1
|
Romualdi D, Versace V, Tagliaferri V, De Cicco S, Immediata V, Apa R, Guido M, Lanzone A. The resting metabolic rate in women with polycystic ovary syndrome and its relation to the hormonal milieu, insulin metabolism, and body fat distribution: a cohort study. J Endocrinol Invest 2019; 42:1089-1097. [PMID: 30847861 DOI: 10.1007/s40618-019-01029-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/25/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate possible alterations of a major determinant of energy expenditure, the resting metabolic rate (RMR), in women with polycystic ovary syndrome (PCOS) compared with age-BMI similar controls. To assess whether the hormonal milieu, the body fat distribution and the insulin metabolism may affect energy consumption in these patients. METHODS This is a monocentric observational prospective cohort study, including 109 Caucasian PCOS subjects and 31 healthy control women. (Median age PCOS 26.0 ± 9.2 years, controls 25.5 ± 8.5 years; median BMI-body mass index PCOS 26.4 ± 9.4 kg/m2, controls 27.2 ± 12.8 kg/m2). RMR was evaluated by the SenseWear Armband (SWA), a reliable and validated metabolic holter, never previously used in the PCOS population to this purpose. Hormonal assessment, insulin metabolism evaluated by HOMA-IR and OGTT, anthropometric features (BMI and WHR) were also assessed. RESULTS Median RMR resulted similar in PCOS and control women: 1520.0 ± 248.00 kcal/day vs 1464.0 ± 332.70 kcal/day (p = 0.472), even after adjusting for BMI, fat distribution, insulin metabolism parameters. RMR resulted significantly correlated with BMI, WHR, estradiol levels, SHBG, total cholesterol, triglycerides, basal glycaemia, basal insulinemia, AUC insulin 240', and HOMA. In the subgroup of patients with WHR > 0.85, PCOS women showed a significantly lower RMR compared with controls. CONCLUSIONS The higher prevalence of obesity, which negatively influences the reproductive and general health of PCOS women, could be related to factors other than an intrinsic alteration of the RMR. Further studies are needed to clarify the possible role of the visceral fat in modulating the energy balance in PCOS. TRIAL REGISTRATION NUMBER clinicaltrials.gov Identifier NCT03132545.
Collapse
Affiliation(s)
- D Romualdi
- Department Of Woman And Child Health And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Department Of Woman And Child Health, Division of Obstetrics and Gynecology, Azienda Ospedaliera "Cardinale Panico", 73039, Tricase, Italy.
| | - V Versace
- Department Of Woman And Child Health And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - V Tagliaferri
- Department of Obstetrics and Gynaecology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", 70021, Acquaviva delle Fonti, Italy
| | - S De Cicco
- Department Of Woman And Child Health And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - V Immediata
- Department Of Woman And Child Health And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - R Apa
- Department Of Woman And Child Health And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - M Guido
- Department of Obstetrics and Gynaecology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", 70021, Acquaviva delle Fonti, Italy
| | - A Lanzone
- Department Of Woman And Child Health And Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| |
Collapse
|
2
|
Hafez M, Musa N, Elbehairy S, Atty SA, Elbarbary M, Amin M. Effect of metformin on clinical and biochemical hyperandrogenism in adolescent girls with type 1 diabetes. J Pediatr Endocrinol Metab 2019; 32:461-470. [PMID: 31005950 DOI: 10.1515/jpem-2018-0430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/07/2019] [Indexed: 12/31/2022]
Abstract
Background Hyperandrogenism with or without polycystic ovarian syndrome is seen in adolescents with type 1 diabetes (T1D), especially those with suboptimal control. Objective To assess the effect of metformin on hyperandrogenism and ovarian function in adolescents with T1D. Methods This prospective study included 28 T1D females showing signs of hyperandrogenism. History taking (detailed diabetes history and menstrual history) and anthropometric measurements (weight, height, body mass index [BMI], waist and hip circumference) were initially performed, and then the patients were assessed for the manifestations of hyperandrogenism (acne, hirsutism as well as pelvic ultrasound [U/S] for ovarian morphology). Biochemical evaluation for ovulation (progesterone assessment during the luteal phase), sex steroids (estradiol, testosterone, dehydroepiandrosterone sulfate [DHEAS] and androstenedione), prolactin, glycemic control (hemoglobin A1c [HbA1c]) and gonadotropin levels (follicle stimulating hormone [FSH] and luteinizing hormone [LH]) was done. Patients were subjected to 500 mg metformin twice daily orally for 1 year, and then the patients were re-evaluated for clinical and biochemical parameters. Results Metformin therapy resulted in a significant reduction in weight (p = 0.001), BMI (p = 0.002), acne (p = 0.008), hirsutism score (0.007), LH (p = 0.008), testosterone (p < 0.001) and androstenedione levels (p = 0.028) in adolescent girls with T1D. Regarding menstrual irregularities, there was a significant reduction in the number of patients with oligomenorrhea (68%) with a p value of <0.001. However, there were no significant reduction in the daily insulin requirements (p = 0.782) or HbA1c (p = 0.068). Nausea and/or abdominal pain were the commonly reported side effects of metformin (64%). Conclusions Metformin as an insulin sensitizing agent improved the BMI and cycle regularity together with clinical and biochemical hyperandrogenism in T1D adolescent girls. However, it did not improve their glycemic control.
Collapse
Affiliation(s)
- Mona Hafez
- Department of Pediatric Endocrinology, DEMPU, Cairo University, Cairo, Egypt
| | - Noha Musa
- Assistant Professor of Pediatric Endocrinology, Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University,Cairo 12111, Egypt, Phone: +2 01225304041
| | - Shaimaa Elbehairy
- Department of Pediatric Endocrinology, DEMPU, Cairo University, Cairo, Egypt
| | - Sahar Abdel Atty
- Department of Chemical Pathology, DEMPU, Cairo University, Cairo, Egypt
| | - Menna Elbarbary
- Pediatric Ultrasonography Unit, Children Hospital, Cairo University, Cairo, Egypt
| | - Maha Amin
- Department of Pediatric Endocrinology, DEMPU, Cairo University, Cairo, Egypt
| |
Collapse
|
3
|
Dzykryanka SM, Yulistani Y, Santoso B. ANALYSIS OF HOMA-IR, FOLLICLE SIZE, AND ESTRADIOL AFTER COMBINATION THERAPY OF METFORMIN AND CLOMIPHENE CITRATE IN POLYCYSTIC OVARY SYNDROME’S PATIENT. FOLIA MEDICA INDONESIANA 2016. [DOI: 10.20473/fmi.v51i3.2828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PCOS is an ovarian dysfunction syndrome which characterized by the present of unovulation, hyperandrogenism, and polycystic ovarian morphology. The main cause of PCOS is still unclear, but many studies report that genetic factor have a great role. There are also two big concept in PCOS, hyperandrogenism and insulin resistance. Previous research by Ayaz et al (2013) has shown that metformin was given if there has been a resistance of clomiphene citrate. This study was designed to provide metformin and clomiphene citrate combination from the early administration to determine the effectiveness of the combination therapy. The objective of this study is to analyze HOMA-IR value, follicle size, and estradiol concentration after metformin and clomiphene citrate treatment in PCOS patient. Design of this study was an observational longitudinal prospective method. There was only a group with a total sample size 19 women of productive age (18-40 years) diagnosed with PCOS. The pre and post combination therapy was observed for ten weeks. Metformin 500 mg three times daily for ten weeks and clomiphene citrate 100 mg in 3rd day until 7th day of menstruation for two cycles were given to the subjects. The result showed that HOMA-IR value decrease after 10 weeks in which value before therapy was 4.9 ± 2.4 and after therapy 3.7 ± 2.2 with the achievement 21.1% HOMA-IR under 2.5. Estradiol concentration after therapy also decreased from 64.8 ± 24.7 pg/ml to 37.9 ± 17.9 pg/ml in ten weeks this concentration remained the range of the follicular phase estradiol levels. On the other hand, follicle size increased from 4.7 ± 0.6 mm to 10.7 ± 2.2 mm after combination therapy of metformin and clomiphene citrate with the occurrence of ovulation 31.6% but none of the samples were successfully pregnant. It is concluded that women with PCOS, declined HOMA-IR, estradiol, and increased follicle size was associated with a good response to combination therapy of metformin and clomiphene citrate.
Collapse
|
4
|
Venturella R, Lico D, Borelli M, Imbrogno MG, Cevenini G, Zupi E, Zullo F, Morelli M. 3 to 5 Years Later: Long-term Effects of Prophylactic Bilateral Salpingectomy on Ovarian Function. J Minim Invasive Gynecol 2016; 24:145-150. [PMID: 27621194 DOI: 10.1016/j.jmig.2016.08.833] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/05/2016] [Accepted: 08/31/2016] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Preliminary data on the effects of prophylactic bilateral salpingectomy (PBS) show that postoperative ovarian function is preserved up to 3 months after surgery. The confirmation of PBS safety on ovarian function even many years after surgery is essential to reassure the medical community that this new strategy, recently proposed for the prevention of ovarian cancer, is at least able to avoid the risk of premature surgical menopause. We investigated whether the addition of PBS during total laparoscopic hysterectomy (TLH) causes long-term effects on ovarian function. DESIGN An observational study (Canadian Task Force classification II-3). SETTING Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy. PATIENTS Seventy-nine patients who underwent TLH plus salpingectomy between September 2010 and September 2012 at our institution have been recalled to be submitted to ovarian reserve evaluation in February 2015. Eight of 79 women refused to participate in this follow-up study. INTERVENTIONS The ovarian age of PBS patients has been determined through OvAge (OvAge sr., Catanzaro, Italy), a statistical model that combines antimüllerian hormone, follicle-stimulating hormone, 3-dimensional antral follicle count, vascular index, flow index, and vascular flow index values. The control group consisted of a large population of 652 healthy women (with intact uterus and adnexa) previously enrolled to build the OvAge model. Comparisons between ovarian ages of PBS patients and the control group have been assessed by analysis of covariance linear statistical modeling. MEASUREMENTS AND MAIN RESULTS The main outcome measurement was the differences in the behavior within OvAge/age relation between PBS and control women. Descriptive statistics of those 71 enrolled PBS patients are the following: age, 49.61 ± 2.15 years; OvAge, 49.22 ± 2.57 years; follicle-stimulating hormone, 43.02 ± 19.92 mU/mL; antimüllerian hormone, 0.12 ± 0.20 ng/mL; 3-dimensional antral follicle count, 1.91 ± 1.28; vascular index, 2.80% ± 5.32%; flow index, 19.37 ± 5.88; and vascular flow index, 0.56 ± 1.12. Analysis of covariance disclosed that PBS and control women do not exhibit different behaviors (p = .900) within OvAge/age relation. CONCLUSION According to our model, the addition of PBS to TLH in the late reproductive years does not modify the ovarian age of treated women up to 3 to 5 years after surgery.
Collapse
Affiliation(s)
- Roberta Venturella
- Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy.
| | - Daniela Lico
- Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy
| | - Massimo Borelli
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Maria G Imbrogno
- Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy
| | - Gabriele Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata", Rome, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynecology, "Magna Graecia" University, Catanzaro, Italy
| |
Collapse
|
5
|
Palomba S, Falbo A, Valli B, Morini D, Villani MT, Nicoli A, La Sala GB. Physical activity before IVF and ICSI cycles in infertile obese women: an observational cohort study. Reprod Biomed Online 2014; 29:72-9. [DOI: 10.1016/j.rbmo.2014.03.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
|
6
|
Palomba S, Falbo A, La Sala GB. Metformin and gonadotropins for ovulation induction in patients with polycystic ovary syndrome: a systematic review with meta-analysis of randomized controlled trials. Reprod Biol Endocrinol 2014; 12:3. [PMID: 24387273 PMCID: PMC3895676 DOI: 10.1186/1477-7827-12-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/18/2013] [Indexed: 11/10/2022] Open
Abstract
The current systematic review with meta-analysis of randomized controlled trials (RCTs) was aimed to evaluate the effects of metformin on reproductive outcomes in patients with polycystic ovary syndrome (PCOS) who receive gonadotropins for ovulation induction. After systematic review of electronic databases and websites for registration of RCTs, a total of 7 RCTs reporting data on 1023 cycles were included in the final analysis. Descriptive data showed an overall low studies' quality due to unclear sequence generation and allocation concealment, lack of blinding procedure, incomplete outcome data and several biases and/or confounders. Data synthesis showed that metformin improved live-birth (odds ratio [OR] = 1.94, 95% confidence interval [CI] 1.10 to 3.44; P = 0.020) and pregnancy (OR = 2.25, 95% CI 1.50 to 3.38; P < 0.0001) rates, without significant heterogeneity across the studies (P = 0.230, estimation of inconsistency = 30%; and P = 0.710, estimation of inconsistency = 0%, respectively, for live-birth and pregnancy rates). A significant reduction of cancellation rate was observed after metformin administration (OR = 0.41, 95% CI 0.24 to 0.72, P = 0.002) without significant heterogeneity across the studies (P = 0.500, estimation of inconsistency = 0%). Metformin administration influenced or did not influence other secondary endpoints assessed with a significant heterogeneity. In conclusion, metformin administration increases the live-birth and pregnancy rate in PCOS patients who receive gonadotropins for ovulation induction. Further well designed, blinded, placebo-controlled, and adequately powered RCTs are need to confirm that metanalytic results.
Collapse
Affiliation(s)
- Stefano Palomba
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Angela Falbo
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Giovanni B La Sala
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Via Università 4, 41100 Modena, Italy
| |
Collapse
|
7
|
Roland AV, Moenter SM. Prenatal androgenization of female mice programs an increase in firing activity of gonadotropin-releasing hormone (GnRH) neurons that is reversed by metformin treatment in adulthood. Endocrinology 2011; 152:618-28. [PMID: 21159854 PMCID: PMC3037157 DOI: 10.1210/en.2010-0823] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Prenatal androgenization (PNA) of female mice with dihydrotestosterone programs reproductive dysfunction in adulthood, characterized by elevated luteinizing hormone levels, irregular estrous cycles, and central abnormalities. Here, we evaluated activity of GnRH neurons from PNA mice and the effects of in vivo treatment with metformin, an activator of AMP-activated protein kinase (AMPK) that is commonly used to treat the fertility disorder polycystic ovary syndrome. Estrous cycles were monitored in PNA and control mice before and after metformin administration. Before metformin, cycles were longer in PNA mice and percent time in estrus lower; metformin normalized cycles in PNA mice. Extracellular recordings were used to monitor GnRH neuron firing activity in brain slices from diestrous mice. Firing rate was higher and quiescence lower in GnRH neurons from PNA mice, demonstrating increased GnRH neuron activity. Metformin treatment of PNA mice restored firing activity and LH to control levels. To assess whether AMPK activation contributed to the metformin-induced reduction in GnRH neuron activity, the AMPK antagonist compound C was acutely applied to cells. Compound C stimulated cells from metformin-treated, but not untreated, mice, suggesting that AMPK was activated in GnRH neurons, or afferent neurons, in the former group. GnRH neurons from metformin-treated mice also showed a reduced inhibitory response to low glucose. These studies indicate that PNA causes enhanced firing activity of GnRH neurons and elevated LH that are reversible by metformin, raising the possibility that central AMPK activation by metformin may play a role in its restoration of reproductive cycles in polycystic ovary syndrome.
Collapse
Affiliation(s)
- Alison V Roland
- Department of Medicine and Cell Biology, University of Virginia, Charlottesville, Virginia 22908, USA
| | | |
Collapse
|
8
|
Falbo A, Rocca M, Russo T, D'Ettore A, Tolino A, Zullo F, Orio F, Palomba S. Serum and follicular anti-Mullerian hormone levels in women with polycystic ovary syndrome (PCOS) under metformin. J Ovarian Res 2010; 3:16. [PMID: 20663178 PMCID: PMC2912910 DOI: 10.1186/1757-2215-3-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/21/2010] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND No data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature. The aim of the present study was to evaluate in patients with polycystic ovary syndrome (PCOS) whether metformin administration affects serum and follicular AMH levels, and whether this is related to ovarian response to the treatment. METHODS Twenty young patients with PCOS who had received metformin were enrolled. Ten patients were anovulatory (Met-anov group), whereas the other 10 were ovulatory (Met-ov group) but had failed to conceive. Further untreated PCOS (PCOS controls, n. 10) and healthy controls (non-PCOS controls, n. 10) who were scheduled for laparoscopic surgery were enrolled. In each subjects, clinical and biochemical evaluations were performed. AMH concentrations in blood and antral follicular fluid were assayed. RESULTS In both Met-anov and Met-ov groups, and without difference between them, serum androgens and AMH, and indices of insulin resistance were significantly (p < 0.05) improved after treatment. On the other hand, significant differences (p < 0.05) between the two groups were detected with respect to the same biochemical parameters in antral follicular fluid. In the Met-anov group, no significant correlation was observed between AMH concentrations in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes; whereas in Met-ov group significant correlations were detected between AMH levels in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes. CONCLUSIONS Metformin administration in patients with PCOS exerts a differential action on the ovarian AMH levels on the basis of ovulatory response. Changes in AMH levels in antral follicular fluid during metformin treatment could be involved in the local mechanisms mediating the ovulatory restoration.
Collapse
Affiliation(s)
- Angela Falbo
- Department of Obstetrics & Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Lujan ME, Brooks ED, Kepley AL, Chizen DR, Pierson RA, Peppin AK. Grid analysis improves reliability in follicle counts made by ultrasonography in women with polycystic ovary syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:712-718. [PMID: 20381953 PMCID: PMC2893214 DOI: 10.1016/j.ultrasmedbio.2010.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/19/2010] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
Poor reliability has been reported when counting the total number of follicles in polycystic ovaries using conventional two-dimensional (2-D) ultrasound viewing methods. In the current study, we report good reliability in follicle counts when observers imposed a programmable grid system over the viewing window. Four observers estimated total follicle counts in 45 ovarian ultrasound scans by compartmentalizing the ovary into 9 to 12 grid sections and performing focused follicle counts per section. The mean number of follicles counted per ovary was 44.6 +/- 2.3. The level of inter-observer agreement when making follicle counts was 0.82 and total follicle counts did not differ among observers. The level of intra-observer agreement was 0.93 which further corroborated the utility of this method for making dependable follicle counts. In summary, the ability to obtain reproducible follicle counts will help to establish reliable diagnostic criteria for polycystic ovarian morphology.
Collapse
Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York 14853, USA.
| | | | | | | | | | | |
Collapse
|