SUN-021 Age-Specific Multiples of the Median Level of Serum Anti-Mullerian Hormone Is a Potential Marker for Diagnosis of Polycystic Ovary Syndrome

Abstract Serum anti-Mullerian hormone (AMH) levels are significantly higher in women with polycystic ovary syndrome (PCOS) than in normal ovulatory women. Different diagnostic cut-off values of AMH for discriminating women with PCOS from normal controls have been proposed. This is attributed partly to the different assay methods used with different calibration, as well as the age-related changes in serum AMH levels. We propose that it may be more appropriate to use age-specific multiples of the median (MoM) of AMH value instead of a “one for all ages” cut-off as a diagnostic threshold. Hence, we conducted a retrospective study to validate the performance of age-specific MoM of AMH value in the diagnosis of PCOS. We studied on a cohort of 751 women presented to the clinic for menstrual disorders or fertility treatment, including 473 women diagnosed with polycystic ovary syndrome by the Rotterdam criteria and 278 normal ovulatory controls. Their archived serum samples, collected at the early follicular phase, were retrieved and assayed for AMH by the automated Access AMH assay. The MOM AMH of each subject was calculated based on the age-specific reference ranges recently established by our group. Our results showed that MOM AMH was significantly higher in women with PCOS compared to controls (p<0.0001). When stratified into five-yearly age groups, there was no significant difference in MOM AMH (p>0.05) among women with PCOS aged 21-25, 26-30 and 31-35 years, but those aged 36-40 years had significantly higher MOM AMH (p<0.05) compared to the other younger age groups. Among the ovulatory controls, no significant difference was observed in MOM AMH among all the age groups (p>0.05). The area under the receiver-operator characteristic curve was 0.852 (95% CI 0.825-0.877) (p<0.0001) for discriminating women with PCOS from ovulatory controls by MOM AMH. The best cut-off value of MOM AMH was 1.44, and the corresponding sensitivity and specificity were 76% and 79% respectively. At the fixed specificity of 80% and the corresponding sensitivity of 73% (with positive and negative likelihood ratios of 3.8 and 0.33 respectively), the cut-off value of MOM AMH was 1.5. In conclusion, age-specific MOM AMH is a promising surrogate of antral follicle count in the diagnosis of PCOS.

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Age-specific reference values improve the diagnostic performance of AMH in polycystic ovary syndrome

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2019-1059 ◽

2020 ◽

Vol 58 (8) ◽

pp. 1291-1301 ◽

Cited By ~ 1

Author(s):

Osman Evliyaoglu ◽

Mathias Imöhl ◽

Ralf Weiskirchen ◽

Josef van Helden

Keyword(s):

Polycystic Ovary Syndrome ◽

Diagnostic Performance ◽

Polycystic Ovary ◽

Reproductive Hormones ◽

Youden Index ◽

Specific Reference ◽

Reference Ranges ◽

Ovary Syndrome ◽

Significant Difference ◽

Age Dependent

AbstractBackgroundThe increased secretion of anti-Müllerian hormone (AMH) by the growing follicles has been supposed as a determinative feature of polycystic ovary syndrome (PCOS). The diagnostic performance of AMH in PCOS is superior compared to the free androgen index (FAI) and luteinizing hormone (LH)/follicle-stimulating hormone (FSH) quotient. We established age-dependent reference ranges to further improve the diagnostic performance of AMH.MethodsIn a cross-sectional study, in samples of 4712 reproductive age patients, ranging from 14 to 50 years, BMI, AMH and other reproductive hormones were determined by immunoassay or tandem mass spectrometry (LC-MS/MS) to calculate age-specific reference ranges and the diagnostic performance.ResultsAge-specific diagnostic performances for Elecsys® AMH, FAI and LH/FSH ratio were established in the reference group. No significant difference in BMI was found between the groups. AMH values were significantly negatively correlated with age (r = −0.628, p < 0.001) in patients with normal ovarian function, but there was no correlation between age and AMH levels in PCOS patients (r = − 0.041, p < 0.174). In all the study groups, AMH showed a weak correlation between FAI and LH/FSH ratio (r = 0.302, p < 0.001 and r = 0.434, p < 0.001, respectively). The sensitivity/specificity for AMH, FAI and LH/FSH ratio were 89/96%, 71/69% and 75/72%, respectively, according to the Youden index.ConclusionsWe determined the age-dependent reference ranges for serum AMH levels in a large population-based study and calculated the age-specific diagnostic performance of FAI and LH/FSH ratio, which allows physicians to evaluate patients with PCOS who have normal AMH levels. AMH is suggested as the strongest diagnostic marker in patients with PCOS compared to FAI and LH/FSH ratio.

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Age-related hormonal and metabolic alterations in women with polycystic ovary syndrome (PCOS)

Endocrine Abstracts ◽

10.1530/endoabs.32.oc5.3 ◽

2013 ◽

Author(s):

Pekka Pinola ◽

Eszter Vanky ◽

Inger Sundstrom-Poromaa ◽

Elisabeth Stener-Victorin ◽

Johanna Puurunen ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

Metabolic Alterations ◽

Age Related

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Indirect Predictors of Visceral Adipose Tissue in Women with Polycystic Ovary Syndrome: A Comparison of Methods

Nutrients ◽

10.3390/nu13082494 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2494

Author(s):

Małgorzata Kałużna ◽

Magdalena Czlapka-Matyasik ◽

Aleksandra Bykowska-Derda ◽

Jerzy Moczko ◽

Marek Ruchala ◽

...

Keyword(s):

Adipose Tissue ◽

Polycystic Ovary Syndrome ◽

Visceral Adipose Tissue ◽

Polycystic Ovary ◽

Age Groups ◽

Ovary Syndrome ◽

Women Subjects ◽

Pcos Group ◽

Total Body ◽

Visceral Adipose

Visceral adipose tissue (VAT) accumulation, is a part of a polycystic ovary syndrome (PCOS) phenotype. Dual-energy x-ray absorptiometry (DXA) provides a gold standard measurement of VAT. This study aimed to compare ten different indirect methods of VAT estimation in PCOS women. The study included 154 PCOS and 68 age- and BMI-matched control women. Subjects were divided into age groups: 18–30 y.o. and 30–40 y.o. Analysis included: body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist/height 0.5 (WHT.5R), visceral adipose index (VAI), lipid accumulation product (LAP), and fat mass index (FMI). VAT accumulation, android-to-gynoid ratio (A/G), and total body fat (TBF) was measured by DXA. ROC analysis revealed that WHtR, WHT.5R, WC, BMI, and LAP demonstrated the highest predictive value in identifying VAT in the PCOS group. Lower cut-off values of BMI (23.43 kg/m2) and WHtR (0.45) were determined in the younger PCOS group and higher thresholds of WHtR (0.52) in the older PCOS group than commonly used. Measuring either: WHtR, WHT.5R, WC, BMI, or LAP, could help identify a subgroup of PCOS patients at high cardiometabolic risk. The current observations reinforce the importance of using special cut-offs to identify VAT, dependent on age and PCOS presence.

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Impact of rs2414096 polymorphism of CYP19 gene on susceptibility of polycystic ovary syndrome and hyperandrogenism in Kashmiri women

Scientific Reports ◽

10.1038/s41598-021-92265-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sairish Ashraf ◽

Shayaq Ul Abeer Rasool ◽

Mudasar Nabi ◽

Mohd Ashraf Ganie ◽

Shariq R. Masoodi ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Clinical Manifestations ◽

Additive Model ◽

Genotypic Frequency ◽

Ovary Syndrome ◽

Significant Difference ◽

Cyp19 Gene ◽

Reproductive Endocrine ◽

The Impact

AbstractPolycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder in pre-menopausal women having complex pathophysiology. Several candidate genes have been shown to have association with PCOS. CYP19 gene encodes a key steroidogenic enzyme involved in conversion of androgens into estrogens. Previous studies have reported contradictory results with regard to association of SNP rs2414096 in CYP19 gene with PCOS and hyperandrogenism in different ethnic populations. Present study was aimed to investigate the impact of SNP rs2414096 polymorphism of CYP19 gene on susceptibility of PCOS and hyperandrogenism in Kashmiri women. Further we also studied the genotypic-phenotypic association for various clinical and biochemical parameters of this polymorphism. Case control study. 394 PCOS cases diagnosed on the basis of Rotterdam criteria and age matched 306 healthy women. We found a significant differences in genotypic frequency (χ2 = 18.91, p < 0.05) as well as allele frequency (OR 0.63, CI 0.51–0.78, χ2 = 17.66, p < 0.05) between PCOS women and controls. The genotype–phenotype correlation analysis showed a significant difference in FG score (p = 0.047) and alopecia (p = 0.045) between the three genotypes. Also, the androgen excess markers like DHEAS (p < 0.001), Androstenedione (p < 0.001), Testosterone (p < 0.001) and FAI (p = 0.005) were significantly elevated in GG genotype and showed a significant difference in additive model in PCOS women. rs2414096 polymorphism of CYP19 gene is associated with the risk of PCOS as well as with clinical and biochemical markers of hyperandrogenism, hence suggesting its role in clinical manifestations of PCOS in Kashmiri women.

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Acupuncture and Clomiphene Citrate for Live Birth in Polycystic Ovary Syndrome: Study Design of a Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/527303 ◽

2013 ◽

Vol 2013 ◽

pp. 1-11 ◽

Cited By ~ 19

Author(s):

Hongying Kuang ◽

Yan Li ◽

Xiaoke Wu ◽

Lihui Hou ◽

Taixiang Wu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Polycystic Ovary Syndrome ◽

Live Birth ◽

Polycystic Ovary ◽

Controlled Trial ◽

Clomiphene Citrate ◽

Fertility Treatment ◽

Ovary Syndrome ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial

Acupuncture is an alternative therapy to induce ovulation in women with polycystic ovary syndrome (PCOS), but there is no study reporting the live birth rate following ovulation induction by acupuncture or its potential as an adjuvant treatment to clomiphene citrate (CC). We assess the efficacy of acupuncture with or without CC in achieving live births among 1000 PCOS women in Mainland China. This paper reports the methodology of an ongoing multicenter randomized controlled trial. The randomization scheme is coordinated through the central mechanism and stratified by the participating sites. Participants will be randomized into one of the four treatment arms: (A) true acupuncture and CC, (B) control acupuncture and CC, (C) true acupuncture and placebo CC, and (D) control acupuncture and placebo CC. To ensure the quality and integrity of the trial we have developed a unique multinational team of investigators and Data and Safety Monitoring Board. Up to the end of April 2013, 326 subjects were recruited. In conclusion, the success of this trial will allow us to evaluate the additional benefit of acupuncture beyond the first line medicine for fertility treatment in PCOS women in an unbiased manner.

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Effects of Metformin compared to Thiazolidinediones on vascular endothelial function in Polycystic Ovary syndrome: A systematic review

10.1101/2020.01.23.20018580 ◽

2020 ◽

Author(s):

Hoimonty Mazumder ◽

Farah Faizah ◽

Md. Mahbub Hossain

Keyword(s):

Polycystic Ovary Syndrome ◽

Endothelial Function ◽

Polycystic Ovary ◽

P Value ◽

Controlled Trials ◽

Cochrane Central Register ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Ovary Syndrome ◽

Significant Difference

AbstractMetformin and Thiazolidinediones are insulin sensitizers used as the first-line treatment of PCOS, which are recently being examined for their extensive beneficial impacts at biochemical and molecular level of body function in Polycystic ovary syndrome. Therefore, purpose of this review is to compare the effectiveness of Metformin and Thiazolidinediones on vascular endothelial function in PCOS. MEDLINE (1966- October 2018), CINAHL (1982 to October 2018), Cochrane Central Register of Controlled Trials and Cochrane Menstrual Disorders and Subfertility Group trials register (October 2018) and Google Scholar were searched electronically without language restriction. Three Randomized controlled trials (RCTs) were selected with a total of 90 participants comparing effect of Metformin (Intervention) to Thiazolidinediones (Comparator) with an outcome on endothelial function among women with PCOS. In results, Meta-analysis shows no statistically significant difference on endothelial-dependent vasodilation between Metformin and Thiazolidinedione (p value= 0.59 at 95% CI - 1.31, 0.74).

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Insulin resistance in relation to clinical, endocrine and metabolic profile of infertile women with polycystic ovary syndrome

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v14i1.50989 ◽

2021 ◽

Vol 14 (1) ◽

pp. 1-6

Author(s):

Shakeela Ishrat ◽

Marufa Hossain ◽

Subrata Kumar Biswas

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Body Mass Index ◽

Waist Circumference ◽

Polycystic Ovary Syndrome ◽

Body Mass ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

Infertile Women ◽

Significant Difference

The objective of this study is to explore how hyperinsulinemia and insulin resistance relate to the clinical, endocrine and metabolic factors in the infertile women with polycystic ovary syndrome. This study was conducted on 121 consecutive infertile women with polycystic ovary syndrome attending the Infertility unit from January 2017 to December 2017. They were divided into two groups: insulin resistant and insulin sensitive. There was significant difference in body mass index and waist circumference between the two groups. Serum lipids were not associated with insulin resistance. Hyperinsulinemia was significantly associated with metabolic syndrome. Reducing body mass index and waist circumference may improve insulin resistance in infertile women with polycystic ovary syndrome. Screening the infertile women with polycystic ovary syndrome for hyperinsulinemia and insulin resistance and subsequent counseling is recommended to address the long-term risks of metabolic syndrome.

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Association between Luteinizing Hormone/Choriogonadotropin Receptor Ins18LQ Gene Polymorphism and Polycystic Ovary Syndrome

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4182 ◽

2020 ◽

Vol 8 (A) ◽

pp. 517-520

Author(s):

Hilma Putri Lubis ◽

Muhammad Fidel Ganis Siregar ◽

Ichwanul Adenin ◽

Binarwan Halim ◽

Henry Salim Siregar ◽

...

Keyword(s):

Luteinizing Hormone ◽

Polycystic Ovary Syndrome ◽

Gene Polymorphism ◽

Polycystic Ovary ◽

Control Group ◽

Control Groups ◽

Ovary Syndrome ◽

Significant Difference ◽

Pcos Group ◽

And Control

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women in the childbearing period. However, its pathophysiology is still unclear. Certain polymorphisms of the luteinizing hormone/choriogonadotropin receptor (LHCGR) genes may lead to changes in the bioactivity of this hormone. The important functional role of LHCGR in the metabolism of androgen and ovulation, the LHCGR gene variant, may be related to the risk of PCOS. AIM: The aim of this study was to evaluate the association between LHCGR Ins18LQ gene polymorphism and PCOS. METHODS: A case–control study was performed in women with PCOS and non-PCOS from May 2019 to October 2019 in HFC IVF Center. We included 50 women with PCOS and 50 healthy controls. Polymorphism of the LHCGR (ins18LQ) gene was genotyped using polymerase chain reaction-restriction fragment length polymorphism. RESULTS: From this study, we found that there was no significant difference in the proportion of ages between the groups (p > 0.05). There were significant differences in the characteristics of body mass index, FSH level, LH level, and LH/FSH ratio between the PCOS and control groups (p < 0.05). We also found that the proportion of heterozygote variant non-ins/ins was higher in the PCOS group compared to the control group, but there was no significant difference between the polymorphisms of the non-ins and non-nonins variants between the PCOS and control groups (p = 0.269). The frequency of ins alleles was higher in the PCOS group compared to the control group. CONCLUSION: There was no significant association between LHCGR ins18LQ gene polymorphism and PCOS.

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Endotrophin as a novel marker in PCOS and its relation with other adipokines and metabolic parameters: a pilot study

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211049607 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110496

Author(s):

Gurhan Guney ◽

Mine Islimye Taskin ◽

Ozgur Baykan ◽

Ertan Adali ◽

Selin Gul Tezcan ◽

...

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Density Lipoprotein ◽

Resistance Index ◽

Total Testosterone ◽

Model Assessment ◽

Homeostasis Model Assessment ◽

Ovary Syndrome ◽

Significant Difference

Background: Polycystic ovary syndrome is known to be the most common hormonal disorder in women of reproductive age. Current evidence shows that regulatory proteins secreted from the adipose tissue called adipokines may have a role in polycystic ovary syndrome. We planned to investigate the role of endotrophin that has never been researched in polycystic ovary syndrome before and its correlation with other metabolic parameters and adipokines such as adiponectin and ghrelin in patients with polycystic ovary syndrome. Methods: Forty-three women ( n: 43) with polycystic ovary syndrome and 43 ( n: 43) women as a control group were enrolled in this cross-sectional study. Serum levels of endotrophin, adiponectin, and ghrelin levels were measured with the enzyme-linked immunosorbent assay method. High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol levels, luteinizing hormone/follicle-stimulating hormone ratio, total testosterone, and triglyceride levels were measured. Homeostasis model assessment for insulin resistance index, body mass index, Ferriman Gallwey Score, and waist-to-hip ratio were also evaluated. Results: Total testosterone, homeostasis model assessment for insulin resistance, C-reactive protein, luteinizing hormone/follicle-stimulating hormone ratio, and triglyceride levels were higher in patients with polycystic ovary syndrome ( p < 0.01). No difference was detected between the groups in terms of body mass index, Ferriman Gallwey Score, waist-to-hip ratio, total cholesterol, low-density lipoprotein, and high-density lipoprotein levels ( p > 0.05). We did not observe any significant difference in adiponectin and ghrelin levels between the groups ( p > 0.05). Patients with polycystic ovary syndrome had significantly higher endotrophin levels ( p < 0.01). According to our regression analyses [area under the curve: 0.973 (0.935–1.000), 95% confidence interval, 95.2% sensitivity, and 100% specificity], it was shown that endotrophin greater than 92 ng/ml and homeostasis model assessment for insulin resistance greater than 2.5 might be good predictors for polycystic ovary syndrome diagnosis. Conclusion: We demonstrated that endotrophin level is higher in patients with polycystic ovary syndrome and may have predicted polycystic ovary syndrome with increased homeostasis model assessment for insulin resistance index. There was no significant difference in adiponectin and ghrelin levels in the polycystic ovary syndrome group. Endotrophin may have a role in polycystic ovary syndrome etiology rather than other adipokines.

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ADULT ACNE: A CLINICAL STUDY WITH SPECIAL REFERENCE TO POLYCYSTIC OVARY SYNDROME

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.898 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Shivani Yadav ◽

Srishti Tripathi ◽

Soumya Agarwal ◽

Titiksha Hans ◽

Anshul Choudhary ◽

...

Keyword(s):

Young Adults ◽

Polycystic Ovary Syndrome ◽

Late Onset ◽

Polycystic Ovary ◽

Age Groups ◽

Clinical Profile ◽

Age Group ◽

Ovary Syndrome ◽

Female Patients ◽

Rotterdam Criteria

Background: According to Global Burden of Skin Disease study data, 2013, Acne affects nearly 85% of adolescents and young adults in the age group 12-25 years.1 traditionally it was considered to be a transitory disease of teenagers and young adults; however recent study reports indicate it to be a disease affecting all age groups in adults. Aims: To study the clinical profile of adult acne, grade the severity using global acne grading system (GAGS) and to determine the proportion of Polycystic Ovary Syndrome (PCOS) in women with adult acne. Material and Methods: Patients with acne in the age group of 25-60 years were included in the study. A detailed examination of clinical profile of acne was done along with grading of severity of acne using GAGS. Also, documentation of hyperandrogenism using Ferriman Gallwey score for hirsutism and diagnosis of PCOS using Rotterdam criteria was done in all female patients of acne. Results: A total of 105 patients were included in the study. Among these, 82.9% were women and 17.1% were men. The mean age of the patients was 28.04±3.60 years. Persistent acne was observed in 85.7%, while late onset in 14.3%. Most common site of involvement was cheek (98%), followed by chin (76%), and forehead (64.7%). Mild grade acne was observed in 93.3% patients. Hyperpigmentation was seen in 78.1% while scarring was observed in 52.4% patients. A total of 8% female patients had PCOS according to Rotterdam criteria. Conclusion: We found a predominance of females and persistent acne. Although the prevalence of PCOS was low in adult female acne patients, they were affected by more severe grades of acne and risk of hyperpigmentation and scarring was higher as compared to non-PCOS patients.

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