scholarly journals Study of prevalence of insulin resistance and other metabolic abnormalities in various phenotypes of polycystic ovary syndrome in central India

2020 ◽  
Vol 9 (7) ◽  
pp. 2978
Author(s):  
Deepti Gupta ◽  
Rini Upadhyaya ◽  
Anjlina Bhati
Keyword(s):  
Insulin Resistance ◽  
Fasting Glucose ◽  
Polycystic Ovary ◽  
Central India ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovarian Volume ◽  
Appropriate Treatment ◽  
Post Hoc ◽  
Lipid Parameters

Background: Till recent times, defining symptoms of PCOS remained a debatable topic. In 2012, National Institute of health consensus panel proposed diagnostic criteria based on phenotypes. Evidence showed higher incidence of diabetes mellitus, insulin resistance and compensatory hyperinsulinemia among women with PCOS. So, the present study was undertaken to compare the clinical, metabolic and hormonal profile among various phenotypes in women with PCOS and to find out the prevalence of insulin resistance among the PCOS phenotypes.Methods: The prospective, observational study was done on 292 women with PCOS-related infertility. These women were divided into 4 phenotypes. Ferriman-Gallwey score, HOMA-IR, OGTT, lipid parameters, hormonal parameters, mean ovarian volume and mean antral follicle counts were compared among the 4 phenotypic groups. One-way ANOVA followed by post-hoc Tukey was applied.Results: Mean weight, BMI, waist circumference, SBP, DBP and Ferriman-Gallwey score, fasting glucose, fasting insulin, OGTT (1 hour) and HOMA-IR was highest in phenotype A, while fasting glucose / insulin ratio was lowest in phenotype A. Total triglycerides, total cholesterol, LDL were higher and HDL was lowest, testosterone, mean ovarian volume and mean antral follicle count were highest and vitamin D was lowest in Phenotype A.Conclusions: Phenotype A is the group with all features of PCOS syndrome, while phenotype D is associated with milder metabolic profile. Women with phenotype A and B are at a higher risk for metabolic syndrome. Identifying various phenotypes will assist in providing appropriate treatment and prognosticating the patients with PCOS-related infertility.

Effect of resveratrol administration on ovarian morphology, determined by transvaginal ultrasound for the women with PCOS

2021 ◽  
pp. 1-18
Author(s):  
Amir Pejman Hashemi Taheri ◽  
Behnaz Moradi ◽  
Amir Reza Radmard ◽  
Milad Sanginabadi ◽  
Mostafa Qorbani ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Polycystic Ovary ◽  
Transvaginal Ultrasound ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovarian Volume ◽  
Exact Test ◽  
Ovarian Morphology ◽  
The Mean

Abstract Background: Intake of resveratrol has been associated with improved ovarian morphology under in vitro and in the animal models; however, this finding has not been confirmed in trials. The aim of our study was, therefore, to use a placebo-controlled approach with the detailed assessment of the ovarian morphology by applying transvaginal ultrasound to examine the effectiveness of this therapeutic approach in this group of women. Methods: Forty-one women with polycystic ovary syndrome (PCOS) were randomly assigned (1:1) to 3 months of daily 1000 mg resveratrol or placebo. Random assignment was done by blocked randomisation. Our primary endpoints were the change in the ovarian volume, stromal area and antral follicle count per ovary (FNPO) from the baseline to 3 months. Secondary endpoints were improvement in the distribution of follicles and ovarian echogenicity. Differences between the resveratrol and control groups were evaluated by Chi-square, fisher’s exact test and repeated-measures of ANOVA. Results: The mean age of all participants was 28.61 ± 4.99 years, with the mean BMI of 28.26 ± 5.62 kg/m2. Resveratrol therapy, as compared with placebo, was associated with a significantly higher rate of improvement in the ovarian morphology (p= 0.02). Women who received resveratrol had a more dominant follicle than those getting placebo, with a significant reduction in the ovarian volume (p<0.05). However, the number of FNPO, stromal area, ovarian echogenicity and distribution of follicles were not significantly altered (P>0.05). Conclusions: Treatment with resveratrol significantly reduced the ovarian volume and PCOM, thus suggesting a disease-modifying effect in PCOS. Trial registration: IRCT, IRCT2017061917139N2. Registered 7 July 2017, http://irct.ir/trial/15836.

INTERRELATIONSHIP OF AMH WITH CLINICAL, HORMONAL AND SONOGRAPHIC PARAMETERS IN PATIENTS WITH POLYCYSTIC OVARIAN DISEASE

2021 ◽  
pp. 66-68
Author(s):  
Uma Jain ◽  
Urvi Gupta
Keyword(s):  
Cycle Length ◽  
Polycystic Ovary ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Reproductive Age ◽  
Ovarian Volume ◽  
Diagnostic Potential ◽  
The Mean ◽  
Criteria For Diagnosis ◽  
High Level

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a frequently encountered problem in reproductive endocrinology, affecting approximately 6% of women of reproductive age. anti-mullerian hormone (AMH) also known as Mullerian inhibiting, substance is produced by granulosa cells of the preantral and small antral ovarian follicles in women and reect the ovarian reserve. Women with PCOS will often have a high number of antral follicles and, as a result, an equally high level of AMH in their blood. it has an inhibitory inuence on the actions of FSH and positively correlated with LH. Various studies demonstrated that oligo/anovulatory women with PCOS have signicantly higher serum concentrations of AMH. MATERIAL AND METHOD: This is a retro respective study of 54 PCOS patients from rst January 2019 to 13 April 2021 at a private gynaecology clinic in district Shivpuri. Data were collected from the medical records of the patients including age, height, weight, waist circumference, BP and modied Ferriman gallway score for hirsutism, Biochemical and hormonal values like LH, FSH, LH/FSH ratio, TSH, Prolactin and AMH, and lipid prole values were also obtained from the records. Abdominal or Vaginal ultrasound was used to assess the ovarian volume antral follicular count. RESULTS: In our study, the age of patients ranges from 20-39 years and a majority of the patients were in the age group of 21-30 years 75.28%) The Mean age of PCOS patients was 23.89. In our study, the mean cycle length of patients was 54.08 and it ranged from 28-190 days. The mean 2 BMI 25.8kg/m2 and modied FG score were 8.1. On ultrasound mean antral follicle count was 26.2 and the mean ovarian volume was 9.4 cm . In hormonal studies mean LH was 11.5, mean FSH was 3.4 and AMH was 4.34 and Testosterone was 2.1. In bio-chemical parameters increased Cholesterol, triglycerides, LDL, VLDL level and decreased HDL level were found in 31.48% of patients and with increased AMH. CONCLUSION: In our study, we found increased AMH concentration in correlation with increased cycle length in cases of oligomenorrhea, clinical hyperandrogenism, increased LH, increased AFC and increased ovarian volume. Our study concluded that AMH levels as an adjunct to existing Rotterdam criteria for diagnosis of PCOS had good diagnostic potential.

scholarly journals Impact of the newly recommended antral follicle count cutoff for polycystic ovary in adult women with polycystic ovary syndrome

2020 ◽  
Vol 35 (3) ◽  
pp. 652-659 ◽  
Author(s):  
Jin Ju Kim ◽  
Kyu Ri Hwang ◽  
Soo Jin Chae ◽  
Sang Ho Yoon ◽  
Young Min Choi
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Metabolic Parameters ◽  
Adult Women ◽  
Ovary Syndrome ◽  
Ovarian Volume ◽  
Irregular Menstruation ◽  
Rotterdam Criteria

Abstract STUDY QUESTION What is the impact of the newly recommended antral follicle count (AFC) cutoff for polycystic ovary (PCO) on the diagnostic status of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Among patients with phenotypes requiring the presence of PCO for diagnosis, approximately half (48.2%) were excluded from having PCOS based on the new AFC cutoff, although these excluded women had worse metabolic and hormonal profiles than the controls and were indistinguishable from the remaining patients with regard to major hormonal and metabolic parameters. WHAT IS KNOWN ALREADY In the Rotterdam criteria, PCO is defined as either 12 or more follicles measuring 2–9 mm in diameter or an increased ovarian volume &gt;10 cm3. Recently, an international PCOS guideline development group recommended an AFC threshold for PCO of ≥20 in adult women when using transducers with a high-resolution frequency, including 8 MHz. STUDY DESIGN, SIZE, DURATION The current study used a case control design. PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was diagnosed according to the Rotterdam criteria. Ultrasonography examinations were conducted with wide band frequency (5–9 MHz) transvaginal transducers and the centre frequency was 8 MHz. In patients who show both irregular menstruation and hyperandrogenism (HA), a diagnosis of PCOS can be made irrespective of the ovarian criteria change. Patients who were diagnosed according to HA and PCO (n = 86) or irregular menstruation and PCO (n = 443) were initially included among a total of 1390 adult women with PCOS (aged 20–40 years). Regardless of the AFC, if the ovarian volume is ≥10 cm3, a diagnosis of PCO can still be made. Thus, only patients who had an ovarian volume of &lt;10 cm3 were analysed. Subjects who had an AFC of 12–19 and an ovarian volume &lt;10 cm3 were designated as the ‘low AFC group’ (n = 255) and were the main focus of the study because they were excluded from having PCOS based on the new cutoff. Subjects with an AFC ≥20 and an ovarian volume &lt;10 cm3 were designated as the ‘high AFC group’ (n = 101). A total of 562 premenopausal women without PCOS were enrolled as controls. MAIN RESULTS AND THE ROLE OF CHANCE Among patients with irregular menstruation and PCO or HA and PCO phenotypes, approximately half (48.2%, 255/529) were excluded from having PCOS, which corresponded to one-fifth (18.3%, 255/1390) of the total adult patients. However, compared to the control group, these excluded women had worse metabolic profiles and were more androgenised. Notably, they were indistinguishable from the ‘high AFC group’ with regard to major hormonal and metabolic parameters (BMI and diabetic classification status, and the prevalence of insulin resistance, metabolic syndrome and HA). LIMITATIONS, REASONS FOR CAUTION We cannot exclude the possibility of inter- and intraobserver variation in the evaluation of AFC. WIDER IMPLICATIONS OF THE FINDINGS With the newly recommended follicle count cutoff, a substantial proportion of women with PCOS might be classified as not having PCOS despite visiting a hospital due to irregular menstruation or hyperandrogenic symptoms. A practical approach to them would involve controlling the menstrual or hyperandrogenic symptoms in hand and regularly evaluating them regarding newly developed or worsening PCOS-related symptoms or metabolic abnormalities. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a grant from the Seoul National University Hospital Research Fund (No. 2520140090), Republic of Korea. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER Not applicable.

scholarly journals Limitations of insulin resistance assessment in polycystic ovary syndrome

2018 ◽  
Vol 7 (3) ◽  
pp. 403-412 ◽  
Author(s):  
Krzysztof C Lewandowski ◽  
Justyna Płusajska ◽  
Wojciech Horzelski ◽  
Ewa Bieniek ◽  
Andrzej Lewiński
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Fasting Glucose ◽  
Polycystic Ovary ◽  
Detailed Comparison ◽  
Ovary Syndrome ◽  
Extreme Caution ◽  
Insulin Resistant ◽  
Method Of Assessment ◽  
Surrogate Method

Background Though insulin resistance (IR) is common in polycystic ovary syndrome (PCOS), there is no agreement as to what surrogate method of assessment of IR is most reliable. Subjects and methods In 478 women with PCOS, we compared methods based on fasting insulin and either fasting glucose (HOMA-IR and QUICKI) or triglycerides (McAuley Index) with IR indices derived from glucose and insulin during OGTT (Belfiore, Matsuda and Stumvoll indices). Results There was a strong correlation between IR indices derived from fasting values HOMA-IR/QUICKI, r = −0.999, HOMA-IR/McAuley index, r = −0.849 and between all OGTT-derived IR indices (e.g. r = −0.876, for IRI/Matsuda, r = −0.808, for IRI/Stumvoll, and r = 0.947, for Matsuda/Stumvoll index, P < 0.001 for all), contrasting with a significant (P < 0.001), but highly variable correlation between IR indices derived from fasting vs OGTT-derived variables, ranging from r = −0.881 (HOMA-IR/Matsuda), through r = 0.58, or r = −0.58 (IRI/HOMA-IR, IRI/QUICKI, respectively) to r = 0.41 (QUICKI/Stumvoll), and r = 0.386 for QUICKI/Matsuda indices. Detailed comparison between HOMA-IR and IRI revealed that concordance between HOMA and IRI was poor for HOMA-IR/IRI values above 75th and 90th percentile. For instance, only 53% (70/132) women with HOMA-IR >75th percentile had IRI value also above 75th percentile. There was a significant, but weak correlation of all IR indices with testosterone concentrations. Conclusions Significant number of women with PCOS can be classified as being either insulin sensitive or insulin resistant depending on the method applied, as correlation between various IR indices is highly variable. Clinical application of surrogate indices for assessment of IR in PCOS must be therefore viewed with an extreme caution.

scholarly journals Reproductive capacity in iron overloaded women with thalassemia major

Blood ◽  
2011 ◽  
Vol 118 (10) ◽  
pp. 2878-2881 ◽  
Author(s):  
Sylvia T. Singer ◽  
Elliott P. Vichinsky ◽  
Ginny Gildengorin ◽  
Jereon van Disseldorp ◽  
Mitchell Rosen ◽  
...  
Keyword(s):  
Antral Follicle ◽  
Thalassemia Major ◽  
Antral Follicle Count ◽  
Reproductive Capacity ◽  
Gonadotropin Secretion ◽  
Ovarian Volume ◽  
Cardiac Iron ◽  
Labile Iron ◽  
Sensitive Marker

Abstract The pathophysiology of iron-induced compromised fertility in women with thalassemia major (TM) was evaluated in 26 adult TM females. Low gonadotropin secretion resulted in reduced ovarian antral follicle count and ovarian volume, but levels of anti-müllerian hormone (AMH), a sensitive marker for ovarian reserve independent of gonadotropin effect, were mostly normal. AMH correlated with non–transferrin-bound iron (NTBI), suggesting a role of labile iron in the pathogenesis of decreased reproductive capacity, possibly occurring in parallel to cardiac iron toxicity, as cardiac iron was associated with the presence of amenorrhea and with NTBI levels. AMH emerges as an important biomarker for assessment of reproductive capacity in TM, demonstrating that fertility is preserved in the majority of those younger than 30 to 35 years. AMH can be useful in future studies aiming at improved chelation for fertility preservation, whereas NTBI and labile plasma iron may be valuable for monitoring iron effect on the reproductive system.

138 Relationships Between Antral Follicle Count, Ovarian Volume, Pre-Antral Follicle Number, and Oocyte Quality

2018 ◽  
Vol 30 (1) ◽  
pp. 209
Author(s):  
G. L. Vasconcelos ◽  
R. Maculan ◽  
N. Alves ◽  
A. L. A. P. L. Ribeiro ◽  
A. W. B. Silva ◽  
...  
Keyword(s):  
Ovarian Follicle ◽  
Primordial Follicle ◽  
Antral Follicle ◽  
Oocyte Quality ◽  
Antral Follicle Count ◽  
Primary Follicle ◽  
Ovarian Volume ◽  
Primordial Follicles ◽  
Antral Follicles ◽  
Grade 3

The objective was to evaluate the possible relationships between AFC, ovarian volume, ovarian follicle reserve and oocyte quality in abattoir-derived ovaries (experiment 1) and in cows (experiment 2) submitted to OPU. Antral follicle counts of ≥25, 16 to 24, and ≤ 16 were used to define AFC classes as high (HAFC), intermediate (IAFC), and low (LAFC) in both experiments. In experiment 1, after antral follicles were aspirated, abattoir ovaries (n = 10 per AFC class) were processed by conventional histology and pre-antral follicles were counted within primordial, primary, secondary, and tertiary classes and classified as either healthy or degenerate under regular microscopy (Cushman et al. 1999). In experiment 2, HAFC (n = 42), IAFC (n = 34), and LAFC (n = 29) cows were submitted to OPU and oocytes classified as grades 1, 2, and 3 or degenerate (IETS, 2010). Antral follicles (≥3 mm in diameter) were counted by ultrasonography. Data were analysed by GENMOD and GLM procedures of SAS (SAS Institute Inc., Cary, NC, USA) after transformations, when required. In experiment 1, mean normal primordial follicle number was higher (P < 0.001) in HAFC (137.0 ± 1.6)a compared with IAFC (52.6 ± 1.9)b and LAFC (20.2 ± 5.3)c ovaries. However, the mean number of degenerate primordial follicles was lower (P < 0.001) in low count ovaries (2.4 ± 0.6) compared with HAFC (19.0 ± 4.7) and IAFC (16.4 ± 1.5, P < 0.001). Normal primary follicle number was higher in the HAFC compared with IAFC and LAFC ovarian classes (86.2 ± 7.0a v. 34.6 ± 5.1b and 14.4 ± 3.3c, respectively; P < 0.01). Degenerate primary follicles were higher in the HAFC compared with LAFC ovarian class (16.8 ± 6.5 v. 5.2 ± 2.64; P < 0.05). Normal secondary follicle number was also higher in the HAFC compared to LAFC ovarian classes (25.2 ± 7.67 v. 2.4 ± 0.8; P < 0.05). The number of degenerate secondary follicles differed (P < 0.01) only between the IAFC and the LAFC ovarian classes (0.6 ± 0.4 and 7.2 ± 2.4, respectively), which were similar (P > 0.5) to the HAFC class (3.8 ± 1.0). In experiment 2, grade 1, 2, and 3 oocytes, viable oocytes, and ovarian volume (mm3) were higher (P < 0.001) in HAFC compared with IAFC and LAFC cows (grade 1: 7.9 ± 0.6a, 4.9 ± 0.7b and 3.3 ± 0.7c; grade 2: 4.0 ± 0.4a, 2.8 ± 0.4b and 1.2c; grade 3: 2.1 ± 0.4a, 2.5 ± 0.4a and 1.3 ± 0.5b, respectively; viable oocytes: 16.3 ± 1.1a, 13.1 ± 1.2b, and 8.1 ± 1.3c, respectively; (volumes: 12.6 ± 0.7a, 10.1 ± 0.8b, and 8.1 ± 0.9c, respectively). In conclusion, high AFC is linked to a higher follicular reserve, oocyte quality, and ovarian volume. It is safe to apply AFC in the selection of bovine females without compromising oocyte or pre-antral follicular population qualities.

scholarly journals Predicting the outcome of different protocols of in vitro fertilization with anti-Muüllerian hormone levels in patients with polycystic ovary syndrome

2017 ◽  
Vol 45 (3) ◽  
pp. 1138-1147 ◽  
Author(s):  
Ya Chen ◽  
Bilv Ye ◽  
Xiaojing Yang ◽  
Jiujia Zheng ◽  
Jinju Lin ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovary Syndrome ◽  
Vitro Fertilization ◽  
Ivf Outcomes ◽  
Basal Serum

Objective This study evaluated associations of basal serum and follicular fluid (FF) anti-Muüllerian hormone (AMH) levels with in vitro fertilization (IVF) outcomes in polycystic ovary syndrome (PCOS) patients. Methods This prospective study included 179 consecutive women undergoing IVF, including 59 with PCOS and non-PCOS controls. Thirty PCOS cases had long gona-dotrophin-releasing hormone agonist (GnRH-a) and 29 had antagonist (GnRH-ant) protocols. Controls underwent conventional GnRH-a. Associations of basal serum and FF AMH levels with IVF outcomes were assessed. Results Median serum and FF AMH levels, antral follicle count (AFC), oestradiol human chorionic gonadotropin injection day (peak E2), and retrieved oocyte numbers were higher in PCOS patients than in controls (all P < 0.01). Oocyte maturation and high-quality embryo rates were lower in PCOS patients than in controls (P < 0.01), but both groups had similar fertilization, implantation, clinical pregnancy, and newborn rates. Peak E2 was higher in GnRH-ant than in GnRH-a protocols (16.5 nmol/L vs. 12.1 nmol/L, P < 0.05). AMH levels were correlated with AFC in PCOS patients ( P < 0.01). Peak E2 and FF AMH levels were independent predictors of oocyte number. Peak E2 predicted the fertilization rate. Conclusion Serum basal AMH levels are predictive of oocyte quantity, but not oocyte quality or IVF outcomes. Serum AMH, FF AMH, and outcomes are similar among protocols.

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