Polycystic Ovary Syndrome Type Research Articles

Evaluation of pregnancy and neonatal outcomes according to the phenotypic types of polycystic ovary syndrome: A prospective study.

We aimed to compare pregnancy and neonatal outcomes in the phenotypic subtypes of patients with polycystic ovary syndrome (PCOS). This prospective cohort included the patients with PCOS (n = 121) diagnosed according to the presence of androgen excess, ovulatory dysfunction, and/or polycystic ovary morphology and healthy controls (n = 125). We stratified PCOS as phenotype A (n = 45), phenotype B (n = 8), phenotype C (n = 32) and phenotype D (n = 35) and followed throughout pregnancy, comparing their outcomes. The study population had a mean age of 28.7 ± 4.9 years and a mean BMI of 31.6 kg/m2 with no difference between the groups. Primary cesarean deliveries were significantly more common in PCOS patients (23.3%) than in the control group (17.6%, P = 0.021). The phenotype A group had significantly higher rates of gestational diabetes mellitus (GDM) (42.2%, P < 0.001) and fetal macrosomia (14.6%, P = 0.002) compared with the control group (4.8% and 0.8%m respectively). We detected a significantly lower rate of normal risk score on the double screening test in the PCOS group (59.0%) than in the control group (75.4%) and in the other groups (P = 0.001). The rates of GDM, fetal macrosomia, and cesarean section were higher in the PCOS group, depending on the phenotype. We observed changes in risk calculation according to phenotypic types at aneuploidy screening.

Effective treatment of different types of polycystic ovary syndrome in adolescent girls

This review is addressing an urgent problem of diagnosis and treatment strategy of polycystic ovary syndrome in adolescent girls. We analysed data from modern literary publications on the epidemiology and classification of the disease, as well as the adaptation of general principles for the management of young female patients tailored to their age peculiarities. The effective treatment strategies for adolescent girls with PCOS depending on its type are presented. Today there are several contradictions associated with both the diagnosis and treatment of the disease in the medical community. Thus, the use of the well-known Rotterdam criteria makes it difficult to diagnose PCOS in adolescent girls, since the criteria do not take into account characteristic changes that occur during puberty. Such manifestations as acne, hirsutism, menstrual irregularities, high androgen levels and morphology of polycystic ovaries on pelvic ultrasound imaging should be assessed with due account for age, puberty, hormonal balance with an assessment of the ratio of LH (luteinizing hormone)/FSH (follicle-stimulating hormone) and Free Androgen Index. There is no consensus in the medical community regarding the treatment strategy for PCOS. International communities have identified two main goals in the management of patients: normalization of menstrual function and improvement of the patients’ quality of life by preventing clinical symptoms of hyperandrogenism, and metabolic disorders of hyperplastic processes in target organs.Our analysis of objective scientific data showed that modern monophasic combined oral contraceptives (COCs) supplemented by of a folate component should be used to treat young female patients with PCOS, hyperandrogenism and psychosomatic disorders.

Licogliflozin &lt;i&gt;versus&lt;/i&gt; Placebo in Women with Polycystic Ovary Syndrome (PCOS): A Randomised, Double-Blind, Phase 2 Trial

Licogliflozin versus placebo in women with polycystic ovary syndrome (PCOS): a randomised, double-blind, phase 2 trial. Background: PCOS is the most common endocrinopathy in women of childbearing age. Currently, there is no approved therapy available. The dual sodium-glucose transporter 1/2 inhibitor (SGLT1/2i) licogliflozin (LIK066) ameliorates hyperinsulinism in patients with diabetes and obesity. Its effect on androgens is unknown. Methods: In a multi-center, randomised, placebo-controlled, double-blind trial, patients with PCOS type A or B and insulin resistance were randomised to either licogliflozin 50 mg or placebo TID in a 1:1 ratio for two weeks. Change from baseline free testosterone (FT) serum concentrations served as primary outcome. Serum levels of various androgens and parameters of insulin resistance were secondary outcomes and exploratory objectives. Findings: Between October 4, 2017, and June 4, 2018, 29 patients were allocated to licogliflozin or placebo (n: 15 vs. 14). After exclusion per protocol of 5 and 4 patients in the licogliflozin and placebo groups, 10 patients were eligible for analysis in each group. The treatment effect of licogliflozin on FT (primary outcome) did not reach statistical significance (TRLIK066 :TRPCB(FT): 0·88; 90%CI: 0·70-1·11; p=0·353). Licogliflozin improved hyperandrogenaemia with reductions of androstendione (A4) by 19% (TRLIK066:TRPCB(A4): 0·81; 90%CI: 0·68-0·99; p=0·089) and dehydroepiandrosteronsulfate (DHEAS) by 24% (TRLIK066:TRPCB(DHEAS): 0·76; 90%CI: 0·65-0·89; p=0·008). Moreover, hyperinsulinaemia was reduced by 70% in the licogliflozin treatment group (highest insulin concentration (MAXI); TRLIK066:TRPCB(MAXI): 0·26; 90%CI: 0·20-0·34; p<0·001 and area under the curve insulin (AUCI); TRLIK066:TRPCB(AUCI): 0·32; 90%CI: 0·25-0·41; p<0·001). The most common adverse events were diarrhea and nausea without occurrence of serious adverse events. Interpretation: Dual inhibition of SGLT1/2 for two weeks reduced hyperinsulinaemia and as a trend hyperandrogenism in women with PCOS in a phase 2 trial. Licogliflozin may represent a promising novel treatment option for PCOS. Trial Registration: This trial is registered at ClinicalTrials.gov (NCT0315259) and EudraCT (2017-001373-16). Funding Statement: The study is funded by Novartis. Declaration of Interests: PM and MH are employees of Novartis. MZ, NH were employees of Novartis when the study was conducted. SI, DZ, and FW declare no competing interests. AD received honoraria for consultancy from Ablacare, Abbvie, Bayer, and Medtronics and received grant funding from the National Institutes of Health. DF received honoria and/or expenses for invited speeches from Eisai, Ipsen, and Sanofi Genzyme, is member of the advisory board of Eisai, Ipsen, and Sanofi Genzyme, and participated in funded research of Astra Zeneca, Bayer Pharma, Bristol-Myers Squibb, Eiger BioPharmaceuticals, Eli Lilly, Horizon Pharma, Hoffmann-La Roche Ltd, HRA Pharma, Immunovant Sciences GmbH, Incyte Biosciences International Sarl, Ipsen, Janssen-Cilag GmbH, Lexicon Pharmaceuticals, Madrigal Pharmaceuticals, Novartis and Otsuka Pharmaceutical. JS received honoraria for talks and/or consultancy and/or research funding from Abbott, Astra Zeneca, Bayer, Berlin Chemie, Boehringer Ingelheim, Bristol Myers Squibb (BMS), GI- Dynamics, Glaxo Smith Kline (GSK), Intarcia, Ipsen, Janssen, LifeScan, Lilly, Merck Sharp Dohme (MSD), MedScape, Mundipharma, Novartis, NovoNordisk, Omniamed, Pfizer, Roche, Sanofi Aventis, Servier, Takeda and Ypsomed. KD participated in funded research of Astra Zeneca, Bayer Pharma, Bristol-Myers Squibb, Eiger BioPharmaceuticals, Eli Lilly, Exelixis, Horizon Pharma, Hoffmann-La Roche Ltd, HRA Pharma, Immunovant Sciences GmbH, Incyte Biosciences International Sarl, Ipsen, Janssen-Cilag GmbH, Lexicon Pharmaceuticals, Madrigal Pharmaceuticals, Novartis and Otsuka Pharmaceutical. ST received honoria and/or expenses for invited speeches and/or consultancy from Abbott, Boehringer Ingelheim, BSN Medical, Chugai, Eli Lilly, Janssen-Cilag, KWHC, Merck, Nationale Gesundheitsakademie, Nova Biomedical, NovoNordisk, and Sanofi-Aventis, and participated in funded research of Astra Zeneca, Bristol-Myers Squibb, Eiger BioPharmaceuticals, Eli Lilly, Exelixis, Horizon Pharma, Lexicon Pharmaceuticals, Madrigal Pharmaceuticals, Novartis, NovoNordisk, and Incyte Biosciences International Sarl. Ethics Approval Statement: Ethics approval Germany (University of Duisburg-Essen, University of Freiburg and Charite Research Organisation GmbH): 17-7599-AF; USA: University of Pennsylvania: 827907.

Alterations of Sphingolipid Metabolism in Different Types of Polycystic Ovary Syndrome

The roles of sphingolipids in polycystic ovary syndrome (PCOS) are still unknown. This study aimed to investigate the sphingolipid characteristics for different types of PCOS using liquid chromatography-mass spectrometry (LC-MS). A total of 107 women with PCOS and 37 healthy women as normal controls were studied. PCOS patients were further classified into non-obesity with insulin resistance (IR) (NOIR), obesity with IR (OIR), and non-obesity and non-IR (NIR) subgroups. A total of 87 serum sphingolipids, including 9 sphingosines, 3 sphinganines, 1 sphingosine-1-phosphate (S1P), 19 ceramides (Cers), 1 ceramide-1-phosphate, 44 sphingomyelins (SMs), 4 hexosylceramides, and 6 lactosylceramides (LacCers) were analyzed using an improved sphingolipidomic approach based on LC-MS. Notable elevations in the levels of S1P, Cer, and SM were observed in PCOS patients when compared with healthy women, and SM species with long saturated acyl chains showed potential as novel biomarkers of PCOS. In addition, the level of LacCer was only elevated in NIR, and there was almost no change in NOIR and OIR. This study is the first to report the comprehensive sphingolipidomic profiling of different subgroups of PCOS with or without IR or obesity and suggests that serum sphingolipids might be useful as diagnostic biomarkers for different types of PCOS.

Tetragonia tetragonioides (Pall.) Kuntze Regulates Androgen Production in a Letrozole-Induced Polycystic Ovary Syndrome Model.

Tetragonia tetragonioides (Pall.) Kuntze (TTK) is a medicinal plant traditionally used to treat various diseases such as diabetic, inflammatory, and female-related disorders. Polycystic ovary syndrome (PCOS) is a common endocrinological disorder in women of reproductive age, and hyperandrogenism is a prominent feature of PCOS resulting in anovulation and infertility. In this study, we investigated the effects of a TTK extract on androgen generation and regulation of steroidogenic enzymes in vitro and in vivo. Human adrenocortical NCI-H295R cells were used to assess the effects of TTK extract on production of dehydroepiandrosterone and testosterone, as well as the protein expression of steroidogenic enzymes. Further, a letrozole-induced PCOS rat model was used in vivo to assess whether dietary administration of TTK extract restores normal hormones and reduces PCOS symptoms. TTK extract significantly inhibited forskolin (FOR)-induced androgen production in NCI-H295R cells and serum luteinizing hormone, testosterone, and follicular cysts, but not estradiol, were reduced in letrozole-induced PCOS rats orally administered the TTK extract. In addition, TTK extract inhibits androgen biosynthesis through the ERK-CREB signaling pathway, which regulates CYP17A1 or HSD3B2 expression. TTK extract could be utilized for the prevention and treatment of hyperandrogenism and other types of PCOS.

Salivary and serum androgens with anti-M\xfcllerian hormone measurement for the diagnosis of polycystic ovary syndrome

To determine the predictive value of a raised androgen level with an elevated anti-Müllerian hormone (AMH) for the diagnosis or exclusion of polycystic ovary syndrome (PCOS), a prospective cross-sectional study of 170 women (105 with PCOS type A and 65 normal) was undertaken. AMH was combined with one of, total serum testosterone (T); calculated free androgen index; salivary testosterone (salT); serum androstenedione (A); salivary androstenedione (salA). The diagnostic sensitivity and specificity of AMH (>35 pmol/l) alone for PCOS were 55% and 79% respectively. The diagnostic sensitivity and specificity of AMH (>35 pmol/l) with either an elevated T or raised FAI level for PCOS showed 100% specificity and a 100% positive predictive value. Conversely, diagnostic exclusion of PCOS was shown by an AMH <35 pmol/l with a normal T or FAI salivary testosterone giving 100% specificity and 100% positive predictive value. AMH with an elevated A or elevated salA level gave specificities of 87% and 94%, and positive predictive values 80% and 94%, respectively. Therefore, the combination of an AMH with a cut off of 35 pmol/l combined with a raised T and/or a FAI will confirm PCOS whilst a normal AMH with a normal T and/or FAI will exclude PCOS, thus addressing diagnostic uncertainty.

Confocal Microscopic Analysis of the Spindle and Chromosome Configurations of in vitro-Matured Oocytes from Different Types of Polycystic Ovary Syndrome Patients

Objective: To evaluate the meiotic spindle and chromosome distribution of in vitro-matured oocytes from infertile nonobese or obese women with polycystic ovary syndrome (PCOS) and to compare in vitro maturation (IVM) rates between groups. Design: Prospective study. Setting: Hospital-based IVF center. Patients: A total of 99 patients (26 obese women with PCOS, 25 nonobese women with PCOS, and 48 controls) undergoing stimulated cycles for intracytoplasmic sperm injection had immature oocytes for IVM. Interventions: Immature oocytes (germinal vesicle and metaphase I stages) were collected from obese and nonobese PCOS patients and controlled infertile patients. The meiotic spindle and chromosome configurations in oocytes matured in vitro were studied by confocal microscopy, with fluorescent labeling techniques for visualization of both microtubules and chromosomes. Main Outcome Measures: Meiotic spindle and associated chromosome configurations. Results: There were no significant differences between the different types of PCOS and the control group with respect to IVM rates (61.8, 63.8, and 63.2%, respectively), the percentage of spindle abnormalities in metaphase II oocytes (40.6, 42.9, and 37.5%, respectively) or chromosome abnormalities in metaphase II oocytes (31.2, 34.3, and 33.3%, respectively). Conclusions: In vitro-matured oocytes obtained from stimulated cycles had a high ratio of meiotic abnormalities. The different types of PCOS had the same ratio of meiotic abnormalities.

Clinical study of area of Jiangsu province of polycystic ovarian syndrome correlation distribution of traditional Chinese medicine syndrome type and improper diet

Polycystic ovary syndrome (PCOS) is one of the most popular diseases in obstetrics and gynecology research at internal and abroad at present, traditional Chinese medicine(TCM)in the clinical treatment of the disease have the advantage. Clinical epidemiological study of descriptive research method this research adopts investigation, observation of TCM syndromes and improper diet through 401 cases in Jiangsu Province confirmed PCOS patients, to explore the relationship between TCM syndrome type distribution and improper diet factors, and to provide the clinical basis for further etiology of this disease research. TCM syndrome type distribution of the disease is kidney deficiency, phlegm stagnation syndrome, qi stagnation and blood stasis syndrome, syndrome of dampness heat of liver channel and is composed of 4 basic syndromes and formed complex syndrome, and the composite and syndrome type (60.85%); combined with the analysis of traditional Chinese medicine dialectical, Pure empirical syndrome this disease (46.88%), followed by the actual card (45.39%), pure deficiency is rare. Improper diet factors associated with the disease, in which improper diet with different TCM syndrome type distribution significantly related. Stagnation of phlegm dampness syndrome is the main syndrome of the disease type, improper diet factors and every syndrome PCOS type distribution is as follows: the partial eclipse fatness greasy with basic syndromes of phlegm dampness stagnation of kidney deficiency syndrome, the nephrasthenia syndrome is less; eating spicy stimulation by basic syndromes of stagnation of Qi and blood stasis; eating cold people the basic certificate type of qi stagnation and blood stasis; The diet of patients are more prone to stagnation of phlegm dampness syndrome.

Characterization of Functionally Typical and Atypical Types of Polycystic Ovary Syndrome

The typical polycystic ovary syndrome (PCOS) phenotype includes 17-hydroxyprogesterone (17OHP) hyperresponsiveness to GnRH agonist (GnRHag) testing. Functionally atypical PCOS lacks this feature. The hypothesis was tested that the typical PCOS ovarian dysfunction results from intrinsically increased sensitivity to LH/human chorionic gonadotropin (hCG) due to a flaw in FSH action. PARTICIPANTS/DESIGN/INTERVENTIONS/MAIN OUTCOME MEASURES: After phenotyping a cohort of 60 women, steroid and inhibin-B responses to gonadotropins were evaluated in representative typical (n = 7) and atypical (n = 5) PCOS and healthy controls (n = 8). Submaximal hCG testing before and after an FSH test dose was performed in random order before and after prolonged ovarian suppression by depot GnRHag. The study was performed at a Clinical Research Center. Of our PCOS cohort, 68% were the typical type. Typical PCOS had 17OHP hyperresponsiveness and, unlike controls, significant androgen and estradiol responses to hCG. FSH increased inhibin-B and did not inhibit free testosterone or enhance estradiol responsiveness to hCG, all unlike controls. After ovarian suppression, 17OHP, androstenedione, and inhibin-B responsiveness to gonadotropin testing persisted. Atypical PCOS had significantly higher body mass index but lower ovarian volume and plasma free testosterone than typical PCOS. Steroid responses to hCG were insignificant and similar to controls. FSH suppressed free testosterone but stimulated inhibin-B. The estradiol level after combined hCG-FSH was subnormal. Free testosterone was less GnRHag suppressible than in typical PCOS. Typical PCOS is characterized by intrinsic ovarian hypersensitivity to hCG to which excessive paracrine FSH signaling via inhibin-B may contribute. Atypical PCOS is due to a unique type of ovarian dysfunction that is relatively gonadotropin hyposensitive.

Discovery of distinct protein profiles for polycystic ovary syndrome with and without insulin resistance by surface-enhanced laser adsorption/ionization time of flight mass spectrometry

To screen the serum protein expression profiles in patients having polycystic ovary syndrome (PCOS) with or without insulin resistance (IR) and search for discriminatory proteins. Cross-sectional study. Reproductive Center of Peking University Third Hospital. Thirty patients with PCOS with IR, 30 patients with PCOS without IR, and 30 control individuals. Fasting serum samples. Serum protein peak spectrum. There were 27 differential protein peaks between patients with PCOS and IR and controls, 17 between patients with PCOS without IR and controls, and 19 between patients with PCOS and IR and patients without IR. Marker proteins from differentially expressed proteins were screened out with use of a support vector machine and were used to establish three diagnostic models for PCOS IR, PCOS non-IR, and IR, respectively. There were statistically significantly different serum proteomic patterns in different types of PCOS. With use of ProteinChip combined with the support vector machine, computer diagnostic models for PCOS with and without IR were set up quickly and efficiently. These discriminatory proteins may help us understand the proteomic changes in serum and find out potential biomarkers of PCOS and IR.

CLINICAL ASPECTS OF THE POLYCYSTIC OVARY SYNDROME

One hundred and one patients with polycystic ovary syndrome (PCO) were treated during an 11-year interval. Sixty-seven cases were classified as typical PCO with enlarged ovaries of probable ovarian origin (Type I) and 34 as atypical PCO of probable adrenal origin (Type II). Fifty-five patients were treated for anovulatory infertility with clomiphene citrate or other endocrine therapy as indicated. There was a 91% ovulatory response and 51% conception rate from therapy in cases of Type I PCO. In Type II PCO, adrenal suppressive therapy resulted in a 55% ovulatory response. Our data support the concept that anovulation of ovarian origin as seen in PCO Type I responds to clomiphene therapy, while anovulation secondary to adrenal hyperandrogenization should be treated by adrenal suppressive therapy.