Transvaginal ultrasound imaging, histopathology and endocrinopathy in patients with polycystic ovarian syndrome

Effect of lncRNA MALAT1 on the Granulosa Cell Proliferation and Pregnancy Outcome in Patients With PCOS

Follicle arrest is one of the main characteristics of polycystic ovary syndrome (PCOS), the most common endocrinological disorder in reproductive-aged women. Increasing evidence proves that high anti-Mullerian hormone (AMH) levels may play an important role in follicular development. Long noncoding RNA (lncRNA) with a length of more than 200 nt is widely involved in the directional differentiation, growth, and development of cells, whereas whether lncRNA is involved in AMH's role in follicular development is unknown. In this study, we analyzed lncRNA expression in ovarian granulosa cells (GCs) collected from women with and without PCOS via high-throughput sequencing. The results showed that a total of 79 noncoding transcripts were differently expressed in GCs of PCOS patients, including upregulated lncRNA MALAT1. The upregulation of MALAT1 was further confirmed by RT-qPCR in GCs from a larger cohort of PCOS patients. Furthermore, knockdown MALAT1 can promote the proliferation of KGN cell in vitro. These data suggested a role for MALAT1 in the development of PCOS. Meanwhile, MALAT1 and phosphorylated SMAD 1/5 (Ser463/465) protein were upregulated in KGN cells after exogenous AMH stimulation, which identified AMH perhaps as a regulator for the expression of MALAT1. We also found that MALAT1 can predict clinical pregnancy outcome to a certain extent by ROC curve analysis (area: 0.771, p = 0.007, 95% CI: 0.617-0.925, sensitivity: 57.1%, specificity: 91.7%). Thus, our findings revealed a role of lncRNA MALAT1 in inhibiting granulosa cell proliferation and may be correlated with pregnancy outcome in PCOS.

Association between baseline LH/FSH and live-birth rate after fresh-embryo transfer in polycystic ovary syndrome women

This study aimed to retrospectively analyse the effect of the baseline luteinising hormone/follicle-stimulating hormone ratio (bLH/FSH) on the live-birth rate per fresh-embryo transfer cycle (LBR/ET) in infertile women with polycystic ovary syndrome (PCOS) who received a fresh-embryo transfer. A total of 424 patients with PCOS who underwent the first cycle of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) fresh-embryo transfer at our hospital was enrolled. Univariate and multivariate logistic regression analyses, along with curve fitting and a threshold effect analysis, were performed. Baseline LH/FSH levels were a significant (P < 0.05) independent risk factor affecting live birth. In the first IVF/ICSI antagonist treatment cycles, LBR/ET after fresh-embryo transfer was relatively flat, until bLH/FSH was 1.0; thereafter, it started to decrease by 17% for every 0.1-unit bLH/FSH increase. Considering the decline in LBR/ET, it is recommended that PCOS women with bLH/FSH > 1.0 carefully consider fresh-embryo transfer during their first IVF/ICSI.

Role of shear wave elastography in predicting the metabolic and androgenic alterations in patients with polycystic ovary syndrome

AIM

To evaluate the variation in tissue stiffness caused by the changes in ovarian volume and stroma in polycystic ovary syndrome (PCOS) using a novel method of ultrasonography, that is shear wave elastography (SWE). The current study also aimed to evaluate the potential applications of this method in predicting the metabolic and androgenic alterations in patients with PCOS.

METHODS

The present study included 33 patients with PCOS. The blood samples for the metabolic and androgenic parameters and SWE values pertaining to the patients were obtained on the same day during the early follicular phase. The predictive ability of SWE to reflect the metabolic and androgenic abnormalities was evaluated using the receiver operating characteristic curve (ROC) analysis.

RESULTS

The mean SWE value pertaining to the group with higher total testosterone levels was significantly lower, compared to the group with normal testosterone levels (p = 0.041). The ROC analysis revealed that the predictive potential of SWE was statistically significant in regard to the serum testosterone levels alone (area under the curve [AUC] = 0.755, 95% confidence interval [CI]: 0.573-0.938, p = 0.041). There was no significant relationship between the SWE values and metabolic parameters.

CONCLUSIONS

Based on the results of the present study, decreased SWE values appear to be associated with increased serum testosterone levels. However, the present study did not observe any significant relationship between the SWE values and metabolic parameters. SWE can be used as a practical and non-invasive method to predict the serum testosterone levels during the follow-up evaluations of the patients with PCOS.

Controversies in the diagnosis of polycystic ovary syndrome

Polycystic ovary syndrome is a common endocrinological condition which is found to be prevalent in 5-10% of women of reproductive age. Historically, a combination of anovulation and androgen excess was considered a hallmark in the diagnosis of polycystic ovary syndrome. Addition of ultrasound features of polycystic ovary syndrome has improved the detection of variation in the polycystic ovary syndrome phenotype. Despite the widespread use of consensus diagnostic criteria, there remain several unresolved controversies in the diagnosis of polycystic ovary syndrome. Difficulty arises in methods of assessment and types of androgens to be measured to detect biochemical hyperandrogenism, setting a cut-off value for the diagnosis of clinical hyperandrogenism, setting an ultrasound threshold of antral follicle count to diagnose polycystic ovaries and also diagnosing this condition in adolescence where there is no clear definition for 'irregular cycles'. This article looks at various controversies in the diagnosis of polycystic ovary syndrome.

Maternal polycystic ovarian syndrome in autism spectrum disorder: a systematic review and meta-analysis

There is evidence showing a positive correlation between prenatal androgens and their effect on the development of central nervous system and the autistic spectrum disorder (ASD) phenotype in offspring of mothers with polycystic ovary syndrome (PCOS). We applied a systematic review to investigate whether women with PCOS have increased odds of having a child with ASD, while, secondarily, if these women themselves are at high risk of having the disease. Major databases from inception until 14th October 2018 were searched. The primary outcome measure was the odds of an ASD diagnosis in children of mothers with diagnosed PCOS, while the secondary outcome was the odds of ASD diagnosis in women with PCOS. Scheduled subgroup analyses were according to the time of birth and maternal age. We assessed the odds ratio (OR), using a random-effects model; heterogeneity was assessed by I² and τ² statistics. The quality of the evidence was evaluated using the Newcastle-Ottawa Scale. Ten studies were eligible for inclusion, including a total of 33,887 ASD children and 321,661 non-ASD children. Diagnosed PCOS was associated with a 1.66 times increase in the odds of ASD in the offspring [95% CI: 1.51, 1.83, p = 1.99 × 10^-25, 7 studies, I² = 0%, τ² = 0]. Women with PCOS were 1.78 times more likely to be diagnosed with ASD (95% CI: 1.10, 2.87, p = 0.0179, 5 studies, I² = 85.4%, τ² = 0.2432). Additional analyses did not change the initial result. The overall quality of the evidence was high. The pooled effects size displayed low heterogeneity (I² = 0%) for the primary outcome. While the heterogeneity in the secondary outcome appears to attenuate when only high quality studies are synthesized, still the result exhibits significant heterogeneity. Τhe available data allowed a subgroup analysis only for classification system for PCOS diagnosis and showed a significant increase of ASD diagnosis in the offspring of women with Read Code and ICD diagnosed PCOS. In conclusion, the available evidence suggests that women with PCOS have increased odds of having a child with ASD, an effect size estimate based on a large number of patients from studies of good quality. Regarding the evidence on the prevalence of ASD in PCOS women, results suggest that women with PCOS are more likely to be diagnosed with ASD.

Sonographic evaluation of polycystic ovaries

The morphological features of the ovaries in women with polycystic ovary syndrome (PCOS) have been well described by ultrasound imaging technology. These include enlarged ovary size, multiple small follicles of similar size, increased ovarian stromal volume and echogenicity, peripheral distribution of the follicles, and higher stromal blood flow. Ultrasound identification of the presence of polycystic ovarian morphology (PCOM) has been recognized as a component of PCOS diagnosis. With the advance of ultrasound technology, new definition has been proposed recently. There is, however, a paucity of data for the ovarian morphology in normal and PCOS adolescents. Magnetic resonance imaging has the potential to be an alternative imaging modality for diagnosing PCOM in adolescence.

Rodent models for human polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most frequent female endocrine disorder, affecting 5%-10% of women, causing infertility due to dysfunctional follicular maturation and ovulation, distinctive multicystic ovaries and hyperandrogenism, together with metabolic abnormalities including obesity, hyperinsulinism, an increased risk of type 2 diabetes, and cardiovascular disease. The etiology of PCOS is unclear, and decisive clinical studies are limited by ethical and logistic constraints. Consequently treatment is palliative rather than curative and focuses on symptomatic approaches. Hence, a suitable animal model could provide a valuable means with which to study the pathogenesis of the characteristic reproductive and metabolic abnormalities and thereby identify novel and more effective treatments. So far there is no consensus on the best experimental animal model, which should ideally reproduce the key features associated with human PCOS. The prenatally androgenized rhesus monkey displays many characteristics of the human condition, including hyperandrogenism, anovulation, polycystic ovaries, increased adiposity, and insulin insensitivity. However, the high cost of nonhuman primate studies limits the practical utility of these large-animal models. Rodent models, on the other hand, are inexpensive, provide well-characterized and stable genetic backgrounds readily accessible for targeted genetic manipulation, and shorter reproductive life spans and generation times. Recent rodent models display both reproductive and metabolic disturbances associated with human PCOS. This review aimed to evaluate the rodent models reported to identify the advantages and disadvantages of the distinct rodent models used to investigate this complex endocrine disorder.

The role of intraovarian regulators in the aetiology of polycystic ovarian syndrome

The present review demonstrates that the availability of bioactive FSH and LH in PCOS is normal and that granulosa cells of PCO are not apoptotic and instead hyperexpress functional FSH receptors and may possess intact aromatase activity. Consequently, these cells respond excessively to exogenous FSH stimulation and produce high amounts of oestradiol bothin vivoandin vitro. The altered developmental capacity of follicles from PCOin vivois most likely due to the abnormal follicular milieu of PCO and the culminating effects of intrafollicular inhibitors and stimulators. The failure of ovarian oestradiol production and follicular maturation to dominancein vivomay be due to a mechanism that interferes with the function of FSH, such as intraovarian steroids and growth factors. It has previously been shown that EGF and TGFα have inhibitory actions on follicular development, aromatization and LH receptor formation. In contrast, EGF enhances early follicular recruitment and growth. Therefore, it is hypothesized that EGF/TGFα may have a causal relationship in the mechanisms of anovulatory infertility in women with PCOS. Thus, an aberration in the regulation of follicular fluid EGF and/or TGFα may result in reduced numbers of granulosa cells, cessation of follicle selection and ultimately in the creation and maintenance of PCOS. The exact mechanism by which the hyperfunction of EGF/TGFα occurs and the trigger for this hyperactivity in the ovary remain to be determined. An experimental animal model may be required to assist such investigations in the future.

The role of ovarian volume as a diagnostic criterion for Chinese adolescents with polycystic ovary syndrome

BACKGROUND

This study revisited the ovarian volume (OV) as one of the diagnostic criteria for Chinese adolescents with polycystic ovary syndrome (PCOS). It is unknown whether the threshold of 10 cm(3) for the OV, chosen at the PCOS international consensus in 2003, was optimal for Chinese PCOS adolescents or not.

METHODS

69 adolescent PCOS patients and 26 controls were involved in this study. Ultrasound examination was performed between cycle days 2 and 7 or at random with a 6-MHz transvaginal transducer. Receiver operating characteristic (ROC) curves analysis was mainly used for statistical analysis.

RESULTS

Mean OV and maximum OV were significantly larger in PCOS group than that in controls. The area under the ROC curve was >0.8 for both criteria, indicating a satisfactory diagnostic potency. The two criteria had no statistical difference in diagnostic potency. Setting the threshold of mean OV at 6.74 cm(3) offered the best compromise between specificity (92.3%) and sensitivity (75.4%) and setting the threshold of maximum OV at 7.82 cm(3) offered the best compromise between specificity (88.5%) and sensitivity (73.9%).

CONCLUSIONS

OV yields good diagnostic accuracy to distinguish normal ovaries from polycystic ovaries in Chinese adolescents, but for Chinese PCOS adolescents, the best compromise between sensitivity and specificity was obtained with a threshold set at 6.74 cm(3) for mean ovarian volume and at 7.82 cm(3) for maximum ovarian volume instead of the 10 cm(3) threshold proposed by the Rotterdam consensus conference based on general PCOS patients.

Ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome in Chinese women

OBJECTIVE

To assess the value of ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome (PCOS) in a Chinese population.

METHODS

This study included 432 women with PCOS selected using the National Institutes of Health criteria, who were compared with 153 age-matched women as controls. All participants were given a transvaginal or transrectal ultrasound scan during day 3-5 of the menstrual cycle (for regularly menstruating women) or randomly (for oligomenorrheic or amenorrheic women). The ovarian volume (calculated using the simplified formula: 0.5 x length x height x width) and follicle number were obtained and the best diagnostic cut-off values were evaluated using receiver-operating characteristics (ROC)-curve analysis.

RESULTS

The 10(th) and 90(th) centiles of ovarian volume in PCOS patients were 4.89 and 15.79 cm(3), respectively, and the median was 9.21 cm(3); the 10(th) and 90(th) centiles of follicle number were 8 and 19, respectively, and the median was 12. The 10(th) and 90(th) centiles of ovarian volume in controls were 2.43 and 7.75 cm(3), respectively, and the median was 4.46 cm(3); the 10(th) and 90(th) centiles of follicle number were 3 and 10, respectively, and the median was 6. The differences in ovarian volume and follicle number between patients and controls were statistically significant. The areas under the ROC curves for mean ovarian volume (MOV), maximum ovarian volume (MaxOV), mean follicle number (MFN) and maximum follicle number (MaxFN) to diagnose PCOS were 0.898, 0.882, 0.909 and 0.911, respectively. Setting the threshold for MOV at 6.4 cm(3) (sensitivity 81%, specificity 85.6%), the threshold for MaxOV at 7.9 cm(3) (sensitivity 78%, specificity 85.6%), the threshold for MFN at 10 (sensitivity 85.2%, specificity 88.8%) and the threshold for MaxFN at 12 (sensitivity 85.2%, specificity 92.6%) obtained the best compromise between sensitivity and specificity, based on the Youden index.

CONCLUSIONS

We conclude that ovarian volume and follicle number have satisfactory power for use in the diagnosis of PCOS. Cut-offs of 6.4 cm(3), 7.9 cm(3), 10 and 12, for MOV, MaxOV, MFN and MaxFN, respectively, obtained the best compromise between sensitivity and specificity for the diagnosis of PCOS in Chinese women.

Odd variation of 75 g oral glucose tolerance test results in a Japanese patient with polycystic ovary syndrome: a case report

We report a young woman of normal body weight who was diagnosed with polycystic ovary syndrome (PCOS) and had an odd variation of 75 g oral glucose tolerance test (OGTT). This woman underwent the 75 g OGTT to evaluate the association between PCOS and insulin secretion capacity. Although the blood sugar levels were within normal range before the OGTT load test, we noted an odd variation of insulin response in which a condition of hyperinsulinemia after the load test was followed suddenly by hypoglycemia. Hyperandrogenism in the PCOS patient and insulin resistance indicated by 75 g OGTT suggest that insulin may influence the ovary and that there could be an association between this disease and insulin resistance. The insulinogenic index in this case showed higher than normal values, demonstrating that there was a positive correlation between hyperinsulinemia and insulin resistance. This patient experienced ovulation followed by pregnancy after treatment with an herbal medicine called Shakuyaku-Kanzo-To. We believed that identifying the subset of PCOS woman who is insulin resistant may be useful, as this resistance could be import in terms of follow-up and future exploration.

Ultrasound diagnosis of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome is not associated with subfecundity or subfertility

OBJECTIVE

To evaluate the effect on fertility of the appearance of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome.

DESIGN

Case-control study.

SETTING

Teaching hospitals in Hull, United Kingdom.

PATIENT(S)

Women with the appearance of polycystic ovaries on ultrasound and women with normal ovaries.

INTERVENTION(S)

A questionnaire about previous subfertility, pregnancies, menstrual pattern, features of polycystic ovary syndrome, gynecological history, and individual lifestyle factors.

MAIN OUTCOME MEASURE(S)

Time to pregnancy (TTP) and relative risk (RR) of subfertility in symptomatic and asymptomatic subgroups of both groups.

RESULT(S)

Women with PCOs took longer TTP and were significantly less fertile if they were obese (RR = 2.6), had menstrual disturbances (RR = 4.6), hirsutism (RR = 2.5), and/or acne (RR = 2.7). Further reductions in fecundity occurred with an increasing number of symptoms (threefold, sevenfold, and 10-fold longer TTP with two, three, and four symptoms, respectively). The TTP of women with no symptoms was not significantly longer and they were not more likely to be subfertile than women with normal ovaries. These symptoms were not associated with significantly reduced fecundity in women with normal ovaries.

CONCLUSION(S)

The appearance of polycystic ovaries has been shown to have no significant impact on fertility in women with no symptoms. Appearances alone do not reflect the pathological features of polycystic ovary syndrome, and additional diagnostic criteria should be considered. Obesity, menstrual disturbances, and/or hyperandrogenism are factors associated with subfertility in women with polycystic ovaries.

Influence of missense mutation and silent mutation of LHbeta-subunit gene in Japanese patients with ovulatory disorders

The frequency of variant LHbeta containing two point mutations (T(986)-C and T(1008)-C) and its relationship to reproductive disorders differ widely between ethnic groups. In a Japanese population, variant luteinizing hormone (LH) correlates with ovulatory disorders. Here we examined the relationship between two missense mutations and five silent mutations (C(894)-T, G(1018)-C, C(1036)-A, C(1098)-T and C(1423)-T) in the LHbeta gene, and ovulatory disorders. We studied 43 patients with ovulatory disorders, 79 patients with normal ovulatory cycles, and 23 healthy men who agreed to join our DNA analysis. PCR-amplified LHbeta-subunit gene sequences were compared with a base sequence of wild-type LH reported after direct sequencing. The highest frequency (0.945) of novel allele was observed at the position of the C(1036)-A transition. No homozygotes for wild-type LHbeta (C(1036)) were identified. The frequency of novel allele in patients with polycystic ovary syndrome, endometriosis, premature ovarian failure and luteal insufficiency was significantly different from that of healthy women. The frequencies of novel alleles (C(894)-T, C(1098)-T and C(1423)-T) in patients with ovulatory disorders were significantly higher than those with normal ovulatory cycles. The mean incidence of point mutation in patients with ovulatory disorders was higher than in those with normal ovulatory cycles. Among patients with variant LH, five silent mutations were identified in 87.5% of patients with ovulatory disorders, whereas only a few silent mutations were identified in patients with normal ovulatory cycles. In a Japanese population, five silent mutations of variant LH could have influenced two missense mutations and/or other unknown missense mutations, causing ovulatory disorders.

Polycystic ovary syndrome: a new ultrasonographic and color Doppler pattern

The aim of this study was to evaluate whether patients with partial bilateral polycystic ovaries show different ovarian and uterine blood flow to those with complete bilateral polycystic ovaries, and to investigate whether there is a correlation between ultrasonographic and hormonal parameters. Fifteen patients with partial polycystic ovaries and eighteen patients with complete bilateral polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation. Hormonal (luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessels pulsatility index, ovarian stromal vascularization) parameters were evaluated, in the early follicular phase (cycle day 3-5) in oligomenorrheic patients, or at random in amenorrheic patients. Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in complete bilateral polycystic ovaries. In partial polycystic ovaries, gray-scale and color Doppler ultrasonography showed different features in affected and unaffected areas of the ovary, similar to polycystic and normal ovary appearance respectively. In conclusion, PCOS does not predetermine a single ultrasonographic or Doppler pattern.

Polycystic ovaries in adolescents and the relationship with menstrual cycle patterns, luteinizing hormone, androgens, and insulin

STUDY OBJECTIVE

To evaluate the possible role of inappropriate LH secretion, hyperandrogenism, and hyperinsulinemia in the development of polycystic ovaries (PCO) and the polycystic ovary syndrome.

DESIGN

Observational.

SETTING

General population samples.

PARTICIPANTS

58 adolescents with regular menstrual cycles, 50 with irregular menstrual cycles, and 29 with oligomenorrhea (age 16.7+/-0.9 years).

INTERVENTIONS

Transabdominal pelvic ultrasonography and vena puncture.

MAIN OUTCOME MEASURES

PCO; LH, androstenedione, and testosterone levels; overnight fasting insulin concentrations; and oligomenorrhea.

RESULTS

The prevalence of PCO increased significantly with the irregularity of the menstrual cycle pattern, as illustrated by the study, finding PCO in 9% of the girls with regular menstrual cycles, 28% of those with irregular menstrual cycles, and 45% of oligomenorrheic girls. The LH and androgen concentrations were significantly higher in girls with PCO; the insulin levels and the glucose-insulin ratio did not differ when the girls with PCO were compared with girls with normal ovaries. Oligomenorrheic girls with PCO had the highest androgen and LH concentrations; their insulin concentrations and glucose-insulin ratio were in the same range as girls with regular menstrual cycles and normal ovaries; and both their hip and waist girths were wider, although their waist-hip ratio was normal.

CONCLUSIONS

PCO in adolescents is associated with irregular menstrual cycles, oligomenorrhea, and/or high androgen and LH levels; but no relationship was found with the insulin level or glucose-insulin ratio. Thus, it is doubtful that hyperinsulinemia is an important factor in the development of PCO or polycystic ovary syndrome.

Polycystic ovaries and associated clinical and biochemical features in young women

OBJECTIVE

To determine the prevalence of polycystic ovaries as identified by ultrasound in a group of young, postmenarcheal women in the normal population, and to investigate how polycystic ovaries are related to the spectrum of clinical and biochemical symptoms associated with the polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional observational study.

SUBJECTS AND METHODS

Volunteers were recruited from two universities and two general practice surgeries in Oxford. 230 women aged 18-25 years participated. Information collected and measurements performed included: a menstrual history, anthropometric measurements, clinical observation of acne and hirsutism, transabdominal pelvic ultrasound, and biochemical analysis of a fasting blood sample.

MAIN OUTCOME MEASURES

Prevalence of polycystic ovaries and their association with symptoms of the polycystic ovary syndrome.

RESULTS

Polycystic ovarian morphology was identified in 74 (33%, 95% CI = 27-39%) of the 224 women who attended for an ultrasound scan. In the non-users of hormonal contraception, irregular menstrual cycles were 20% more common in women with polycystic ovaries than in women with normal ovaries (P = 0.07). There were no significant differences in acne, hirsutism, body mass index or body fat percentage between women with polycystic and normal ovaries. Analysis of biochemical data showed that women with polycystic ovaries had higher total serum testosterone concentrations (P = 0.03). The prevalence of PCOS in this age group was as low as 8% or as high as 26% depending on which criteria were applied to define the syndrome. Sub-group analyses of women according to ovarian morphology and features of PCOS revealed greater mean BMI in women with PCOS, and also indicated lower fasting insulin concentrations and greater insulin sensitivity in polycystic ovary and PCOS groups when compared to women with normal ovaries.

CONCLUSIONS

Polycystic ovaries are very common in this age group but are not necessarily associated with other symptomatology. The prevalence of polycystic ovary syndrome varies widely according to the definition applied. Sub-group analysis of women with polycystic ovaries according to the presence or absence of features of polycystic ovary syndrome does not reveal an increasing trend for progression of endocrine abnormalities usually associated with polycystic ovary syndrome.

Increased prevalence of luteinizing hormone beta-subunit variant in patients with premature ovarian failure

OBJECTIVE

To evaluate the significance of an LH variant with a mutant beta-subunit (Trp8 to Arg8 and Ile15 to Thr15) in gynecologic disease, including infertility.

DESIGN

Clinical study.

SETTING

Department of Obstetrics and Gynecology, Shimane Medical University Hospital, Izumo, Japan.

PATIENT(S)

Two hundred forty-five Japanese women with endocrine disorders and/or gynecologic disease and 153 healthy, nonpregnant, fertile Japanese women.

INTERVENTION(S)

A blood sample was collected.

MAIN OUTCOME MEASURE(S)

The ratio of LH values from the SPAC-S and Immulyze assays (LH ratio: SPAC-S LH/Immulyze LH) was used to determine variant (< or =0.5) or wild-type (>0.5) LH status according to a demonstrated relation between the ratio and the sequence of the LH beta-subunit gene.

RESULT(S)

The LH ratio was lower (0.80+/-0.31) in the 245 patients than in the controls (1.00+/-0.38), and the variant was more frequent in the patients (18.4%) than in the controls (8.5%). We found no difference in the frequency of the variant between infertile and fertile patients. The prevalence of infertility did not differ between patients with variant LH and patients with normal LH. Ovulatory disorders, hyperprolactinemia, premature ovarian failure, menstrual disorders, and luteal insufficiency were significantly more frequent in patients with the variant.

CONCLUSION(S)

Variant LH may contribute to female reproductive disorders, including infertility and premature ovarian failure.

The use of gonadotrophin-releasing hormone antagonists in polycystic ovarian disease

Polycystic ovarian disease (PCOD) is characterized by anovulation, eventually high luteinizing hormone (LH) levels, with increased LH pulse frequency, and hyperandrogenism. As the aetiology of the disease is still unknown, gonadotrophin-releasing hormone (GnRH) antagonists, competitive inhibitors of GnRH for its receptor, are interesting tools in order to study and treat the role of increased LH levels and pulse frequency in this disease. Their administration provokes a rapid decrease in bioactive and immunoactive LH followed by a slower decrease in follicle-stimulating hormone (FSH). In patients with PCOD, the suppression of gonadotrophin secretion eradicates the symptoms of the disease as long as the treatment lasts. Several authors have suggested that increased plasma LH levels have deleterious effects on the fertility of women with PCOD. Indeed, fewer spontaneous pregnancies with more miscarriages are observed when plasma LH levels are high. Assisted reproduction techniques such as in vitro fertilization (IVF) have provided other clues to the role of the LH secretory pattern in women with PCOD. The number of oocytes retrieved, the fertilization rate and the cleavage rate are lower in PCOD patients undergoing IVF and this is inversely correlated with FSH:LH ratio. These abnormalities are corrected when endogenous secretion of LH is suppressed. On the other hand, implantation and pregnancy rates after IVF are similar to those observed in control women. New GnRH antagonists are devoid of side effects and suppress LH secretion within a few hours without a flare-up effect. This action lasts for 10-100 hours. When GnRH antagonists are associated with i.v. pulsatile GnRH, this combination both suppresses the effect of endogenous GnRH and because of the competition for GnRH receptors restores a normal frequency of LH secretion. We have studied two women with PCOD, administering first 10 mg s.c. every 72 hours for 7 days of the GnRH antagonist Nal-Glu, then adding on top i.v. pulsatile GnRH: 10 micrograms/pulse every 90 minutes for 15 days. We thus succeeded in normalizing LH secretion pattern and observed a significant decline in testosterone levels. We failed to induce appropriate ovarian response and ovulation. In conclusion, the combination of GnRH antagonist and GnRH pulsatile treatment can re-establish normal LH secretory pattern in patients with PCOD. The failure to induce ovulation with this regimen suggests the existence of an inherent ovarian defect in women with PCOD.

Color Doppler analysis in oligo- and amenorrheic women with polycystic ovary syndrome

The objective of this study was to determine whether amenorrheic women have more severe blood flow variations and clinical-endocrinological patterns in comparison with oligomenorrheic polycystic ovary syndrome (PCOS) patients. Twenty oligomenorrheic women (cycle length > 35 days; Group I), and 20 amenorrheic women (no vaginal bleeding for at least 6 months; Group II) were submitted to ultrasonographic evaluation of ovarian volume, follicle distribution, number and diameter, color Doppler analysis of uterine and intraovarian blood flow, hormonal assay of different compartments, and plasma evaluation of lipid profile. The number of subcapsular small-sized follicles, and the ovarian volume, androstenedione and luteinizing hormone (LH) plasma levels, and the LH/follicle-stimulating hormone (FSH) ratio were significantly higher in the amenorrheic group compared with the oligomenorrheic patients. Furthermore, significantly lower high-density lipoprotein (HDL) and HDL/total cholesterol ratio were observed in Group II compared with Group I. In addition, in Group II, higher resistance in the uterine arteries and lower impedance to blood flow in the intraovarian arteries have been shown. The assessment of ovarian morphology by transvaginal ultrasound and Doppler flow analysis of both intraovarian and uterine arteries in patients with PCOS may provide an insight into the pathological state and the degree of progression of the disease.

The significance of high follicular-phase luteinizing hormone levels in the treatment of women with polycystic ovarian syndrome by in vitro fertilization

It seems, therefore, that in PCOS patients stimulated for IVF with HMG, follicular-phase LH levels have an adverse effect on follicle and oocyte numbers as well as on oocyte quality. Moreover, an inappropriately raised LH appears to have a deleterious effect on the pregnancy outcome by being associated with a greater possibility for miscarriage. On the other hand, the administration of GnRH-a in the long desensitization protocol seems to reverse the detrimental effect of increased LH concentrations on follicular and oocyte development, whereas the beneficial effect on oocyte maturity, although significant, appears to be less profound. Furthermore, GnRH-a administration is associated with a decreased risk for early abortion.

Ultrasound diagnosis of polycystic ovary syndrome

The US diagnostic criteria of the PCO have been refined with each successive advance in US technology. Diagnostic accuracy has evolved from a mere appreciation of overall ovarian size to the recognition of characteristic follicular patterns of distribution and subtle textural changes in the ovarian stroma. The most consistent features are the presence of multiple small follicles arranged around, or scattered through, a dense echogenic ovarian stroma, although recognition of the latter is highly subjective. Sophisticated innovations such as 3D US, together with colour and pulsed Doppler US, should improve the objectivity of observations and allow quantitative analysis of the ovarian stroma, which is known to be the source of the characteristic hyperandrogenaemia in PCOS. Valid comparative studies of women with normal and polycystic ovaries should now be feasible and will hopefully bring us closer to understanding the pathogenesis of this fascinating condition.

Optimal use of hormone determinations in the biochemical diagnosis of the polycystic ovary syndrome

OBJECTIVE

To investigate, using logistic regression analysis and receiver operator characteristic analysis, the biochemical diagnosis of polycystic ovary syndrome (PCOS) and if it could be improved by using an array of hormone measurements chosen to yield optimal and cost-effective discrimination between women with PCOS and healthy women.

DESIGN

Retrospective clinical study.

SETTING

Outpatient clinic of reproductive endocrinology at Turku University Central Hospital, Turku, Finland.

PATIENTS

Fifty-four oligomenorrheic women with PCOS diagnosed by ovarian ultrasonography, and 29 healthy regularly menstruating women with normal ovarian morphology.

MAIN OUTCOME MEASURES

Concentrations of LH, FSH, androstenedione (A), T, and sex hormone-binding globulin in serum.

RESULTS

Luteinizing hormone, FSH and A, when used in combination, were the hormonal analytes of highest clinical utility. Diagnostic sensitivity, specificity, and overall concordance of 98%, 93%, and 96%, respectively, were attained. Each of the analytes used alone yielded lower degree of discrimination.

CONCLUSIONS

Simultaneous use of the levels of LH, FSH, and A in serum can be used effectively for classification between women with PCOS and healthy women.