Características clínicas en pacientes con menos de 12 folículos ováricos como hallazgo ecográfico / Clinical and ultrasound findings in patients with ovaries with a count of less than 12 follicles

Introducción y objetivos: Determinar los hallazgos clínicos y ecográficos en pacientes que presentan menos de 12 folículos ováricos. Método: Estudio observacional (cohorte histórica) con 505 pacientes seleccionadas mediante muestreo consecutivo, entre el 14 de enero del 2019 y el 15 de marzo del 2021, que consultan por diversas alteraciones ginecológicas. Se generan dos grupos de pacientes, las que presentaron uno a tres folículos en uno de los ovarios (n = 377) y las que presentaban 4 a 11 folículos (n = 128). Se midió como resultado primario la presencia de al menos un signo clínico de hiperandrogenismo. Resultados: De 505 pacientes analizadas, al comparar las que presentaron 4 a 11 folículos en uno de los ovarios (n = 377) con las que presentaban 1 a 3 folículos (n = 128), las primeras mostraron mayor presencia de signos de hiperandrogenismo, endometrio en fase lútea de mayor espesor y un patrón menstrual con uno a cuatro días de sangrado menstrual abundante, diferencias todas estadísticamente significativas (p < 0,05). Conclusión: En pacientes con 4 a 11 folículos en uno de sus ovarios, se observaron signos de hiperandrogenismo, similares al síndrome de ovario poliquístico.

Introduction and objectives: Determine the clinical and ultrasound findings in patients who present less than 12 ovarian follicles in the ultrasound count. Method: Observational study (historical cohort) with 505 patients selected by consecutive sampling, between January 14, 2019 and March 15, 2021, who consulted for different gynecological disorders. Two groups of patients were generated: those with 1 to 3 follicles in one of the ovaries (n = 377) and those with 4 to 11 follicles (n = 128). The primary outcome was the presence of at least one clinical sign of hyperandrogenism. Results: Of 505 patients analyzed, when comparing those who presented 4 to 11 follicles in one of the ovaries (n = 377) with those who presented 1 to 3 follicles (n = 128), the first group showed a greater presence of signs of hyperandrogenism, thicker endometrium in luteal phase and a menstrual pattern with one to four days of heavy menstrual bleeding, all differences were statistically significant (p < 0.05). Conclusion: In patients with 4 to 11 follicles in one of their ovaries, signs of hyperandrogenism, similar to polycystic ovary syndrome, were observed.

Prevalence of Polycystic Ovarian Syndrome in Girls with a History of Idiopathic Central Precocious Puberty.

INTRODUCTION: The prevalence of polycystic ovarian syndrome (PCOS) in adolescent girls is between 1 and 4.3%. It remains controversial whether women with a history of idiopathic central precocious puberty (ICPP) are at increased risk for PCOS. Our objective was to assess the prevalence of PCOS in adolescents with a history of ICPP compared with healthy adolescents and the prevalence of PCOS among ICPP girls who have received or not gonadotropin-releasing hormone analogue (GnRHa) treatment. METHODS: We assessed post-menarcheal girls with a history of ICPP. Girls were evaluated at gynecological age ≥2.5 years. Data collected were age at menarche, menstrual cycle characteristics, BMI, clinical hyperandrogenism (HA), total and free testosterone levels. PCOS diagnosis was defined by criteria for adolescents. Subjects were also analyzed regarding whether or not they had received GnRHa treatment. RESULTS: Ninety-four subjects were assessed, and 63 had been treated with GnRHa. Menstrual disorders were found in 29%, clinical HA in 36%, and biochemical HA in 23%. Twelve percent met the diagnostic criteria for PCOS. There was no difference in BMI or in the incidence of menstrual dysfunction or hyperandrogenemia between treated and untreated patients. A higher proportion of clinical HA was found in untreated patients when compared to treated girls. The relative risk (RR) of developing PCOS in ICPP girls was 2.5 compared to a population of healthy adolescents. This RR was not higher in patients who received treatment with GnRHa than in those who did not. CONCLUSION: Adolescent girls with a history of ICPP have an increased risk of PCOS. This risk seems not to be related to GnRHa treatment.

Nas fronteiras entre saúde, beleza e aprimoramento: uma análise sobre a Síndrome dos Ovários Policísticos / On the borderlines of health, beauty, and enhancement: an analysis of Polycystic Ovary Syndrome

Resumo Este artigo analisa as publicações de mulheres que sofrem da Síndrome dos Ovários Policísticos (SOP), em grupos na rede social Facebook. A SOP é uma síndrome metabólica experienciada por um vasto número de mulheres em idade fértil. Entre seus sintomas, destacam-se a acne, o aumento de peso e a presença de pelos indesejáveis. Já o tratamento está concentrado na mudança de estilo de vida associado a um controle da dieta e adoção de novos hábitos. Por meio da análise dos depoimentos e imagens postados pelas participantes dos grupos, que expressam as suas transformações entre o antes e depois, constata-se que, atualmente, o diagnóstico, o tratamento e a percepção da SOP estão profundamente associados a fatores estéticos. Discute-se, por fim, como este fenômeno está atrelado ao padrão de gênero binário, centrado nas diferenças corporais, produzido historicamente, e, também, como ilustra a ênfase no aprimoramento de si, especialmente no que se refere à sua expressão nos padrões corporais e estéticos.

Abstract This article analyzes the publications of women who suffer from Polycystic Ovary Syndrome (PCOS) in Facebook groups. PCOS is a metabolic syndrome experienced by a vast number of women of childbearing age. Some of its main symptoms are acne, weight gain, and unwanted hair. On the other hand, the treatment focuses on changing the lifestyle associated with diet control and adopting new habits. The analysis of statements and pictures posted by the participants of the groups, which express their before-after transformations, reveals that diagnosis, treatment, and perception of PCOS are currently deeply associated with aesthetic factors. Finally, we discuss how this event is linked to the historically produced binary gender pattern centered on body differences and how it illustrates the emphasis on self-enhancement, especially concerning its expression in body and aesthetic standards.

Copper in Gynecological Diseases.

Copper (Cu) is an essential micronutrient for the correct development of eukaryotic organisms. This metal plays a key role in many cellular and physiological activities, including enzymatic activity, oxygen transport, and cell signaling. Although the redox activity of Cu is crucial for enzymatic reactions, this property also makes it potentially toxic when found at high levels. Due to this dual action of Cu, highly regulated mechanisms are necessary to prevent both the deficiency and the accumulation of this metal since its dyshomeostasis may favor the development of multiple diseases, such as Menkes' and Wilson's diseases, neurodegenerative diseases, diabetes mellitus, and cancer. As the relationship between Cu and cancer has been the most studied, we analyze how this metal can affect three fundamental processes for tumor progression: cell proliferation, angiogenesis, and metastasis. Gynecological diseases are characterized by high prevalence, morbidity, and mortality, depending on the case, and mainly include benign and malignant tumors. The cellular processes that promote their progression are affected by Cu, and the mechanisms that occur may be similar. We analyze the crosstalk between Cu deregulation and gynecological diseases, focusing on therapeutic strategies derived from this metal.

A Brief Review on the Regulatory Roles of MicroRNAs in Cystic Diseases and Their Use as Potential Biomarkers.

miRNAs are small endogenous conserved non-coding RNA molecules that regulate post-transcriptional gene expression through mRNA degradation or translational inhibition, modulating nearly 60% of human genes. Cystic diseases are characterized by the presence of abnormal fluid-filled sacs in the body, and though most cysts are benign, they can grow inside tumors and turn malignant. Recent evidence has revealed that the aberrant expression of a number of miRNAs present in extracellular fluids, including plasma or serum, urine, saliva, follicular fluid, and semen, contribute to different cystic pathologies. This review aims to describe the role of different miRNAs in three worldwide relevant cystic diseases: polycystic ovarian syndrome (PCOS), polycystic kidney disease (PKD), and pancreatic cyst tumors (PCTs), as well as their potential use as novel biomarkers.

Telomere Length and Telomerase Activity in Immature Oocytes and Cumulus Cells of Women with Polycystic Ovary Syndrome.

Metaphase II oocytes (MII) from polycystic ovary syndrome (PCOS) frequently have impaired oocyte competence. Since telomere maintenance is important for folliculogenesis, oocyte maturation, and early embryonic development, we sought to verify the implications of PCOS on telomere length and telomerase activity in immature oocytes and cumulus cells. 43 PCOS and 67 control women were included, and anthropometric, biochemical, and hormonal characteristics were evaluated. The telomere length in germinal vesicle stage (GV) and in metaphase I (MI) oocytes, as well as in the cumulus cells of immature (CCI) and mature oocytes (CCM), and in leukocytes was measured by qPCR. The telomerase activity in reproductive cells was evaluated by the TRAPeze® XL Kit. The body mass index (p = 0.001), LH (p = 0.015), estradiol (p = 0.004), insulin (p = 0.002), testosterone (p < 0.0001), androstenedione (p = 0.001), free androgen index (p < 0.0001), and c-reactive protein (p = 0.003) were greater, while the FSH (p = 0.0002) was lower in the PCOS group. The telomere length in the CCI (p = 0.649) and CCM (p = 0.378) did not differ between the PCOS and the control groups. On the other hand, telomerase activity in the CCI (p = 0.003) and CCM (p = 0.022) was higher in the PCOS group. In the leukocyte's cells, the telomere length was reduced in the PCOS group (p = 0.025). In the GV and MI oocytes, no differences were observed in telomere length and telomerase activity between the groups. We showed that telomere length is not altered in reproductive cells from PCOS. However, higher telomerase activity in the CCI and CCM may be required for telomere length maintenance.

Expressed proteins and activated pathways in conditioned embryo culture media from IVF patients are diverse according to infertility factors.

OBJECTIVE: Given that the embryo culture medium secretome reflects the embryo development, we hypothesize that protein profiles are affected according to infertility factors, which can be responsible for detrimental embryonic developmental competence. The aim of this study was to screen the protein profile of conditioned embryo culture media in patients presenting deep infiltrating endometriosis (ENDO) and polycystic ovarian syndrome (PCOS) undergoing IVF, by proteomics approaches. The control group was constituted by tubal factor patients. METHODS: Patients underwent in vitro fertilization (IVF) treatment as routine and oocytes were fertilized by ICSI. The embryos were group cultured until day 3 of development, and after transfer the culture media were collected. For the proteomics analysis, two pools of samples were prepared for groups CONTROL and PCOS, and 4 pools of samples for group DIE. Samples were prepared to deplete high abundant proteins and followed evaluated by high throughput proteomics approach. RESULTS: The embryonic organ and tissue development were physiological functions activated, based on proteins identified in the 3 study groups of samples. The samples coming from DIE patients presented a high calcium activity and on the other hand, embryos coming from PCOS patients showed a decreased calcium action. Other pathways as grow factors through the EGF signaling pathway overexpressed in ENDO culture medium and protein kinase A in PCOS were also observed. CONCLUSIONS: Proteomic embryonic secretome will advance our knowledge of early embryogenesis and additionally could lead to improved selection of embryos for transfer warrants further investigation.

The Effects of Overweight and Obesity on Assisted Reproduction Technology Outcomes.

The aim of the present study was to assess the impact of professional nutrition assistance on assisted reproduction technology (ART) outcomes in overweight or obese patients with polycystic ovarian syndrome (PCOS). The study represents a retrospective analysis of fertilization rates, embryo quality and gestations after ART in seven PCOS patients, five obese and two overweight. The women attended a private Fertility Center in Brazil between the years 2010 and 2016. Out of the seven patients, the three that reached a successful gestation were the ones that underwent comprehensive lifestyle changes, taking care of their diet for a more prolonged period of time and reached an ideal weight loss during the nutrition counseling period.

The prevalence of metabolic syndrome in the different phenotypes of polycystic ovarian syndrome / A prevalência da síndrome metabólica nos diferentes fenótipos da síndrome do ovário policístico

Abstract Objective To evaluate the prevalence of metabolic syndrome (MetS) in the phenotypes of polycystic ovarian syndrome (PCOS). Methods This was a cross-sectional study involving 111 women aged between 18 and 39 years old diagnosed with PCOS, according to the Rotterdam Criteria, and grouped into four phenotypes: A: ovulatory dysfunction + hyperandrogenism + polycystic ovaries; B: ovulatory dysfunction + hyperandrogenism; C: hyperandrogenism + polycystic ovaries; D: ovulatory dysfunction + polycystic ovaries. To evaluate the presence of MetS, wemeasured serum triglyceride levels, HDL cholesterol, fasting blood glucose, blood pressure, and waist circumference. Results The prevalence of MetS found in this sample was 33.6%, and there was no statistically significant difference (p < 0.05) among the 4 phenotypes. However, phenotype D presented a significantly higher mean glucose level after fasting (93.6 mg/dL) and 2 hours after ingesting a solution with 75 g of anhydrous glucose (120 mg/dL), as well as the lowest mean level of high-density lipoprotein (HDL) cholesterol (44.7 mg/dL). The women in this group demonstrated a high prevalence of abdominal circumference ≥ 80 cm (68.2%), as well as the highest mean abdominal circumference (90.1 cm). Amongst the women with an abdominal circumference ≥ 80 cm, phenotype A increased approximately six-fold the chance of developing metabolic syndrome in relation to phenotype C. Conclusion The four phenotypes of PCOS demonstrated similar prevalence rates of metabolic syndrome; abdominal obesity presented a relevant role in the development of metabolic alterations, regardless of the phenotype.

Resumo Objetivo Avaliar a prevalência da síndromemetabólica nos fenótipos da síndrome do ovário policístico. Métodos Trata-se deum estudo transversal envolvendo 111 mulheres comidade entre 18 e39 anos com diagnóstico de síndrome do ovário policístico, segundo os critérios de Roterdã, e agrupadas em quatro fenótipos: A: Disfunção ovulatória + hiperandrogenismo + ovários policísticos;B: disfunçãoovulatória + hiperandrogenismo; C: hiperandrogenismo + ovários policísticos; D: disfunção ovulatória + ovários policísticos. Para avaliar a presença de síndrome metabólica, foram medidos os níveis séricos de triglicérides, colesterol HDL e glicemia de jejum, pressão arterial e circunferência da cintura. Resultados A prevalência de síndrome metabólica encontrada nesta amostra foi de 33,6%, e não houve diferença estatisticamente significativa (p < 0,05) entre os quatro fenótipos. Entretanto, o fenótipo D apresentou um nível médio de glicose significativamente mais alto após o jejum (93,6 mg/dL) e duas horas após a ingestão de uma solução com 75g de glicose anidra (120 mg/dL), bem como o menor nível médio de colesterol HDL (44,7 mg/dl). As mulheres deste grupo demonstraram alta prevalência de circunferência abdominal ≥ 80 cm (68,2%), bem como a maior média de circunferência abdominal (90,1 cm). Entre as mulheres com circunferência abdominal ≥ 80 cm, o fenótipo A aumentou em aproximadamente 6 vezes a chance de desenvolver síndrome metabólica em relação ao fenótipo C. Conclusão Os quatro fenótipos da síndrome do ovário policístico demonstraram taxas semelhantes de prevalência de síndrome metabólica; a obesidade abdominal apresentou papel relevante no desenvolvimento de alterações metabólicas, independentemente do fenótipo.

Evaluation of pretreatment with Cetrotide in an antagonist protocol for patients with PCOS undergoing IVF/ICSI cycles: a randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the effect of three days of GnRH antagonist pretreatment on the pregnancy outcomes of women with polycystic ovarian syndrome (PCOS) on GnRH antagonist protocols for IVF/ICSI. METHODS: Fifty women with PCOS in the control group received conventional antagonist protocols, starting on day 2 of the cycle. In the pretreatment group (n=38), a GnRH antagonist was administered from day 2 of the menstrual cycle for three days. RESULTS: Controlled ovarian stimulation (COS) duration and gonadotropin dosages were similar in both groups. The number of metaphase II (MII) oocytes, 2PN oocytes, embryos, along with implantation and clinical pregnancy rates, were higher in the pretreatment group when compared with controls, although the increment was not significant (P value ≥0.05). The chemical pregnancy rate was significantly higher in the pretreatment group. The rate of OHSS was significantly lower in the pretreatment than in the control group. CONCLUSION: Women with PCOS offered early follicular phase GnRH antagonist pretreatment for three consecutive days had significantly fewer cases of OHSS and higher chemical pregnancy rates. There were trends toward greater numbers of MII oocytes, 2PN oocytes, and embryos, and higher clinical pregnancy rates in the pretreatment group.

Early Clinical Expressions of Insulin Resistance: The Real Enemy to Look For.

The type 2 diabetes mellitus epidemic threatens public healthcare systems worldwide. Efforts to prevent chronic complications of diabetes and reduce their associated mortality have been ineffective. Hence, early prevention of type 2 diabetes mellitus and cardiovascular disease needs to be prioritized. This strategy, however, must be centered not on an approach based on hyperglycemia but on early pathophysiologic mechanisms, such as insulin resistance. Non-alcoholic fatty liver disease, androgenic alopecia, acanthosis nigricans, and polycystic ovarian syndrome are all well-accepted early clinical manifestations of insulin resistance that represent, in themselves, a risk for further development of type 2 diabetes and that appear years before hyperglycemia. Therefore, focusing efforts on detecting and rigorously treating patients with early clinical expression of insulin resistance (insulin resistance clinical syndrome) is probably the course of action that needs to be taken to counterbalance the type 2 diabetes mellitus epidemic.

Síndrome de ovario poliquístico y su potencial asociación con trastorno bipolar en pacientes con trastorno del comportamiento alimentario / Polycystic ovarian syndrome and its potential association with bipolar disorder in patients with eating disorder

Resumen La exploración del síndrome de ovario poliquístico (SOP) en mujeres con trastorno del comportamiento alimentario (TCA) es infrecuente, y particularmente su asociación con el trastorno bipolar (TB) ha sido poco estudiada. El propósito de este estudio fue evaluar la prevalencia de SOP en mujeres con TCA, y analizar su potencial asociación con TB. Participaron 388 pacientes de entre 14 y 61 años de edad (88 con SOP y 300 sin SOP). Se realizó ultrasonido pélvico, examen físico y de laboratorio. Se aplicaron análisis bivariados entre SOP, TB y otras variables, como son: comorbilidades psiquiátricas, índice de masa corporal y tipo de TCA. Se construyó un modelo de asociación. Las prevalencias de SOP y de TB en la muestra fueron 22.7 y 13.1%, respectivamente. Las variables asociadas con SOP fueron TB tipo II, sobrepeso u obesidad, y presentar un TCA con atracones y/o purgas. Controlando por obesidad y subtipos bulímicos de TCA, las pacientes con SOP tienen 5.8 veces mayor riesgo de presentar TB tipo II (OR = 5.85, IC 95% = 2.9-11.6). La comorbilidad entre estas tres patologías es frecuente, por lo que su exploración y manejo deben ser considerados.

Abstract Exploration of polycystic ovarian syndrome (PCOS) in women with eating disorders (ED) is uncommon, and its association with bipolar disorder (BD) has been understudied. The aim of this study was to determine the prevalence of PCOS in women with ED in an outpatient program and to analyze the potential associations with BD. A total of 388 patients (88 with PCOS and 300 without PCOS) aged among 14 to 61 years were included in the study. Pelvic ultrasound, laboratory tests, and physical exams were performed to each participant. Bivariate analyses were carried out between PCOS, BD and other variables such as: psychiatric comorbidities, body mass index and type of ED. An association model was built. PCOS and BD prevalence were 22.7% and 13.1% respectively. The variables associated with PCOS were: BD type II, overweight or obesity and having an ED with binges and/or purges. When obesity and bulimic ED subtypes were controlled, patients with PCOS and BD type have 5.8 times higher risk of BD type II (OR = 5.85; 95% IC = 2.9-11.6). Comorbidities among these three pathologies are frequent, therefore its exploration and management should be considered.

New Diagnostic Criteria of Polycystic Ovarian Morphology for Adolescents: Impact on Prevalence and Hormonal Profile.

BACKGROUND: The ultrasonographic criteria used to identify polycystic ovarian morphology (PCOM) during adolescence have changed over time. Recently, a Worldwide Pediatric Consensus (PedC) defined PCOM using stricter criteria than the previous recommendations of the Rotterdam Consensus (RC) and Androgen Excess-Polycystic Ovarian Syndrome Society (AES/PCOS) criteria. The aim of this study was to determine the prevalence of PCOM in healthy adolescents according to the 3 reported diagnostic criteria and compare the hormonal profile in females with and without PCOM based on the PedC criteria. METHODS: Nonobese adolescents (n = 102) with regular menstrual cycles were studied. Transabdominal ultrasound and hormonal profiles were assessed during the follicular phase. PCOM was defined on the basis of the 3 published criteria. RESULTS: On the basis of the PedC, RC, and AES/PCOS criteria, PCOM was diagnosed in 13, 34, and 24% of adolescents, respectively. Adolescents with and without PCOM according to the PedC criteria had similar androgen levels. Serum anti-Müllerian hormone (AMH) levels were elevated in adolescents with PCOM, irrespective of the criteria used. CONCLUSIONS: Use of the new PedC diagnostic criteria for PCOM results in a lower prevalence of this ultrasonographic pattern in adolescents, but this condition is not associated with hyperandrogenism. Elevated AMH is associated with PCOM in adolescents regardless of the criteria used to determine the ultrasonographic pattern.

Criterios diagnósticos y tratamiento integral terapéutico del síndrome de ovarios poliquísticos / Diagnostic criteria and therapeutic integral treatment of polycystic ovary syndrome

Introducción: el síndrome de ovarios poliquísticos es un cuadro clínico caracterizado por la presencia de ovarios con pequeños quistes, amenorrea, hirsutismo y obesidad. Objetivo: proporcionar criterios diagnósticos vigentes y tendencias de tratamiento integral mediante una revisión sistemática de la literatura que permita un direccionamiento de los criterios médicos en atención a las mujeres con síndrome de ovario poliquístico. Métodos: estudio descriptivo retrospectivo, realizado mediante búsquedas en base de datos electrónicos como, Pubmed, Google Scholar, Cochrane Library, Science Direct y Elsevier. Se consultaron 25 artículos publicados desde el año 2011 para realizar esta revisión en torno al síndrome de ovario poliquístico, los cuales presentan evidencias científicas, en relación a la utilidad de la misma con contribuciones en el diagnóstico y manejo terapéutico de esta patología. Resultados: el abordaje diagnóstico implica ciertas dificultades en relación con el momento de presentación de los síntomas y la tendencia actual es considerar como un diagnóstico de exclusión, empleándose los cuatros fenotipos propuestos en Rotterdam. El estudio encontró que los cambios en el estilo de vida, la reducción del peso, dieta, ejercicios, medicina alternativa, tratamientos cosméticos, prevención de factores epigenéticos, la terapia quirúrgica y farmacológica contribuyen a mejorar la calidad de vida y sintomatología en las pacientes afectadas con esta entidad nosológica. Conclusión: el síndrome de ovario poliquístico sigue siendo una enfermedad con diagnóstico de exclusión, pero la tendencia actual es investigar la hormona antimulleriana como predictor de esta enfermedad. El tratamiento está orientado a corregir el hiperandrogenismo, los trastornos menstruales, las alteraciones metabólicas asociadas y la anovulación(AU)

Introduction: the polycystic ovarian syndrome (PCOS) is a clinical condition characterized by the presence of ovaries with small cysts, amenorrhea, hirsutism and obesity. Objective: Provide current diagnostic criteria and comprehensive treatment trends, through a systematic review, which allows addressing the medical criteria in care for women with polycystic ovarian syndrome (PCOS). Methods: A retrospective descriptive study was conducted by searching electronic database as Pubmed, Google Scholar, Cochrane Library, Science Direct and Elsevier. Twenty-five articles published since 2011 are addressed for this review on SOP, which present scientific evidence, in relation to its utility with contributions in the diagnosis and therapeutic management of this pathology. Results: the diagnostic approach implies certain difficulties in relation to the time of presentation of the symptoms. The current tendency is to consider it as a diagnosis of exclusion, using the four phenotypes proposed in Rotterdam. The study found that changes in lifestyle, weight reduction, diet, exercise, alternative medicine, cosmetic treatments, and prevention of epigenetic factors, surgical and pharmacological therapy contribute to improve the quality of life and symptoms in affected patients with this nosological entity. Conclusion: Polycystic ovarian syndrome remains a disease with a diagnosis of exclusion, but the current trend is to investigate the anti-mullerian hormone as a predictor of this disease. The treatment aimed at correcting hyperandrogenism, menstrual disorders, associated metabolic disorders and anovulation(AU)

Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

ABSTRACT Objective To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). Subjects and methods 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. Results Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). Conclusion This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Quality of Life in Women with Polycystic Ovary Syndrome after a Program of Resistance Exercise Training / Qualidade de vida emmulheres com síndrome de ovários policísticos após um programa de treinamento de exercício resistido

Abstract Purpose Aerobic exercises may improve quality of life (QoL) in women with polycystic ovary syndrome (PCOS). However, there is no data on the effect of resistance exercise training (RET) programs on the QoL of women with PCOS. Thus, this study aimed to assess the effect of a 16-week RET program on QoL in PCOS women. Methods This 16-week case-control study enrolled 43 women with PCOS (PCOS group, PCOSG) and 51 healthy pre-menopausal controls aged 18 to 37 years (control group, CG). All women underwent a supervised RET program for 16 weeks, and were evaluated in two different occasions: week-0 (baseline), and week-16 (after RET). Quality of life was assessed using the 36-Item Short Form Health Survey (SF-36). Results Testosterone reduced significantly in both groups after RET (p < 0.01). The PCOSG had improvements in functional capacity at week-16 relative to week-0 (p = 0.02). The CG had significant improvements in vitality, social aspects, and mental health at week-16 relative to week-0 (p ≤ 0.01). There was a weak correlation between social aspects of the SF-36 domain and testosterone levels in PCOS women. Conclusion A 16-week RET program modestly improved QoL in women with PCOS.

Resumo Objetivos Exercícios aeróbicos podem melhorar a qualidade de vida (QV) de mulheres com síndrome dos ovários policísticos (SOP). No entanto, não há dados sobre o efeito de um programa de treinamento de exercício resistido (TER) sobre a QV destas mulheres. Assim, este estudo teve como objetivo avaliar o efeito de um programa de TER de 16 semanas na QV em mulheres com SOP. Métodos Estudo caso-controle com 16 semanas de duração, para o qual foram incluídas 43 mulheres com SOP (grupo com SOP, GSOP) e 51 controles saudáveis com received idade entre 18 a 37 anos (grupo de controle, GC). Todas as mulheres foramsubmetidas ao protocolo TER supervisionado por 16 semanas, e foram avaliadas em dois momentos: na semana 0 (linha de base), e na semana 16 (após TER). A qualidade de vida foi avaliada pelo 36-Item Short Form Health Survey (SF-36). Resultados Houve redução significativa da testosterona emambos os grupos após o TER (p < 0,01). O GSOP obteve significativa melhora na capacidade funcional na semana 16 em relação à semana 0 (p = 0,02). O GC apresentou significativa melhora no escore do domínio vitalidade, aspectos sociais e saúde mental na semana 16 em relação à semana 0 (p ≤ 0,01). Houve uma fraca correlação entre os aspectos sociais de domínio SF-36 e o nível de testosterona em mulheres com SOP. Conclusão a aplicação de um programa de treinamento físico resistido durante 16 semanas resultou em melhora modesta da QV de mulheres com SOP.

Resistencia a la insulina en la mujer: ¿cómo y cuándo evaluarla? / Insulin resistance wing women: how and when evaluated?

La obesidad resulta de un desequilibrio entre la ingesta de alimentos y el gasto energético, lo que conduce a una acumulación excesiva de tejido adiposo. El aumento del tejido adiposo principalmente visceral, se ha relacionado con alteración de factores proinflamatorios y antinflamatorios, que junto a los ácidos grasos libres producto de la lipólisis, parecen estar involucrados en el desarrollo de la resistencia a la insulina. La resistencia a la insulina es muy frecuente en pacientes con síndrome de ovario poliquístico. Aunque la causa exacta del síndrome de ovario poliquístico es aún desconocida, una de las hipótesis más aceptadas en su fisiopatología es la resistencia a la insulina e hiperinsulinemia. Se plantea que la obesidad, resistencia a la insulina e hiperinsulinismo están estrechamente relacionadas y cada una de estas patologías afecta a la otra. La resistencia a la insulina contribuye a la fisiopatología de la diabetes mellitus tipo 2 (DM2) y es un marcador de la obesidad, el síndrome metabólico, y las principales enfermedades cardiovasculares. Por tanto, la cuantificación de la resistencia a la insulina es de gran importancia. Se utilizan varios métodos para evaluar la resistencia a la insulina, algunos se basan en el análisis de la glucosa e insulina en condiciones de ayuno, mientras que otros se basan en pruebas dinámicas. Cada uno de estos métodos tiene sus ventajas y limitaciones. Por lo tanto, la elección óptima y el empleo de un método específico dependen de la naturaleza del estudio que se realiza. Métodos directos establecidos para medir la sensibilidad a la insulina in vivo son relativamente complejos. Se necesita la elaboración de un marcador universal en el diagnóstico de resistencia a la insulina que se pueda aplicar en entornos clínicos y ambulatorios. Actualmente, la determinación de insulina plasmática y estimación de resistencia a la insulina no son requeridas en la práctica clínica diaria.

Obesity results from an imbalance between food intake and energy expenditure, which leads to an excessive accumulation of adipose tissue. The increase mainly visceral adipose tissue, has been associated with impaired pro-inflammatory and anti-inflammatory factors, together with the free fatty acid product of lipolysis, appear to be responsible for the development of insulin resistance. The insulin resistance is very common in patients with Polycystic Ovarian Syndrome. Although the exact cause of Polycystic Ovarian Syndrome is still unknown, one of the most commonly accepted hypotheses for underlying pathophysiologic mechanisms is hyperinsulinemia and insulin resistance. It is suggested that obesity, hyperinsulinemia and insulin resistance are closely related and each of these diseases affect the other. The insulin resistance contributes to the pathophysiology of type 2 diabetes mellitus (T2DM) and is a marker of obesity, metabolic syndrome and many cardiovascular diseases. Therefore, quantification of insulin resistance is very important. Some methods rely on steady state analysis of glucose and insulin, whereas others rely on dynamic testing. Each of these methods has distinct advantages and limitations. Thus, optimal choice and employment of a specific method depend on the nature of the studies being performed. Established direct methods for measuring insulin sensitivity in vivo are relatively complex. There is a need for elaboration of a universal marker in the diagnosis of insulin resistance that could be applied in both clinical and ambulatory settings. Currently, measurements of serum insulin and estimates of insulin resistance are not required for routine clinical management.

Embryos from in Vitro Maturation (IVM) Technique Can Be Successfully Vitrified Resulting in the Birth of a Healthy Child.

IVM can be an advantageous technique when applied to PCOS (Polycystic Ovarian Syndrome) patients. The oocytes are retrieved from antral follicles of non-stimulated ovaries, specially preventing hyperstimulation syndrome. Apart from its role as a reproductive treatment, IVM has emerged as a promising tool for emergency fertility preservation, since it can be performed flexibly in either follicular or luteal phase. A 34-year-old patient with PCOS, high body mass index and tubal factor was submitted twice to IVM treatment. Her husband has low count spermatozoa. The first IVM cycle was in 2009, she transferred 3 fresh embryos and got pregnant giving birth to a healthy boy weighing 3.3 kg. In 2013, the patient returned for another IVM cycle and the embryos had to be vitrified because she failed to develop an adequate endometrium for transfer. In the next cycle, the endometrium was prepared using estrogen and progesterone and the two best embryos were warmed up and transferred. She became pregnant and after 36 weeks gave birth to a healthy girl weighing 2.7 kg. She still has four embryos left to transfer. IVM may be an alternative technique to be considered when dealing with PCOS patients. Although clinical outcomes are currently inferior when compared with conventional hormone driven ART (Artificial Reproductive Techniques), it does apply in some cases while preventing hyperstimulation risks. Thus, embryos obtained by IVM can also be vitrified with successful outcomes.

Maduración in vitro de ovocitos humanos: una opción para preservar la fertilidad de las mujeres: reporte del primer caso realizado en Chile / Oocyte in vitro maturation: alternative approach for fertility preservation: report the first case in Chile

La maduración in vitro (MIV) de ovocitos humanos es parte de las técnicas de fecundación in vitro, que consiste en la aspiración de ovocitos inmaduros. Es ofrecida principalmente a pacientes con alto riesgo de desarrollar un síndrome de hiperestimulación ovárica, especialmente pacientes con síndrome de ovario poliquístico. Adicionalmente, es un método ofrecido a las pacientes oncológicas para preservar su fertilidad. Presentamos el primer caso de MIV realizado en Chile, en la Unidad de Medicina Reproductiva de Clínica Monteblanco, en una paciente con sospecha de resistencia ovárica a la FSH y quien, con el consentimiento de sus padres, realizó este procedimiento para preservar su fertilidad a futuro.

Oocyte in vitro maturation (IVM) is an assisted reproductive technology in which immature oocytes are retrieved from antral follicles. It has been applied mainly in patients with an increased risk of ovarian hyperstimulation syndrome, particularly in patients with polycystic ovarian syndrome. Moreover, it has been proposed as an alternative approach for fertility preservation for oncological patients. We report the first IVM case in Chile, preformed at the Centre for Reproductive Medicine at Clínica Monteblanco, in a patient with suspected ovarian resistance to FSH, who with the consent of her parents, performed IVM to preserve her fertility.