Assessment of metabolic syndrome in infertile women with polycystic ovary syndrome in a rural population of South India: A cross-sectional study.

Background: Polycystic ovary syndrome (PCOS) is known to be associated with metabolic syndrome (MS). It is characterised by insulin resistance, hyperinsulinemia, dyslipidemia, obesity and hypertension. Data related to MS in infertile women with PCOS are limited in Indian populations. Objective: This study aims to compare the prevalence of MS in infertile women with and without PCOS in a rural population in South India. Materials and Methods: 130 women with PCOS and 130 women without PCOS were enrolled in this cross-sectional study. A detailed history was taken and a physical examination was done for all women. Anthropometric parameters, a glucose tolerance test, fasting glucose / insulin levels, trigylcerides, high-density lipoprotein cholesterol and blood pressure were assessed in all participants. The International Diabetes Federation criteria were applied for assessment of MS. Results: MS was more prevalent in infertile women with PCOS (42.3%) compared to women without PCOS (19.3%). 56.9% of women with PCOS had low high-density lipoprotein cholesterol levels, 46.2% had high triglycerides, 71.5% had a high waist circumference, 31.5% had high blood pressure and 37.7% had high blood glucose levels. 26.0% of the women with PCOS had a healthy weight, and MS was seen in 6.9% of these women. Conclusion: The prevalence of MS was higher in women with PCOS in comparison to women without PCOS. Among the women with PCOS, the prevalence of MS increased with age ( > 27 yr), body mass index and waist circumference (71.5%), and even healthy women with PCOS contributed to 7% of MS. Hence it becomes necessary to screen all women with PCOS for metabolic profile risk factors at young age itself to prevent long term cardiovascular complications.

Reduced Angiopoietin-2 as a Predictive Biomarker for Clomiphene Citrate Resistance in Polycystic Ovary Syndrome.

BACKGROUND: Even though angiopoeitin-2 and interleukin (IL)-23 are known to be altered in polycystic ovary syndrome (PCOS), their association with clomiphene citrate (CC) resistance has not been studied. AIM: The objective of the study was to investigate whether angiopoietin-2 levels are associated with inflammation and CC resistance in PCOS. SETTINGS AND DESIGN: This study was conducted in a tertiary care hospital. MATERIALS AND METHODS: Eighty-one women diagnosed with PCOS and on treatment with CC were enrolled in the study. Angiopoeitin-2 and IL -23 were analyzed in all the subjects. RESULTS: Angiopoietin-2 was significantly reduced (P = 0.018), and body mass index (BMI) (P = 0.049) and duration of infertility (0.006) were significantly increased in PCOS women with CC resistance compared to those who are sensitive to CC. In CC resistant PCOS, IL-23 predicts reduction in angiopoietin-2 levels (P = 0.010). Among angiopoietin-2, IL-23, BMI, and duration of infertility, we found that angiopoeitn-2 (P = 0.020) and duration of infertility (0.036) can predict resistance to CC therapy among PCOS subjects. CONCLUSION: We conclude that reduced angiopoietin-2 levels predict CC resistance in women with PCOS.

Effect of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in Benign Ovarian Cysts.

BACKGROUND: Laparoscopic cystectomy is one of the common modes of treatment for benign ovarian cysts. The data related to the effect of cystectomy on ovarian reserve are limited. AIM: The aim of this study was to investigate the effect of laparoscopic ovarian cystectomy on anti-Mullerian hormone (AMH) levels in benign ovarian cysts. SETTINGS AND DESIGN: It was a prospective clinical study conducted in a tertiary care hospital from March 2017 to August 2018. MATERIALS AND METHODS: Seventy-two benign ovarian cyst patients who were admitted for cystectomy were enrolled in the study. Serum AMH levels were estimated in all the patients at baseline, 1 week, and 3 months after cystectomy. STATISTICAL ANALYSIS: Paired t-test was used to assess the differences in AMH levels before and after laparoscopic cystectomy. RESULTS: AMH was significantly reduced after 1 week (P < 0.05) and 3 months (P < 0.05) of cystectomy compared to preoperative levels in both endometriotic and nonendometriotic cysts. The percentage of reduction in the AMH values measured on the 7th postoperative day was found to be greater with endometriotic cysts (54%) followed by mucinous cystadenoma (32%). On day 90, greater recoveries of the AMH values to the baseline AMH levels were observed with cystic teratoma (83% of the baseline AMH levels). CONCLUSIONS: Laparoscopic ovarian cystectomy reduces AMH levels immediately after surgery, and improvement in AMH level was observed after 3 months.

Matrix metalloproteinase-9 is elevated and related to interleukin-17 and psychological stress in male infertility: A cross-sectional study.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9), interleukin-17 (IL-17) and psychological stress are known to play a role in the pathogenesis of male infertility. OBJECTIVE: To assess the association of MMP-9 with IL-17 and psychological stress in infertile men. MATERIALS AND METHODS: In this cross-sectional study, 39 men with infertility diagnosed based on semen analysis and 39 subjects with normal semen analysis were included in the study. MMP-9 and IL-17 were estimated in both groups by ELISA. Perceived stress scale was used to assess psychological stress in controls and cases. RESULTS: In infertile cases, MMP-9 and IL-17 were significantly increased when compared with controls (p = 0.046, p = 0.041 respectively). A significant association of MMP-9 was observed with IL-17 (r = 0.335, p = 0.037) and perceived stress scale (r = 0.329, p = 0.041). CONCLUSION: IL-17 and stress increase MMP- 9 levels in infertile men.

Laparoscopic Ovarian Drilling Reduces Testosterone and Luteinizing Hormone/Follicle-Stimulating Hormone Ratio and Improves Clinical Outcome in Women with Polycystic Ovary Syndrome.

BACKGROUND: Laparoscopic ovarian drilling (LOD) is one of the common modes of treatment for women with polycystic ovary syndrome (PCOS) who are resistant to clomiphene citrate. The data related to the effect of LOD on sex hormones are limited. AIM: The objective of the study was to investigate the effect of LOD on hormonal parameters and clinical outcomes in women with PCOS. SETTINGS AND DESIGN: This study was conducted in a tertiary care hospital. MATERIALS AND METHODS: Fifty PCOS patients who were admitted for LOD were enrolled in the study. Serum testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels were estimated in all the patients before and after LOD. STATISTICAL ANALYSIS: Paired t-test was used to assess the differences in hormonal parameters before and after LOD. RESULTS: LOD reduces testosterone (P < 0.001), LH (P < 0.001), and LH/FSH ratio (P < 0.001), increases FSH (P < 0.001) levels, and improves the rate of ovulation (38/50) and clinical pregnancy (21/50) in PCOS. When subgroup analysis was done, LOD significantly reduced testosterone and LH/FSH ratio in ovulatory and conceived groups. Furthermore, the menstrual cycle became regular, and hirsutism and acne were reduced after LOD in women with PCOS. CONCLUSIONS: LOD reduces testosterone and LH/FSH ratio and improves clinical outcome in PCOS.

Clomiphene citrate increases nitric oxide, interleukin-10 and reduces matrix metalloproteinase-9 in women with polycystic ovary syndrome.

OBJECTIVES: Matrix metalloproteinase-9, Nitric oxide and inflammation plays a role in the pathogenesis of poly cystic ovary syndrome (PCOS). Even though these parameters are altered in PCOS, the effect of clomiphene citrate on them has not been studied till date. The present study was done to assess the effect of clomiphene citrate on matrix metalloproteinase-9, nitric oxide and interleukin-10 levels in women with PCOS. STUDY DESIGN: 72 women diagnosed with PCOS were enrolled in the study. Matrix metalloproteinase-9, nitric oxide and interleukin-10 levels were compared at baseline and after three weeks following Clomiphene citrate treatment. RESULTS: Clomiphene citrate increases both nitric oxide (p = 0.03) and interleukin-10 (p < 0.001) levels and reduces matrix metalloproteinase-9 levels (p < 0.001) in women with PCOS. It also improves the ovulation rate (52.8%) and clinical pregnancy rate (19.4%) in PCOS. Also there was a significant reduction in matrix metalloproteinase-9 levels in both the ovulatory (p < 0.001) and conceived groups (p = 0.024) compared to non ovulatory and non conceived group. There was no difference in nitric oxide and interleukin-10 levels in ovulatory and conceived groups compared to non ovulatory and non conceived group. CONCLUSION: We conclude that clomiphene citrate increases the levels of nitric oxide and interleukin-10 and decreases the matrix metalloproteinase - 9 levels and improves the ovulation rate and clinical pregnancy rate in PCOS.