Resistant Polycystic Ovary Syndrome Women Research Articles

A Cross-Sectional Study of Protein Changes Associated with Dementia in Non-Obese Weight Matched Women with and without Polycystic Ovary Syndrome.

Dysregulated Alzheimer's disease (AD)-associated protein expression is reported in polycystic ovary syndrome (PCOS), paralleling the expression reported in type 2 diabetes (T2D). We hypothesized, however, that these proteins would not differ between women with non-obese and non-insulin resistant PCOS compared to matched control subjects. We measured plasma amyloid-related proteins levels (Amyloid-precursor protein (APP), alpha-synuclein (SNCA), amyloid P-component (APCS), Pappalysin (PAPPA), Microtubule-associated protein tau (MAPT), apolipoprotein E (apoE), apoE2, apoE3, apoE4, Serum amyloid A (SAA), Noggin (NOG) and apoA1) in weight and aged-matched non-obese PCOS (n = 24) and control (n = 24) women. Dementia-related proteins fibronectin (FN), FN1.3, FN1.4, Von Willebrand factor (VWF) and extracellular matrix protein 1 (ECM1) were also measured. Protein levels were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement. Only APCS differed between groups, being elevated in non-obese PCOS women (p = 0.03) relative to the non-obese control women. This differed markedly from the elevated APP, APCS, ApoE, FN, FN1.3, FN1.4 and VWF reported in obese women with PCOS. Non-obese, non-insulin resistant PCOS subjects have a lower AD-associated protein pattern risk profile versus obese insulin resistant PCOS women, and are not dissimilar to non-obese controls, indicating that lifestyle management to maintain optimal body weight could be beneficial to reduce the long-term AD-risk in women with PCOS.

High density lipoprotein-associated proteins in non-obese women with and without polycystic ovary syndrome.

Dyslipidemia frequently occurs in women with polycystic ovary syndrome (PCOS), but it is unclear whether dyslipidemia is due to obesity and insulin resistance (IR) or is inherent to PCOS. To address this, proteomic analysis of proteins important in lipid metabolism, particularly for high-density lipoprotein cholesterol (HDL-C), was performed in non-obese, non-insulin resistant PCOS women compared to matched controls. Weight and aged-matched non-obese subjects with PCOS (n=24) and without IR were compared with control women (n=24). 19 proteins were measured by Somalogic proteomic analysis: alpha-1-antichymotrypsin, alpha-1-antitrypsin, apolipoproteins A-1, B, D, E, E2, E3, E4, L1, M, clusterin, complement C3, hemopexin, heparin cofactor-II (HCFII), kininogen-1, serum amyloid A-1, amyloid beta A-4 and paraoxonase-1. Women with PCOS had a higher free androgen index (FAI) (p<0.001) and anti-Mullerian hormone (AMH) (p<0.001), but IR and C-reactive protein (CRP), a marker of inflammation, did not differ from controls (p>0.05). The triglyceride:HDL-cholesterol ratio was elevated (p=0.03) in PCOS. Alpha-1-antitrypsin levels were lower (p<0.05) and complement C3 levels were higher (p=0.001) in PCOS. C3 correlated with body mass index (BMI) (r=0.59, p=0.001), IR (r=0.63, p=0.0005) and CRP (r=0.42, p=0.04) in women with PCOS, though no correlations of these parameters with alpha-1-antitrypsin were found. Total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and levels of the other 17 lipoprotein metabolism-associated proteins did not differ between the two groups (p>0.05). However, in PCOS, alpha-1-antichymotrypsin correlated negatively with BMI (r=-0.40, p<0.04) and HOMA-IR (r=-0.42, p<0.03), apoM correlated positively with CRP (r=0.36, p<0.04) and HCFII correlated negatively with BMI (r=-0.34, p<0.04). In PCOS subjects, when obesity, IR and inflammation confounders were absent, alpha-1-antitrypsin was lower and complement C3 was higher than in non-PCOS women, suggesting increased cardiovascular risk; however, subsequent obesity related IR/inflammation likely stimulates other HDL-associated protein abnormalities, thus increasing cardiovascular risk further.

Clomiphene citrate (CC) plus L-Carnitine improves clinical pregnancy rate along with glycemic status and lipid profile in clomiphene-resistant polycystic ovary syndrome patients: A triple-blind randomized controlled clinical trial

Despite the high prevalence of polycystic ovary syndrome (PCOS), its pathogenesis has not been well understood. This study was designed to evaluate the reproductive and metabolic effects of L-carnitine in clomiphene citrate (CC)-resistant PCOS women. The triple-blind randomized controlled clinical trial was conducted in the infertility clinic of the Imam Hossein hospital and registered with registration number: IRCT20210415050980N1. A total of 148 CC-resistance PCOS women have randomly divided into two groups; group A received 150 mg/day CC from day 5 to day 9 of the ovulation cycle and 3 g oral L-carnitine, and Group B received 150 mg/day oral CC plus placebo. The primary outcome was the clinical pregnancy rate. The secondary outcomes were hormonal and metabolic profile changes. L-carnitine significantly improves ovulation and pregnancy rate (71.4% vs. 28.6%; p < 0.001 and 33% vs. 11%; p < 0.001). The number of stimulated follicles reaching˃17 mm diameter was significantly higher in Group A compared to Group B (2.14 ± 0.64 vs. 0.71 ± 0.7; p < 0.001). Endometrium was significantly thicker in Group A (8.14 ± 1.89 mm vs. 6.43 ± 1.3 mm; p < 0.001). L-carnitine treatment significantly decreased fasting serum glucose and Hb A1c (P > 0.001) and improved lipid profile. L-carnitine treatment may increase pregnancy rate along with improving the glycemic status and lipid profile. However, further studies are recommended to explore the exact mechanisms of L-carnitine role in patients with PCOS. • The number of stimulated follicles reaching˃17 mm diameter was significantly higher in Clomiphene citrate plus L-carnitine group compared to Clomiphene citrate plus placebo Group. • L-carnitine treatment significantly increased endometrium thickness. • L-carnitine treatment significantly decreased fasting serum glucose and Hb A1c as well as improved lipid profile. • L-carnitine significantly improve ovulation rate and pregnancy rate.

Inflammatory Markers in Non-Obese Women with Polycystic Ovary Syndrome Are Not Elevated and Show No Correlation with Vitamin D Metabolites.

Introduction. Chronic low-grade inflammation is a characteristic of women with polycystic ovary syndrome (PCOS), although this may be obesity-driven rather than an intrinsic facet of PCOS; furthermore, vitamin D deficiency, another common feature of PCOS, is reported to have an association with increased inflammation. Therefore, circulating inflammatory protein levels and circulating levels of vitamin D may be linked in PCOS, though it is unclear which vitamin D metabolites may be important. Methods. We measured plasma levels of 24 inflammatory proteins and 12 matrix metalloproteinases (proteins modulated by the inflammatory process) by slow off-rate modified aptamer (SOMA)-scan plasma protein measurement in weight and aged-matched non-obese non-insulin resistant PCOS (n = 24) and control (n = 24) women. Inflammatory proteins and matrix metalloproteinases were correlated to 25-hydroxy vitamin D3 (25(OH)D3), its epimer 25-hydroxy-3epi-vitamin D (3epi25(OH)D) and the active 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) as measured by gold standard isotope-dilution liquid chromatography tandem mass spectrometry. Results. PCOS women had both an elevated free androgen index and circulating anti-mullerian hormone, though insulin resistance was comparable to controls. C-reactive protein, as a standard circulatory marker of inflammation, was comparable between cohorts. Levels of circulating inflammatory proteins and matrix metalloproteinases were not different between the PCOS and control women, with no correlation of 25(OH)D3, 1,25(OH)2D3 or 3epi25(OH)D with any of the inflammatory proteins. Conclusion. In a non-obese PCOS population matched for age and insulin resistance, circulating inflammatory proteins and matrix metalloproteinases were not elevated and did not correlate with 25(OH)D3, its epimer 3epi25(OH)D or 1,25(OH)2D3 in either control or PCOS women, indicating that the inflammatory response is absent and the vitamin D-metabolite independent in non-obese women with PCOS.

Pregnancy rates after laparoscopic ovarian drilling in polycystic ovary syndrome patients following unsuccessful ovulation induction

Polycystic ovary syndrome (PCOS) is one of the most common endocrine pathologies and is a frequent cause of anovulatory infertility affecting 5-20% of reproductive age women1. Medical induction of ovulation is considered the first-line treatment option for infertile PCOS women. Laparoscopic ovarian drilling (LOD) is currently accepted as a successful second-line treatment in drug-resistant PCOS2. Many authors have reported high ovulation (∼80%) and pregnancy (∼60%) rates following LOD3. The aim of this study was to evaluate the efficacy of laparoscopic ovarian drilling (LOD) on the reproductive outcome of anovulatory PCOS women. The results of our study were compared to historical controls from literature. Retrospective cohort study. Women unable to achieve pregnancy with ovulation drugs who underwent LOD from 2013-2018 were included. One physician followed a standard technique for LOD and performed all surgeries. Age, BMI, years of infertility, tobacco or alcohol use, pre and post surgery ovulation rates, pre and post surgery pregnancy rate, time until ovulation and pregnancy after surgery were documented. 136 patients who underwent LOD were included in this study. Demographics were divided as follows: mean age 28.9; mean BMI 22.2 kg/m2, and mean duration of infertility 2.9 years. Race was divided as follows: 58.8% Caucasian, 22.8% Hispanic, 14% African American, 3.7% Asian, 0.7% other. Tobacco use was reported by 4.4% and social alcohol use was reported by 37.5%. 39.0% reported successful ovulation with drugs prior to surgery but were unable to achieve a pregnancy. Ovulation after LOD was reported by 77.2% with a live birth rate of 47.1% and mean time until ovulation of 79.0 days. Statistical analysis showed a woman was 2.27% (95% CI 1.83 - 2.82) more likely to ovulate following LOD. This was considered significant on a Chi Square test (X2 = 69.8, P<0.05). Furthermore, a patient was 1.95% (95% CI 1.48 - 2.58) more likely to achieve a live birth following LOD with a mean time of 241.1 days until pregnancy. This was also considered significant on a Chi Square test (X2=22.9, P<0.05). (Table 1). Our study demonstrates significantly improved ovulation and pregnancy rates in drug resistant PCOS women after LOD. Although our rates are lower than those reported in previous published studies, this may be attributed to 37 out of 136 patients (27.2%) being lost to follow up. Some patients also did not achieve desirable results after the surgery due to other factors like male infertility, marital issues and diagnosis of cancer.Table 1ResultsYesNoUnknownOvulation prior to LOD39.0%58.1%2.9%Ovulation after LOD77.2%7.4%15.4%Pregnancy rate prior to LOD33.1%66.9%n/aPregnancy rate after LOD47.1%25.7%27.2% Open table in a new tab

Evaluation of the effectiveness of transvaginal ovarian drilling under ultrasound guide in patients with resistant polycystic ovary syndrome to clomiphene citrate

Polycystic ovary syndrome (PCOS), is a heterogeneous disorder found in 3% - 10% of women worldwide, and it constitutes about 80 % of anovulation infertility. In cases of resistance to CC surgical option in form of ovarian drilling, for using maneuver with less invasive than laparoscopy we study the effect of transvaginal ovarian drilling under ultrasound guide in patients with resistant polycystic ovary syndrome to clomiphene citrate This study was conducted o evaluate the effectiveness of transvaginal ovarian drilling under ultrasound guide in patients with resistant polycystic ovary syndrome to CC. In this, A prospective, clinical trial study 42 infertile women with PCOS resistant to 3 months course of treatment with CC enrolled in this study. The preoperative assessment includes history, physical examination, the serum levels of FSH, LH, AMH, testosterone, and TVS was done for ovarian morphology. Transvaginal ovarian drilling under ultrasound guide using a needle connected to manual vacuum pressure that punctured each ovary between 3 – 6 punctures. Postoperatively Signs of spontaneous ovulation, levels of FSH, LH, AMH, testosterone, and pregnancy rate were recorded. The results revealed that There is a significant reduction in the level of LH, FSH, Testosterone, and Anti-Mullerian hormones. Signs of spontaneous ovulation was developed, and the pregnancy rate after the operation was recorded. This low cost, no recorded adverse effects, and quickly done manoeuvre has an excellent result in improving fertility rate in resistant PCOS women to CC.

Insulin Resistance and Its Associated Risk Factors in Nigerian Women with Polycystic Ovary Syndrome

Background: The etiology of polycystic ovary syndrome (PCOS) is not completely understood; however one condition that correlates closely with the pathogenesis of PCOS is insulin resistance (IR). The objective of this study was to determine the prevalence of insulin resistance (IR) and the association of such abnormality with potential risk factors in women with PCOS. Method: 116 women with confirmed PCOS attending a reproductive clinic at the University of Benin Teaching Hospital in Benin City were studied. IR was determined by homeostatic model assessment (HOMA) ≥ 2 and pre-diabetes by fasting plasma glucose between 110 and 125 mg/dl and/or plasma glucose value between 140 and 200 mg/dl at 2 hours during an oral glucose tolerance test (OGTT) after ingestion of 75 g oral glucose load. Results: Forty-two women were insulin resistant among the 116 women with PCOS. The prevalence of IR was 36.2% (95% CI 26.6 - 46.2). The prevalence of impaired fasting glucose (IFG) showed 1.7% (95% CI 0.97 - 2.03), impaired glucose tolerance (IGT) was 2.6% (95% CI 1.97 - 3.03) and diabetes mellitus (DM) was 1.7% (95% CI 0.97 - 2.03) in the 116 PCOS women. Of these 42 insulin resistant PCOS women, 23.8% (n = 10) were obese and 40.5% (n = 17) were overweight. Multivariate analysis revealed that total cholesterol (OR, 1.07; 95% CI, 1.04 - 1.10), triglycerides (OR, 1.08; 95% CI, 1.04 - 1.13) and LDL-cholesterol (OR, 1.08; 95% CI, 1.04 - 1.12) were statistically significant independent risk factors for IR. Conclusion: The prevalence of IR was high in women with PCOS, and there was a significant association between IR, obesity, and dyslipidemia. However, the prevalence rates of impaired glucose tolerance and DM were low in women with PCOS compared to other studies. Since women with PCOS are at risk of IR and dyslipidemia, early screening, detection, intervention, and lifestyle modification would ameliorate the financial burden of DM and cardiovascular disease (CVD).

Short term effects of laparoscopic ovarian drilling in clomiphene citrate resistant patients with polycystic ovary syndrome

Abstract Objective The study aims to assess the effect of laparoscopic ovarian drilling (LOD) in clomiphene citrate resistant patients with polycystic ovary syndrome (PCO) on the changes occurred in ovarian reserve. Study design A prospective cohort study. Setting Sohag University Hospital, Sohag, Egypt. Materials and methods Thirty-seven patients with PCO were enrolled in the study. We evaluated the effect of LOD on the ovarian reserve using hormonal assay (measuring FSH, LH, AMH, Testosterone, SHBG, E2 and FAI) and sonographic markers (including ovarian volume, antral follicle count (AFC) and ovarian stromal blood flow). Results Amongst the 37 patients underwent LOD, regulation of the cycle occurred in 20 patients after 6 months (54.06%) (p = 0.001). Occurrence of pregnancy occurred in 4 patients after three months and in 18 patients after 6 months. As regard the hormonal profile, LOD has reducing effect on the serum levels of FSH, LH, AMH, SHBG, Testosterone and free androgen index. This reduction is of statistically significance in case of LH, AMH, testosterone and FAI especially after 6 months (p = 0.01, 0.001, 0.05, 0.05 respectively). The deleterious effect of LOD was statistically significant in the AFC which was reduced from 18.1 ± 2.7 to 11.5 ± 1.8 after 6 months (p = 0.05). Also, the ovarian blood flow indices were reduced with p = 0.01 for all indices. Conclusions Using the AMH and AFC as reliable markers of the ovarian reserve and measuring them for women with anovulatory PCO undergoing LOD may provide a useful tool in evaluating the outcome of LOD as the gold standard treatment for CC resistant PCO women.

Adipokines and soluble cell adhesion molecules in insulin resistant and non-insulin resistant women with polycystic ovary syndrome

Introduction: Insulin resistance (IR) is closely associated with increased atherogenic risk.Objective: To investigate leptin, adiponectin, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) levels and their relationship with each other and metabolic parameters in women with polycystic ovary syndrome (PCOS).Methods: The study included 76 PCOS women divided into insulin resistant and non-insulin resistant. Anthropometric parameters, glucose and lipid parameters, leptin, adiponectin, sICAM-1 and sVCAM-1 were determined. Homeostasis model of IR index(HOMA-IR), atherogenic index of plasma(AIP) and leptin/adiponectin ratio were calculated. HOMA-IR > 2.5 and/or fasting plasma glucose/immunoreactive insulin ratio < 0.333 were used as markers for IR.Results: Non-insulin resistant PCOS had significantly higher adiponectin and sVCAM-1 levels. AIP was significantly higher in insulin resistant PCOS. Adiponectin showed a positive correlation with sVCAM-1 and sICAM-1.Conclusion: Insulin resistant PCOS women were at higher atherogenic risk compared to non-insulin resistant group. sVCAM-1 data confirms the necessity of further investigations for clarifying its role in IR.

The LIPT-Study: On Risk Markers of Vascular Thrombosis in Polycystic Ovary Syndrome. A Randomized, Double-Blind, Placebo-Controlled Study of the Effect of Liraglutide

Overweight and insulin resistance (IR) are central pathogenic features of the Polycystic Ovary Syndrome (PCOS), and weight loss is the main treatment option. PCOS is also associated with signs of a chronic inflammation, activation of the coagulation system, defect endothelial function and increased arterial stiffness, all regarded as risk factors or markers for the development of cardiovascular disease. These factors are not taken into account in the definition of the syndrome, which is based on the 3 Rotterdam criteria. An uncertainty of the clinical risk of cardiovascular disease (CVD) in these relatively young women has led to many studies on surrogate markers of CVD in PCOS, including the search for new markers with additional information of the arteriosclerotic burden in PCOS. GLP-1 analogues, originally developed for the treatment of diabetes, induce weight loss also in non-diabetic people. We therefore questioned whether treatment with the GLP-1 analogue Liraglutide to women with PCOS in doses used for diabetes could induce weight loss and improve IR and through this action, or independently, improve markers of vascular thrombosis in women with PCOS. Thus, 70 overweight and/or insulin resistant PCOS women were planned treated for 26 weeks in a placebo controlled randomized trial with the following effect parameters to be evaluated: Changes in Thrombin generation time, Adrenomedullin, Atrial natriuretic peptide, body fat composition (DEXA), liver fat content (MRI), BMI, IR, sex hormones and ovarian morphology. The protocol and the background for the study are brought in this report.

The prevalence of metabolic syndrome in clomiphene citrate resistant polycystic ovary syndrome

Objective: To investigate the prevalence of metabolic syndrome in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients. Methods: 58 CC resistant PCOS patients, 52 CC responders, 53 fertile PCOS and 53 age and body mass index-matched normoandrogenic ovulatory fertile women were evaluated for metabolic syndrome. Results: Metabolic syndrome prevalence was 41.4% in CC resistants, in 23.1% of CC responders, in 11.3% of PCOS fertiles and 0% of controls (p < 0.0001). Waist circumference (WC) > 88 cm was 44.8%, systolic blood pressure (BP) ≥ 130 mmHg and diastolic BP ≥85 mmHg were 27.6%, TG (triglyceride) ≥150 mg/dL was 36.2%, HDL(high density lipoprotein) < 50 mg/dL was 63.8%, fasting glucose levels ≥ 100 mg/dL was 20.7% in CC resistant PCOS women. There were positive associations between CC resistance and WC >88 cm, BP ≥ 130 ≥ 85 mmHg, TG ≥ 150 mg/dL, HDL < 50 mg/dL, fasting glucose ≥ 100 mg/dL, and presence of metabolic syndrome (p < 0.05, for all). Moreover, WC > 88 cm, and HDL < 50 mg/dL were independent variables that were associated by CC resistance by multivariate regression analysis. Conclusions: CC resistant PCOS patients have high prevalence of metabolic syndrome. These women have an increased risk of future cardiovascular disease.

Functional neuroimaging of emotional processing in women with polycystic ovary syndrome

Polycystic Ovary Syndrome (PCOS) is associated with increased risk of depression. Other metabolic disorders are also associated with depression, with glycemic control improving symptoms. Our goal was to evaluate emotional processing in insulin resistant PCOS women (IR-PCOS) and to assess the impact of improved insulin regulation.

The impact of insulin resistance on the outcome of laparoscopic ovarian electrocautery in infertile women with the polycystic ovary syndrome

In this study we assessed how insulin resistance affects pregnancy rates in infertile women with the polycystic ovary syndrome (PCOS) treated with laparoscopic ovarian electrocautery. Sixty-four PCOS women were included in the study in a consecutive fashion. Following the CIGMA (continuous infusion of glucose with model assessment) test, 28 women were classified as insulin resistant and 36 women as non-insulin resistant. After the ovarian electrocautery patients were observed for 12-18 months. If pregnancy did not ensue, they were referred for one or more cycles of in vitro fertilization (IVF). Following ovarian electrocautery the non-insulin-resistant women more frequently achieved a regular menstrual cycle and ovulation than the insulin-resistant PCOS women. Consequently 18 (50%) of the non-insulin-resistant PCOS women achieved a pregnancy versus only five (18%) of women in the insulin-resistant PCOS group. Following treatment with both ovarian electrocautery and IVF, 27 (75%) of the non-insulin resistant PCOS women achieved a successful pregnancy, while 13 (46%) of the insulin-resistant PCOS group achieved this. In conclusion, insulin resistance may be an important marker of a poor outcome of treatment in PCOS infertility. Further studies are needed to evaluate the possible effect of treatment alternatives to alleviate the unfavorable influences of insulin resistance and hyperinsulinemia on ovulation induction in PCOS women.

Impact of Insulin Resistance on Pregnancy Complications and Outcome in Women with Polycystic Ovary Syndrome

The aim of the study was to determine the risk of developing gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH)/pre-eclampsia in a cohort of pregnant women with the polycystic ovary syndrome (PCOS) and known insulin sensitivity status. Pregnancies and neonatal outcome were recorded in a prospective cohort study comprising 29 non-insulin-resistant PCOS women, 23 insulin-resistant PCOS women and a control group of 355 women who had conceived after assisted reproduction. Hypertension, pre-eclampsia and GDM were recorded as well as pregnancy duration, method of delivery and birth weight. The frequency of hypertension was significantly elevated in PCOS women (11.5%) compared to controls (0.3%), p < 0.01. However, the frequency of pre-eclampsia was significantly elevated only in the insulin resistant PCOS women (13.5%) compared to controls (7.0%), p < 0.02. GDM was significantly more frequent in PCOS women (7.7%) than controls (0.6%), p < 0.01. Insulin resistance prior to pregnancy, determined by continuous infusion of glucose with model assessment (CIGMA) test, did not further increase the frequency of GDM. Newborns from PCOS pregnancies were significantly more often delivered by Caesarean section than controls (40.3 vs. 27.3%, p < 0.05) and transferred to neonatal intensive care unit more often than controls (19.2 vs. 9.0%, p < 0.01). Thus we show that the frequencies of pre-eclampsia and GDM are increased in PCOS pregnancies.

The impact of insulin resistance on the outcome of ovulation induction with low-dose follicle stimulating hormone in women with polycystic ovary syndrome.

In this study we examined the possible correlation between insulin metabolism and outcome of gonadotrophin stimulation in infertile clomiphene citrate resistant women with polycystic ovary syndrome (PCOS). The patient group comprised 42 women who were entered into the study in a consecutive fashion. Following performance of the CIGMA (continuous infusion of glucose with model assessment) test, 17 women were classified as insulin resistant and 25 women as non-insulin resistant. Each woman received up to two cycles of low-dose follicle stimulating hormone (FSH) stimulation starting with 75 IU of FSH for 1 week, giving a total of 70 cycles performed. The insulin resistant PCOS women required more gonadotrophin and a longer time to achieve follicular maturation. By multiple regression gonadotrophin consumption correlated best with CIGMA value but not with fasting insulin concentration or body mass index. In the insulin resistant PCOS women 10 out of 29 cycles were cancelled due to a multifollicular response, while only one of 41 cycles was cancelled in the non-insulin resistant PCOS women. Although ovulation rate in completed cycles was similar between the groups, the conception rate was significantly better in the non-insulin resistant PCOS women. In conclusion, in PCOS women insulin resistance seems to be an unfavourable condition resulting in an elevated cancellation rate and a low conception rate following low-dose FSH stimulation.

Serum immunoreactive leptin concentrations in women with polycystic ovary syndrome.

Recent data in the mouse demonstrate that leptin, a protein hormone produced by fat cells, is required for fertility. In the absence of leptin the mice become obese, diabetic and infertile. Polycystic ovary syndrome (PCOS), a common cause of infertility in women, is associated with obesity and insulin resistance. Because of the increased frequency of PCOS in obese women we tested the hypothesis that alterations in serum leptin concentrations might be associated with PCOS. Immunoreactive leptin concentrations were measured in 58 women with PCOS and 70 regularly menstruating (control) women. As has previously been shown there was a positive correlation between leptin levels and body mass index (BMI). Although the leptin levels in the majority of women with PCOS fell within the control range, 29% of PCOS women had leptin levels above the 99% prediction interval for their BMI and none had low leptin levels. There were also positive correlations of leptin levels with free testosterone and insulin sensitivity in control women. In women with PCOS, 13% and 9.5% exhibited higher than expected leptin concentrations with respect to free testosterone and insulin sensitivity, respectively. Insulin resistant PCOS women had higher leptin levels than controls. The data demonstrate that a substantial proportion of women with PCOS have leptin levels that are higher than expected for their BMI, free testosterone and insulin sensitivity. These results suggest that abnormalities in leptin signaling to the reproductive system may be involved in certain cases of PCOS.