Metabolic implications of menstrual cycle length in non-hyperandrogenic women with polycystic ovarian morphology.

This cross-sectional study aimed to investigate the association between menstrual cycle lenght and metabolic parameters in non-hyperandrogenic women with polycystic ovarian morphology, n = 250. Metabolic profiles of all participants were evaluated using anthropometric parameters (body mass index, waist circumference), parameters of dyslipidemia (total cholesterol, HDL-cholesterol, triglycerides) and markers of insulin resistance (fasting insulin, homeostasis model assessment for insulin resistance index). The associations between menstrual cycle lenght and cardiometabolic risk factors such as insulin resistance, dyslipidemia, and obesity were investigated. In non-hyperandrogenic women with polycystic ovarian morphology, menstrual cycle lenght was associated with hypertriglyceridemia and insulin resistance independently of body mass index. Moreover, menstrual cycle lenght added value to body mass index in predicting hypertriglyceridemia. The optimal menstrual cycle lenght cut-off value for identifying of non-hyperandrogenic women with polycystic ovarian morphology at metabolic risk was found to be 45 days. Metabolic profile of non-hyperandrogenic women with polycystic ovarian morphology (n = 75) with menstrual cycle lenght >45 days was similar to that of hyperandrogenic women with polycystic ovarian morphology (n = 138) while metabolic profile of non-hyperandrogenic women with polycystic ovarian morphology with menstrual cycle lenght ≤45 days (n = 112) was similar to that of controls (n = 167). Non-hyperandrogenic women with polycystic ovarian morphology with menstrual cycle lenght >45 days had higher prevalence of cardiometabolic risk factors compared to those with menstrual cycle lenght ≤45 days. Non-hyperandrogenic women with polycystic ovarian morphology are not metabolically homogeneous. Menstrual cycle lenght is an easy-to-obtain clinical parameter positively associated with the probability of unfavorable metabolic status in non-hyperandrogenic women with polycystic ovarian morphology. Menstrual cycle lenght cut-off value of 45 days was found to have the best capacity in discriminating non-hyperandrogenic women with polycystic ovarian morphology with and without metabolic derangement(s) corroborating in favor of the cardiometabolic risk factors screening and management in non-hyperandrogenic women with polycystic ovarian morphology with menstrual cycle lenght >45 days through strategies for prevention of cardiovascular disease.

Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria.

Polycystic ovary syndrome (PCOS) women are more insulin resistant than general population. Prevalence data on insulin resistance (IR) in PCOS vary depending on population characteristics and methodology used. The objectives of this study were to investigate whether IR in PCOS is exclusively associated with body mass and to assess the prevalence of IR in lean and overweight/obese PCOS. Study included 250 consecutive women who attended a Department of Human Reproduction diagnosed as having PCOS according to the Rotterdam criteria. Control group comprised 500 healthy women referred for male factor infertility evaluation during the same period as the PCOS women. PCOS women (n = 250) were more insulin resistant than controls (n = 500) even after adjustment for age and body mass index (BMI) (P = 0.03). Using logistic regression analysis, BMI ≥ 25 kg/m(2) (OR 6.0; 95 % CI 3.3-11.0), PCOS (OR 2.2; 95 % CI 1.4-3.5) and waist circumference ≥ 80 cm (OR 2.0; 95 % CI 1.1-3.8) were identified as independent determinants of IR (P < 0.001). IR was more prevalent in overweight/obese controls (n = 100) than in lean PCOS women (n = 150), 31 versus 9.3 %, but less prevalent than in overweight/obese PCOS (n = 100), 31 versus 57 %. The prevalence of IR between lean controls (5 %) and lean PCOS (9.3 %) did not significantly differ. Both PCOS-specific and obesity-related IR independently contribute to IR in PCOS. Using HOMA-IR cutoff value of 3.15 specific for Croatian women in our clinical setting, the assessed prevalence of IR in lean and overweight/obese PCOS women was 9.3 and 57 %, respectively.

Dehydroepiandrostendione sulphate and prediction of live birth after IVF in young women with low anti-Müllerian hormone concentration.

Baseline dehydroepiandrostendione sulphate (DHEAS) has been demonstrated to discriminate between young, expected poor responders with favourable clinical pregnancy prospects after IVF treatment and their counterparts with significantly lower pregnancy chances. This study investigated DHEAS ability to predict live birth before starting the first gonadotrophin-releasing hormone (GnRH) antagonist ovarian stimulation for IVF/intracytoplasmic sperm injection in young women (⩽37years) with low serum AMH (<6.5pmol/l). Medical records of 90patients were analysed. DHEAS was predictive for live birth (AUC-ROC 0.69, 95% CI 0.59-0.79). Its predictive accuracy for live birth was similar to that of the number of oocytes retrieved. The cut-off value for DHEAS of 5.4µmol/l offered the best discriminative performance between patients who achieved live birth and those who did not. The live birth rate per initiated cycle in women with DHEAS concentration >5.4µmol/l was 5-fold higher compared with women with DHEAS ⩽5.4µmol/l (38.9% versus 7.4%, P<0.001) despite similar oocyte yield in both groups. In conclusion, the association between baseline DHEAS and probability of live birth after the GnRH antagonist IVF cycle in young women with low AMH was demonstrated. This association could not be explained by the effect of DHEAS on the oocyte yield. This study demonstrates an association of baseline dehydroepinadrostendione sulphate (DHEAS) concentration with implantation rate and live birth rate after the first gonadotrophin-releasing hormone antagonist IVF cycle in young women who are expected to respond poorly to ovarian stimulation. Compared with the number of oocytes retrieved, DHEAS showed a similar ability to distinguish women who will achieve a live birth from those who will not. However, as a parameter available to clinicians and patients before commencing an ovarian stimulation for IVF, DHEAS could be used in predicting probability of live birth at the initial consultation. Women whose DHEAS concentrations were above the derived cut-off value 5.4µmol/l had 5-fold more favourable prognosis for live birth than their counterparts with DHEAS concentrations below the cut-off value. The findings could not be explained by the difference in the oocyte yield and/or the number of embryos transferred but rather by the possible association between the endogenous DHEAS concentration and the oocyte competence to produce a viable embryo.

The IVF Outcome Counseling Based on the Model Combining DHEAS and Age in Patients with Low AMH Prior to the First Cycle of GnRH Antagonist Protocol of Ovarian Stimulation.

Objective. To investigate the endocrine and/or clinical characteristics of women with low anti-Müllerian hormone (AMH) that could improve the accuracy of IVF outcome prediction based on the female age alone prior to the first GnRH antagonist IVF cycle. Methods. Medical records of 129 patients with low AMH level (<6.5 pmol/L) who underwent their first GnRH antagonist ovarian stimulation protocol for IVF/ICSI were retrospectively analyzed. The main outcome measure was the area under the ROC curve (AUC-ROC) for the models combining age and other potential predictive factors for the clinical pregnancy. Results. Clinical pregnancy rate (CPR) per initiated cycles was 11.6%. For the prediction of clinical pregnancy, DHEAS and age showed AUC-ROC of 0.726 (95%CI 0.641-0.801) and 0.662 (95%CI 0.573-0.743), respectively (P = 0.522). The predictive accuracy of the model combining age and DHEAS (AUC-ROC 0.796; 95%CI 0.716-0.862) was significantly higher compared to that of age alone (P = 0.013). In patients <37.5 years with DHEAS >5.7 pmol/L, 60% (9/15) of all pregnancies were achieved with CPR of 37.5%. Conclusions. DHEAS appears to be predictive for clinical pregnancy in younger women (<37.5 years) with low AMH after the first GnRH antagonist IVF cycle. Therefore, DHEAS-age model could refine the pretreatment counseling on pregnancy prospects following IVF.