ABSTRACT
Introduction@#PCOS prevalence is 5-10 percent among reproductive age women in worldwide. It is caused by imbalance of sex hormones which ultimately leads to menstrual irregularities, infertility, anovulation and other metabolic disturbances. Most women with chronic anovulation is caused by polycystic ovary syndrome [PCOS] The Rotterdam criteria is useful diagnostic tool for PCOS. In Mongolia there is almost no study on PCOS related infertility and there are increasing trend infertility among reproductive aged women with PCOS, lead us to conduct the study. @*Objective@#The aim of this study was to estimate incidence of PCOS and to study clinical and biochemical characteristics of PCOS among infertility women.@*Material and Methods@#We used the cross-sectional and case control study designs. Total 1334 infertility women enrolled in this study. The study was conducted after approval from the Ethical and research review board of the hospital, and written informed consent was taken from all the women. Among 114 women with PCOS were found by Rotterdam’s criteria at the Infertility and reproductive department, National Center for Maternal and Child Health, between December, 2018 - 2019. Total of 43 females with PCOS were screened among 1334 infertile women. All parameters were assessed either with ELISA in 43 infertile PCOS women and 17 age matched apparently healthy controls diagnosed according to Rotterdam consensus. IDF diagnostic criteria for MS was used. The PCOS patients divided into following groups: (1) with MS ( n=42) and (2) without MS (n=72).@*Results@#The main age, body mass index (BMI), and duration of infertility were 28.7±4.1 years, 27.3±5.2 kg/ m² and 4.4±3.1y, respectively. Among patients 57.9% of them have oligomenorrhea, 22.8% with amenorrhea, primary infertility 57.0% and 51.9% with hirsutism and acne 50.8%. As a result of hormone assays were LH 9.3±3.5mIU/ml, LH/FSH 1.6 ±0.83 [0.1-3.6], AMH 6.1ng/ml ±3.6 /2.9-21.0/. The prevalence of MS was 36.8%. The variables including age (30.9±4.9), body mass (75.9±11.6kg) and also some metabolic parameters which is hypertension (133.6/88.4±13.6 mm Hg), WC (94.1±8.6 cm) and high triglyceride (1.8±1.0 mmol/l) were observed in MS group compared to without MS group.@*Conclusion@#Among 1334 women with infertility, the incidence of PCOS 8.7% (116), close to the prevalence in other countries. Considering the diagnose was confirmed of three criteria by the Rotterdam criteria. We found out that the prevalence of metabolic syndrome was 35.3% among infertility women with PCOS. Age, BMI, WC, amenorrhea, acne and acanthosis nigricans, were highly related to metabolic syndrome.
ABSTRACT
Background@#Endometriosis is a condition in which cells in the endometrium, layer of tissue normally covers uterine cavity, which grows outside to ovaries and other pelvic organs [1-4]. That may happen chronic pelvic pain, adhesion and pelvic organs dysfunction which leads to infertility later life [1-4]. In worldwide, 19-45 aged women have endometriosis, which is counted for 176 million, from 44% women have ovarian endometrioma [5]. In our country, 56% women received laparoscopic surgery due to ovarian cysts, which is diagnosed endometrioma. In recent years, ovarian endometriosis treated by synthetic progestin, gonadotropin analogues, combined contraceptive pills, intra-uterine device containing with progestin, and non-steroid anti-inflammatory drugs and laparoscopic surgeries [6, 7]. Serum antimullerian hormone (AMH) is key marker to define ovarian reserve, which correlates ovarian number of antral follicle counts [6, 7].@*Material and Methods@#We studied 129 patients who has diagnosed with ovarian endometrioma, aged 20-46 years, using case-control study design. There are 4 groups with medication and surgeries. </br> Approval for the study was obtained from the review board and the ethics committee of MNUMS. All the recruited patients provided their informed written consents. @*Results@#When treatment groups were compared, level of AMH before synthetic progestin therapy was 3.48±0.9 and after it 3.41±1.0 (p-0.456), and that was before non-steroid anti-inflammatory drugs 3.68±0.8 and after it 3.11±0.8 ng/ml (p-0.212). Before laparoscopic surgeries for severe endometrioma, average level of AMH was 2.3±1.8ng/ml for synthetic progestin therapy group and it was 1.68±0.2ng/ml (p-0.007) after surgical peeling of endometrioma. For patients of 4th group who had not taking oral synthetic progestin before laparoscopic surgeries average level of AMH was 3.11±1.88 ng/ml before surgery and it became 2.21±0.28 ng/ml (p-0.005). Level of СА-125 marker was before medical therapy for group 1 was 37,9±5,25 IU/ml and after therapy - 20,6±2,03 IU/ml. For group 2 it was 69,9±9,79IU/ml and 35.1±6.76 IU/ml respectively. Average level for group 4 before surgical treatment it was 96.6±36.6 IU/ml, and after surgery became 25.71±2.96 IU/ml, and that for group 3 was before surgery 102±29.1 IU/ml and decreased after surgery to 29.2±4.15 IU/ml.</br> There are significant reduction of pain in patients who received synthetic progestin (p=0.001) groups. Serum AMH were 3.48±0.9 before treatment and 3.41±1.0 after treatment respectively (p=0.456). Prior treatment of laparoscopic surgery with progestin 3 months, it decreases abdominal lower pain (p=0.001) and dysmenorrhea (p=0.001). Serum AMH level were 3.11±1.8 before surgery and 2.21±0.2 after surgery,respectively, (p=0.005).@*Conclusion@#</br> 1. There were little decrease in level of antimullerian hormone and less risk for ovarian reserve when mild endometrioma was treated with synthetic progestin and non-steroid anti-inflammatory drugs in two groups. </br> When severe and middle degree of endometrioma was treated with laparoscopic surgery there were significant decrease of antimullerian hormone, but it was less in group that had synthetic progestin therapy before surgery and it was more effective that surgical therapy without preparation. </br> 2. Comparison of Serum level of СА-125, marker of ovarian tumor, was decreased less in group of non-steroid anti-inflammatory drugs, and was decreased more or it was more effective.