Polycystic Ovarian Disease Group Research Articles

Threshold value of Anti Mullerian Hormone (AMH) and its correlation with other related hormones in Polycystic Ovarian Disease

Background: Polycystic ovarian disease (PCOD) is the commonest endocrine disorder affecting women at reproductive age. As a complex multisystem disorder, its background can be confusing to understand. The key feature is an increased production of AMH by antral follicles. Aim: The aim of the present study was to assess the threshold value of serum AMH in PCOD and its correlation with other related hormones such as FSH, LH and Prolactin. Materials and Methods: Serum AMH, FSH, LH and Prolactin in all subject (PCOD and Non PCOD groups) were estimated using Cobas-e-411analyser. The results analyzed statistically by Using Z-test (p value <0.05 considered as significant), Correlation test and ROC analysis. Result: Serum AMH and LH shown significant increase level in PCOD groups compared to Non PCOD groups (p value=0.00, 0.001 respectively). Serum FSH and Prolactin have shown no much significant variation between the two groups (p value=0.75, 0.8 respectively). Threshold values of serum AMH and LH was observed as 8.47 ng/ml and 15.57 mIU/ml respectively. Additionally, serum AMH and LH has shown the strong positive correlation in PCOD group; no other parameters shown any correlation in both groups. Conclusion: Serum AMH level estimation can be considered as a better choice for diagnosis of PCOD especially in the situation wherever ultrasonography examination is not convenient to conduct

Is the use of a GnRH antagonist effective in patients with polycystic ovarian syndrome? A South African perspective

Introduction. Polycystic ovarian disease (PCOS) can account for up to 35 - 40% of the female factor causes of infertility. These patients present as medically complex cases and are challenging to manage and treat successfully. They are resistant to treatment and are often offered controlled ovarian stimulation (COS) and in vitro fertilisation (IVF) technology. Aim. The aim of this study was to assess whether there was a difference in the pregnancy outcomes of women with PCOS when a standard gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix) protocol was used for ovarian stimulation, compared with non-PCOS patients undergoing IVF. Methods. A retrospective patient record audit was performed on 142 patients with PCOS and 501 non-PCOS patients undergoing a similar cetrorelix-based COS treatment protocol during a specified time period. Results. The main primary outcome was an ongoing pregnancy at 12 weeks, achieved in 34% of patients in the PCOS group and 27% in the non-PCOS group. This was not significantly different (p=0.07). No patient in the PCOS group experienced severe hyperstimulation syndrome. Conclusion. There was no significant difference in pregnancy rates in patients with PCOS undergoing GnRH-antagonist ovarian stimulation compared with non-PCOS patients. The fact that no hyperstimulation syndrome occurred makes this an attractive option for women with PCOS. SAJOG • January 2012, Vol. 18, No. 1

Prevalence of a positive family history of type 2 diabetes in women with polycystic ovarian disease

The known association between insulin resistance and polycystic ovarian disease (PCOD) has been studied by determination of the prevalence of a positive family history of diabetes in a consecutive series of oligomenorrheic women with polycystic ovaries and eumenorrheic women with normal ovaries who served as controls.A significantly greater proportion of the families of the patients with PCOD had at least one member affected by type 2 diabetes (39.1% of the PCOD group and 7.6% of the controls; p < 0.001). Both obese (54.8%) and non-obese women (24.2%) with PCOD had an increased prevalence of type 2 diabetes within their families. Paternal and maternal family members affected were in similar proportions, there being no evidence of preferential transmission through the female line in this study.The increased prevalence of type 2 diabetes in the families of women with polycystic ovaries is further evidence for the association between PCOD and insulin resistance, and provides a possible explanation for the familial nature of the ovarian disorder.

Differential androgen response to adrenocorticotropic hormone stimulation in polycystic ovarian syndrome: relationship with insulin secretion

To investigate the relationship between insulin and adrenal androgens in patients with polycystic ovarian disease (PCOD). Patients with PCOD and a group of volunteers who attended the department during a period of 6 months were studied. Department of Gynaecology and Obstetrics, Università Cattolica del Sacro Cuore, Roma, Italy. Healthy women with ovulatory cycles (hospital personnel, n = 8) and women affected by PCOD (n = 32) were studied on day 5 to 6 of their follicular phase. All women had an oral glucose tolerance test (OGTT) (75 g) on day 5 to 6 of the cycle. Then plasma samples were collected at 7.00 A.M.; at 11.00 P.M., 2 mg of dexamethasone (DEX) were orally administered with blood samples collected the day after at 7.00 A.M. (effect of DEX). Then adenocorticotropic hormone (ACTH, Synacten; Ciba-Geigy, Varese, Italy) 250 micrograms was injected intravenously (IV) and samples collected 60 minutes later (effect of ACTH). Plasma glucose and insulin concentration were assayed on OGTT samples collected at time 0, 30, 60, 90, 120, 180, and 240 minutes after glucose ingestion. Data are expressed as area under the curve. Cortisol, 17 alpha-hydroxyprogesterone (17-OHP), testosterone (T), androstenedione (A), and dehydroepiandrosterone sulphate (DHEAS) plasma levels were evaluated on the samples collected before and after DEX or ACTH administration. Data are expressed as absolute concentrations and percent increase in respect to values before the treatment. According to the OGTT response, 21 patients were classified as hyperinsulinemic and 11 as normoinsulinemic. The ideal body weight was greater in hyperinsulinemic patients. No differences in baseline hormone levels were found between the two groups. Only sex hormone binding globulin levels were significantly greater in normoinsulinemic patients (P less than 0.05). Also, the plasma concentration of all steroids after DEX were similar in both groups. Intravenous injection of ACTH significantly increased plasma androgens levels. Cortisol, DHEAS, and T enhancement did not differ in normoinsulinemic and hyperinsulinemic patients, whereas significantly greater A (P less than 0.01) and 17-OHP (P less than 0.05) plasma concentrations were observed after ACTH injection in hyperinsulinemic when compared with normoinsulinemic PCOD subjects. Control group after IV ACTH showed an increase of A and 17-OHP similar to those found in normoinsulinemic PCOD group. These data suggest that insulin could be involved in the androgen production by adrenal gland and it could influence the responsiveness of adrenal to its trophic hormones.

Insulin and C-Peptide Secretion in Non-Obese Patients with Polycystic Ovarian Disease

Plasma glucose, immunoreactive insulin (IRI) and C-peptide responses during an oral glucose tolerance test (oGTT) were assessed in 11 non-obese patients with polycystic ovarian disease (PCOD) and 11 reference subjects matched for age, height and weight. Also, 6 patients with PCOD and 6 normal women were subjected to intravenous glucose tolerance testing (ivGTT) On oGTT, all subjects exhibited normal glucose tolerance; however, PCOD patients had significantly higher mean plasma glucose levels at 30, 60, 90 and 120 min and higher mean incremental glucose areas. In addition the patients with polycystic ovaries showed higher mean basal IRI and C-peptide levels, higher mean glucose stimulated IRI and C-peptide levels and higher mean incremental IRI and C-peptide values. The molar ratios of C-peptide/IRI were significantly lower in the PCOD group at all time intervals after glucose stimulation when compared to the normal women. During ivGTT, there were significantly higher mean glucose levels at 5, 40, 50 and 60 min in the PCOD group when compared to the reference group. The IRI response to intravenous glucose in the PCOD women was similar to the reference group. The findings on oGTT suggest that non-obese patients with PCOD have increased pancreatic IRI secretion as well as impaired hepatic extraction of the hormone.

Dexamethasone suppresses sex-hormone binding globulin

Dexamethasone suppression (DEX-S) for 14 days has been used to determine the probable source of androgen excess. The exact mechanism(s) of DEX-S is still unclear. The authors postulated that dexamethasone (DEX) inhibits either the synthesis or secretion of sex-hormone binding globulin (SHBG). To examine this hypothesis, 14 women with polycystic ovarian disease (PCOD) and 3 volunteers were given DEX for 14 days. The PCOD group included obese and nonobese women (+/- 15% ideal body weight). Plasma determinations by radioimmunoassay of total testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate, luteinizing hormone; follicle-stimulating hormone; cortisol, and SHBG were made. DEX suppressed SHBG levels (P less than 0.01). SHBG levels were significantly lower in the obese than in the nonobese (P less than 0.01). All androgens were suppressed by DEX, with the exception of androstenedione post-DEX levels, which were significantly greater than pre-DEX levels in 6 of 14 subjects (P greater than 0.05). This observation is consistent with DEX suppression of SHBG.

Elevated plasma levels of β-endorphin in a group of women with polycystic ovarian disease

The relationship of endogenous opiates in patients with polycystic ovarian disease (PCOD) and their influence on body weight was studied. The study group consisted of 19 women with PCOD. They were amenorrheic, hirsute, and hyperandrogenic, and their average weight was 124% of the ideal body weight. They had luteinizing hormone/follicle-stimulating hormone ratios greater than or equal to 2. The control group consisted of ten women with regular ovulatory menses. Plasma beta-endorphin (beta-EP) was measured by using a very specific radioimmunoassay. beta-Lipotropin (beta-LPH) was entirely removed from the sample by preincubation of the plasma with rabbit anti-beta-LPH/Sepharose complex (Pharmacia, New Brunswick, NJ). The mean +/- standard deviation of the plasma beta-EP in the control group was 70.18 +/- 18.06 pg/ml, and the mean +/- standard deviation of beta-EP in the study group was 185.6 +/- 93.4 pg/ml, which was significantly higher than the control levels (P less than 0.001). A significant correlation was also found between plasma beta-EP level and the patient's weight in the PCOD group (r = 0.462, P = 0.025). The data from this study suggest that the elevated levels of endogenous opiates may be involved in the pathophysiology of PCOD and be related to inappropriate secretion of gonadotropins influencing body weight.

Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease.

We evaluated basal plasma total immunoreactive insulin (insulin), androstenedione, and testosterone in 14 obese women: 8 with polycystic ovarian disease (PCOD) and 6 obese controls. All 3 hormones were significantly elevated (P less than 0.02 to P less than 0.001) in PCOD patients. A significant correlation among basal levels of plasma insulin, androstenedione, and testosterone was demonstrated. The PCOD group had significantly higher levels of glucose at 1, 2, and 3 h, with similar significant increases in plasma insulin levels at 0, 2, and 3 h. A significant correlation was found between plasma insulin response areas and plasma testosterone (P less than 0.001) in the control and PCOD patients. These studies demonstrate that hyperandrogenism correlates with hyperinsulinism.