Polycystic Ovaries Group Research Articles

Serum vaspin and C-reactive protein levels in women with polycystic ovaries and polycystic ovary syndrome

Objective. Our aim was to evaluate C-reactive protein (CRP) and serum vaspin levels in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO).Design. Twenty-four women with PCOS and 23 women with PCO constituted the study groups. The control group comprised 24 healthy women.Methods. Homeostatic model assessment for insulin resistance (HOMA-IR), CRP and serum vaspin levels were measured. The receiver–operating characteristic curve (ROC) of vaspin for prediction of women with increased diabetogenic risk was constructed.Results. The three groups did not significantly differ in age and body mass index. HOMA-IR was significantly higher in the PCOS and PCO groups than in control group. Median CRP levels in the control, PCO and PCOS groups were 0.66, 1.28 and 3.2 mg/l, respectively (p = 0.0001). Women with PCOS had significantly higher serum vaspin levels than the healthy controls [3.52 ± 1.38 vs. 0.36 ± 0.19 ng/ml, p = 0.0001]. Serum vaspin could differentiate between women with and without increased diabetogenic risk at a cut-off value of 1.82 ng/ml with a sensitivity of 83.3% and a specificity of 66.1%.Conclusion. The results of our study showed that the presence of the increased vaspin, CRP and higher HOMA-IR levels in women with PCOS and PCO could contribute to increased diabetogenic and atherogenic risk in these patients.

The impact of rescue in vitro fertilization converted from high-response gonadotropin intrauterine insemination cycles in terms of implantation and pregnancy rates as compared with matched controls

To determine whether conversion of high-response gonadotropin/intrauterine insemination (IUI) cycles to "rescue" in vitro fertilization (IVF) yields a higher implantation and pregnancy rate as found in matched IVF controls. A prospective study with a retrospective controlled section. Baskent University Department of Obstetrics and Gynecology. Thirty-two patients switched from high response gonadotropin/IUI cycles to "rescue" IVF, 202 women with polycystic ovaries (PCO), and 452 women without PCO from the IVF database. High-response gonadotropin/IUI cycles were converted to IVF to avoid cycle cancellation and high-order multiple pregnancies. Clinical parameters and characteristics of controlled ovarian hyperstimulation and intracytoplasmic sperm injection results. The pregnancy rate was 78.1% in the rescue IVF group: 66.3% and 58.2% in the PCO and non-PCO groups, respectively. Clinical pregnancy rates and ongoing pregnancy rates also tended to be higher in the rescue IVF group but the difference was not statistically significant. The main difference between the groups was in the implantation rate: 37.5% in the rescue IVF group, which was greater than that of the PCO and non-PCO groups (27.58% and 24.46%, respectively). Our study demonstrates that conversion of gonadotropin IUI cycles in patients with excessive follicles to IVF is a safe, effective strategy. Implantation rates are higher than those in hyper-responder and normal responder IVF patients.

Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography

Objective. To assess whether there are differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler angiography (3D-PDA) between women with polycystic ovaries (PCO) and women with normal ovaries (NO).Methods. Eighty-three women were classified into two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 45) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 38) with oligo-anovulation, clinical and/or biochemical features of hyperandrogenism, and polycystic ovary morphology at two-dimensional ultrasound. All women were evaluated by means of 3D-PDA. The parameters studied in both groups were follicle number per ovary (FNPO), ovarian volume (OV), mean gray value (MG) and three vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI).Results. The PCO group showed a higher mean OV as well as FNPO. No differences in MG, VI, FI and VFI were found between the groups.Conclusions. 3D-PDA indices are not useful for discriminating between normal and polycystic ovaries.

Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome?

Aim. Our aim was to assess C-reactive protein (CRP) levels and insulin resistance in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO).Methods. The study population included 30 women with PCOS, 30 with PCO and 30 healthy controls. CRP and insulin resistance index (IRI) (fasting glucose/insulin) were measured. A receiver–operator characteristic (ROC) curve was constructed to determine the cut-off value of CRP to predict increased cardiovascular risk.Results. There were no statistically significant differences between the three groups with regard to age and body mass index. IRI was significantly lower in the PCOS group than in the PCO and control groups. No difference existed between the PCO and control groups. Median CRP levels in the control, PCO and PCOS groups were 0.75, 1.3 and 1.5 mg/l, respectively (p = 0.005). CRP could differentiate between women with and without increased cardiovascular risk at a cut-off value of 2.42 mg/l, with a sensitivity of 79% and a specificity of 81%.Conclusion. As in PCOS patients, women with PCO have higher serum CRP levels than healthy control women. This may contribute to increased cardiovascular disease risk in patients with PCO.

Effect of Exercise on Ovarian Morphology and Expression of Nerve Growth Factor and α1‐ and β2‐Adrenergic Receptors in Rats with Steroid‐Induced Polycystic Ovaries

Oestadiol valerate (EV)-induced polycystic ovaries (PCO) in rats cause anovulation and cystic ovarian morphology. Denervation of ovarian sympathetic nerves restores ovulatory disruption. In the present study, we determined whether 5 weeks of voluntary exercise influence ovarian morphology and the expression of sympathetic markers in the EV-induced PCO rat model. The effect of exercise on (i) ovarian morphology; (ii) mRNA and protein expression of nerve growth factor (NGF); and (iii) mRNA and number of ovarian-expressing cells for the NGF receptor (p75 neurotrophin receptor) and the alpha(1a)-, alpha(1b)-, alpha(1d)- and beta(2)-adrenergic receptors (ARs) in rats with EV-induced PCO was evaluated. PCO was induced by a single i.m. injection of EV, and controls were injected with oil alone in adult cycling rats. The rats were divided into four groups: (i) control (oil); (ii) exercise group (oil + exercise); (iii) a PCO group (EV); and (iv) a PCO exercise group (EV + exercise). The exercise and PCO exercise groups ran voluntarily for 5 weeks in computer-monitored wheels placed in the cages where they were housed. The results obtained indicated that ovarian morphology was almost normalised in the PCO exercise group; NGF mRNA and protein concentrations were normalised in the PCO exercise group; high numbers of NGF receptor expressing cells in PCO ovaries were lowered by exercise; and the number of immunopositive cells of the different AR subtypes were all reduced after exercise in the PCO group, except for the alpha(1b)- and beta(2)-AR whereas the mRNA levels were unaffected, indicating transcriptional regulation. In conclusion, our data indicate a beneficial effect of regular exercise, as a modulator of ovarian sympathetic innervation, in the prevention and treatment of human PCOS.

Effect of anti-NGF on ovarian expression of α1- and β2-adrenoceptors, TrkA, p75NTR, and tyrosine hydroxylase in rats with steroid-induced polycystic ovaries

Estradiol valerate (EV)-induced polycystic ovaries (PCO) in rats are associated with higher ovarian release and content of norepinephrine, decreased beta2-adrenoceptors (ARs), and dysregulated expression of alpha1-AR subtypes, all preceded by an increase in the production of ovarian NGF. The aim of this study was to further elucidate the role of NGF in the ovaries by blocking the action of NGF during development of EV-induced PCO in rats. Control and EV-injected rats were treated with intraperitoneal injections of IgG (control and PCO groups) or with anti-NGF antibodies (anti-NGF and PCO anti-NGF groups) every third day for 5 wk starting from the day of PCO induction. Rat weight, estrous cyclicity, ovarian morphology, ovarian mRNA, and protein expression of alpha1-AR subtypes, beta2-AR, the NGF receptor tyrosine kinase A (TrkA), p75 neurotrophin receptor (p75NTR), and tyrosine hydroxylase (TH) were analyzed. Ovaries in both PCO and PCO anti-NGF groups decreased in size as well as in number and size of corpora lutea. mRNA expression of alpha1a-AR and TrkA in the ovaries was lower, whereas expression of alpha1b- and alpha1d-AR and TH was higher, in the PCO group than in controls. Protein quantities of alpha1-ARs, TrkA, p75NTR, and TH were higher in the PCO group compared with controls, whereas the protein content of beta2-AR was lower. Anti-NGF treatment in the PCO group restored all changes in mRNA and protein content, except that of alpha1b-AR and TrkA mRNAs, to control levels. The results indicate that the NGF/NGF receptor system plays a role in the pathogenesis of EV-induced PCO in rats.

Ultrasound Diagnosis of Polycystic Ovaries in Women Who Have No Symptoms of Polycystic Ovary Syndrome Is Not Associated With Subfecundity or Subfertility

Obstetrical & Gynecological Survey: April 2004 - Volume 59 - Issue 4 - p 263-265 doi: 10.1097/01.OGX.0000119180.39359.BE

Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries

BackgroundMaintenance of ovarian blood flow (OBF) is suggested to be important for regular ovulation in women with polycystic ovaries (PCO). The purpose of the present study was to investigate whether electro-acupuncture (EA) of different frequencies and intensities can improve the OBF of anaesthetized rat in the animal model of PCO.MethodsPCO was experimentally induced by a single intramuscular (i.m.) injection of estradiol valerate (EV) in rats. Control rats were given i.m. injection of oil. The involvement of the two ovarian sympathetic nerves; superior ovarian nerve (SON) and plexus ovarian nerve (OPN), in OBF responses was elucidated by severance of SON and OPN in both control and PCO rats. How systemic circulatory changes affect OBF was evaluated by continuous recording of the blood pressure. OBF was measured on the surface of the ovary-using laser Doppler flowmetry. Acupuncture needles were inserted bilaterally into the abdominal and hind limb muscles and connected to an electrical stimulator. Two frequencies – 2 Hz (low) and 80 Hz (high) – with three different intensities – 1.5, 3, and 6 mA – were applied for 35 s.ResultsLow-frequency EA at intensities of 3 and 6 mA elicited significant increases in OBF in the Control group compared to baseline. In the PCO group the increases in OBF were significant only when stimulating with low-frequency EA at 6 mA. After severance of the ovarian sympathetic nerves, the increased response of OBF that had been induced by low-frequency EA in both the Control and PCO group was abolished, indicating that the OBF response is mediated via the ovarian sympathetic nerves. High-frequency EA at 6 mA significantly decreased OBF and mean arterial blood pressure (MAP) in the Control group compared to baseline. In the PCO group, the same stimulation produced similar decreases in MAP, but not in OBF.ConclusionLow-frequency EA stimulation with a strong intensity (6 mA) increases OBF in rats with steroid-induced PCO whereas less strong intensity (3 mA) induces similar changes in control rats. Severance of the ovarian sympathetic nerves, abolish this OBF increase in both study groups, which suggests that the responses of OBF to EA are mediated via the ovarian sympathetic nerves.

Follicular fluid renin concentration in patients with polycystic ovaries treated with gonadotrophins in an in vitro fertilisation programme.

The initial hypothesis was that the follicular fluid prorenin concentration was higher in women with polycystic ovaries (PCO) compared to normally cycling women stimulated by gonadotrophins. In a controlled prospective study, 47 women undergoing in vitro fertilisation (IVF) were enrolled: 20 women with PCO represented the study group and 27 normally cycling women the control group. Plasma prorenin, active renin, serum oestradiol, and androstenedione concentrations were measured on the day of human chorionic gonadotrophin (HCG) administration and 36 hours after HCG administration. Follicular fluid prorenin, active renin, oestradiol, and androstenedione concentrations from the dominant follicle and pooled follicles were measured 36 hours after HCG administration. Plasma prorenin concentration 36 hours after HCG administration was significantly higher in the PCO group (1867 microU/l; range 1137-3162 microU/l) than in controls (860 microU/l; range 433-1763 microU/l) (p = 0.007). The follicular fluid prorenin concentration in the dominant follicle and in the pooled follicles was lower in the PCO group (20190 microU/l; range 11130-25955 microU/l) than in controls (46930 microU/l; range 20671-66171 microU/l) (p = 0.003). We conclude that plasma prorenin concentrations in gonadotrophin-stimulated PCO cycles are augmented due to numerous follicles. Lower follicular fluid prorenin concentrations in women with PCO show that the synthesis of prorenin in theca cells starts later after HCG administration than in normally cycling women.

Luteal phase progesterone excretion in ovulatory women with polycystic ovaries.

Various studies have reported a prevalence of polycystic ovaries (PCO) of approximately 20% in the 'normal' population. Our aim was to investigate the frequency of ovulation and pattern of luteal phase progesterone secretion in a group of women with PCO who reported regular cycles and in whom ovulation had been established on the basis of previous investigations. Subjects collected early morning urine samples for pregnanediol-3-glucuronide measurement from day 10 of the cycle to day 1 of their next menses. Results in three consecutive cycles from women with PCO (group 1, n = 10 and 29 for patients and cycles respectively) were compared with results from two groups with normal ovaries; with either infertility (group 2, n = 10 and 30) or proven fertility (group 3, n = 6 and 19). There were considerable variations in cycle length. The median (range) was group 1: 28 (23-47); group 2: 26 (21-36) and group 3: 27 (25-38) days with more short cycles in both infertile groups. There was more variation in pregnanediol:creatinine in the normal-ovary infertile and PCO groups than in the fertile controls. Levels were higher in the early luteal phase in the fertile normal group than in either infertile group, and the mid-luteal phase peak was lower in the infertile women with normal ovaries. In summary, there was greater variability in luteal phase pregnanediol:creatinine ratios in the PCO and infertile normal-ovary groups than in women with normal ovaries and proven fertility. Women with PCO did not have more variation in cycle length than fertile women with normal ovaries, but there were significantly lower levels of progesterone in the early luteal phase. This may contribute to the delay in conception in these patients.

In vitro maturation and fertilization of oocytes from unstimulated normal ovaries, polycystic ovaries, and women with polycystic ovary syndrome

Objective: To investigate differences in immature oocyte maturation, fertilization, and pregnancy rates among women with unstimulated normal ovaries, polycystic ovaries (PCOs), or PCOS. Design: Prospective observational study. Setting: University fertility clinic. Patient(s): One hundred forty-four women undergoing 180 in vitro oocyte maturation treatment cycles. Intervention(s): Transvaginal immature oocyte recovery from unstimulated ovaries 36 hours after hCG priming. In vitro oocyte maturation and fertilization. Fresh embryo transfer. Main Outcome Measure(s): Immature oocytes collected, metaphase II oocytes, and embryos produced. Implantation and pregnancy rates. Result(s): The overall oocyte maturation and fertilization rates attained were 80.3% (1,222 of 1,522) and 76.5% (935 of 1,222), respectively. Significantly fewer immature oocytes were retrieved from normal ovaries (5.1 ± 3.7) compared with the PCO (10.0 ± 5.1) or PCOS (11.3 ± 9.0) groups. Fertilization and cleavage rates were comparable among the three groups. The implantation, pregnancy, and live birth rates per transfer for normal ovaries were 1.5%, 4.0%, and 2.0%, respectively; for PCOs 8.9%, 23.1%, 17.3%, respectively; and for women with PCOS 9.6%, 29.9%, and 14.9%, respectively. Conclusion(s): Immature oocytes retrieved from normal ovaries, PCOs, or women with PCOS, when using hCG priming before oocyte retrieval, have a similarly high maturation, fertilization, and cleavage potential. In vitro maturation is a useful treatment option, particularly for women with PCOs.

Effects of electro-acupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries

The aims of the present study were to investigate corticotropin-releasing factor (CRF) concentrations in the brain, the adrenal glands, and the ovaries in rats with estradiol valerate (EV) induced polycystic ovaries (PCO). The effect of 12 electro-acupuncture (EA) treatments on CRF concentrations was also investigated. The CRF concentrations in the median eminence (ME) were significantly increased in rats with PCO (both the PCO control group and the PCO group receiving EA) compared with the healthy control group (veichle control group), indicating increased activity in the hypothalamus-pituitary axis. The CRF concentrations in the ovaries were significantly reduced in the PCO group receiving EA compared with the PCO control group. Also, there was a decrease in comparison withthe healthy control group but the decrease was not as significant. This finding indicates that repeated EA treatments change the neuroendocrinological state in the ovaries, which may play an important role in reproductive failure.

High prevalence of polycystic ovaries and associated clinical, endocrine, and metabolic features in women with previous gestational diabetes mellitus.

The prevalence of polycystic ovaries, according to ultrasonography, and associated clinical, endocrine, and metabolic features were investigated in women with previous gestational diabetes mellitus (GDM). Thirty-four women with GDM 3-5 yr before the investigation and 36 controls with uncomplicated pregnancies, selected for similar age, parity, and date of delivery, were investigated. The women with previous GDM showed a higher prevalence of polycystic ovaries [14 of 34 (41%) vs. 1 of 36 (3%); P < 0.0001], hirsutism (P < 0.01), irregular menstrual cycles (P < 0.01), and a higher body mass index (BMI; P < 0.001) than the controls. Five women (15%) with previous GDM had developed manifest diabetes (excluded in comparisons of metabolic variables). After dividing the women with previous GDM into subgroups according to ovarian appearance, the 2 subgroups showed similar glucose tolerance and prevalence of diabetes, whereas the women with polycystic ovaries were younger (mean +/- SD, 33.3 +/- 1.4 vs. 38.2 +/- 1.1; P < 0.01), had higher truncal-abdominal/femoral fat ratio according to skin folds (P < 0.05), had higher concentrations of androstenedione (P < 0.01) and testosterone (P < 0.01), and had a higher LH/FSH ratio (P < 0.01), lower levels of GH (P < 0.01), higher levels of triglycerides (P < 0.05) and cholesterol (P < 0.05) in very low density lipoprotein, all independent of age and BMI, and had a higher prevalence of pregnancy-induced hypertension (50% vs. 15%; P < 0.05) during the index pregnancy compared with the women with normal ovaries. The group of women with GDM showed a lower early insulin release after glucose (i.v. glucose tolerance test) for their degree of insulin resistance (euglycemic hyperinsulinemic clamp) compared with controls (P < 0.05). In the two subgroups, insulin sensitivity was lower in the polycystic ovaries group, independent of BMI (P < 0.05), than in the group with normal ovaries. In conclusion, ultrasonographic, clinical and endocrine signs of polycystic ovary syndrome were much increased in women with a history of GDM. Compared with the women with normal ovaries and previous GDM, those with polycystic ovaries formed a distinct subgroup that may be more prone to develop various features of the insulin resistance syndrome. Both groups showed a similarly disturbed balance between beta-cell activity and insulin sensitivity, but in women with polycystic ovaries, insulin resistance may be the dominant component.

Effect of gonadotrophin-releasing hormone agonist treatment on growth hormone secretion in women with polycystic ovarian syndrome.

The suppression of the pituitary-gonadal axis by the administration of gonadotrophin-releasing hormone agonists (GnRH-a) is used occasionally as an adjunct therapy with gonadotrophins for ovulation induction in women with polycystic ovarian syndrome (PCOS). A number of recent clinical studies have suggested that women with polycystic ovaries (PCO) may have disturbances of normal growth hormone (GH) kinetics and alterations in the GH/insulin-like growth factor (IGF)-I system. The purpose of this study was to determine the effect of GnRH-a administration on GH-releasing hormone (GHRH)-stimulated GH release in women with PCOS. Eight women with PCO and six control women were studied before and after 2 months of treatment with the long acting GnRH-a triptoreline (3.75 mg monthly injections). GHRH was given as a single i.v. injection and blood samples for GH measurements were obtained at -15, 0, 30, 60, 90 and 120 min. The GH responses were expressed as the area under the curve (AUC) or the differences from the basal value (delta(max)). The GH response to GHRH (mean +/- SEM) was lower in women with PCO (AUC 114.9 +/- 43.1 versus 206.2 +/- 28.7 ng/ml/120 min, P < 0.05 and delta(max) 31.6 +/- 8.2 versus 49.4 +/- 5.8 ng/ml, P < 0.05). After treatment with the GnRH-a, the GH response to GHRH was significantly smaller than before treatment in both groups (PCO AUC 34.6 +/- 9.0 ng/ml/120 min and delta(max) 12.4 +/- 3.1 ng/ml; controls AUC 148.8 +/- 28.4 ng/ml/120 min and delta(max) 31.2 +/- 6.1 ng/ml), but the PCO group had a significantly smaller response. These data demonstrate that women with PCO have a reduced GH response to GHRH compared with normal controls and that GnRH-a administration causes a further GH reduction in both groups. Women with PCO have a greater suppression of GH response to GHRH during treatment with GnRH-a. This suggests that a different level of sensitivity in the somatotrophic axis exists in PCOS.

Frequency of a polymorphism in the regulatory region of the 17 alpha-hydroxylase-17,20-lyase (CYP17) gene in hyperandrogenic states.

Dysregulation of 17 alpha-hydroxylase (CYP17) has been proposed as a cause of hyperandrogenism. We have determined the prevalence of a polymorphic allele in the CYP17 gene in sporadic patients with polycystic ovaries (PCOS) compared to a reference population, and to a group of hyperandrogenic individuals, to assess its significance to androgen production. DNA was isolated from EDTA blood samples from 69 patients with PCOS, 63 patients with congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency and 124 consecutive patients attending for a full blood examination. The thymine (T) to cytosine (C) polymorphism at -34 base pairs (bp), denoted alleles A1 and A2 respectively, was detected by amplification of DNA followed by restriction enzyme digestion. Testosterone and LH. The frequency of alleles A1 and A2 in each of the subject groups was determined. The prevalences of the A1 and A2 alleles were 75 and 25% respectively in the PCOS group which was not significantly different from that in either the hyperandrogenic or the reference group. Neither allele segregated with hyperandrogenism. The polymorphism plays no apparent role in the dysregulation of CYP17.

Endocrinological and clinical analysis of hyperprolactinemic patients with and without ultrasonically diagnosed polycystic ovarian changes.

In the present study we aimed to identify the relationship of hyperprolactinemia and polycystic ovarian changes. We retrospectively analyzed the endocrinological and clinical features of 79 hyperprolactinemic patients detected during a 3-year period ending in March 1995. Patients who had hypothyroidism, macroprolactinoma and drug-induced hyperprolactinemia were excluded from the study. Among 61 hyperprolactinemic patients, 41 (67.2%) had ultrasonographically diagnosed polycystic ovaries (PCO). Prolactin levels in the PCO and non-PCO groups were 32.8 +/- 5.8 and 36.7 +/- 5.1 ng/dl, respectively, which was a significant difference (p < 0.05). Hirsutism was associated with hyperprolactinemia in 55.7% of the patients and was found to be more frequent in the PCO (58.8%) than the non-PCO group (41.2%). The mean Ferriman Gallwey scores and both total and free testosterone levels were significantly higher in the PCO group in comparison to the non-PCO group. In addition, a significantly higher body mass index was detected in patients with PCO. We documented a frequent association between hyperprolactinemia and polycystic ovarian changes and suggested that hyperprolactinemia in PCO is most likely related to a pathologic-endocrinologic milieu.

Oestrogen and androgen states in oligo-amenorrhoeic women with polycystic ovaries

Summary. Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo-amenorrhoea. Of the 48 women with polycystic ovaries (PCO), 44 (92%) had a withdrawal bleed following progestogen challenge (indicating oestrogenization) compared with just three (18%) of the 17 with non-PCO (P < 0.001). Median serum concentrations of oestradiol and oestrone were statistically significantly higher in the PCO group but the ranges overlapped widely. Of the four women with PCO but oestrogen deficiency, two were hirsute and had evidence of a severe form of the disorder. The other two were not hirsute and appeared to have hypo-thalamic dysfunction associated with weight loss overriding the disorder due to pre-existing PCO. Compared with the non-PCO group, the PCO subgroup without hirsutism (n = 31) had statistically significantly higher median values of LH, testosterone, androstendione, and dehydro-epiandrosterone sulphate concentrations, and free androgen index. Concentrations of androgen, but not LH, were significantly higher still in the PCO subgroup with hirsutism (n = 17).

Twenty-four-hour serum growth hormone, insulin, C-peptide and blood glucose profiles and serum insulin-like growth factor-I concentrations in women with polycystic ovaries.

Raised insulin levels are now recognized as a characteristic feature of women with polycystic ovaries (PCO), and hyperinsulinism has been shown to stimulate androgen production in such women. We have, however, recently shown that hyperinsulinaemia is present only in the obese subjects with PCO in whom insulin concentrations correlate with those of luteinizing hormone. We therefore studied 24-hour blood profiles of growth hormone (GH) and insulin-like growth factor-I (IGF-I) in obese and non-obese women with PCO, for comparison with their levels of insulin, C-peptide and other hormones, such as androgens which are known to be disturbed in PCO. Mean 24-hour GH levels were higher overall in PCO than in control subjects, although the difference was not significant. When, however, a separate analysis was made in obese as compared with non-obese PCO patients, GH concentrations were significantly higher in the non-obese group than in the obese (p = 0.0005). There was a significant negative correlation between body mass index and mean 24-hour GH concentrations (r = -0.641; p = 0.0006). IGF-I concentrations were however similar in the PCO group overall and in controls, as well as in the obese and non-obese PCO patients. The 24-hour blood glucose profile pattern was significantly different in PCO women from controls (p = 0.009), with absence of post-prandial peaks in blood glucose concentrations. These changes were most marked in the non-obese PCO group, who also had significantly lower blood glucose levels than either controls or obese PCO subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Oestrogen and androgen states in oligo‐amenorrhoeic women with polycystic ovaries

Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo-amenorrhoea. Of the 48 women with polycystic ovaries (PCO), 44 (92%) had a withdrawal bleed following progestogen challenge (indicating oestrogenization) compared with just three (18%) of the 17 with non-PCO (P less than 0.001). Median serum concentrations of oestradiol and oestrone were statistically significantly higher in the PCO group but the ranges overlapped widely. Of the four women with PCO but oestrogen deficiency, two were hirsute and had evidence of a severe form of the disorder. The other two were not hirsute and appeared to have hypothalamic dysfunction associated with weight loss overriding the disorder due to pre-existing PCO. Compared with the non-PCO group, the PCO subgroup without hirsutism (n = 31) had statistically significantly higher median values of LH, testosterone, androstenedione, and dehydroepiandrosterone sulphate concentrations, and free androgen index. Concentrations of androgen, but not LH, were significantly higher still in the PCO subgroup with hirsutism (n = 17).

The diagnosis of polycystic ovaries in subfertile women

Laparoscopy was used to identify the polycystic ovary (PCO) in a group of subfertile women. A third were found to have PCO. These patients had higher levels of luteinizing hormone (LH), testosterone (T) and a higher free androgen index (FAI) than those with normal ovaries. Only 15% of patients with laparoscopic evidence of PCO were obese, hirsute and oligomenorrhoeic. Within the PCO group, hirsutism was strongly associated with obesity and a high FAI. A group of subfertile women with PCO and regular cycles was found who had no other identifiable cause for their infertility. These women had higher follicular phase concentrations of LH and higher FAI than ovulatory women with normal ovaries.