Infertility in Polycystic Ovary Syndrome: Focus on Low-Dose Gonadotropin Treatment

Gorry, Anwen; White, Davinia; Franks, Stephen

doi:10.1385/endo:30:1:27

Cited by 79 publications

(42 citation statements)

References 46 publications

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“…The mechanism of anovulation is uncertain but there is evidence that arrested antral follicle development is associated with the abnormal endocrine profile, in particular the interaction of insulin and LH on granulosa cell differentiation. 14 In present study, 43.3% (39 out of 90) women presented with complaint of excessive hair growth and 31.1% complained of acne. In some women, acne and hirsutism were present independently.…”

Section: Discussionsupporting

confidence: 46%

Metabolic syndrome and insulin resistance in PCOS phenotypes

Sobti

Dewan

Ranga

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Polycystic ovary syndrome(PCOS) is an endocrine metabolic disorder which is rapidly gaining epidemic proportions. Hyperinsulinemia and insulin resistance (IR) are thought to be key pathological factors. This study was undertaken to characterize the phenotypes of PCOS and to determine the prevalence of metabolic syndrome (MetS) and insulin resistance in them.Methods: This observational cross-sectional study was undertaken to assess the distribution of the Rotterdam PCOS phenotypes and to report the prevalence and risk factors for MetS syndrome and insulin resistance using homeostasis model assesment for insulin resistance (HOMA-IR). 90 women aged 18-35 years newly diagnosed with PCOS were classified into one of the four potential PCOS phenotypes based on history, examination and investigations.Results: Phenotype A was the most prevalent phenotype (45.5%). Prevalence of insulin resistance in our study was 31% using HOMA- IR cutoff of 2.5, with highest prevalence in phenotype A and least in phenotype D. The overall prevalence of MetS was 36% with a two- to six-fold higher prevalence in hyperandrogenic phenotypes compared to the non-hyperandrogenic phenotype. Highest mean hs- CRP was found in phenotype A which could possibly indicate greater cardiovascular risk in future. Univariate logistic regression for predictive association of MetS parameters was significantly high for deranged parameters i.e. WC≥80cm, fasting plasma glucose ≥100mg/dl, HDL ≤50mg/dl and WHR ≥0.85. Strong positive association was found with all these parameters (p<0.001) Hirsutism (modified Ferriman Gallwey score ≥8) was strongly associated with MetS (p=0.005).Conclusions: An appropriate diagnosis of PCOS and accurate dentification of phenotype is important as it has long-term health implications for women. We recommend screening all hyperandrogenic PCOS women for IR and metabolic abnormalities. This study has shown that HOMA-IR is a valuable tool in identifying PCOS women with metabolic syndrome and also serve to identify PCOS subtype at high risk of future metabolic syndrome.

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Section: Discussionsupporting

confidence: 46%

Metabolic syndrome and insulin resistance in PCOS phenotypes

Sobti

Dewan

Ranga

2017

Int J Reprod Contracept Obstet Gynecol

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“…In women, PCOS is the major cause of infertility and other consequences ranging from hirsutism and acne first appearing during adolescence to long-term health risks, in particular a significant increase in the risk of developing type II diabetes in later life (Gorry et al, 2006, Wang et al, 2010. Although the clinical and biochemical features of PCOS are well described, our paper provides novel and unique insight into the regulation of LHCGR receptor in granulosa cells of normal and PCOS women.…”

Section: Discussionmentioning

confidence: 92%

“…Moreover, previous studies have suggested that LHCGR, which is critical for ovulation, may be induced prematurely in women with PCOS (Jakimiuk et al, 2001, Willis et al, 1998. Despite a plethora of studies on clinical, metabolic, genetic and evolutionary factors in PCOS (Gorry et al, 2006, BenShlomo and Younis, 2014, Corbett and Morin-Papunen, 2013, Williams et al, 2013, only few studies have advanced our understanding of the physiopathology of this disorder. A specific clinical risk in PCOS is the development of ovarian hyperstimulation syndrome (OHSS) due to excessive and unpredictable response to gonadotrophin stimulation (Swanton et al, 2010), hence studies on the regulation of LHCGR response are needed to increase our understanding of PCOS and to identify biological mechanisms that might explain the severity of OHSS in women at risk.…”

Section: Introductionmentioning

confidence: 99%

Luteinizing hormone/chorionic gonadotrophin receptor overexpressed in granulosa cells from polycystic ovary syndrome ovaries is functionally active

Kanamarlapudi

Gordon

Bernal

2016

Reproductive BioMedicine Online

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. AbstractPolycystic ovarian syndrome (PCOS) is associated with anovulatory infertility. Luteinizing hormone/chorionic gonadotropin receptor (LHCGR), which is critical for ovulation, has been suggested to be expressed prematurely in the ovarian follicles of women with PCOS. The objective of this study was to analyse the expression and activity of LHCGR in ovarian granulosa cells from PCOS patients and the involvement of ARF6 small GTPase in LHCGR internalisation. Granulosa cells (GCs) isolated from follicular fluid collected during oocyte retrieval from normal women (n=19) and women with PCOS (n=17) were used to study differences in LHCGR protein expression and activity between normal and PCOS patients.LHCGR expression is up-regulated in GCs from PCOS women. LHCGR in PCOS GCs is functionally active as evidenced by increased cAMP production upon human gonadotrophin (HCG)-stimulation. Moreover, ARF6 is highly expressed in GCs from PCOS patients and HCG-stimulation increases the levels of active ARF6. The inhibition of ARF6 activation attenuates HCG-induced LHCGR internalisation in both normal and PCOS GCs, indicating that there are no alterations in LHCGR internalisation in GCs from PCOS. In conclusion, the expression and activation of LHCGR and ARF6 are up-regulated in GCs from PCOS women but the mechanism of agonist-induced LHCGR internalisation is unaltered.

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“…Polycystic ovarian disease causes hormonal imbalance in women that is thought to be one of the leading causes of female infertility. Polycystic ovarian syndrome causes more than 75% of cases of anovulatory infertility (26).The prevalence of polycystic ovarian disease (PCOD) in asymptomatic women is thought to be between 16 and 33% (27). The incidence of polycystic ovaries in our study was 12.1% in case of primary infertility and no case of it was found in secondary infertility group.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Laparoscopy in the Evaluation of Female Factors in Infertility in Kashmir Valley

Ain¹,

Ara²,

Ahmad³

et al. 2014

IJWHR

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Objectives: To evaluate the female factors in infertility using laparoscopy in Kashmiri women. Materials and Methods: One hundred cases of infertility [primary and secondary] were included in this prospective study. Before the procedure, apart from complete history and detailed examination, baseline investigations (complete blood count, blood sugar, kidney and liver function tests, ECG, chest X-ray) were performed as per our institutional protocol for pre-anaesthesia check up. Laparoscopy was done in proliferative phase of menstrual cycle. To test the patency of tubes, chromotubation was done in all cases under laparoscopic vision by using 10-15 ml of autoclaved methylene blue dye. All the data was collected on pre-designed proforma and the results were tabulated and raw percentages calculated to describe the results. Results: In primary infertility group [n=82], most common laparoscopic finding was tubal occlusion in 15 (18.3%), followed by endometriotic deposits in 14 (17.1%) patients. Other findings were polycystic ovaries in 10 patients (12.2%), peritubal and periovarian adhesions in 6 patients (7.3%), fibroids in 6 patients (7.3%), genital tract tuberculosis in 5 patients (6.1%), ovarian cysts in 4 patients (4.8%), hypoplastic uterus in 2 patients (2.4%) and pelvic inflammatory diseases in 2 patients (2.4%), in this group. The commonest finding by laparoscopy in patients with secondary infertility [n=18] was tubal occlusion in 5 (27.7%), followed by peritubal and periovarian adhesions in 4 (22.2%) patients. Conclusion: laparoscopy is very effective and cheap method in evaluating infertile women and should be considered earlier in infertility workup for effective and early treatment decisions.

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Infertility in Polycystic Ovary Syndrome: Focus on Low-Dose Gonadotropin Treatment

Cited by 79 publications

References 46 publications

Metabolic syndrome and insulin resistance in PCOS phenotypes

Metabolic syndrome and insulin resistance in PCOS phenotypes

Luteinizing hormone/chorionic gonadotrophin receptor overexpressed in granulosa cells from polycystic ovary syndrome ovaries is functionally active

Diagnostic Laparoscopy in the Evaluation of Female Factors in Infertility in Kashmir Valley

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