproductiveage women, which interferes with fertility, menstruation, and body composition. Some biochemical parameters change in women with PCOS, a feature which can be a consequence of the disease itself or of the accompanying obesity. This study investigated the glucose and lipid profiles, sex hormones, and hsCRP in normal weight and overweight/ obese Iranian women with and without PCOS.
 Methods: 314 women with PCOS and 138 healthy and fertile women were recruited for the study. The patients and controls were divided according to body mass index (BMI) into two groups as follows: BMI<25 Kg/m2 and BMI≥ 25 Kg/m2 . Blood samples were collected from all participants to assess fasting blood glucose, fasting insulin, lipid profile, FSH, LH, free testosterone, and hs-CRP levels. The homeostasis model of insulin resistance (HOMA-IR) was calculated for assessing insulin sensitivity.
 Results: BMI, fasting insulin, HOMA-IR, triglyceride, FT, LH, and hs-CRP levels were significantly higher in the PCOS group, while lower levels of FSH were observed in comparison to non-PCOS women. Among overweight PCOS women, hs-CRP levels were significantly elevated compared to normal-weight PCOS women. However, there was no significant difference in circulating hs-CRP levels between normal-weight and overweight participants in the control group.
 Conclusion: The study results suggest that both insulin resistance and an increase in hs-CRP may be relevant to PCOS. Moreover, the findings indicated that chronic inflammation in PCOS is not solely dependent on the pathogenesis of the disease but may be exacerbated by increased body weight.

Observational study of usage of a combination of inositols with alpha-lactalbumin (Ovamystic) in the treatment of menstrual irregularity in PCOS

This observational study aimed at evaluating the effects of Ovamystic in groups of women with menstrual irregularities in Polycystic Ovary Syndrome (PCOS), treated at Mahavir Hospital and Manish IVF Center Surendranagar, Gujarat. : The study involved 126 normal weight or overweight PCOS patients aged 18 to 30 years, with menstrual irregularity and anovulation > 12 months. Patients were administered orally chewable tablets of Ovamystic (myo-inositol 1100mg + D-chiro-inositol 27.6mg + alpha-lactalbumin 50mg + chromium picolinate 400mcg + vitamin D2 400IU) twice daily for 6 months. The primary outcome was measured in terms of certain parameters like changes in body mass index (BMI), change in ovarian volume, and change in frequency and duration of menstrual cycle (M-SCORE). Alpha-lactalbumin is effective in increasing myo-inositol intestinal absorption, which is very useful in reducing the therapeutic failure of myo-inositol in some patients (inositol resistant subjects).: Recovery was general, and its relevance was higher when the starting point was further away from the normal range. The most important results with Ovamystic were obtained in correcting the menstrual irregularity, and also decreasing ovarian volume and BMI. No significant adverse effects were detected in this group of patients, and Ovamystic had good tolerability and compliance. This observational study demonstrated that Ovamystic improves important parameters in PCOS patients characterized by different metabolic profiles like BMI, menstrual irregularities, and ovarian volume.

Body mass index is a good predictor of metabolic abnormalities in polycystic ovary syndrome.

To assess which parameters among hyperandrogenism (total testosterone-tT-or free androgen index-FAI), sex hormone binding globulin (SHBG) or body mass index (BMI) could better predict a worse metabolic profile in women with polycystic ovary syndrome (PCOS). Five hundred and eighty-six women with PCOS and clinical or biochemical hyperandrogenism were included. Receiver Operating Characteristics (ROC) curves with tT, FAI, SHBG and BMI were performed for metabolic parameters and a cut-off with sensitivity and specificity was obtained for each parameter. The women were then divided into three groups and compared according to their BMI. Based on the ROC curves, tT proved not to be a good predictor of metabolic alterations. FAI and SHBG resulted to be good predictors of some markers of metabolic damage. The area under the curves (AUC) of SHBG were greater than those of FAI. SHBG levels affects the values of homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin, high density lipoproteins (HDL), low density lipoproteins (LDL), and total cholesterol also when corrected for BMI. However, the highest AUCs of the ROC curves were observed when BMI was used, which was significantly related to all the metabolic parameters analyzed. Dividing women according to their BMI, BMI between 25.00 and 30.00 kg/m2 had a worse metabolic profile but still in a normal range, while BMI≥30 kg/m2 women had a significant metabolic derangement. BMI is a good predictor factor of metabolic changes in PCOS women at any age, and obesity is associated to the appearance of metabolic complications. Overweight and obese PCOS women should be addressed to perform a complete metabolic assessment.

A Comparative Study of Clinical, Radiological, Hormonal, and Metabolic Parameters between Nonobese and Overweight Polycystic Ovarian Syndrome (PCOS) Patients

A Comparative Study of Clinical, Radiological, Hormonal, and Metabolic Parameters between Nonobese and Overweight Polycystic Ovarian Syndrome (PCOS) Patients

Maternal preconception thyroid autoimmunity is associated with neonatal birth weight conceived by PCOS women undergoing their first in vitro fertilization/intracytoplasmic sperm injection

BackgroundThyroid autoimmunity and polycystic ovary syndrome (PCOS) are the most common endocrinopathies and have close relationships based on common etiology and pathogenesis, including genetic susceptibility, metabolic disorders, hormonal dysregulation, immune response, and inflammatory activation. The co-occurrence of both diseases is associated with adverse reproductive outcomes, but its effect on neonatal outcomes remains largely unknown. We aim to explore the effect of thyroid autoimmunity on neonatal birth weight in PCOS women undergoing IVF/ICSI.MethodsThis is a retrospective analysis of 486 PCOS women who underwent the first IVF/ICSI cycles and gave birth to 361 singletons and 125 twins during 2018 – 2020 at a reproductive center. The associations between maternal preconception serum thyroid function and autoimmunity indicators and birth weights of the singleton and twin groups were evaluated using generalized linear models (GLMs) and generalized estimate equations (GEEs), respectively. Analyses were further stratified by neonatal sex, maternal age, and maternal preconception BMI to assess the possible interaction effects.ResultsMaternal preconception serum TPOAb had a significant negative association with singleton birth weight (P for trends = 0.03). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in singleton birth weight of − 119.72 g (95% CI: − 222.68 g, − 16.70 g). Maternal preconception serum TPOAb had a significant positive association with twin birth weight (P for trends = 0.01). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in twin birth weight of 138.62 g (95% CI: 33.96 g, 243.30 g). Besides, maternal preconception serum TPOAb had a specific association with increased twin birth weight for female neonates, a specific association with decreased singleton birth weight for PCOS women under 35 years, and a specific association with decreased twin birth weight for overweight PCOS women (all P for interactions < 0.05).ConclusionsMaternal preconception thyroid autoimmunity may affect the birth weights of both singleton and twin neonates. Further large cohorts and experimental studies are required to confirm these findings and explore the underlying mechanisms.

Marrow adipose tissue is increased in overweight and obese women with PCOS independently of hyperandrogenism related obesity and metabolic disorders.

This study aimed to investigate the increase in bone marrow adipose tissue (BMAT) in overweight and obese women with polycystic ovary syndrome (PCOS) and its relationship with hyperandrogenism, obesity, and metabolic disorders. The study included 87 overweight or obese women with PCOS (mean age 29 ± 4 years), as well as 87 age-matched controls recruited from a separate population study. All PCOS patients were measured for anthropometric features, abdominal adipose tissue areas, BMAT, biochemistry, and sex hormones. BMAT was compared between the PCOS patients and controls. In PCOS patients, subgroup comparisons of BMAT and its associations with body adiposity indices, biochemistry, and sex hormones were analyzed. The odds ratios (ORs) of elevated BMAT (defined as BMAT ≥ 38%) were calculated. On average BMAT was increased by 5.6% ( ± 11.3%) in PCOS patients compared to controls. BMAT were significantly higher in the upper tertiles of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C). BMAT was not correlated with abdominal adiposity indices or biochemistry except for LDL-C (r = 0.253-0.263, p = 0.014-0.018). LDL-C was not significantly different between the normal and abnormal androgen PCOS subgroups (p = 0.10-0.887). LDL-C, follicle stimulating hormone (FSH), and total testosterone (TT) were risk factors for elevated BMAT, with ORs of 1.899 (p = 0.038-0.040), 1.369 (p = 0.030-0.042), and 1.002 (p = 0.040-0.044) for each unit increase, respectively. BMAT was increased in overweight and obese PCOS patients, but the increase in BMAT was not associated with the hyperandrogenism related obesity or metabolic disorders.

The Nutritional Intervention Improves the Metabolic Profile of Overweight and Obese PCOS Along with the Differences in Gut Microbiota.

Previous studies had shown that the gut microbiota of polycystic ovary syndrome (PCOS) patients had significant differences from those of healthy individuals, which may play an important role in the pathogenesis of PCOS. Lifestyle intervention, such as nutritional intervention, could improve the metabolic profiles and PCOS-like phenotypes of PCOS patients. Meanwhile, nutritional intervention could rapidly alter and reshape the distribution of gut microbiota in individuals. Therefore, we sought to investigate the differences in gut microbiota in overweight and obese PCOS patients with or without nutritional intervention. Thirty-six overweight and obese PCOS patients were finally enrolled in the study. Eighteen individuals who refused nutritional intervention (RNI) were collected as the RNI group. Eighteen individuals who received the nutritional intervention were collected as the pre-NI group before the nutritional intervention. And they were also collected as the NI group after the nutritional intervention for 4-12weeks. Significant decreases in BMI, FBG, TC, TG, APO A1, and APO B were observed when comparing the NI group with the pre-NI and RNI groups after the nutritional intervention for 4-12weeks. Meanwhile, the differences in the phylum Firmicutes, Bacteroidetes, and the species Eubacterium rectale, Flavonifractor plautii, and Bacteroides vulgatus between the NI and the RNI groups were observed, which may be potentially linked to the improved inflammatory state and PCOS-like phenotypes of overweight and obese PCOS individuals.

Impact of body mass index and vitamin D on serum AMH levels and antral follicle count in PCOS.

To investigate the effects of body mass index (BMI) values and 25(OH) vitamin D levels determined by Endocrine Society on serum Anti Mullerian Hormone (AMH) and antral follicle count (AFC) in women with polycystic ovary syndrome (PCOS). Sixty infertile women with PCOS and 30 age-matched women with unexplained infertility (UEI), were included. Patients in PCOS and control groups were divided into three subgroups according to their BMI values as normal, overweight and obese. Each BMI group was divided into three subgroups according to vitamin D levels. While AMH and vitamin D levels were determined at first admission, AFC was measured on the third day of cycle. BMI, AFC, and AMH levels of women with PCOS were significantly higher than the UEI group. AMH values of women with PCOS with normal BMI were found to be significantly higher than UEI controls with normal BMI. AMH values of overweight and obese PCOS patients and controls were similar. As BMI values of the PCOS group increased, vitamin D levels decreased significantly. Vitamin D levels of the patients in the PCOS group were found to be significantly lower than the control group. When evaluated according to BMI, the vitamin D levels of normal, overweight and obese women with PCOS were significantly lower than the UEI. Rising BMI in PCOS leads to a significant decrease in vitamin D and AMH. Deficiency, insufficiency or normality of vitamin D do not affect the main markers of ovarian reserve.

Relationship of Body Mass Index and Waist Hip Ratio with Insulin Resistance in Polycystic Ovarian Syndrome Patients

Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy among young women. Insulin resistance is a key feature in the pathogenesis of PCOS. Obesity, which is frequently associated with PCOS women, seems to amplify the degree of insulin resistance. The aim of the study is to investigate the relationship of insulin resistance with obesity in PCOS patients.&#x0D; Materials and methods: This was a hospital based cross-sectional study comprising fifty (50) diagnosed PCOS patients aged between 20 and 40 years. This study was carried out in the Department of Biochemistry, Chittagong Medical College (CMC) and inpatients, outpatient Department of Gynaecology and Obstetrics, Chittagong Medical College Hospital (CMCH). Samples were taken by non-probability purposive sampling. Results: The percentage of Insulin Resistance (IR) was 60% in this study. Mean age of PCOS patients was 30.6±0.65years. Obese PCOS patients with insulin resistance were 46% and overweight PCOS patients with IR were 48% in this study. There were also significant positive association of IR with increased BMI and waist hip ratio. Additionally 06% non-obese PCOS patients showed IR in this study cases.&#x0D; Conclusions: This study suggested that abdominal obesity was a good predictor of IR among PCOS patients. So, waist circumference or waist hip ratio may be used as a screening tool for IR risk assessment among PCOS patients as an inexpensive, noninvasive and easy-to-detect marker. Hence early diagnosis and proper preventive management of these patients will reduce the reproductive complications.&#x0D; IAHS Medical Journal Vol 4(2), December 2021; 3-7

Canagliflozin combined with metformin versus metformin monotherapy for endocrine and metabolic profiles in overweight and obese women with polycystic ovary syndrome: A single-center, open-labeled prospective randomized controlled trial.

ObjectivesCanagliflozin (CANA), a kind of sodium-glucose cotransporter-2 (SGLT-2) inhibition, study in which the role of CANA monotherapy in polycystic ovary syndrome (PCOS) has been investigated, and it could become a novel option in the PCOS treatment. Nevertheless, trials focused on SGLT-2 combination therapy’s efficacy, and safety in PCOS patients are limited. This randomized controlled trial compared the efficacy and safety of CANA and metformin (MET) combination therapy and MET monotherapy in endocrine and metabolic profiles of overweight and obese women with polycystic ovary syndrome (PCOS).MethodsFifty-one overweight or obese non-diabetic PCOS women between 18 and 40 years old were enrolled. Patients were randomly allocated to receive either CANA/MET or MET treatment. The CANA/MET group received CANA 100 mg once daily plus MET 1000 mg twice daily, while the MET group received MET 1000 mg twice daily for three months. Changes in menstrual pattern, anthropometric parameters, gonadal parameters, glucose and lipid homeostasis, and adverse events (AEs) were evaluated.ResultsCompared with the MET group, women have a significantly lower level of total testosterone (TT), area under the curve for glucose (AUCGlu), and area under the curve for insulin (AUCIns) to AUCGlu ratio in the combination group. There were no significant differences in menstrual frequency, body weight, body mass index, follicle-stimulating hormone, luteinizing hormone, free androgen index, sex hormone-binding globulin, androstenedione, fasting blood glucose, fasting insulin, AUCIns, homeostasis model assessment-insulin resistance (HOMA-IR), triglycerides, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), and APO B/A1 ratio. AEs were seen in 57.70% (15/26) and 68.00% (17/25) of patients in the CANA/MET and MET groups, respectively.ConclusionsIn overweight and obese women with PCOS, CANA and MET combination therapy may be similar to MET monotherapy in improving menstrual frequency, weight control, hyperandrogenemia, and relieving insulin resistance. CANA/MET may have more benefits in reducing TT, AUCGlu, and the AUCIns/AUCGlu ratio within three months than MET monotherapy.Trial registration ClinicalTrials.gov, NCT04973891.

Effect of metformin and exenatide on pregnancy rate and pregnancy outcomes in overweight or obese infertility PCOS women: long-term follow-up of an RCT.

The majority of Polycystic ovary syndrome (PCOS) are overweight or obese with increased infertility and high risk of pregnancy complications. We aim to compare efficacy of metformin and exenatide on spontaneous pregnancy rate, overall pregnancy rate after assisted reproductive technology treatment (ART) and pregnancy outcomes in overweight or obese infertility PCOS. In this long-term follow-up study, 160 overweight or obese infertility Chinese PCOS were randomized to exenatide or metformin treatment for 12weeks. Afterward, all were treated with metformin alone until pregnancy confirmed and followed until delivery. If patients failed spontaneous pregnancy during the second 12weeks, ART could be offered until end of 64weeks. The primary outcome was spontaneous pregnancy rate. At week 24, 29.2% of women in exenatide group conceived spontaneously while 14.7% in metformin group (p = 0.03). At week 64, total pregnancy rates were 79.2% in exenatide group and 76% in metformin group without significant difference (p = 0.65). Between two groups, there was no significant difference of pregnancy outcomes (p > 0.05). A stepwise logistic regression showed that spontaneous pregnancy was positively associated with body weight reduction and HOMA-IR improvement in either group. In overweight or obese infertility Chinese PCOS, 12weeks pregestational exenatide treatment resulted in more spontaneous pregnancy likely due to greater weight reduction and improvement of insulin resistance compared with metformin treatment without obvious benefit on overall pregnancy rate after ART or pregnancy outcomes of successful conceived women. This clinical trial was registered at Chinese Clinical Trials Registry (ChiCTR-IIR-16008084) on 13/3/2016.

A Study on the Association between Subclinical Hypothyroidism and Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) and hypothyroidism are endocrine and metabolic disorders. Hypothyroidism has been found to be related to changes in blood lipids and insulin insensitivity. However, the relationship between subclinical hypothyroidism (SCH) and endocrine disorders in PCOS patients remains unclear. The incidence of SCH in PCOS patients is increasing. Metabolomics methods have been used to investigate the differences in metabolites and metabolic pathways between normal body weight and overweight (not obese) PCOS patients with SCH. Understanding the association between PCOS and SCH can guide diagnosis and treatment. Methods: We performed an untargeted serum metabolomics analysis in 62 PCOS patients. From 38 PCOS patients with SCH, 24 were selected and divided into the overweight (n = 13) and normal weight (n = 11) groups. Differential metabolites were identified using ultra-high-performance liquid chromatography–quadrupole time-of-flight mass spectrometry analysis. The significance of metabolites was evaluated by calculating the variable importance in projection score (&gt; 1 and P &lt; 0.01) from partial least squares discriminant analysis (PLS-DA) and orthogonal PLS-DA models. Kyoto Encyclopedia of Genes and Genomes pathway analysis was conducted to investigate the metabolomic pathways. P &lt; 0.05 (Fisher’s exact test) was considered statistically significant. Results: In PCOS patients with SCH, significant differences in body weight, right ovary volume, homeostasis model assessment for insulin resistance value, insulin level at 2 h after a meal, and triglyceride level were observed between the overweight and normal weight groups. Twenty-six different metabolites were identified, mainly fatty acids and phosphatidylcholines, to have significantly levels in overweight patients with SCH. Moreover, 18 enriched metabolic pathways were identified, mainly biosynthesis of fatty acids and unsaturated fatty acids, digestion and absorption of proteins, aminoacyl-tRNA biosynthesis, and ATP-binding cassette (ABC) transporters. Conclusion: The interaction between body mass index and thyroid-stimulating hormone affects the metabolic status of PCOS patients. Overweight PCOS patients with SCH may have the worst metabolic status. The overweight and normal weight groups showed differences in glycerol phospholipid, sterol lipid, phosphatidylcholine, and androsterone sulphate levels. PCOS with SCH affects endocrine metabolism and ester metabolism through fatty acid biosynthesis, protein digestion and absorption, and ABC transporters.

Effect of orlistat during individualized comprehensive life-style intervention on visceral fat in overweight or obese PCOS patients

Objective To investigate the effect of orlistat combined with drospirenone/ethinylestradiol tablets (DRSP/EE) on the visceral fat area (VFA) compared to DRSP/EE-alone in overweight or obese patients with polycystic ovary syndrome (PCOS). Methods 90 PCOS patients [body mass index (BMI) ≥24kg/m2] were recruited for a prospective, open-label, 1:2 paired 3-monthly study. All were included during the per-protocol defined recruitment time and numbered according to the entry-order: group-1: No.1-60, orlistat plus DRSP/EE; group-2: No.61-90, DRSP/EE-alone. Both groups received the same comprehensive intervention in terms of individualized, standardized management and lifestyle monitoring such as diet and exercise. Primary study-endpoint was VFA, secondary endpoints were anthropometric indices, sex hormones and glucolipid metabolism. Within- and between-group analyses were performed. Results VFA [cm2] in group-1 after treatment decreased significantly (p = 0.001), and the between-group comparison was highly significant (p = 0.001). Body weight, hip circumference (HC), BMI, body fat (BF), free testosterone (FT) and low-density lipoprotein-cholesterol (LDL-C) significantly decreased in both groups (within-group analysis); the decrease in group-1 was significantly greater than in group-2 (p < 0.05). Systolic and diastolic blood pressure (SBP/DBP) and fasting plasma glucose (FPG) in group-1 were significantly decreased, significantly more in group-1 than in group-2 (p < 0.05). Conclusion This study is the first to investigate the effect of orlistat combined with DRSP/EE in overweight or obese PCOS patients compared with using DRSP/EE-alone. Orlistat combined with DRSP/EE was better than using DRSP/EE-alone in reducing VFA, body weight, FT, BP and FPG, which provides evidence for the choice of rational drug use in clinical practice.

Relationship of inflammatory and metabolic parameters in adolescents with PCOS: BMI matched case-control study.

Polycystic ovary syndrome (PCOS) begins in adolescence and has cardiovascular and metabolic components in later years. Cystatin C and high-sensitivity C-reactive protein (hs-CRP) levels and neutrophil-lymphocyte and platelet-lymphocyte ratios are associated with metabolic and inflammatory events. Here, we evaluated inflammatory and metabolic parameters in normal and overweight adolescents with PCOS. This prospective case-control study enrolled 90 adolescents with PCOS and 100 matched by age and BMI healthy adolescents classified as either normal weight (NW) and overweight (OW). Groups were compared based on inflammatory and metabolic parameters (serum cystatin C, hs-CRP, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lipids, fasting blood glucose-insulin (FBG-FI), HOMA-IR levels, waist circumference [WC], and waist-hip ratio [WHR]). The relationship between the parameters were compared and predictive abilities were evaluated. Cystatin C, hs-CRP, NLR, triglyceride (TG), FBG-FI, HOMA-IR, WC, and WHR were significantly higher in those with PCOS. The NW PCOS group had significantly higher TG, cystatin C, hs-CRP, and NLR versus OW controls. The highest HOMA-IR values were observed in OW PCOS (p < .05). Cystatin C and hs-CRP sensitivity and specificity were significant (p < 0.05). Cystatin C and hs-CRP were positively correlated with other metabolic parameters. Independent of BMI, inflammatory and metabolic parameters are significantly higher in adolescents with PCOS compared to controls and even worse in those who are also OW. Therefore, adolescents with PCOS should be encouraged to maintain healthy lifestyles and weights to avoid metabolic risks. Hs-CRP and cystatin C could be promising markers to predictive of future metabolic risks.

Effect on the cardiovascular independent risk factor lipoprotein(a) in overweight or obese PCOS patients with ethinyl-estradiol/drospirenone alone or plus orlistat

Objective This study aimed to assess the effect on the cardiovascular independent risk factor Lipoprotein(a) [Lp(a)] in overweight or obese polycystic ovary syndrome (PCOS) patients with ethinyl-estradiol/drospirenone (EE/DRSP) alone or plus orlistat. Methods In this randomized controlled prospective study, 66 PCOS patients with overweight or obesity were matched according to age and BMI. All participants were randomly divided into two groups to receive EE/DRSP plus Orlistat (n = 33) or EE/DRSP alone (n = 33) for 3 months. Changes in cardiovascular risk factors including Lp(a), CRP, LDL-C, anthropometric assessments, variations in sex hormones related parameters, and in glucolipid metabolic index were evaluated after the intervention. Results Lp(a) and CRP were significantly decreased at 3 months only in the EE/DRSP plus Orlistat group. There were significant reductions in LDL-C, weight, BMI, waist circumference (WC), body fat percentage (BFP), FT in both groups compared to baseline. However, these reductions were significantly greater in EE/DRSP plus Orlistat group. The levels of HDL-C, TG, and SHBG significantly increased, while TT and LH significantly decreased in both groups over time. TC, FINS, FPG were not significantly changed in both groups after the intervention. Conclusions This is the first study found that EE/DRSP plus Orlistat could significantly decrease Lp(a) in overweight or obese PCOS patients. This result can be assessed as particularly important, because Lp(a) is well-known as an independent risk factor predicting an increased risk of cardiovascular diseases (CVDs).