Evaluation of the impacts of insulin on ovulation in Nigerian women with polycystic ovarian syndrome: a cross-sectional sonographic study

Background:Insulin resistance (IR) is a metabolic state characterized by a decrease in cellular ability to respond to insulin signaling, which contribute to pathophysiological mechanism in the development of all metabolic complication of polycystic ovary syndrome (PCOS). The aim of thestudy wasto match categorized values of patient’s biochemical predisposing factors for polycystic ovaries such as insulin with change in follicular sizes as determined by sonography following CLOMID inducement therapy. Methods:This experimental study was carried out in Anambra State, Nigeria from June 2018 to May 2021.Those included in the study were women of child bearing age (18 to 45 years) for both groups. The ultrasound examinations and insulin levels measurements were performed on each subject and data such as follicular sizes, insulin levels before and after treatment were recorded. Obtained data were analyzed using both descriptive and inferential statistical tools. Results:There were no statistically significant mean differences in the insulin levels (t=1.16, p=0.81) and maximal follicular size (t=0.39, p=0.70) of women with and without polycystic ovary who had successful and failed ovulation before the clomid treatment. Both the insulin level (t=2.85, p<0.01) and follicular size (t=4.88, p<0.01) showed statistically significant mean differences. There was significant difference in insulin (F=7.55, p<0.01), with the control having the lowest insulin concentration. Conclusions: There were statistically significant mean differences in the insulin level and follicular size in women with polycystic ovary after clomid treatment. Therefore, clomiphene citrate inducement triggers increase in serum concentration of insulin.

Polycystic Ovary Syndrome and Metabolic Syndrome: Clinical and Laboratory Findings and Non-Alcoholic Fatty Liver Disease Assessed by Elastography / Síndrome dos ovários policísticos e síndrome metabólica: Achados clínicos e laboratoriais e doença hepática gordurosa não alcoólica avaliada por elastografia

Abstract Objective To evaluate the association between polycystic ovary syndrome (PCOS) and metabolic syndrome (MetS), adding liver assessment through elastography and ultrasound, for correlation with non-alcoholic fatty liver disease (NAFLD). Metabolic syndrome occurs in~43% of women with PCOS, and NAFLD is the hepatic expression of MetS. Methods One hundred women, 50 with PCOS and 50 controls, matched by age (18- 35 years) and body mass index (BMI) were included, restricted to patients with overweight and obesity grade 1, at the Assis Chateaubrian Maternity School, Universidade Federal do Ceará, Brazil. For the diagnosis of PCOS, we adopted the Rotterdam criteria, and for the diagnosis of MetS, the criteria of the National Cholesterol Education Program (NCEP/ATP III). Hepatic elastography and ultrasound were performed to assess liver stiffness and echotexture, respectively. Results The average ages were 29.1 (±5.3) and 30.54 (±4.39) years, for the PCOS and the control group, respectively. Patients with PCOS had a risk 4 times higher of having MetS, odds ratio (95% confidence interval)=4.14, than those in the control group. Women with PCOS had higher average of abdominal circumference (100.9±9.08 cm vs 94.96±6.99 cm) and triglycerides (162±54.63 mg/dL vs 137.54±36.91mg/dL) and lower average of HDL cholesterol (45.66±6.88 mg/dL vs 49.78±7.05 mg/dL), with statistically significant difference. Hepatic steatosis was observed on ultrasound in women with PCOS; however, with no statistically significant difference. There was no change to NAFLD at elastography in any group. Conclusion Women with PCOS had 4-fold higher frequency of MetS andmore hepatic steatosis, with no statistically significant difference. There was no change in liver stiffness between the groups at elastography. The results can be extended only to populations of overweight and obesity grade 1, with PCOS or not. They cannot be generalized to other untested groups.

Resumo Objetivo Avaliar a associação entre a síndrome do ovário policístico (SOP) e a síndrome metabólica (SM), agregando avaliação do fígado por elastografia e ultrassonografia, para correlação com doença hepática gordurosa não alcoólica (DHGNA). A SM ocorre em cerca de 43% dasmulheres comSOP, e DHGNA é a expressão hepática da SM. Métodos Foramincluídas 100 mulheres, pareadas por idade (18-35 anos) e índice de massa corporal (IMC), 50 comSOP e 50 controles com sobrepeso e obesidade grau I, na Maternidade-Escola Assis Chateaubriand, Brasil. Para o diagnóstico de SOP, adotamos os critérios de Rotterdam e, para o diagnóstico de SM, os critérios do National Cholesterol Education Program (NCEP/ATP III). Elastografia hepática e ultrassonografia foram realizadas para avaliar a rigidez e a ecotextura do fígado, respectivamente. Resultados As médias de idade foram de 29,1 (±5,3) e 30,54 (±4,39) anos para os grupos SOP e controle, respectivamente. Pacientes com SOP apresentaram risco 4 vezes maior de SM do que aquelas no grupo controle [[razão de chances (intervalo de confiança de 95%) = 4,14]. Mulheres com SOP tiveram maior média de circunferência abdominal (100,9±9,08cm vs 94,96±6,99 cm) e triglicérides (162±54,63 mg/dL vs 137,54±36,91 mg/dL) e menor média de colesterol HDL (45,66±6,88 mg/dL vs 49,78±7,05mg/dL), com diferença estatisticamente significativa. Esteatose hepática foi observada em ultrassonografias de mulheres com SOP, porém sem diferença estatisticamente significativa. Não houve mudança para DHGNA na elastografia em nenhum dos grupos. Conclusão Mulheres com SOP tiveram frequência quatro vezes maior de SM e mais esteatose hepática, sem diferença estatisticamente significativa. Não houve mudança na rigidez do fígado entre os grupos na elastografia. Os resultados podem ser estendidos apenas a populações com sobrepeso e obesidade grau 1, com SOP ou não. Eles não podem ser generalizados para outros grupos não testados.

The Effect of Clomiphene Citrate versus Tamoxifen versus Letrozol on Endometrial Thickness and Blood Flow in Ovulation Induction in Women with Polycystic Ovaries.

Aim of Work: To compare between the effects of clomiphene citrate, tamoxifen and letrozol as ovulation induction agents on endometrial thickness and blood flow as non-invasive parameters of endometrial receptivity in women with polycystic ovaries. Patients and Methods: One hundred and fifty cases meeting the selection criteria were prospectively randomized into three groups 1st Group took 100 mg clomiphene citrate, 2nd Group took 5 mg letrozol and 3rd group took 40 mg tamoxifen. Transvaginal ultrasound and Doppler were done to measure endometrial thickness and endometrial blood flow both pulsatility index (PI) and resistance index (RI) at the day of the maximum follicular growth or at day 20 in the absence of the dominant follicle in the three groups. Results: Significantly thinner endometrium in the clomiphene citrate group as compared to the other two groups and lower impedance in the spiral arteries in both letrozol and tamoxifen groups (P value less than 0.001). Conclusion: Endometrium was thicker with lower impedance in the spiral arteries in both letrozol and tamoxifen groups as compared to clomiphene citrate group. Ovulation and pregnancy rates were not significantly different. Other studies are needed to measure the cumulative results of six cycles, increasing the dose in nonresponders and the incidence of miscarriage.

Evaluación de las alteraciones lipídicas en el síndrome de ovarios poliquísticos y su relación con la resistencia a la insulina / Assessment of the lipid alterations in polycystic ovaries syndrome and its relation to insulin-resistance

El síndrome de ovarios poliquísticos excede el eje reproductivo por su frecuente asociación con alteraciones metabólicas y cardiovasculares. Objetivo: basado en lo anterior se realizó un estudio descriptivo transversal para determinar la frecuencia y las características de las alteraciones lipídicas en un grupo de mujeres con síndrome de ovarios poliquísticos y su relación con las alteraciones en la sensibilidad a la insulina. Se estudiaron 23 mujeres según los criterios de la Androgen Excess Society, se realizaron determinaciones hormonales y lipídicas así como glucemia e insulinemia en ayunas para evaluar sensibilidad a la insulina. Resultados: 95,6 por ciento de las pacientes presentaron dislipidemia. La disminución de las lipoproteínas de alta densidad (cHDL) y apolipoproteínas (Apo) A-I fueron las alteraciones lipídicas más frecuentes (91,3 y 87,0 por ciento, respectivamente) mientras que el aumento de los triglicéridos (Tg) y del colesterol total (Ct) fueron infrecuentes (13 y 4,3 por ciento, respectivamente). Los índices lipídicos calculados: Tg/cHDL, Ct/cHDL, cHDL/cLDL y Apo B/A-I tuvieron valores medios superiores en las mujeres con insulinorresistencia, el índice Apo B/A-I fue el que mostró mayor diferencia en mujeres con insulinorresistencia y sin esta. La frecuencia de las alteraciones lipídicas en las mujeres estudiadas fue alta pero no todas se relacionan con la insulinorresistencia, lo cual sugiere que en la expresión del síndrome de ovarios poliquísticos podrían intervenir múltiples factores metabólicos y hormonales(AU)

The polycystic ovaries syndrome to exceed the reproductive axis due to its frequent association with metabolic and cardiovascular alterations. Objetive: based on above mentioned a cross-sectional and descriptive study was conducted to determine the frequency and the characteristic of lipid alterations en a group of women diagnosed with polycystic ovaries and its relation to alterations in insulin-sensitivity. Methods: twenty three women were studied according to Androgen Excess Society criteria, hormonal and lipid determinations were made as well as fasting glycemia and insulinemia to assess the insulin-sensitivity. RESULTS: the 95,6 percent of patients presenting with dyslipemia. The more frequent lipid alterations were a decrease of the high density lipoproteins (cHDL) and apolipoproteins (Apo) (91,3 and 87,0 percent, respectively) whereas the increase of triglycerides(Tg) and the total cholesterol (tC) were infrequent (13 and 4,3 percent, respectively). The estimated lipid rates: Tg/cHDL, Ct/cHDL, cHDL/cLDL and Apo B/A-I had higher mean values in women with insulin-resistance; the Apo B/A-I rate had the greater difference in women with insulin-resistance and without it. The lipid alterations frequency in study women suggest that in expression of polycystic ovaries syndrome could be involved many metabolic and hormonal factors(AU)

Effect of the treatment with dexamethasone, for 10 and 15 days, on the fertility in induced rats to polycystic ovaries, by constant illumination / Efecto del tratamiento con dexametasona, por 10 y 15 días, sobre la fertilidad en ratas inducidas a ovarios poliquísticos por la iluminación constante

The present study had the objective of obtaining information about fertility in rats treated with dexamethasone for 10 and 15 days consecutively, to polycystic ovaries, induced by constant illumination. It was used 40 albino rats (Rattus norvegicus albinus), aged 90 days, form the lineage Wistar, which were split, randomly, in four groups, each constituted of 10 animals, namely: Group I - rats kept in a clear/dark cycle for 12/12 hours, and after 100 days submitted to fertility evaluation (control); Group II - rats kept under constant illumination during 100 days and then submitted to fertility evaluation; Group III - rats kept under constant illumination during 100 days, then treated with dexamethasone for 10 days and submitted to fertility evaluation; Group IV - rats kept under constant illumination during 100 days, then treated with dexamethasone for 15 days and submitted to fertility evaluation. The results showed that the number of implanted sites was 38(G1), 37(G2), 32(G3) and 06(G4). The reduction in group IV was due to the high mortality during the experiment, probably because of the prolonged treatment with dexamethasone. These sites presented similar histological aspects. The macroscopic analysis of the neonates haven't shown any indication of malformation. Also, abortion haven't been observed. The treatment with dexamethasone for 10 days in rats does not affect the fertility and the development of the lungs, liver and kidneys of neonates, while the administration during 15 days leads to a high maternal mortality.

El estudio tuvo el objetivo de obtener informaciones sobre la fertilidad en ratas tratadas con dexametasona por 10 y 15 días seguidos, para ovarios poliquísticos, inducidos por iluminación constante. Se utilizó 40 ratas albinas (Rattus norvegicus albinus) con 90 días de edad, del linaje Wistar, las cuales fueron divididas, en cuatro grupos, cada uno constituido por 10 animales: Grupo I - ratas mantenidas en ciclo claro/oscuro de 12/12 horas, y después de 100 días sometidas a la evaluación de la fertilidad (control); Grupo II- ratas mantenidas bajo iluminación constante, durante 100 días, y luego sometidas a la evaluación de la fertilidad ; Grupo III - ratas mantenidas bajo iluminación constante, a lo largo de 100 días, y posteriormente tratadas con dexametasona por diez días, y sometidas a la evolución de la fertilidad; Grupo IV - ratas mantenidas bajo iluminación constante, durante 100 días, en seguida tratadas con dexametasona por 15 días, y sometidas a la evaluación de la fertilidad. Los resultados mostraron que el número de sitios implantados fue 38(GI), 37(G2), 32(G3), y 06(G4). La reducción en el grupo IV fue como consecuencia de la alta mortalidad durante la experiencia, probablemente en función del largo tratamiento con dexametasona. Esos sitios presentaron aspectos histológicos semejantes. El análisis macroscópico de los neonatos no mostró ningún vestigio de malformación. Tampoco fueron observados abortos. El tratamiento con dexametasona por 10 días en ratas, no afecta la fertilidad y el desarrollo de los pulmones, hígado y riñones de neonatos, mientras que la administración por 15 días lleva a una alta mortalidad materna.

Modificações do estilo de vida na síndrome dos ovários policísticos: papel do exercício físico e importância da abordagem multidisciplinar / Lifestyle modifications in the polycystic ovary syndrome: role of physical exercise and importance of multidisciplinary approach

A síndrome dos ovários policísticos (SOP) é uma desordem endócrina heterogênea com prevalência de 5 a 10 por cento nas mulheres em idade reprodutiva. Na SOP, há associação com vários fatores de risco para desenvolvimento de doença cardiovascular, como resistência à insulina, dislipidemia, diabetes mellitus, hipertensão arterial, disfunção endotelial, obesidade central, síndrome metabólica e marcadores pró-inflamatórios crônicos. A prática de exercício físico, juntamente com orientação nutricional, tem sido recomendada como estratégia de primeira linha no tratamento da oligomenorréia, hirsutismo, infertilidade e obesidade nas mulheres com SOP. Nesse sentido, o objetivo da presente revisão foi analisar o papel específico do exercício e/ou atividade física nas modificações da composição corporal, sistema cardiovascular, níveis plasmáticos bioquímicos e hormonais e função reprodutiva de mulheres com SOP.

The polycystic ovaries syndrome (POS) is a heterogeneous endocrinal disorder prevalent in 5 to 10 percent of women in reproductive age. In POS, there is an association with risk factors linked to the development of cardiovascular disease such as insulin resistance, dislipidemia, diabetes mellitus, arterial hypertension, endothelial dysfunction, central obesity, metabolic syndrome and chronic pro-inflammatory markers. Physical exercise practice together with nutritional guidance have been recommended as first rate strategies in the treatment of oligomenorrhea, hirsutism, infertility and obesity in POS women. This way, the objective of the present review was to analyze the specific role played by exercise and/or physical activity in changes of the body shape, in biochemical and hormonal plasmatic levels, and in the POS women’s reproductive function.

Effects of Exogenous Ethinyl Estradiol on Endometrial Receptivity in Clomiphene Induced Cycles in Infertile Women with Polycystic Ovaries

To compare the effectiveness of clomiphene citrate used alone and in combination with ethinyl estradiol on endometrial receptivity in infertile women with polycystic ovaries (PCO). Color doppler ultrasonographic evaluation of endometrial thickness (ET) and pulsatility index (PI) was done for 27 infertile women with polycystic ovaries. These women were studied for one control unmedicated cycle and randomized to receive clomiphene citrate (CC) alone and CC with ethinyl estradiol (EE) in subsequent 2 cycles. The total duration of follow up of patients was 77 months in which 2 women conceived in control cycle and 1 conceived in CC+ EE cycle. On day of HCGinjection, mean ET was 6.96 + 1.63mmin control cycle, 7.25 + 1.64mmin CC and 8.53 + 1.36mmin CC + EE cycle, whereas, the mean pulsatility index (PI) of dominant uterine arteries was 4.09 + 0.97 in control cycle, 3.96 + 0.95 in CC cycle and 3.75 + 0.98 in CC + EE cycle. On day of HCG injection, mean PI of non-dominant uterine arteries was 4.06 + 1.01 in control, 4.00 + 1.02 in CC and 3.71 + 0.95 in CC + EE cycles. A statistically significant change (p< 0.05) was observed in ET and PI of dominant and non-dominant uterine arteries in control and CC+ EE cycle and those in CC and CC+ EE cycles. Addition of ethinyl estradiol to clomiphene induced cycles produces a favorable endometrial response in infertile women with PCO.