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Nguyen TT, Doan HT, Quan LH, Lam NM. Effect of letrozole for ovulation induction combined with intrauterine insemination on women with polycystic ovary syndrome. Gynecol Endocrinol 2020; 36:860-863. [PMID: 32241195 DOI: 10.1080/09513590.2020.1744556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
Objectives: To evaluate the efficacy and safety of letrozole on ovulation induction and pregnancy in infertility patients with polycystic ovary syndrome (PCOS). In addition, the insulin resistance was analyzed in these patients.Subjects and methods: Progressive description study with comparison. The study included 80 infertility women divided into two groups: 40 women with PCOS (the study group) and 40 women without PCOS (the control group). The both used letrozole for ovulation induction from cycle day 2.Results: No differences in the dominant follicle between the study group and the control group (1.16 ± 0.37 follicles and 1.30 ± 0.46 follicles, respectively). The clinical pregnancy rate was 22.5% of the both groups. The average insulin of the study group (10.85 ± 5.84 µUI/ml) and their average HOMA-IR (2.42 ± 1.34) were higher than the control group (7.44 ± 2.84 µUI/ml and 1.57 ± 0.68), p < .05. The QUICKI of the study group (0.35 ± 0.29) was lower than the control group (0.36 ± 0.25), p < .05.Conclusion: Letrozole is used to stimulate the ovaries of the infertile women with PCOS combined with intrauterine insemination is the effective treatment. These patients had the high risk of insulin resistance.
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Affiliation(s)
- Tung Thanh Nguyen
- IVF Department, Military Institute of Clinical Embryology and Histology, Military Medical University, Ha Noi, Vietnam
| | - Hang Thi Doan
- IVF Department, Military Institute of Clinical Embryology and Histology, Military Medical University, Ha Noi, Vietnam
| | - Lam Hoang Quan
- Military Institute of Clinical Embryology and Histology, Military Medical University, Ha Noi, Vietnam
| | - Ngoc Mai Lam
- Assisted Reproductive Technique Unit, Phu Tho Obstetrics and Pediatrics center, Viet Tri, Vietnam
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Coo H, Brownell MD, Ruth C, Flavin M, Au W, Day AG. Interpregnancy Intervals in a Contemporary Manitoba Cohort: Prevalence of So-Called Suboptimal Intervals and Associated Maternal Characteristics. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1024-1030. [PMID: 30103875 DOI: 10.1016/j.jogc.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Short and long interpregnancy intervals (IPIs) have been associated with various adverse outcomes, and a 2016 American College of Obstetricians and Gynecologists' Committee Opinion recommends an optimal IPI of 18 months to 5 years. Descriptive data on the IPI in Canada are lacking. The objective of this study was to examine IPIs in a Manitoba cohort. METHODS The study analyzed a subset of records from a larger dataset used to examine the IPI and adverse perinatal outcomes. For that study, Manitoba's Hospital Abstracts data were searched to identify births from 1985 to 2014. Each two consecutive live births to the same mother formed a sibling pair. The IPI was calculated as the interval between the two siblings' births, minus the younger sibling's GA. Information on maternal characteristics was extracted from various datasets housed in the Manitoba Population Research Data Repository. The current analysis examined second and higher-order births between 2010 and 2014. The proportion of suboptimal IPIs was determined and IPIs were cross-tabulated with birth year and maternal subgroups. RESULTS More than half of pregnancies were conceived following a suboptimal interval. IPIs of less than 6 months - which have been associated with the highest risk of adverse outcomes - were more prevalent among certain subgroups. These included younger women as well as women who received inadequate prenatal care, smoked or drank alcohol during pregnancy, were low income, or did not graduate from high school. CONCLUSION Suboptimal IPIs were common in this Manitoba cohort. Stakeholders should consider whether greater efforts to promote appropriate birth spacing are warranted.
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Affiliation(s)
- Helen Coo
- Department of Pediatrics, Queen's University, Kingston, ON.
| | - Marni D Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, Winnipeg, MB
| | - Chelsea Ruth
- Manitoba Centre for Health Policy, Winnipeg, MB; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB
| | - Michael Flavin
- Department of Pediatrics, Queen's University, Kingston, ON
| | - Wendy Au
- Manitoba Centre for Health Policy, Winnipeg, MB
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston, ON
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Bhingardive K, Sarvade D, Bhatted S. Clinical efficacy of Vamana Karma with Ikshwaaku Beeja Yoga followed by Shatapushpadi Ghanavati in the management of Artava Kshaya w. s. r to polycystic ovarian syndrome. Ayu 2017; 38:127-132. [PMID: 30254392 PMCID: PMC6153915 DOI: 10.4103/ayu.ayu_192_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Due to sedentary lifestyle and stress, the incidence of metabolic disorders are increasing day by day. Among these polycystic ovarian syndrome (PCOS) is an intricate disorder affecting 4%–8% women in their reproductive age and related to ovarian dysfunction characterized by obesity, oligomenorrhea, anovulation and hyperandrogenism. In modern system of medicine, the available allopathic regimen has its own limitations, so it is need of time to find a safe and effective alternative therapy for such type of condition. The most common symptom in 85%–90% of PCOS patients is oligomenorrhea which can be correlated to Artava Kshaya (loss of menstrual fluid) in Ayurveda. Hence, in the present clinical study, Vamana Karma (therapeutic vomiting) with Ikshwaaku seed formulation followed by Shatapushpadi Ghanavati was planned. Aims: To evaluate the efficacy of Vamana Karma (therapeutic vomiting) followed by Shatapushpadi Ghanavati in the management of Aartava Kshaya (loss of menstrual fluid) w. s. r to PCOS. Materials and Methods: A total of 15 patients of PCOS were clinically diagnosed and treated by Vamana Karma (therapeutic vomiting) procedure with Ikshwaaku seed formulation. After completion of Vamana Karma (therapeutic vomiting) and Samsarjana Krama, (post therapy dietary regimen for revival) Shatapushpadi Ghanavati 2 Vati (each 500 mg) twice in a day with lukewarm water was given for 45 days. After completion of 2-month trial, assessment of therapy was estimated by subjective and objective parameters. Results: Statistically extremely significant (P < 0.0001) results were found in menstrual irregularities, obesity, and body mass index. The significant result in reduction of nondominant follicles (P = 0.01 and 0.03 for right and left ovary, respectively), lowering the fasting blood sugar level (P = 0.02) and hirsutism (P = 0.03) was found. Conclusion: Vamana Karma (therapeutic vomiting) followed by Shatapushpadi Ghanavati is very effective in the management of obese PCOS patients and increasing chances of conception.
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Escobar-Morreale HF, Roldán-Martín MB. Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis. Diabetes Care 2016; 39:639-48. [PMID: 27208367 DOI: 10.2337/dc15-2577] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/27/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND A few small studies have reported increased prevalences of polycystic ovary syndrome (PCOS) and symptoms of androgen excess in women with type 1 diabetes. PURPOSE We performed a systematic review and meta-analysis of studies evaluating androgen excess symptoms and PCOS in women with type 1 diabetes. DATA SOURCES The Entrez-PubMed and Scopus electronic databases were used. STUDY SELECTION We selected studies addressing androgen excess signs, symptoms, and disorders in girls, adolescents, and adult women with type 1 diabetes. DATA EXTRACTION The main outcome measures were prevalences of PCOS, hyperandrogenemia, hirsutism, menstrual dysfunction, and polycystic ovarian morphology (PCOM). DATA SYNTHESIS Nine primary studies involving 475 adolescent or adult women with type 1 diabetes were included. The prevalences of PCOS and associated traits in women with type 1 diabetes were 24% (95% CI 15-34) for PCOS, 25% (95% CI 17-33) for hyperandrogenemia, 25% (95% CI 16-36) for hirsutism, 24% (95% CI 17-32) for menstrual dysfunction, and 33% (95% CI 24-44) for PCOM. These figures are considerably higher than those reported earlier in the general population without diabetes. LIMITATIONS The data collected in the original studies were heterogeneous in age, race, ethnicity, and criteria used for the diagnosis of PCOS; yet, we used a quality-effects model in the meta-analyses to overcome this limitation. CONCLUSIONS PCOS and its related traits are frequent findings in women with type 1 diabetes. PCOS may contribute to the subfertility of these women by a mechanism that does not directly depend on glycemic/metabolic control among other negative consequences for their health. Hence, screening for PCOS and androgen excess should be included in current guidelines for the management of type 1 diabetes in women.
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Affiliation(s)
- Héctor F Escobar-Morreale
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, CIBERDEM, Madrid, Spain
| | - M Belén Roldán-Martín
- Department of Pediatrics, Hospital Universitario Ramón y Cajal and Universidad de Alcalá, Madrid, Spain
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Ashoush S, Abou-Gamrah A, Bayoumy H, Othman N. Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. J Obstet Gynaecol Res 2015; 42:279-85. [PMID: 26663540 DOI: 10.1111/jog.12907] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/22/2015] [Accepted: 10/18/2015] [Indexed: 02/02/2023]
Abstract
AIM To investigate the effect of chromium picolinate (CrP) on insulin resistance (IR) in polycystic ovary syndrome (PCOS). METHODS This double blinded randomized controlled trial was conducted in the Gynecology outpatient clinics at Ain Shams University Women's Hospital. Using closed and randomly mixed envelopes, 100 women were selected out of 400 PCOS patients. Eighty-five patients finished the study and were analyzed, 44 in group I and 41 in group II. They were randomly allocated to 6 months of either 1000 μg CrP (50 patients), or placebo capsules (50 patients). Patients were seen monthly to encourage similar diet control and physical exercise plans. The primary outcome was fasting glucose insulin ratio (FGIR), secondary outcomes included ovulation, regularity of the cycle, body mass index (BMI), fasting blood sugar (FBS), fasting serum insulin (FSI), and serum testosterone level. RESULTS There were no significant differences between women of both groups regarding pretreatment levels of FBS, FSI, FGIR, and serum testosterone. Use of CrP for 6 months was associated with significant reduction of BMI (P < 0.001) and FSI (P = 0.007), and significant rise in FGIR (P = 0.045). CrP significantly increased the chances of ovulation (P = 0.011) and regular menstruation (P = 0.002) by almost twofold after the fifth month of treatment. CONCLUSION Chromium picolinate is useful in PCOS to reduce IR and stimulate ovulation.
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Affiliation(s)
- Sherif Ashoush
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amgad Abou-Gamrah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hassan Bayoumy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Noura Othman
- Department of Obstetrics and Gynecology, El-Sahel Hospital, Cairo, Egypt
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Morad AWA, Elhadi Farag MA. Impact of letrozole on ultrasonographic markers of endometrial receptivity in polycystic ovary syndrome women with poor endometrial response to clomiphene citrate despite adequate ovulation. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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The effect of chromium supplementation on polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol 2015; 28:114-8. [PMID: 25850593 DOI: 10.1016/j.jpag.2014.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common condition. Treatment with chromium has been shown to improve insulin sensitivity in adults with PCOS. Treatment of adolescents with PCOS remains a challenge. OBJECTIVE To investigate the effect of chromium supplementation on the various components of polycystic ovary syndrome in adolescent girls. PATIENTS AND METHODS Thirty-five adolescent girls with PCOS were enrolled. History of menstrual irregularities was recorded. All underwent physical examination for presence of acne, scoring of hirsutism, and calculation of body mass index. Pelvic ultrasonography was done and serum free testosterone was measured in all subjects. All subjects received 1000 μg chromium picolinate for 6 months followed by re-evaluation. RESULTS Mean (SD) age was 15.5 (1) years (range: 14-17 y). No significant change in BMI standard deviation score (SDS) with chromium supplementation was noted (1.9 (0.7) SDS vs 2 (0.7) SDS, P = .638). The number of patients with oligo/amenorrhea decreased with treatment (29/35 (83%) versus 11/35 (31%), P < .001). Significant reduction in mean ovarian volume (P < .001), total follicular count (P < .034), and free testosterone (P< .002) was observed. No significant improvement in acne or hirsutim was noted. CONCLUSION Supplementation with chromium to adolescents with PCOS is a promising treatment option.
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Abstract
The insulin/insulin-like growth factor (IGF) pathways and glucose metabolism act as mediators of human ovarian function and female fertility. In normal insulin action, insulin binds to its own receptors in the ovary to mediate steroidogenesis and act as a co-gonadotropin. Insulin with other factors may influence ovarian growth and cyst formation. The IGF pathway also seems to influence normal ovarian function. Insulin signaling affects reproductive function. Dysregulation of this pathway leads to altered puberty, ovulation, and fertility. Better understanding of the normal physiology and pathophysiology of insulin, IGF, and glucose effects on the human reproductive system will allow for better outcomes.
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Affiliation(s)
- Anindita Nandi
- Division of Endocrinology and Metabolism, Beth Israel Medical Center, Albert Einstein College of Medicine, 317 East 17th Street, 7th Floor, New York, NY 10003, USA
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Rajani S, Chattopadhyay R, Goswami SK, Ghosh S, Sharma S, Chakravarty B. Assessment of oocyte quality in polycystic ovarian syndrome and endometriosis by spindle imaging and reactive oxygen species levels in follicular fluid and its relationship with IVF-ET outcome. J Hum Reprod Sci 2012; 5:187-93. [PMID: 23162358 PMCID: PMC3493834 DOI: 10.4103/0974-1208.101020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/20/2012] [Accepted: 04/28/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES: The aim of this study is to examine meiotic spindle in oocytes along with reactive oxygen species (ROS) levels in follicular fluid of women undergoing IVF and to correlate these findings with embryo quality and pregnancy outcome. MATERIALS AND METHODS: 167 women aged 25–35 years with endometriosis (Group A), polycystic ovarian syndrome (PCOS) (Group B) and tubal block (Group C) were included. Long protocol downregulation using recombinant follicular stimulating hormone was used for ovarian stimulation. Aspirated follicular fluid containing mature oocytes were analyzed for ROS levels and the oocytes were assessed for the presence of meiotic spindle using Cri-Oosight™ Polscope. Fertilization, embryo quality, endometrial assessment, and final pregnancy outcome were assessed. RESULTS: Meiotic spindles were visualized in a higher proportion of mature oocytes retrieved from women with endometriosis (66%) as compared to those with PCOS (50.5%) and tubal block (62.3%). ROS levels were also observed to be significantly less in the follicular fluid of oocytes in women with endometriosis (Group A) as compared to the other two groups (P ≤ 0.001). However, pregnancy rates were observed to be lower in Group A (32%) than Groups B (39%) and C (44%), respectively. Within each group, oocytes with spindle visualization yielded a higher number of Grade 1 embryos (P < 0.05) as well as lower ROS levels in follicular fluid (P ≤ 0.001) as compared to those where spindle could not be visualized. CONCLUSIONS: There was good correlation between spindle imaging and ROS levels as reliable predictors of oocyte assessment. Women with endometriosis had low ROS levels and good spindle imaging results suggesting a possible role of endometrial receptivity accounting for lower pregnancy rates in these women. Poor oocyte quality, as reflected by higher mean ROS levels and low number of oocytes with spindle visualization, could be the factor impeding pregnancy in women with PCOS as compared to women with tubal block.
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Bellver J, Cruz F, Martínez MC, Ferro J, Ramírez JF, Pellicer A, Garrido N. Female overweight is not associated with a higher embryo euploidy rate in first trimester miscarriages karyotyped by hysteroembryoscopy. Fertil Steril 2011; 96:931-3. [PMID: 21802669 DOI: 10.1016/j.fertnstert.2011.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/01/2011] [Accepted: 07/05/2011] [Indexed: 11/29/2022]
Abstract
Overweight women (body mass index ≥ 25 kg/m(2)) present an embryo euploidy rate in first trimester miscarriages similar to normoweight controls after a selective biopsy and karyotyping of embryo and/or chorion samples taken by hysteroembryoscopy.
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Affiliation(s)
- José Bellver
- Instituto Valenciano de Infertilidad, Valencia, Spain.
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Abstract
During the last years, numerous consensuses have been held in different countries in order to review the data concerning diagnosis and treatment and their relationship with the ethnic origin, social status and lifestyle of women with Polycystic Ovary Syndrome (PCOS). This study describes the conclusions concerning diagnostic criteria and the appropriate treatment of women with PCOS reached during the International Symposium Polycystic Ovary Syndrome, First Latin-American Consensus held in Buenos Aires, Argentina on 4th and 5th May 2009 to be applied in South American.
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Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health 2011; 3:25-35. [PMID: 21339935 PMCID: PMC3039006 DOI: 10.2147/ijwh.s11304] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Indexed: 11/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or androgen-related symptoms. Weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy. Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight. The treatment of obesity includes modifications in lifestyle (diet and exercise) and medical and surgical treatment. In PCOS, anovulation relates to low follicle-stimulating hormone concentrations and the arrest of antral follicle growth in the final stages of maturation. This can be treated with medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic ovarian drilling. In vitro fertilization will remain the last option to achieve pregnancy when others fail. Chronic anovulation over a long period of time is also associated with an increased risk of endometrial hyperplasia and carcinoma, which should be seriously investigated and treated. There are androgenic symptoms that will vary from patient to patient, such as hirsutism, acne, and/or alopecia. These are troublesome presentations to the patients and require adequate treatment. Alternative medicine has been emerging as one of the commonly practiced medicines for different health problems, including PCOS. This review underlines the contribution to the treatment of different symptoms.
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Affiliation(s)
- Ahmed Badawy
- Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt
| | - Abubaker Elnashar
- Department of Obstetrics and Gynecology, Benha University, Benha, Egypt
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Landres IV, Milki AA, Lathi RB. Karyotype of miscarriages in relation to maternal weight. Hum Reprod 2010; 25:1123-6. [PMID: 20190263 DOI: 10.1093/humrep/deq025] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity has been identified as a risk factor for spontaneous miscarriage although the mechanism is unclear. The purpose of this study is to better understand the effect of obesity on early pregnancy success by examining the cytogenetic results of miscarriages in women with normal and elevated body mass index (BMI). METHODS We conducted a retrospective case-control study in an academic infertility practice. Medical records of women ages <40 years with first trimester missed abortion (n = 204), who underwent dilatation and curettage between 1999 and 2008, were reviewed for demographics, BMI, diagnosis of polycystic ovary syndrome (PCOS) and karyotype analysis. chi(2) and Student's t-test analysis were used for statistical analysis, with P < 0.05 considered significant. RESULTS A total of 204 miscarriages were included, from women with a mean age of 34.5 years. The overall rate of aneuploidy was 59%. Women with BMI > or = 25 kg/m(2) had a significant increase in euploid miscarriages compared with women with lower BMI (P = 0.04), despite a similar mean age (34.4 years for both). CONCLUSIONS We found a significant increase in normal embryonic karyotypes in the miscarriages of overweight and obese women (BMI > or = 25). These results suggest that the excess risk of miscarriages in the overweight and obese population is independent of embryonic aneuploidy. Further studies are needed to assess the impact of lifestyle modification, insulin resistance and PCOS on pregnancy outcomes in the overweight and obese population.
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Affiliation(s)
- Inna V Landres
- Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, Stanford, CA, USA.
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Kulshreshtha B, Marumudi E, Khurana ML, Kriplani A, Kinra G, Gupta DK, Kucheria K, Khadgawat R, Gupta N, Seith A, Ammini AC. Fertility among women with classical congenital adrenal hyperplasia: report of seven cases where treatment was started after 9 years of age. Gynecol Endocrinol 2008; 24:267-72. [PMID: 18569031 DOI: 10.1080/09513590801945230] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND AIM Androgen excess is believed to be one of the major factors responsible for poor fertility outcomes in females with congenital adrenal hyperplasia (CAH). Some believe that the adverse effect of androgens on fertility could have its origins as early as the antenatal years. To assess the impact of prolonged androgen exposure on fertility in CAH patients, we compiled the data of females with CAH followed in our clinic during the last 25 years who were sexually active and had not been initiated on steroids until age 9 years. STUDY DESIGN AND PATIENTS This was an observational case study on seven patients with classical CAH who fulfilled the inclusion criteria. The age at initiation of therapy in these females ranged from 9 years to 29 years. RESULTS All patients had varying degrees of genital ambiguity. The most common presenting complaints were genital ambiguity, non-development of secondary sexual characteristics, hirsutism and primary amenorrhea. Genital surgery was performed in all patients at ages ranging from 12 to 29 years, except for one patient who underwent surgery at age 5 years without a diagnosis of CAH being made. Breast development ensued within 2 to 12 months and periods started in all patients within 2-24 months of steroid initiation. There were 13 pregnancies (seven normal vaginal deliveries, two spontaneous abortions and four pregnancies were medically terminated). CONCLUSIONS Late initiation of steroid therapy did not affect fertility in our cohort of CAH women. Androgen excess in situations of subnormal cortisol may not adversely affect fertility in females with CAH.
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Affiliation(s)
- Bindu Kulshreshtha
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Ramos RG, Olden K. The prevalence of metabolic syndrome among US women of childbearing age. Am J Public Health 2008; 98:1122-7. [PMID: 18445796 DOI: 10.2105/ajph.2007.120055] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We sought to determine whether the prevalence of metabolic syndrome among US women of childbearing age (18-44 years) has increased since 1988 and to estimate its current prevalence by race/ethnicity and risk that a maternal history of select metabolic syndrome characteristics imposes on offspring. METHODS We used survey-specific data analysis methods to examine data from the National Health and Nutrition Examination Surveys conducted from 1988 to 2004. RESULTS The prevalence of the metabolic syndrome phenotype and 2 of its clinical correlates significantly increased between 1988 and 2004 (increase for metabolic syndrome phenotype=7.6%, for obesity=13.3%, and for elevated C-reactive protein=10.6%; P < .001 for all 3). Hispanic women were more likely than were White women to possess the phenotype (P = .004). Women who reported that their mothers had been diagnosed with diabetes were more likely to possess the phenotype than those whose mothers had not been so diagnosed (odds ratio=1.9; 95% confidence interval=1.3, 2.8). CONCLUSIONS The current trends of metabolic syndrome among women of childbearing age demonstrate the need for additional rigorous investigations regarding its long-term effects in these women and their offspring.
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Affiliation(s)
- Rosemarie G Ramos
- Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA.
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Eng GS, Sheridan RA, Wyman A, Chi MMY, Bibee KP, Jungheim ES, Moley KH. AMP kinase activation increases glucose uptake, decreases apoptosis, and improves pregnancy outcome in embryos exposed to high IGF-I concentrations. Diabetes 2007; 56:2228-34. [PMID: 17575082 DOI: 10.2337/db07-0074] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Women with polycystic ovarian syndrome are at increased risk of miscarriage. Although evidence exists that metformin reduces this risk, the mechanism is unknown. This study tests the hypothesis that AMP kinase (AMPK) activation with metformin directly improves insulin signaling within the blastocyst, leading to improved pregnancy outcomes. Murine embryos were exposed to 200 nmol/l IGF-I, similar to the concentrations that can occur during polycystic ovary syndrome (PCOS). Resulting blastocysts were compared with embryos cocultured with excess IGF-I plus metformin and embryos cultured in control medium for the following: AMPK phosphorylation, insulin-stimulated glucose uptake, and apoptosis. Study and control blastocysts were also transferred into control animals. On embryonic day (E) 14.5, resulting fetuses were examined for size and rates of fetal implantation and resorption. Compared with control blastocysts, blastocysts exposed to high concentrations of IGF-I showed a decrease in AMPK activation and insulin-stimulated glucose uptake and an increase in the number of apoptotic nuclei. Blastocysts cocultured in metformin and excess IGF-I performed as well as controls in all studies. 5-Aminoimidazole-4-carboxamide 1-beta-d-ribofuranoside, another AMPK activator, also prevented the effects of excess IGF-I on blastocysts. Implantation rates and fetal size at day 14.5 were significantly lower among IGF-I-exposed embryos transferred into control mothers compared with control embryos transferred into control mothers. Both of these parameters were reversed by co-incubation with metformin and IGF-I before transfer. Activation of embryonic AMPK may be the mechanism responsible for the improved pregnancy outcomes seen in PCOS patients taking metformin.
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Affiliation(s)
- Grace S Eng
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110-1094, USA
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Torre A, Fernandez H. Le syndrome des ovaires polykystiques (SOPK). ACTA ACUST UNITED AC 2007; 36:423-46. [PMID: 17540511 DOI: 10.1016/j.jgyn.2007.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 02/15/2007] [Accepted: 04/06/2007] [Indexed: 01/04/2023]
Abstract
Polycystic ovaries syndrome (PCOS) is one of the most common female hormonal disorders. Its multiple components--reproductive, metabolic, neoplasic and cardiovascular--have a major impact on the public health. Androgen excess and resistance to insulin, probably from genetic origin, are responsible for most of the clinical symptomatology. Resistance to insulin seems to be accompanied by a greater risk of glucose intolerance, type 2 diabetes, lipidic anomalies and can involve the development of cardiovascular diseases. In addition, sleep apnea syndrome is more progressively described in PCOS. Infertility, menses disorders and hirsutism often push these patients to consult their physician. A better understanding of the physiopathological mechanisms led to the emergence of new therapeutic options increasing the sensitivity to insulin. Besides the pregnancy wishes, cares aim to attenuate the marks of the hyper-androgenism (hormonal treatment and cosmetic) and to correct cardiovascular, respiratory and gynaecological risk factors. In case of infertility by anovulation, cares must be performed by trained experts to minimize the risk of ovarian hyper-stimulation syndrome and multiple pregnancies. A gradation from loose weight to clomiphene citrate ovulation induction, ovarian drilling, low dose gonadotropin, in vitro fertilisation, or in vitro maturation of oocytes should bring back good reproduction potential.
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Affiliation(s)
- A Torre
- Université Paris-Sud, UMR-S0782, Service de gynécologie-obstétrique et de médecine de la reproduction, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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