1
|
Wang S, Tan J, Wang C, Huang J, Zhou C. Free Androgen Index Might Not Be a Perfect Predictor of Infertility Outcomes in Patients with Polycystic Ovary Syndrome Undergoing Frozen Embryo Transfer:A Retrospective Cohort Study. Int J Womens Health 2024; 16:1349-1359. [PMID: 39135910 PMCID: PMC11318606 DOI: 10.2147/ijwh.s465541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose It is well known that androgen excess impairs oocyte quality, endometrial receptivity and even embryo invasion to some extent. Free androgen index (FAI) is strongly recommended to evaluate active androgen. Previous studies have showed conflicting conclusions on the effect of hyperandrogenism on the pregnancy outcomes in patients with polycystic ovary syndrome (PCOS). This study aims to analyze the influence of hyperandrogenemia based on FAI on frozen embryo transfer (FET) outcomes in patients with PCOS. Patients and Methods Patients diagnosed with PCOS who underwent their first FET between January 2017 and April 2022 were stratified into two cohorts using FAI, a highly recommended parameter: PCOS with hyperandrogenemia (n=73) and PCOS without hyperandrogenemia (n=255). Basic and infertility characteristics were analyzed using Student's t-test or chi-square (χ2) statistics. Logistic regression analysis was performed to verify whether FAI was helpful in predicting pregnancy outcomes in women with PCOS. Results Body mass index (BMI), total gonadotropin (Gn), basal serum follicle-stimulating hormone (bFSH), basal serum testosterone (bT), sex hormone binding globulin (SHBG), and FAI were significantly different between the two groups. (P=0.005, P<0.001, P<0.001, P<0.001, and P<0.001, respectively). However, clinical pregnancies, abortions, and live births did not differ significantly. Further regression analyses showed that FAI was not related to clinical pregnancy, abortion, or live birth rates (adjusted odds ratio (OR)=0.978, 95% confidence interval (CI)=0.911-1.050, P=0.539; adjusted OR=1.033, 95% CI=0.914-1.168, P=0.604; and adjusted OR=0.976, 95% CI=0.911-1.047, P=0.499, respectively). Conclusion FAI was not associated with pregnancy outcomes in patients with PCOS; that is, it did not reflect any negative effects of hyperandrogenemia on pregnancy outcomes in patients with PCOS and was not an informative clinical parameter. Therefore, more attention should be paid to the factors that influence the accuracy of FAI in reflecting androgen levels in vivo, and further discussion is needed.
Collapse
Affiliation(s)
- Senlan Wang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Jifan Tan
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Can Wang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Jia Huang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, People’s Republic of China
| |
Collapse
|
2
|
Lissaman AC, Girling JE, Cree LM, Campbell RE, Ponnampalam AP. Androgen signalling in the ovaries and endometrium. Mol Hum Reprod 2023; 29:gaad017. [PMID: 37171897 PMCID: PMC10663053 DOI: 10.1093/molehr/gaad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/27/2023] [Indexed: 05/14/2023] Open
Abstract
Currently, our understanding of hormonal regulation within the female reproductive system is largely based on our knowledge of estrogen and progesterone signalling. However, while the important functions of androgens in male physiology are well known, it is also recognized that androgens play critical roles in the female reproductive system. Further, androgen signalling is altered in a variety of gynaecological conditions, including endometriosis and polycystic ovary syndrome, indicative of regulatory roles in endometrial and ovarian function. Co-regulatory mechanisms exist between different androgens, estrogens, and progesterone, resulting in a complex network of steroid hormone interactions. Evidence from animal knockout studies, in vitro experiments, and human data indicate that androgen receptor expression is cell-specific and menstrual cycle stage-dependent, with important regulatory roles in the menstrual cycle, endometrial biology, and follicular development in the ovaries. This review will discuss the expression and co-regulatory interactions of androgen receptors, highlighting the complexity of the androgen signalling pathway in the endometrium and ovaries, and the synthesis of androgens from additional alternative pathways previously disregarded as male-specific. Moreover, it will illustrate the challenges faced when studying androgens in female biology, and the need for a more in-depth, integrative view of androgen metabolism and signalling in the female reproductive system.
Collapse
Affiliation(s)
- Abbey C Lissaman
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane E Girling
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Lynsey M Cree
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Rebecca E Campbell
- Department of Physiology and Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
| | - Anna P Ponnampalam
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Pūtahi Manawa-Healthy Hearts for Aotearoa New Zealand, Centre of Research Excellence, New Zealand
| |
Collapse
|
3
|
Ho VNA, Pham TD, Nguyen NT, Hoang HLT, Ho TM, Vuong LN. The impact of hyperandrogenism on the outcomes of ovulation induction using gonadotropin and intrauterine insemination in women with polycystic ovary syndrome. Clin Exp Reprod Med 2022; 49:127-134. [PMID: 35698775 PMCID: PMC9184886 DOI: 10.5653/cerm.2022.05204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to investigate the impact of hyperandrogenism (HA) on the outcomes of ovulation induction (OI) using gonadotropin and intrauterine insemination (IUI) in patients with polycystic ovary syndrome (PCOS). Methods This was a retrospective cohort study including 415 patients undergoing OI using gonadotropin and IUI treatment between January 2018 and December 2020 at a single infertility center. Baseline characteristics, clinical and laboratory parameters, and pregnancy outcomes were investigated. Results Among the study population, there were 105 hyperandrogenic (25.3%) and 310 non-hyperandrogenic patients (74.7%). The live birth rate was lower in the HA group than in the non-HA group, but this difference did not reach statistical significance due to the limited sample size (14.3% vs. 21.0%, relative risk=0.68; 95% CI, 0.41–1.14, p=0.153). No predictive factors for live birth were identified through logistic regression analysis. Conclusion HA did not negatively affect the outcomes of OI using gonadotropin and IUI cycles in Vietnamese women with PCOS. The result may not be applicable elsewhere due to the large variation in the characteristics of women with PCOS across races and populations.
Collapse
Affiliation(s)
- Vu Ngoc Anh Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
- Corresponding author: Vu Ngoc Anh Ho IVFMD, My Duc Hospital, 4 Nui Thanh St, Ward 13, Tan Binh District, Ho Chi Minh City, Viet Nam Tel: +84-93-5843336, E-mail:
| | - Toan Duong Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Nam Thanh Nguyen
- IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Hieu Le Trung Hoang
- IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Tuong Manh Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Lan Ngoc Vuong
- IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| |
Collapse
|
4
|
Ou M, Xu P, Lin H, Ma K, Liu M. AMH Is a Good Predictor of Metabolic Risk in Women with PCOS: A Cross-Sectional Study. Int J Endocrinol 2021; 2021:9511772. [PMID: 34422047 PMCID: PMC8376462 DOI: 10.1155/2021/9511772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/28/2021] [Accepted: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The relationship between metabolic risk and ovarian function is ambiguous. This retrospective study analyzed the medical records of 461 PCOS patients collected between January 2019 and June 2020 to investigate the relationship between serum anti-Müllerian hormone (AMH) and parameters of metabolic risk in the population with polycystic ovary syndrome (PCOS). METHODS A total of 461 PCOS patients aged 20-40 years were included and stratified into four groups according to the AMH level. The association between AMH and the parameters related to metabolic risk in these groups was compared, and the discrepancies were further explored. Binary logistic regression was performed to examine the risk factors of HOMA-IR. The values of AMH that best predicted the risk of HOMA-IR were also analyzed by ROC curves. RESULTS AMH was negatively associated with HOMA-IR (odds ratio (OR) -0.279, 95% confidence interval (CI) -0.36 to -0.20), fasting insulin (OR -0.282, 95% CI -0.36 to -0.20), 1-hour postprandial insulin (OR -0.184, 95% CI -0.28 to -0.11), 2-hour postprandial insulin (-0.180, 95%CI -0.28 to -0.11), 3-hour postprandial insulin (OR -0.198, 95% CI -0.30 to -0.13), waist-hip ratio (OR -0.235, 95% CI -0.31 to -0.14), and body mass index (OR -0.350, 95% CI -0.43 to -0.27). There was no statistically significant relationship between blood pressure, serum glucose profile, or lipid levels and AMH. Binary logistic regression showed that AMH protected against the occurrence of PCOS patients (OR: 0.835, 0.776, and 0.898). For the prediction of HOMA-IR, AMH had an AUC-ROC of 0.704 (95% CI 0.652-0.755) with a cutoff value of 7.81 mmol/L, a sensitivity of 70.3%, and a specificity of 70.1%. CONCLUSIONS Higher AMH levels were significantly associated with a lower insulin profile and might be a useful predictor for HOMA-IR in PCOS patients.
Collapse
Affiliation(s)
- Miaoxian Ou
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pei Xu
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Han Lin
- Department of Gynecology of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kaichi Ma
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingxing Liu
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
5
|
Yang Y, Ouyang N, Ye Y, Hu Q, Du T, Di N, Xu W, Azziz R, Yang D, Zhao X. The predictive value of total testosterone alone for clinical hyperandrogenism in polycystic ovary syndrome. Reprod Biomed Online 2020; 41:734-742. [PMID: 32912651 DOI: 10.1016/j.rbmo.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION Is the sole measurement of total testosterone sufficient to assess the presence of hyperandrogenism in women with polycystic ovary syndrome (PCOS)? DESIGN Serum samples from 294 patients with PCOS who met the Rotterdam criteria were used for the analysis of total testosterone by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) and chemiluminescent immunoassay (CLIA). The free androgen index (FAI) was calculated as total testosterone (TT)/sex hormone-binding globulin (SHBG) × 100%, and the presence/degree of hirsutism were assessed using the modified and simplified Ferriman-Gallwey (mFG and sFG, respectively) scoring systems. RESULTS The hirsute subjects presented higher LC-MS/MS-based total testosterone and FAI values than the non-hirsute subjects (all P < 0.001), including those defined based on mFG ≥5 or sFG ≥3. Total testosterone and FAI were both positively correlated with the mFG (rank correlation coefficient [RCC] 0.598 and 0.443, P < 0.001) or sFG (RCC 0.747 and 0.568, P < 0.001) score, and a receiver operating characteristic curve analysis indicated that both parameters could significantly predict the presence of hirsutism determined by the mFG (area under the curve [AUC] 0.797 and 0.725, P < 0.001) or sFG (AUC 0.894 and 0.817, P < 0.001) score. However, similar results were not obtained with the CLIA platform. CONCLUSIONS In this East Asian population, total testosterone was found to be a strong predictor of the presence and degree of hyperandrogenism (i.e. assessed by the presence and degree of hirsutism), but this finding was obtained only if the total testosterone level was measured by LC-MS/MS and not by CLIA. These findings might have important implications for global epidemiologic, phenotypic and clinical studies of PCOS.
Collapse
Affiliation(s)
- Yabo Yang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China
| | - Nengyong Ouyang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China
| | - Yang Ye
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China
| | - Qin Hu
- Kobilka Institute of Innovative Drug Discovery, Chinese University of Hong Kong (Shenzhen), Shenzhen 518172, China
| | - Tao Du
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China
| | - Na Di
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China
| | - Wenming Xu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu 610041, China
| | - Ricardo Azziz
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, SUNY, Rensselaer NY 12144, USA
| | - Dongzi Yang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China.
| | - Xiaomiao Zhao
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou Guangdong 510120, China.
| |
Collapse
|
6
|
Zhou J, Sun Y, Sun J, Zhao JM, Cui YH, Wu LX, Wu HG, Shi Y, Li L. Effect of electroacupuncture on anti-Mullerian hormone expression in rats with polycystic ovarian syndrome. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2019. [DOI: 10.1007/s11726-019-1094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
7
|
Minato S, Sakane N, Kotani K, Nirengi S, Hayashi I, Suganuma A, Yamaguchi K, Takakura K, Nagai N. Prevalence and Risk Factors of Elevated Liver Enzymes in Japanese Women With Polycystic Ovary Syndrome. J Clin Med Res 2018; 10:904-910. [PMID: 30425763 PMCID: PMC6225863 DOI: 10.14740/jocmr3639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder among reproductive-aged women. While PCOS is associated with an increased risk of obesity and insulin resistance, little is known regarding the prevalence of and risk factors for nonalcoholic fatty liver disease (NAFLD) among Japanese women with PCOS. We estimated the prevalence of and risk factors for elevated liver enzymes, as the index of NAFLD, in Japanese women with PCOS. Methods We retrospectively reviewed 102 reproductive-aged women who visited the Department of Gynecology, Kyoto Medical Center in Japan from January 2000 to September 2016. Inclusion criterion was confirmed diagnosis of PCOS using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10) codes. Exclusion criteria were women with a history of liver diseases, missing body mass index (BMI) and serum alanine aminotransferase (ALT) data, and pregnancy. Data regarding age; BMI; and levels of blood glucose, serum lipid, liver enzymes, and sex hormones were obtained from medical records. Elevated liver enzymes was defined as ALT > 19 IU/L. Optimal cutoffs for risk factors for elevated liver enzymes were calculated to determine predictors of elevated liver enzymes using area under the curve (AUC) by receiver-operating characteristics (ROC). Results The prevalence of elevated liver enzymes was 33.3%. BMI was significantly higher in PCOS patients than in those without elevated liver enzymes (25.3 vs. 20.7 kg/m2, P < 0.05). ROC analyses were performed using BMI and blood glucose and testosterone levels because BMI and blood glucose showed differences between the groups and testosterone is related to fatty liver. AUC of the model including BMI and blood glucose and testosterone levels was 0.861 (sensitivity, 66.7%; specificity, 100%). Conclusions These findings suggest that elevated liver enzymes are common in women with PCOS. An algorism using BMI and blood glucose and testosterone levels might be useful to determine elevated liver enzymes in women with PCOS. Our finding may be useful for the study of NAFLD among Japanese women with PCOS since several previous studies have indicated elevated liver enzymes to be related to the potential presence of NAFLD. Further examination, including abdominal ultrasonography and/or liver biopsy data, is required to confirm these results.
Collapse
Affiliation(s)
- Satomi Minato
- Graduate School of Human Science and Environment, University of Hyogo, Hyogo, Japan.,Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuhiko Kotani
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.,Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ikuyo Hayashi
- Graduate School of Human Science and Environment, University of Hyogo, Hyogo, Japan.,Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kenji Takakura
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Narumi Nagai
- Graduate School of Human Science and Environment, University of Hyogo, Hyogo, Japan
| |
Collapse
|