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.

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.