Clinical efficacy of bushen huatan huoxue recipe in combination with acupuncture in treating patients suffering from polycystic ovary syndrome with insulin resistance

Objective:To investigate the clinical efficacy and effects on sex hormone level and glucose metabolism indexes of acupuncture therapy combined with the Bushen Huatan Huoxue Recipe in patients with polycystic ovary syndrome(PCOS)with insulin resistance(IR).Methods:The patients with PCOS-IR admitted from December 2021 to December 2022 were randomly divided into two groups,30 cases in each group.The comparison one and the observation one were given the relevant treatment of metformin and traditional Chinese medicine combined with acupuncture,respectively.The evidence points,sex hormone indexes and glucose metabolism indexes were compared between the two groups before and after treatment,and the insulin resistance index(HOMA-IR),glucose area under the curve(GLU-AUC)and blood insulin area under the curve(INS-AUC)were calculated.Results:The evidence points of the observation group of patients were less than the pre-treatment and comparison groups;after treatment,the follicle-stimulating hormone(FSH)level of patients in the observation group was more than the control and pre-treatment groups(P<0.05),and the ratio of luteinizing hormone(LH)to follicle-stimulating hormone(FSH)was less than that of the comparison and pre-treatment groups(P<0.05),and the levels of LH and testosterone(T)were reduced to varying degrees in both groups around the time of treatment(P<0.05).The patients in the observation group had lower levels of 0.5hPG than those in the comparison group and pretreatment(both P<0.05),and the levels of 3hPG in both groups were lower than those before treatment(P<0.05).The oral OGIRT in each of the two groups after treatment was lower than that of pretreatment(P<0.05).HOMA-IR and INS-AUC of the observation group were lower than those of the control group and pre-treatment(P<0.05).Conclusion:The treatment of PCOS-IR patients with Bushen Huatan Huoxue Recipe combined with acupuncture can improve the sex hormone,glucose metabolism level and insulin resistance.

The Expression of Resistin in Adipose Tissues of Patients with Polycystic Ovary Syndrome and Insulin Resistance

The relationship between the expression of resistin in polycystic ovary syndrome （PCOS） and insulin resistance was investigated. The plasma resistin concentrations in 35 patients with PCOS and 40 controls were measured by ELISA. Luteinizing hormone （LH）, follicle-stimulating hormone （FSH）, and fasting insulin （FIN） were tested by radioimmunoassay. Insulin resistance index （HOMA-IR） was calculated. Fasting plasma glucose （FPG） was determined by oxidase test. Western blot and reverse transcriptase PCR （RT-PCR） methods were used to detect the expression of resistin in adipose tissues. The levels of plasma resistin, LH, LH/FSH and FIN and HOMA-IR in patients with PCOS were significantly higher than those in control group （all P〈0.05）. Plasma resistin was correlated positively with FPG, FIN, HOMA-IR, LH and LH/FSH （r=0.56, 0.60, 0.65, 0.48, and 0.42 respectively）. Resistin protein and mRNA expression levels in patients with PCOS were significantly higher than those in normal tissues （all P〈0.01）. It was concluded that resistin might be involved in the pathogenesis of insulin resistance of PCOS.

Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome

BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.

Potent Therapeutic Effects of Shouwu Jiangqi Decoction(首乌僵芪汤)on Polycystic Ovary Syndrome with Insulin Resistance in Rats

Objective：To investigate the effect of Shouwu Jiangqi Decoction（首乌僵芪汤,SJD） on polycystic ovary syndrome（PCOS） with insulin resistance（IR） in rats and to explore the underlining molecular mechanisms.Methods：A total of 51 female Sprague-Dawley rats were randomly divided into 6 groups：control group（n=7）,model group（n=8）,SJD high-dose group（n=9）,SJD medium-dose group（n=9）,SJD low-dose group（n=9） and DMBG group（n=9）.Radioimmunoassay was used to measure serum follicle-stimulating hormone（FSH）,luteinizing hormone（LH） and testosterone concentrations and qRT-PCR and western blot were used to examine the expression levels of mRNA and protein respectively of insulin receptor substrate 1（IRS-1）and phosphatidylinositide 3-kinases（PI3K） p85α in different groups.Results：FSH level significantly decreased in the model group compared with the normal control（P〈0.01）,and high-dose SJD and DMBG can significantly increase FSH level（P〈0.01）.LH level showed a mild increase without statistic significance in the model group compared with the control and different dosages of SJD had no significance effect on LH level,while DMBG can significantly decrease LH level（P〈0.01）.Testosterone level significantly increased in the model group compared with the control group（P〈0.01）,and high-dose SJD and DMBG can significantly decrease testosterone level（P〈0.01）.The expression of IRS-1 as well as PI3Kp85α were significantly decreased in the model group compared with the normal control group at both mRNA（P〈0.001） and protein（P〈0.01） level,and both high-dose SJD and DMBG can enhance IRS-1 and PI3 K expression（P〈0.05）.Conclusions：SJD has potent therapeutic effects on PCOS with IR in rats.The therapeutic effects of SJD on IR and ovulatory dysfunction are probably achieved through correcting the defective insulin signaling transduction.

Follicular hyperandrogenism and insulin resistance in polycystic ovary syndrome patients with normal circulating testosterone levels

Polycystic ovary syndrome（PCOS） is a common reproductive disease with high heterogeneity. The role of excess androgen in PCOS etiology remains disputed, since around 20%-50% of PCOS women do not display hyperandrogenemia. The microenvironment of the ovary critically influences follicular development. In the present study, we assessed the role of androgen in PCOS by investigating whether excessive follicular fluid androgen was present in PCOS patients with normal serum androgen levels and influenced by follicular fluid insulin resistance（IR）.Follicular fluid samples of 105 women with PCOS and 105 controls were collected. Levels of steroid hormones,glucose and insulin in the follicular fluid were examined and compared with data from serum biochemistry tests. We found that 64.9%（63/97） of PCOS patients with normal serum androgen levels displayed abnormally high follicular fluid androgen level. The follicular fluid androgen level was positively correlated with follicular fluid IR within a certain range and follicular fluid estrogen-to-testosterone（E2/T） ratio was significantly reduced in these patients.These results indicated that there existed a subgroup of PCOS patients who displayed excessive follicular fluid androgen and IR despite their normal circulating testosterone（T） levels. Our study highlights the importance of ovary hyperandrogenism and IR in the etiology of PCOS.

Effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome patients with insulin resistance

Objective To investigate the effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome(PCOS)patients with insulin resistance(IR).Methods Thirty-five PCOS patients with IR were treated with pioglitazone 15mg/d for 12 weeks.The results of ovulation induction were observed.The changes of fasting plasma glucose(FPG),fasting serum insulin(FINS),serum levels of leptin,adiponectin,follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T)and blood fat were examined at the baseline and after the therapy by enzyme-linked immunosorbent assay(ELISA)and radioimmunoassay(RIA).Results After the treatment,the rate of ovulation per cycle was improved in 31(88.5%)out of the 35 patients.After treatment,the level of serum leptin was decreased(P<0.05)while the level of serum adiponectin was increased(P<0.05).After 12 weeks’ treatment,waist-to-hip ratio and F-G score were significantly decreased(P<0.05),BMI declined but without significant difference(P>0.05).The levels of LH,T,FINS,Homa-IR,total cholesterol,triglyceride and low density lipoprotein-cholesterol were significantly decreased(P<0.01,P<0.05),whereas the level of high density lipoprotein-cholesterol was significantly increased(P<0.01).No significant difference was seen in FSH and FPG following treatment(P>0.05).Conclusion Pioglitazone treatment can effectively improve PCOS with IR patients’ clinical syndromes,insulin sensitivity,glucose and lipid metabolism at least partly through improving the profiles of leptin and adiponectin.

Effect of Rosiglitazone on Endocrine, Metabolism and Ovulatory Performance in Patients with Polycystic Ovary Syndrome and Insulin Resistance

The effect of rosiglitazone on endocrine, metabolism and ovulatory performance in the paitents with polycystic ovary syndrome(PCOS) and insulin resistance was investigated. Twenty-five patients diagnosed as having polycystic ovary syndrome (PCOS) combined with insulin resistance were treated with rosiglitazone for 12 weeks. Before and after treatment, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone (T), androstenedione (A), sex hormone binding globulin (SHBG), insulin and glucose concentration, total cholesterol, triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholestero (LDL-C), apolipoprotein A, apolipoprotein B levels and ovulatory performance were determined. The results showed that after treatment serum insulin levels was decreased significantly (P<0.01). The HDL-C was increased while LDL-C decreased significantly (P<0.05, P<0.01). The serum LH, T, A concentrations and the ratio of LH/FSH were decreased, while SHBG levels increased significantly (P<0.01). The ovulation rate during clomiphene citrate therapy was 72 %, significantly higher than that before treatment. It is likely that reduction of hyperinsulinemia that is produce by rosiglitazone may effectively improve the endocrine, metabolism and ovulatory performance in the patients with PCOS and insulin resistance.

Insulin Resistance and Its Associated Risk Factors in Nigerian Women with Polycystic Ovary Syndrome

Background: The etiology of polycystic ovary syndrome (PCOS) is not completely understood;however one condition that correlates closely with the pathogenesis of PCOS is insulin resistance (IR). The objective of this study was to determine the prevalence of insulin resistance (IR) and the association of such abnormality with potential risk factors in women with PCOS. Method: 116 women with confirmed PCOS attending a reproductive clinic at the University of Benin Teaching Hospital in Benin City were studied. IR was determined by homeostatic model assessment (HOMA) ≥ 2 and pre-diabetes by fasting plasma glucose between 110 and 125 mg/dl and/or plasma glucose value between 140 and 200 mg/dl at 2 hours during an oral glucose tolerance test (OGTT) after ingestion of 75 g oral glucose load. Results: Forty-two women were insulin resistant among the 116 women with PCOS. The prevalence of IR was 36.2% (95% CI 26.6 - 46.2). The prevalence of impaired fasting glucose (IFG) showed 1.7% (95% CI 0.97 - 2.03), impaired glucose tolerance (IGT) was 2.6% (95% CI 1.97 - 3.03) and diabetes mellitus (DM) was 1.7% (95% CI 0.97 - 2.03) in the 116 PCOS women. Of these 42 insulin resistant PCOS women, 23.8% (n = 10) were obese and 40.5% (n = 17) were overweight. Multivariate analysis revealed that total cholesterol (OR, 1.07;95% CI, 1.04 - 1.10), triglycerides (OR, 1.08;95% CI, 1.04 - 1.13) and LDL-cholesterol (OR, 1.08;95% CI, 1.04 - 1.12) were statistically significant independent risk factors for IR. Conclusion: The prevalence of IR was high in women with PCOS, and there was a significant association between IR, obesity, and dyslipidemia. However, the prevalence rates of impaired glucose tolerance and DM were low in women with PCOS compared to other studies. Since women with PCOS are at risk of IR and dyslipidemia, early screening, detection, intervention, and lifestyle modification would ameliorate the financial burden of DM and cardiovascular disease (CVD).

The relationship of serum Myostatin content with lipid metabolism, insulin resistance and inflammatory response in patients with polycystic ovary syndrome

Objective:Objective:To investigate the relationship of serum Myostatin content with lipid metabolism,insulin resistance and inflammatory response in patients with polycystic ovary syndrome(PCOS).Methods:118 PCOS patients were taken as the PCOS group,and 100 healthy women of child-bearing age who underwent physical examination in our hospital during the same period were taken as the normal control group.The differences in serum Myostatin content,lipid metabolism index levels,insulin resistance index levels and inflammatory mediator contents were compared between the two groups,and the internal relationship between serum Myostatin content and the above disease-related index levels in PCOS patients was further analyzed.Results:Serum Myostatin content of PCOS group was higher than that of normal control group.Peripheral blood lipid metabolism indexes TC,LDL-C and ApoB levels of PCOS group were higher than those of normal control group whereas HDL-C and ApoA-Ⅰlevels were lower than those of normal control group;insulin resistance indexes FINS and HOMA-IR levels were higher than those of normal control group;inflammatory mediators IL-18,MCP-1 and CRP contents were higher than those of normal control group.Pearson test showed that serum Myostatin content in PCOS patients was directly correlated with the levels of the above disease-related indexes.Conclusion:Serum Myostatin content is abnormally high in PCOS patients,and the specific content is positively correlated with the disease severity.

Effect of Bailing capsule combined with ethinylestradiol and cyproterone acetate and metformin on lipid metabolism and insulin resistance in patients with polycystic ovary syndrome

Objective:To investigate the effect of Bailing capsule combined with ethinylestradiol and cyproterone acetate and metformin on lipid metabolism and insulin resistance in patients with polycystic ovary syndrome (PCOS).Methods: A total of 108 patients with PCOS who were treated in our hospital between November 2014 and April 2017 were reviewed and divided into routine group (n=67) who received routine therapy and Bailing capsule group (n=41) who received Bailing capsule combined with routine therapy. Routine group received ethinylestradiol and cyproterone acetate and metformin therapy, and Bailing capsule group were treated with Bailing capsule combined with ethinylestradiol and cyproterone acetate and metformin therapy. The differences in the levels of lipid metabolism, insulin resistance indexes as well as inflammatory factors were compared between the two groups before and after treatment.Results: There was no statistically significant difference in serum levels of lipid metabolism, insulin resistance-related indexes and inflammatory factors between the two groups before treatment. After treatment, serum HDL-C content of Bailing capsule group was higher than that of routine group whereas LDL-C and TC contents were lower than those of routine group;serum insulin resistance-related indexes FINS and HOMA-IR levels were lower than those of routine group;serum inflammatory cytokines IL-6, TNF-α, APN and LEP contents were lower than those of routine group.Conclusion: Bailing capsule combined with ethinylestradiol and cyproterone acetate and metformin therapy can effectively improve the lipid metabolism level and inhibit the insulin resistance in patients with PCOS.

The Effect of Insulin Resistance on In-Vitro Fertilization-Embryo Transfer in Women without Polycystic Ovary Syndrome

Purpose: Insulin resistance (IR) plays an important role in the pathogenesis of polycystic ovary syndrome (PCOS);therefore, insulin-sensitizing agents are widely used to improve IR in women with PCOS. However, whether IR in patients without PCOS should be treated remains uncertain. This study aims to clarify whether IR in patients without PCOS affects the outcomes of in-vitro fertilization-embryo transfer (IVF-ET) and pregnancy. Methods: Between January 2011 and December 2013, we retrospectively reviewed the medical records of 116 non-PCOS patients who underwent the first IVF–ET cycle. IR was calculated using the homeostasis model assessment (HOMA) index [HOMA-IR = (insulin × glucose)/405]. A HOMA index of >2.5 was used to indicate IR. Based on the HOMA index calculation, 28 patients were IR(+) and 88 patients had normal insulin sensitivity. We retrospectively compared the response with controlled ovarian hyperstimulation, retrieved oocytes number, fertilization rates, pregnancy rate, live birth rates, and gestational diabetes mellitus (GDM) incidence. Results: There were no significant differences in human menopausal gonadotropin administration, peak estradiol, retrieved oocyte number, fertilized embryo number, good quality embryo number, implantation rate, clinical pregnancy rate, miscarriage rate, delivery rate, or ovarian hyperstimulation syndrome and GDM incidences between the groups. Conclusion: IR in non-PCOS patients has no effect on IVF-ET outcomes or perinatal prognosis.

Markers of insulin resistance in Polycystic ovary syndrome women:An update

Polycystic ovary syndrome(PCOS)is one of the most common endocrine disorders,affecting 5%-10%of women of reproductive age.The importance of this syndrome lies in the magnitude of associated comorbidities:infertility,metabolic dysfunction,cardiovascular disease(CVD),plus psychological and oncological complications.Insulin resistance(IR)is a prominent feature of PCOS with a prevalence of 35%-80%.Without adequate management,IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS.Furthermore,epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance,gestational diabetes mellitus and type 2 diabetes.In addition,metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS.Indeed,the severity of IR in women with PCOS is associated with the amount of abdominal obesity,even in lean women with PCOS.Given these drastic implications,it is important to diagnose and treat insulin resistance as early as possible.Many markers have been proposed.However,quantitative assessment of IR in clinical practice remains a major challenge.The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp.However,it is not used routinely because of the complexity of its procedure.Consequently,there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations.Despite this,many of them are either difficult to apply in routine clinical practice or useless for women with PCOS.Considering this difficulty,there is still a need for an accurate marker for easy,early detection and assessment of IR in women with PCOS.This review highlights markers of IR already used in women with PCOS,including new markers recently reported in literature,and it establishes a new classification for these markers.

Assessing and treating insulin resistance in women with polycystic ovarian syndrome

Polycystic ovarian syndrome(PCOS) is a highly prevalent hormonal and metabolic disorder among reproductive aged women worldwide.Women with PCOS have widely varying phenotypes and seek medical care for differing reasons.In addition to concern for menstrual cycle function,ovulation,hirsutism and acne,many PCOS women have abnormal glucose metabolism.While diabetes mellitus and impaired glucose tolerance are easily diagnosed,the diagnosis of and concern for insulin resistance as a precursor disorder is underappreciated.Insulin resistance may be the first important marker of metabolic disease in PCOS women at risk for metabolic syndrome and coronary artery disease.

Study of Androgen and Androgen Receptor in Relation to Insulin Resistance in Polycystic Ovary Syndrome

In order to investigate the relationship between serum testosterone level and expression of androgen receptors in ovary in relation to insulin resistance in polycystic ovary syndrome (PCOS). Serum testosterone levels were determined by radioimmunoassay in 17 patients with PCOS and 20 cases as control group. The expression of androgen receptor in ovary was detected by immunohistochemistry method. The results showed that serum testosterone level \[(3.1±1.5) nmol/L\] and insulin resistance index (0.85±0.49) in patients with PCOS were significantly higher than in control group (P<0.05), and showed a positive relation (r=0.65, P<0.01). The expression levels of androgen receptor in ovary of patients with PCOS were significantly higher than that in control group(P<0.05). The optical density value was positively related with insulin resistance index (r=0.59, P<0.01). It was concluded that androgen and androgen receptor could accelerate insulin resistance and the interaction of them might aggravate the pathophysiological change in PCOS.

A Meta-analysis on the Treatment of Insulin Resistance in Polycystic Ovary Syndrome by Bushen Huatan Recipe

Objective:To systematically evaluate the efficacy and safety of Bushen Huatan recipe compared with metformin in the treatment of insulin resistance in polycystic ovary syndrome(PCOS).Methods Researches were reviewed by searching the China National Knowledge Infrastructure(CNKI),VIP network,WanFang database,SinoMed,Cochrane Library,Web of Science,PubMed and Embase up to December 8,2019.We retrieved the RCTs of Bushen Huatan recipe and metformin in the treatment of insulin resistance in polycystic ovary syndrome and applied Revman5.3 software for meta analysis.Results A total of 5 RCTs were included,with a total of 285 PCOS patients.The results showed:①There was no significant difference between the two groups in LH[WMD=-2.68,95%CI(-6.21,0.84),P=0.14]、FSH(WMD=0.36,95%CI(-0.59,1.32),P=0.45]、LH/FSH(WMD=-0.29,95%CI(-1.06,0.48),P=0.46)、fasting blood glucose(FPG)[WMD=0.05,95%CI(-0.18,0.28),P=0.67]、fasting insulin(FINS)[WMD=-0.91,95%CI(-15.28,13.46),P=0.9].②TCM syndrome score:Bushen Huatan recipe group[WMD=-3.10,95%CI(-5.39,-0.81),P=0.008]was better than metformin group;③Total clinical effective rate:Bushen Huatan recipe group[RR=1.50,95%CI(1.18,1.92),P=0.001]was better than metformin group.Conclusion Bushen Huatan recipe has the same effect as metformin in improving the sex hormones and glucose metabolism of patients with PCOS complicated with insulin resistance,and can effectively improve the clinical symptoms of patients,reduce TCM syndrome score,and improve the total therapeutic efficiency.

Effects of Metformin Treatment on Soluble Leptin Receptor Levels in Women with Polycystic Ovary Syndrome

The effects of metformin treatment on soluble leptin receptor (sOB-R) levels in women with polycystic ovary syndrome (PCOS) were investigated.This prospective and open-label study was conducted by the Department of Obstetrics & Gynecology at Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,China.Fifty-five women with PCOS and insulin resistance (IR) were treated with metformin for 6 months.According to body mass index (BMI),the patients were divided into two groups:lean PCOS group (BMI <23 kg/m^2,n=34) and overweight or obese PCOS group (BMI >23 kg/m^2,n=21).Before and after treatment,serum luteinizing hormone (LH),follicle stimulating hormone (FSH),testosterone (T),androstenedione (A),dehydroepiandrosterone sulfate (DHEAS),insulin and sOB-R levels were determined.Thirty-one BMI-matched ovulatory women served as controls.The results showed:(1) The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR),androgen levels and hirsutism scores were higher,and sOB-R levels were lower in PCOS groups than in control group.A subgroup analysis of lean and overweight or obese PCOS patients revealed there was significant difference in sOB-R level between lean PCOS group and overweight or obese PCOS group.There were no significant differences in anthropometric parameters between lean PCOS patients and BMI-matched controls.However,sOB-R level was significantly lower in lean PCOS women than in controls.(2) There was no correlation between sOB-R level and BMI,waist and hip circumference,total testosterone,androstendione,DHEAS,LH or hirsutism scores in PCOS patients,but there was a significant negative correlation between sOB-R and HOMA-IR.(3) After treatment with metformin for 6 months,serum insulin levels decreased,and sOB-R levels increased significantly (P<0.01).It was suggested that considering low sOB-R levels supposedly compensate diminished leptin action,PCOS per se might cause leptin resistance.It is likely that reduction of hyperinsulinemia produced by metformin effectively improves the sOB-R levels in PCOS.

Resistin levels of serum and follicular fluid in non-obese patients with polycystic ovary syndrome during IVF cycles

Objectives: To measure serum and follicular resistin, steroids hormone levels in women with PCOS (polycystic ovary syndrome) (BMI (body mass index)<25 kg/m2), to assess possible correlations of resistin to hormonal and metabolic parameters and to analyze the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with PCOS and tubal infertility. Study design: We analyzed the clinical outcomes of IVF-ET in women with PCOS (BMI<25 kg/m2) and tubal infertility during the years 2002 to 2004 and compared the serum and follicular fluid resistin levels, estradiol (E2), progesterone (P), testosterone (T) levels in 20 PCOS and 20 healthy, age-matched women without PCOS during IVF-stimulated cycles. The correlations between the resistin levels and the outcomes of IVF-ET were evaluated. Results: No significant differences in resistin levels of either serum or follicular fluid between PCOS and control group were found. However, resistin levels in serum were higher than that in follicular fluid in both groups. Multiple regression analysis showed that resistin levels in serum did not correlate with BMI, estradiol, LH (luteinizing hormone) and insulin level in fasting blood. No significant correlations were found between follicular fluid reisistin levels and fertilization rate, implantation rate, clinical pregnancy rate or early miscarriage rate in both PCOS and control groups. Conclusion: Our results show that resistin does not have correlation with the hormonal and metabolic parameters as well as the outcomes of IVF. These data suggest that resistin is unlikely to be a local determinant factor in steroidogenesis and growth and maturation of oocytes during IVF-ET in lean women with PCOS.

Study of Mutation in Tyrosine Protein Kinase of Insulin Receptor Gene in Patients with Polycystic Ovarian Syndrome

Objective To explore the molecular mechanism of insulin resistance in the patients with polycystic ovarian syndrome (PCOS)Methods Polymerase chain reaction, silver staining-single strand conformation poly-morphism(PCR-SSCP) and DNA direct sequencing were used to detect the mutation of insulin receptor (INSR) gene in exon 17-21 with the abdominal wall adipose tissue from 31 patients with PCOS (PCOS Group) and 30 patients with pure hysteromyoma in reproductive lift (Control Group).Results Tiventy-two variant SSCP patterns in exon 17 of INSR gene were detected. Direct sequence analysis of exon 17 showed that homozygous nonsense mutation was two alleles single nucleotide polymorphism (SNP) at the codon 1058 (CAC→CAT). Exons 18-21were not detected with any significantly mutation. The INSR gene His1058C→ T substitution collecting rate and insulin resistance were significantly higher in the PCOS group than in the control group (P = 0. 0293, P<0. 05, P<0. 01). Conclusion It is suggested that the SNP in codon 1058 of the INSR gene might be related with the insulin resistance in PCOS patients, which has hereditary tendency. And the missense mutation,nonsense mutation and frameshift mutation at exons 18-21 in tyrosine protein kinase region of INSR gene for PCOS patients were not frequently observed.

Effect of laparoscopic sleeve gastrectomy on related variables of obesity complicated with polycystic ovary syndrome

BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to 2020.The changes in anthropometric indices,insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH),menstrual cycle and LH/FSH ratio before and 1 mo,3 mo,6 mo and 12 mo after the operation were statistically analyzed.RESULTS At 1 mo,3 mo,6 mo and 12 mo after surgery,the anthropometric indices,such as body weight and body mass index,of all patients were lower than those before the operation.The percentage excess weight loss(EWL%)at 1 mo,3 mo,6 mo and 1 year of follow-up were 25,40,46 and 65,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During the 1-year follow-up,the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL(P<0.05),average fasting insulin level(9.0 mIU/mL,preoperative 34.2 mil,LH level,4.4 mIU/mL,preoperative 6.1 mIU/mL).The level of FSH(3.8 U/L,4.8 U/p0.05)and the ratio of LH/FSH(0.7,1.3/p0.05)were more relieved than those before surgery.During the postoperative follow-up,it was found that the menstrual cycle of 27 patients(nasty 27)returned to normal,and 6 patients(18%)who intended to become pregnant became pregnant within 1 year after surgery.CONCLUSION The weight loss effect of LSG is obvious and affirmative,and the endocrine index of obese patients with PCOS is also improved to some extent,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.

Risk factors for atypical endometrial hyperplasia in infertile women:possible association with polycystic ovary syndrome

Objective:Endometrial hyperplasia is considered as a precursor of endometrial carcinoma,in which oncogenic potential is low in hyperplasia without atypia,but high in atypical hyperplasia.The objective of this study was to identify the risk factors for atypical endometrial hyperplasia in infertile women.Methods:Fifty four infertile women with endometrial hyperplasia,which were selected from a large cohort of 2 098 women who desired for the future childbearing in our center,were diagnosed by hysteroscopy with directed biopsies or dilation and curettage (D&C),including 44 with hyperplasia without atypia,10 with atypical hyperplasia.Clinical characteristics were recorded in terms of age,body mass index (BMI),parity,insulin resistance,polycystic ovary syndrome (PCOS).Statistical comparison was made between women with hyperplasia without atypia and atypical hyperplasia.Logistic regression analysis was employed to assess the contribution of PCOS,obesity and insulin resistance to atypical hyperplasia.Results:The incidence of endometrial hyperplasia in infertile women was 2.57% (54/2098),which included 10 women (0.48%) were diagnosed as atypical hyperplasia.PCOS in women with atypical hyperplasia (70%,7/10) was significantly higher than those of hyperplasia without atypia (27.27%,12/44).Stepwise regression analysis showed that PCOS contributed maximally to atypical endometrial hyperplasia in infertile women.Conclusion:PCOS is an independent risk factor for atypical endometrial hyperplasia in women with infertility.The infertile women with PCOS are at an increased risk for atypical endometrial hyperplasia and endometrial cancer.