Anti-Müllerian hormone dynamics during ovulation induction treatment with recombinant follicle-stimulating hormone in women with polycystic ovary syndrome.

INTRODUCTION: Anti-Müllerian hormone (AMH) has been suggested as a predictor of ovarian response to ovulation induction and controlled ovarian hyperstimulation. MATERIAL AND METHODS: Twenty-six women, wishing to become pregnant and who showed resistance to clomiphene citrate, were included in the study. All women received recombinant follicle-stimulating hormone (recFSH). RESULTS: In the group of good responders, luteinising hormone (LH) and oestradiol levels were lower than in the group of non-responders. Free testosterone levels, free androgen index, and insulin resistance were higher in the group of non-responders. In the group of good responders, AMH levels decreased on successive days of ovarian stimulation and a greater slope of AMH levels was observed in patients with a higher number of increasing follicles. PCOS patients have low FSH and high AMH levels. It could be suggested that the serum AMH decrease preceded growth of many follicles, which is a consequence of the FSH stimulation. In anovulatory PCOS women, gently increasing the serum FSH level reduces the AMH excess, thus relieving the inhibition from the latter on aromatase expression by selectable follicles and allowing the emergence of growing follicles. Patients with severe hyperandrogenism, insulin resistance and high level of LH do not respond to stimulation. CONCLUSIONS: The decrease of AMH levels in PCOS women after one week of ovarian stimulation is a practical, valuable indicator which could predict the patients with a high risk of ovarian hyperstimulation. Anovulating PCOS patients with severe hyperandrogenism, insulin resistance and hyperinsulinaemia should not be qualified for recFSH ovarian stimulation.

MURCS Association with Partial Duplication of the Distal Long Chromosome 5 and Unilateral Ovarian Agenesis.

A combination of the congenital abnormalities, Müllerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia, is defined as the MURCS association. Various genetic defects have been described in the MURCS association so far, yet the unambiguous molecular basis of these disorders has not been established. We report the case of an 18-year-old woman who presented with primary amenorrhea, right kidney, Arnold-Chiari malformation, and Klippel-Feil syndrome. In addition, the patient showed the following unusual features: right ovarian and Skenes gland agenesis, cubitus valgus with hyperextension and decreased range of motion at elbows, and facial changes. Moreover, the performed DNA analysis showed interstitial duplication in chromosome 5 (5q35.1). In the duplicated region, there are genes whose function is not well known. It is thought that they have an influence on the early stages of development and their joining in the later period can lead to neoplastic disorders, especially leukemias.

Is the plasma anti-Müllerian hormone (AMH) level associated with body weight and metabolic, and hormonal disturbances in women with and without polycystic ovary syndrome?

OBJECTIVE: The aim of the study was to analyze interrelation between AMH levels and body weight, metabolic, and hormonal status in normal and overweight weight women with and without polycystic ovary syndrome (PCOS). STUDY DESIGN: Eighty-seven women (54 normal weight and 33 overweight) diagnosed with PCOS and 50 apparently healthy women - Non-PCOS (28 normal weight and 22 overweight) were enrolled. The body weight and height were measured and BMI was calculated. In addition to serum glucose, lipids, androgens, FSH, LH, SHBG and insulin, AMH were assessed in fasting state and free androgens index (FAI) was calculated. The insulin resistance was assessed based on the homeostasis model of assessment-insulin resistance (HOMA-IR). RESULTS: Plasma AMH levels were similar in normal weight and overweight PCOS groups (9.6±3.5 vs. 11.2±4.5ng/mL, respectively), and as expected markedly higher than in both Non-PCOS groups (2.5±0.8 and 2.3±0.7ng/mL, respectively). There were no correlations between BMI and AMH levels in all study groups. A significant positive correlation between HOMA-IR, free testosterone concentrations or FAI and AMH levels were found (R=0.31, p<0.001; R=0.91, p<0.001 and R=0.62, p<0.001, respectively). Moreover, there was positive correlation between total or LDL cholesterol and AMH levels (R=0.22, p<0.05 and R=0.31, p<0.05, respectively) and a negative one between HDL cholesterol and AMH levels (R=-0.17, p<0.05) in all study subjects. CONCLUSIONS: The plasma AMH level is associated with insulin resistance but not with BMI per se. Increased circulating AMH level seems to reflect the disturbances of gonadotrophins release in PCOS. It seems that AMH level may be used not only as new surrogate marker of ovarian hyperandrogenism in PCOS but also as a potential new cardiovascular risk factor.

Serum adiponectin and resistin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome.

OBJECTIVES: It seems that adipokines participate in disturbances of the function of the hypothalamus-pituitary-ovary axis. The aim of the study was to assess the relationship between plasma adiponectin and resistin levels and insulin resistance and markers of hyperandrogenism in lean and obese PCOS women. STUDY DESIGN: Forty-one women with PCOS (22 lean and 19 obese) and 16 healthy lean women were enrolled. Body mass and height were measured and body mass index was calculated. In addition to serum glucose, lipids, androgens and insulin, adiponectin and resistin concentration were assessed in the fasting state. The insulin resistance was calculated based on the HOMA-IR. RESULTS: Similar serum resistin concentrations were found in both PCOS subgroups and controls. The obese PCOS subgroup was characterized by the lowest serum adiponectin level (10.8 ± 8.3, compared with 21.0 ± 15.1 in the normal weight PCOS subgroup and 26.7 ± 12.5 µg/ml in controls). There were no correlations between resistin and adiponectin levels and HOMA-IR values and serum androgen concentrations. Significant positive correlations between adiponectin to resistin ratio and plasma FSH (r = 0.49; p = 0.001) and LH (r = 0.45; p = 0.003) concentrations, and a negative correlation with free androgen index (r = -0.34; p = 0.03) in PCOS group were found. CONCLUSIONS: Obese but not normal weight PCOS women have lower adiponectin levels whereas resistin concentration did not differ in normal weight and obese PCOS compared to control subjects. We hypothesize that changes of the relative proportion of adiponectin to resistin, but not circulating adiponectin and resistin levels themselves, may play a role in hormonal disturbances but not in insulin resistance in PCOS.

[The influence of anti-Mullerian hormone on folliculogenesis]. / Wplyw hormonu anty-Mullerowskiego (AMH) na folikulogeneze.

The main biological role of the anti-Mullerian hormone (AMH) is to induce the involution of the Muller ducts in embryos during differentiation of masculine gender. In case of women, AMH is produced in granular cells of primary, preantral and antral follicles. The expression of AMH initiates at the moment of the follicle recruitment and it lasts until the stage of an antral follicle. The level of this hormone decreases with age and in postmenopausal period is undetectable in blood. Therefore, AMH could be a useful marker of ovarian reserve. Multiple investigations have revealed higher AMH levels in the blood of PCOS patients. It is believed to be the consequence of the increased amount of small antral follicles. AMH is considered to have an essential role in folliculogenesis. It inhibits the process of recruitment of primordial follicles and modifies the growth of preantral and antral follicles by diminishing the sensitivity of follicles for FSH stimulation. The paper is a review of the present knowledge of the structure and activity of AMH. AR gene and protein. Participation of AMH in folliculogenesis and changes of AMH levels depending on structure and age of the ovary have also been discussed. Recent findings concerning the possibility of using AMH to assess ovarian reserve and efficiency of the stimulation of ovulation in infertile women have been presented. It is believed that increased knowledge concerning AMH might improve the diagnosis and treatment of infertility caused by lack of ovulation.

[Analysis of leptin pulses in serum in women with polycystic ovary syndrome]. / Analiza wystepowania pulsów w dobowych zmianach stezen leptyny w surowicy krwi u kobiet z zespolem policystycznych jajników.

OBJECTIVES: Authors estimate the influence of body mass on the leptin serum concentrations changes in course of 24 hours in twelve women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: The course of leptin pulses was analysed in two volunteers' six-persons groups, both with PCOS. first group with BMI < 22 kg/m2 and the second group with BMI >26 kg/m2. The blood samples (0,5 ml) were taken from cubital vein in 15-20 minutes intervals through 48 hours. In the first day of clinical experiment three meals were accepted but in the second day the women were starved and they could drink only mineral water. RESULTS: The significant difference in average leptin concentration in any woman's group between each experimental day was observed. The value of leptin pulses amplitude compared between both women's group on each experimental daytime was significant too. The results we got relating number of leptin pulses and their duration time compared between both women's group and into groups between night and day were not statistically significant. CONCLUSION: For leptin pulses detection in blood the cluster method was applied, which confirmed the pulses appearance in leptin secretion in both woman's group.

Expression of aromatase and 5-alpha-reductase genes in endometrial adenocarcinoma.

The aim of this study was to investigate the expression of genes coding aromatase and 5-alpha-reductase type 1 and type 2 in endometrial adenocarcinoma, with parallel analysis of testosterone concentrations in serum isolated from blood of basilic and ovarian vein. A significant difference between the copy numbers of mRNA for 5-alpha-reductase type 1 and type 2 was disclosed. The content of the mRNA copies was higher for 5-alpha-reductase type 2 than for type 1. We noted a positive correlation between the mRNA copy number for aromatase and 5-alpha-reductase type 1 as well as between the mRNA copy number for aromatase and 5-alpha-reductase type 2. A positive correlation was disclosed between the mRNA copy number for 5-alpha-reductase type 1 and type 2. We concluded that in tissues of endometrial adenocarcinoma, there is expression of aromatase and 5-alpha-reductase type 1 and 2 genes, and that the expression of aromatase and 5-alpha-reductase genes in tissues of endometrial adenocarcinoma is not controlled by testosterone.

[The metabolic aspects of polycystic ovarian syndrome]. / Metaboliczne aspekty zespolu policystycznych jajników (PCOS).

Polycystic ovarian syndrome (PCOS) is considered to be the main reason of hyperandrogenism in reproductive women. There are often metabolic disorders connected with carbohydrate and adipose metabolism in the patients with PCOS. However, presence of metabolic disorders does not influence the diagnosis of the syndrome. The investigations demonstrated that the changes in lifestyle and use of proper medications could normalize endocrine system and metabolism through insulin-sensitivity increase and in the result it could restore the menses and ovulations. This paper introduces present knowledge concerning metabolic disorders associated with PCOS.

[The endocrinology of the human placenta]. / Czynnosc hormonalna lozyska.

The human placenta performs various, important functions essential for the maintenance of pregnancy and development of the fetus. Its secretory diversity surpasses any of the other endocrine organs. The placenta is provided with precursors of hormones by the mother as well as by the fetus. It synthesizes and secretes steroid and protein hormones, growth factors, cytokines. The paper is the review of the present knowledge of steroid hormones (progesterone, estrogens), in particular their synthesis and functions in fetoplacental unit. The protein hormones (chorionic gonadotropin, placental lactogen) are also discussed. The last findings concerning placental gonadotropin-releasing hormone, corticotropin-releasing hormone, leptin, activin, inhibin, follistatin and urocortin are presented. The endocrinology of the placenta is considered to be a progressive field of science. The performed studies elucidate the role of the newly identified hormones in the placenta. It is believed, that research on endocrinology of the placenta contributes to the development of perinatology and, moreover, they improve the prenatal care.