Evaluation of the Efficacy and Threshold of Serum Anti-mullerian Hormone (AMH) Levels for Diagnosis and Prediction of Polycystic Ovary Syndrome (PCOS) Among Indian Women.

Purpose: PCOS women exhibit higher levels of AMH and has been proposed to add value to diagnosis of PCOS incase ambiguity. However, variable cutoffs of AHM for PCOS prediction have been reported. This study was designed to determine diagnostic threshold of serum AMH levels and its correlation with clinical, hormonal and ultrasonographic parameters among women with PCOS.Materials: In this prospective study, 113 women with PCOS as per Rotterdam criteria 2003 and 75 normo-ovulatory women were included. Clinical, biochemical, hormonal and sonographic assessment in addition to serum AMH levels were determined using standard methodology.Results: Mean age was comparable (23.43±3.42vs.24.21±3.18 years) between cases and controls. The mean number of menstrual cycles per year were lower while as mean BMI, FG score, and serum testosterone were higher in cases than controls (p<0.05). The mean serum AMH level was significantly higher in PCOS group (7.84±3.67vs. 3.23 ±1.56 ng/mL) than controls. The serum AMH levels showed a positive correlation(p<0.05) with LH/FSH ratio (r = 0.206, p = 0.029), number of ovarian follicles(r=0.461) and volume,(r=0.521), but no correlation significant with age and BMI. As per receiver operating characteristic (ROC) curve, cut-off was worked out to be 3.76 ng/mL with 86.7% sensitivity and 62.7% specificity. Conclusion: Serum AMH levels correlate positively with PCOM among PCOS women and may be a potent diagnostic marker of ovarian dysfunction either alone or in conjunction with other tools to ensure timely diagnosis and early treatment of the disorder.

Transmen Individuals Have Hyperandrogenism Related Metabolic Changes Compared Ciswomen: Case Controlled Study

Introduction : This study aims to evaluate metabolic parameters and hormonal profiles of transmen individuals who are referred from psychiatry outpatient clinic, compared to natal women. Method This study is designed as a single-center observational cohort study. Seventy drug-naive female to male transgender individuals (FtoM) and 34 healthy natal women for the control group were included. Hormone profile and metabolic parameters were measured and compared between the two groups. Results Sixteen of the 70 FtoM individuals meet Rotterdam criteria and are diagnosed with PCOS (22,85%), on the other hand in 4 individuals in the control group meet the criteria (11,7%). Although there wasn't any significant difference between the two groups weight and BMI; total testosterone, triglyceride, FAI, androstenedione, 17-OH progesterone, muscle strength, HOMA-IR levels were significantly higher in the transmen group and HDL levels were significantly higher in the control group (p values 0.001, 0.007, 0.013, 0.011, 0.001, 0.004 respectively.) Conclusion This is the first case-controlled study that compared anthropometric, metabolic, and endocrinological parameters of transmen individuals with cis women. In our study, we showed that even when PCOS patients were excluded, hyperandrogenemia continues in these individuals compared to cis women. It is clear that transmen individuals have higher androgen levels which may have been the reason for increased muscle strength, insulin resistance, and dyslipidemia compared to natal women. But the main reason for hyperandrogenism in drug-naïve transmen individuals is still not known and more comprehensive further studies are needed.

Role of oral inositol supplementation in women with polycystic ovarian syndrome

Background: PCOS is one of the most common endocrine disorder in women of reproductive age, it affects about 5-10% of women of reproductive age. It is characterized by chronic anovulation, hyperandrogenism, and insulin resistance. 30-40% of PCOS women have impaired glucose tolerance.Methods: This was prospective observational study carried out on 100 patients of PCOS visiting outpatient Department of Obstetrics and Gynecology, BRD Medical College, Gorakhpur from 1st July 2018 to 30th June 2019. Patients were diagnosed as PCOS on basis of Rotterdam criteria. In these 100 patients, oral inositol 2 gm twice daily was given for 3 months to 6 months depending upon the response of the patient and patients were examined every 4 week for menstrual regularity, acne improvement, hirsutism, spontaneous ovulation and pregnancy.Results: With inositol supplementation, menstrual abnormality corrected in 80% cases, 45% cases having acne improved. Ovulation occurred in 75.5% cases and 66.6% cases conceived with inositol supplementation.Conclusions: Insulin resistance is the basic pathophysiology for PCOS hence inositol supplementation is supposed to be very good medicine for management of PCOS to improve insulin sensitivity. Inositol leads to improvement in regularity of menstrual cycle, insulin resistance, hyperandrogenic features like hirsutism, acne, restores ovulation and improves oocyte quality.

Effect of Metformin and Its Combination with Probiotic on Menstrual Irregularity and TSH Levels in Patients with Polycystic Ovarian Syndrome: A Randomized Controlled Trial

Background: Polycystic ovarian syndrome (PCOS), the far most common endocrine disorder among sexually active women. The disease is typically characterized by irregular menstrual cycles and appears to be influenced by associated thyroid dysfunction. Aim: The goal of this research was to assess and compare the effects of Metformin and its combination with Probiotic on monthly cycle irregularity and TSH levels in PCOS women. Methodology: This was a single-center study conducted at Karachi's Gynecological Outpatient department from January 2019 to September 2019. A total of 52 PCOS patients aged 18 to 40 years were included in this trial, which followed Rotterdam criteria. After providing written and consent form, individuals were randomized into one of the two groups and received Metformin 500 mg TD (n = 26) or Metformin Combination (n = 26). Results: After three months of treatment, both groups improved in terms of menstrual cycle irregularity and TSH levels, but the combination treatment improved the most. Conclusion: Probiotics may be considered in conjunction with Metformin for improving TSH levels to achieve better results.

A CROSS SECTIONAL STUDY OF POLY CYSTIC OVARIAN SYNDROME (PCOS) AMONGST ADOLESCENT GIRLS IN LUCKNOW.

Background: Polycystic ovary disease is a common endocrine condition which is rapidly gaining epidemic proportions. Objectives: Current study was undertaken to screen adolescents and young unmarried girls aged 15-24 years for PCOS. Material and Methods: A cross-sectional hospital-based study was undertaken in Lucknow to assess the prevalence of polycystic ovarian syndrome (PCOS) among 389 adolescents and young girls aged 15-24 years. Among them, 300 completed all clinical, ultrasonography (USG), and biochemical investigations. Results: The prevalence of PCOS among them was 22.5% by Rotterdam and 10.7% by Androgen Excess Society criteria. Nonobese comprised 71.8% of PCOS diagnosed by Rotterdam criteria. Mild PCOS (oligomenorrhea and polycystic ovaries on USG) was the most common phenotype (52.6%). History of oligomenorrhea had a positive predictive value of 93.3% and negative predictive value of 86.7% to detect a possible case of PCOS. Hyperinsulinemia (serum insulin >15 μlU/mL) was present among 19.2% of diagnosed PCOS cases. Conclusion: The study demonstrates that PCOS is an emerging disorder during adolescence and screening could provide opportunity to target the group for promoting healthy lifestyles and early interventions to prevent future morbidities

Changes in LIF expression on PCOS as biomarker implantation

Objectives: This study aimed to compare the endometrial expression of LIF PCOS compared to normal and determine the effect of PCOS and external variables that affect LIF expression.Materials and Methods: This retrospective case control study with a correlational approach was conducted at Sekar Clinic, General Hospital Dr. Moewardi Surakarta. Subject were taken by consecutive sampling starting from September 2018 –. Februari 2019. External variable: age, occupation, family history PCOS, menarche, and BMI were recorded. The research samples were 60 subjects consisting of 30 PCOS patients based on Rotterdam criteria and 30 fertile women. In the luteinizing hormone (LH) secretion phase at LH + 5 days - LH + 10 days, an endometrial biopsy is performed with pipelle curettage, then it is examined by immunohistochemistry. Statistical analysis was performed using the Mann-Whitney, linier regression test.Results: Mean of LIF expression was found significantly lower in PCOS group (1.53±3.65) compared to control group (35.33±21.04, with p=<0.001). Multivariate analysis linear regression in the effect of PCOS and external variables to endometrial LIF expression models showed PCOS (b=-1.14; 95% CI=-1.56 – -0.72; p=<0.001) and occupation (b = 0.32; 95% CI=0.14 – 0.52; p=0.001) significantly decreases LIF expression. PCOS (B=-1.14) is more important than Occupation (B=0.33) in decreasing LIF expression.Conclusion:LIF expression decreased in the endometrium of PCOS patients and occupations compared to normal group, with considering all existing variables.

STUDY OF PATIENTS WITH PCOS (POLYCYSTIC OVARY SYNDROME) AND LIPID PROFILE

Background: Aims of this study was found the association of PCOS with Lipid profile of patients. Methods: Cross sectional Hospital based study conducted on Women at reproductive age (15-45 years) and who presented with Rotterdam Criteria. Results: Mean triglyceride of patients was 113.68±19.25 mg/dl, mean LDL of patients was 95.24±14.94 mg/dl, mean cholesterol of patients was 159.98±18.26 mg/dl and mean HDL of patients was 52.16±6.32 mg/dl Conclusion: PCOS, being a common condition prevailing in women with reproductive age group, is the cause of problem for one in four patients attending a gynecologist. Despite treating the infertility and menstrual complaints of the PCOS patients, it is a treating doctor’s duty to take it as an opportunity to screen for metabolic syndrome and advice for healthy diet, physical activity and weight reduction. Healthy life style modification not only improves their menstrual and ovulatory symptoms, but also prevents the future cardiovascular and other morbid ailments. Keywords: PCOS, LDL, FBS, HDL

Elucidating the impact of obesity on hormonal and metabolic perturbations in polycystic ovary syndrome phenotypes in Indian women

Polycystic ovary syndrome is a complex endocrinopathy with heterogeneous presentation and multifactorial etiology. We have undertaken this case-control study to compare metabolic and endocrine characteristics in different phenotypic subgroups of women with PCOS and the impact of obesity on them. Women with PCOS (n = 489) were classified into 4 phenotypes according to Rotterdam criteria. Comparisons of clinical, biochemical and hormonal parameters were performed across all phenotypic groups of PCOS and with controls (n = 270) by Welch’s ANOVA with subsequent Games-Howell post-hoc test. We found maximum prevalence of normoandrogenic phenotype D, which is milder form of PCOS in terms of insulin resistance, gonadotropin levels and dyslipidemia, followed by phenotype A, in our total study population. After classification of the study group into lean and obese groups, only few insulin and lipid-related traits showed marked differences between phenotypes. Further, we noted that obese women showed adverse metabolic but not androgenic traits compared to lean counterparts in the same phenotype. Metabolic syndrome frequency is increased in hyperandrogenic phenotypes with HDL-C and waist circumference being most predominant contributing factors in total, lean and obese groups. We demonstrate that in our study population there is greater occurrence of phenotype D of PCOS. Our study highlights the importance of clinicians concurrently employing Rotterdam criteria along with obesity status for ascertaining accurate PCOS status and formulating suitable therapeutic intervention.

Risk of Insulin Resistance and Metabolic Syndrome in Women with Hyperandrogenemia: A Comparison between PCOS Phenotypes and Beyond

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in premenopausal women, with a wide spectrum of possible phenotypes, symptoms and sequelae according to the current clinical definition. However, there are women who do not fulfill at least two out of the three commonly used “Rotterdam criteria” and their risk of developing type 2 diabetes or obesity later in life is not defined. Therefore, we addressed this important gap by conducting a retrospective analysis based on 750 women with and without PCOS. We compared four different PCOS phenotypes according to the Rotterdam criteria with women who exhibit only one Rotterdam criterion and with healthy controls. Hormone and metabolic differences were assessed by analysis of variance (ANOVA) as well as logistic regression analysis. We found that hyperandrogenic women have per se a higher risk of developing insulin resistance compared to phenotypes without hyperandrogenism and healthy controls. In addition, hyperandrogenemia is associated with developing insulin resistance also in women with no other Rotterdam criterion. Our study encourages further diagnostic and therapeutic approaches for PCOS phenotypes in order to account for varying risks of developing metabolic diseases. Finally, women with hyperandrogenism as the only symptom should also be screened for insulin resistance to avoid later metabolic risks.