Day1: June 7, 2018
UT Health San Antonio, USA
George B Kudolo primarily teaches Clinical Chemistry in the Undergraduate Clinical Laboratory Sciences Program, and Forensic Toxicology in the Graduate Toxicology Program. His university is UT Health San Antonio, USA. His research interests are in Reproduction, Nutrition, Diabetes, Complementary and Alternative Medicine (CAM). He has conducted clinical trials with the herbal supplement. His other interests are the effect of herbal remedies in general on interpretation of diagnostic laboratory tests and forensic drug tests, and conventional drug-herb interactions
Ginkgo biloba extract is one of the most common dietary supplements ingested by a wide cross section of the United States population and therefore most likely to be used by women suffering from polycystic ovarian syndrome (PCOS). PCOS is an ovarian disorder associated with excess androgen in women, the cause of which includes hyperinsulinemia secondary to insulin resistance. The major objective of our study was to determine who might benefit from the use of Ginkgo biloba extract. This presentation will discuss the results of a decade of studies in healthy, non-diabetic and type 2 diabetic subjects, showing that ingestions of 120 mg of Ginkgo biloba extract (as a single dose) daily for three months, had the following significant effects (p<0.05) (a) decreased collagen-mediated platelet aggregation accompanied by reduction in urinary 11-dehydro-TXB2 and prostacyclin metabolites, (b) decreased platelet in vitro arachidonic acid-mediated TXB2 production, (c) reduced platelet malondialdehyde, an index of lipid peroxidation, and (d) increased pancreatic beta cell insulin and C-peptide production, most significantly in type 2 diabetic subjects with pancreatic exhaustion. In a randomized double-blind placebo-controlled crossover study, and using a 2-step euglycemic insulin clamp technique, it was found that ingestion of Ginkgo biloba extract did not affect glucose metabolic rates at low (10 mU/m2/min) or high (40 mU/m2/min) insulin infusion rates in healthy, non-diabetics, those with impaired glucose tolerance or overt type 2 diabetic subjects. Co-ingestion of Ginkgo with 500 (500 mg), a diabetes treatment which may also be prescribed for PCOS patients, did not significantly affect the pharmacokinetic properties of metformin. In conclusion, while all persons might benefit from the ingestion of Ginkgo biloba extract, physicians might want to caution PCOS patients about the possibility of an increase in ovarian theca cell androgen production, even though Ginkgo biloba extract ingestion is unlikely to increase whole body insulin resistance or affect metformin pharmacological activity.
Fachinstitut fÃ¼r Stoffwechsel und Gesundheit, Austria
Marion Eckert-Krause is a Specialist in Metabolic Diseases. After training as a Practice Nurse and Gardener, she studied Biology and Waste Management, and then worked for several years in Field Sales before moving to Internal Sales via Key Account Management. She spent nearly 10 years in Sales Operations before earning a Doctorate in Medicine. Since then, she has worked in Quality Management and began with PCOS research. She developed the DEBEC-Method® and ran several case studies with menopausal/postmenopausal women including PCOS-diagnosed patients. Since 2012, she is actively joining congresses in USA, Switzerland, Germany and Austria. Her institute, Fachinstitut für Stoffwechsel und Gesundheit—“FISGES” was founded in 2014 to take care of the PCOS-patients’ needs with a focus on defined study. Since 2017, she is a Lecturer at the Private University in the Principality of Liechtenstein (UFL). Since 2018, DEBEC-Method® is registered with number 295512 at the Austrian Patent and Trademark Office
Background: One of the main health risk factors is overweight/obesity and this is one player in all multifactorial metabolic-endocrinology disorders of PCOS. Gaps exist in diagnostic, treatment and prevention. A major role in management of PCOS plays a healthy lifestyle—also to be seen a key for prevention. Assisted by well-balanced diet, regular exercises and based on factual diagnostic as well as balancing and coaching health risk factors which probably enable PCOS, it could be treated and used for prevention. DEBEC-Systematic with its related method is a new approach in health coaching for chronic metabolic diseases to support patients helping themselves. DEBEC delivers the following modules: diagnostic, eating, balance, exercise, and coaching.
Method: DEBEC-Method ™ was used to manage diagnosed PCOS within a case study. The method was also tested in overweight female and male patients. To know about prevention measures, a short inquiry was done using PubMed, with the keywords “PCOS and prevention”.
Result: The case studies with a PCOS-diagnosed and an overweight patient were conducted to show how an individual based therapy with defined modules (DEBEC-Method ™ derived from DEBEC-System) can be successfully related to health risk reduction and be suitable for daily use. Prevention measures for PCOS are not existent but some articles to prevent other comorbidities.
Conclusion: Therapy with defined modules (DEBEC) is a sustainable and successful method within overweight/obesity related diseases. Suitable for daily use, the trained patient is enabled to maintain a healthy lifestyle. This patient orientated approach could be the key for prevention measure. Overweight and obesity with signs of insulin resistance and lipid metabolism should alert the medical fraternity. Because of a rather poor study situation, there is need for action. Long-term studies are recommended including body fat distribution in young girls
Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh
M A Hasanat holds an MPhil and MD degree in Endocrinology and is currently working as Professor and Chairman in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. He has more than 50 original articles published in reputed national and international journals. His major research areas are Diabetes (special fascination in gestational diabetes mellitus—GDM and diabetes of young), PCOS and Infertility, Thyroid Autoimmunity and Childhood Obesity. He is also working as an Editor (American Research Journal of Endocrinology, International Journal of Diabetes, and Diabetes & Obesity International Journal of different open access journals
The polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphologic features. PCOS affects 6 to 10% of women of reproductive age. Marked controversy surrounds the pathophysiology and management issues of PCOS. One school proposes it to be a reproductive disorder while other one considers it as an endocrine disorder. In fact PCOS is an endocrine disorder with adverse reproductive outcome and associated with cardiometabolic abnormalities like impaired glucose tolerance, type 2 DM, dyslipidemia, subclinical vascular disease and an increased risk of cardiovascular disease. Controversies exist on the prevalence of insulin resistance and metabolic derangement among different PCOS phenotypes. In our studies, women with phenotype A and B have been found to have worse metabolic profiles and higher prevalence of cardiovascular risk factors compared with phenotype C and D. Similarly, amenorrhoea and oligo-amenorrhoea were found to have worst metabolic profile and insulin resistance compared with eumenorrhoea. Although serum antimüllerian hormone levels and prostate specific antigen correlate with the sonographically determined antral follicle count and ovarian volume, the diagnostic usefulness of these in women with PCOS is uncertain. Similarly, no definitive association could be ascertained from our studies. Biochemical parameters of hyperandrogenemia, including total testosterone, free androgen index and testosterone dihydrotestosterone ratio were studied, and have been found to significantly correlate with clinical parameters. There is controversy regarding thresholds for diagnosis in adolescents and peri-menopausal women and the most appropriate therapeutic approaches for these patients. Metformin is found to have significant role in the management as insulin resistance is the key etiopathogenic factor in PCOS, which was also evidenced in our randomized control trial. PCOS lies at the crossroad of metabolic and reproductive disorder and a multi-systemic approach with involvement of the concerned specialties is required for successful outcome.
Sub delegaciÃ³n sur ISSSTE, Mexico City, Mexico
Dr. Juan Carlos Paredes Palma is a Specialist in internal medicine, Subspecialist in Endocrinology, Biology of human reproduction and endocrine gynecology, has a Master in Medical Sciences and a PHD in Health Sciences. He has held various positions in one of the most important public health institutions in Mexico; Institute of Social Security and Health of workers of the State, (ISSSTE), was National Coordinator of Clinical Research, Head of Teaching of the Hospital Dr. Darío Fernández Fierro of Mexico City and currently is the Head of Teaching and Research of the Delegation South of ISSSTE. He was the winner of The National Research prize of the ISSSTE in 2015
To determine the efficacy of sitagliptin alone or in combination with metformin in women with polycystic ovary in terms of ovarian cyclicity, fertility and cardiometabolic profile compared to metformin alone.
Polycystic ovarian syndrome (PCOS) affects a percentage of 5–10% of women of reproductive age worldwide and has a prevalence of 6.6% (95% CI: 2.3–10.9%) in Mexican women and most common cause of infertility in developed countries.
Treatment with insulin sensitizing drugs (metformin and pioglitazone) has been shown to improve menstrual cyclicity and fertility in the metabolic profile with polycystic ovarian patients. Incretins and DPP-4 inhibitors have been shown to enhance pancreatic β cell activity, increasing weight loss by its anorexic effect and resulting in an adequate weight control and improved fertility.
Previous evidence has compared the effect of exenatide and alone or in combination with metformin in the treatment of PCOS, in this article we will compare sitagliptin and metformin alone or in combination.
Blind, controlled and randomized clinical trial.
Women between 18 and 40 years of age, with a BMI >20 and diagnosed with PCOS with the Rotterdam criteria.
In the normalized index of menstruations it was found that there was a statistically significant intragroup increase in each one of the treatments. With a higher percentage of change, that of metformin with 80%, followed by that of sitagliptin with 65% and then COMBO with 30%. No statistically significant differences were found between treatment groups.
Therapeutic effect of sitagliptin was observed in patients with PCOS comparable to metformin and the combination of metformin-sitagliptin is more effective in terms of ovulation than the other two treatments alone.
- PCOS and Pregnancy | Prevention and Management of PCOS | Effects of PCOS on Womenâ€™s Health | Long-Term Effects of PCOS |PCOS and Obesity
The Chinese University of Hong Kong, Hong Kong
Ronald Wang is currently Professor at the Department of Obstetrics & Gynaecology; Deputy Director, Prenatal Genetics Diagnosis Centre; Laboratory-in-charge, Department of Obstetrics & Gynaecology; Professor (by courtesy), School of Biomedical Sciences; and Principal Investigator, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong. His major research interests are in clinical and basic research in reproductive medicine, and he has been recently involved in a RCT on PCOS. With a wide range of experience in clinical diagnosis, medical research and teaching, he was appointed to the Editorial Boards and Review Panels of many important research funding agents and journals. He has worked on many research projects, received a total of 60 million research grants and owns two patents. He has published over 150 ISI articles in many acclaimed journals
Smoking in women impairs fecundity at some stages of reproductive process including folliculogenesis, embryo transport, endometrial angiogenesis, and uterine blood flow. Yet little is known about the hazards of second-hand smoke (SHS) exposure in women with PCOS. This is a secondary analysis of the Polycystic Ovary Syndrome Acupuncture and Clomiphene Trial (PCOSAct), a large randomized controlled trial conducted at 27 hospitals from 2012 to 2015 in mainland China. Out of 1,000 women with PCOS, SHS exposure status were available in 500 women, of whom 271 women were non-exposed, and 229 exposed to cigarette smoke (170≤10 cigarettes per day as low-SHS exposed and 59>10 cigarettes per day as high-SHS exposed). We compared circulating sex steroids, glucose and lipid metabolism, metabolic syndrome and phenotypes, fertility and obstetric outcomes between non-exposed and exposed women. Women exposed to SHS, compared to non-exposed women, had a higher serum total testosterone (1.7 vs. 1.5 nmol/L, P=0.01), free androgen index (5.7 vs. 4.0, P=0.001) and lower sex hormone binding globulin (30.1 vs. 35.6 nmol/L, P=0.03). Metabolic syndrome, but not other phenotypes, was more frequent in exposed women as compared to non-exposed women (21.8% vs. 13.3%, adjusted OR=1.66; 95% CI, 1.02–2.71, P=0.04). Ovulation rates between exposed and non-exposed groups were not significantly different (76.9% vs. 82.9%, adjusted OR=0.72; 95% CI, 0.45–1.15, P=0.17). Conception rates were significantly lower in exposed group (26.6% vs. 36.9%; adjusted OR=0.61; 95% CI, 0.41–0.91; P=0.01), while clinical pregnancy and live birth rates showed a similar trend that was not significantly different. Gestational age, birth weight and other obstetric outcomes were not affected by SHS exposure. In conclusion, SHS exposure is associated with worsened biochemical hyperandrogenism, higher incidence of metabolic syndrome and reduced conception rates in women with PCOS. These data suggest that smoking partners of infertile women with PCOS who seek treatment should be advised to quit smoking
Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh
N Parajuli is a Resident Doctor studying MD in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh. His research interests are in PCOS, Infertility, Diabetes and obesity. He has attended and presented posters in reputed National and International conferences. He is also working as a member in PCOS Study Group at BSMMU, Bangladesh.
Background: Menstrual disturbance in polycystic ovary syndrome (PCOS) may be a predictor for grade of insulin resistance (IR).
Objectives: To observe relation of variants of menstrual disturbances with IR and metabolic syndrome in PCOS.
Methods: This cross sectional study included 100 PCOS women [age: 22.34±4.40 years; body mass index (BMI) 25.96±4.87 kg/m2; mean±SD], diagnosed by Rotterdam criterion and 60 age matched controls (age: 22.98±4.64 years, BMI 21.15±3.91 kg/m2; mean±SD). The subgroups were classified according to menstrual cycle length as: gr-I (<26 days; polymenorrhoeic), gr-II (26–34 days; eumenorrhoeic), gr-III (35–45days; mild oligomenorrhoeic), gr-IV (six weeks to three months; severe oligomenorrhoeic) and gr-V (>three months; amenorrhoeic). Insulin and glucose were measured to determine glycemic status and IR.
Results: Oligomenorrhoea was more among the age group of 16–30 (~60%), whereas one third of age group of 31–35 was amenorrhoeic. BMI and waist circumference (WC) were significantly higher in all subgroups of PCOS than control (gr-I: 30±4.49, gr-II: 24.75±3.85, gr-III: 26.08±5.37, gr-IV: 26.02±4.68, gr-V: 83.58±14.51, control: 21.14±3.90 kg/m2; p<0.001; WC: 92.00±0.00, 81.28±9.75, 85.56±11.57, 81.22±10.61, 83.58±14.51 and 72.02±7.44, respectively; p<0.001). PCOS and control also showed statistically significant differences for IR (100% vs. 27.3% vs. 51.4% vs. 53.8% vs. 61.5% vs. 3.3%, respectively; p<0.001) and metabolic syndrome (50% vs. 11.1% vs. 31.3% vs. 22.25% vs. 41.7% vs. 3.3%; p=0.002) and prediabetes (50% vs. 22.25% vs. 29% vs. 27.8% vs. 33.3% vs. 1.6%; p=0.002). Each subgroup had statistically significant values of fasting glucose, 2-h glucose, fasting insulin, FG/FI, HOMA-IR, total cholesterol, triglycerides, HDL, LDL than that of control (p<0.05 for all). Multiple regression analysis revealed that cycle length of menstruation (p=0.014), WC (p=0.050) and Ferriman-Gallwey score (p=0.0108) were independent predictors of homeostatic model assessment (HOMA-IR) in PCOS.
Conclusions: Prevalence of IR and metabolic abnormalities are higher in PCOS. Subgroups with amenorrhoea and oligoamenorrhoea have adverse metabolic profile and IR
Kyoto University, Japan
Nobuhiko Suganuma—MD, PhD—is a Professor in the Department of Human Health Sciences, Kyoto University Graduate School of Medicine in Japan. He is the Director of Japan Societies of Fertilization and Implantation, Maternal Health, Reproductive Psychology, and Sexual Science. He is also the Councilor of Japan Society of Reproductive Medicine, and Japan Endocrine Society. Recently, he became the President of Japan Society for Uterus Transplantation (JSUTx), and a Vice President of International Society of Uterus Transplantation (ISUTx), specializing in Uterine Factor Infertility Treatment. As a Reproductive Endocrinologist, he demonstrated that the PCOS occurrence could be connected with LH gene variation using molecular biological technologies. Based on this work, he received the Research Award from the Japan Endocrine Society in 1996. Based on the clinical aspects, his group could succeed the first childbirth in Japan in 1994 using TESE-ICSI method. He has established a Center for Advanced Reproductive Medicine in Kyoto University Hospital in 2013, and is performing cryopreservation of oocytes or ovarian tissues as oncofertility management
As the management for women with polycystic ovary syndrome (PCOS), Japan Society of Obstetrics and Gynecology recommends a treatment using oral contraceptive (OC) or progestin, prior to desiring pregnancy because PCOS is a progressive disease. However, in Japan, OC-users for contraception are only 3%, which means that OC is not a familiar treatment amongst Japanese people. Recently, a medicine consisting of low-dose estrogen-progestin (LEP) became available for the treatment of dysmenorrhea, covered with National Health Insurance. Moreover, a tablet containing much lower hormone doses (Lunabell ULD: ethinyl-estradiol 0.02mg/norethisterone 1mg, Nobelpharma Co.) is widely used. For the management of PCOS women, the effects of OC, LEP, and conventional Kaufmann therapy (conjugated estrogens/progestin) were evaluated from the viewpoints of improvement of gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) and androgen secretion. The side-effects such as irregular genital bleeding, digestive symptoms, and liver function were compared among those medicines. By indicating our results, we can discuss a better way to prepare the future childbearing among PCOS women
Dept. of Obstetrics, Gynecology & Reproductive Sciences, USA
Tendai M Chiware is a Reproductive Endocrinology and Infertility Fellow in Vermont, USA. She attended medical school at the University of Birmingham in the UK. She was a Trainee in the UK and a member of the Royal College of Obstetricians and Gynaecologists. She completed her Residency in Michigan, USA and is board certified with the American Board of Obstetrics and Gynecology. She worked at the Department of Reproductive Health and Research of the World Health Organization in Geneva, Switzerland. Her interests include PCOS, Diminished Ovarian Reserve, Fertility Preservation, Minimally Invasive Surgery, Reproductive Surgery and Global Health. She has presented her work at national and international meetings including, the Society for Reproductive Investigation, and she will be speaking at the European Society of Human Reproduction and Embryology’s annual meeting
Introduction: Polycystic ovarian syndrome (PCOS) affects 5 to 10% of women of reproductive age resulting in menstrual abnormalities, hyperandrogenism, infertility, metabolic disturbances and cardiovascular risk. We aimed to examine the subclinical metabolic and cardiovascular features in young women with PCOS.
Methods: 118 young women were recruited, with 15 self-reporting a diagnosis of PCOS. Body composition was evaluated by DEXA scan and physical fitness by VO2 max testing. Women were assessed for blood pressure, response to volume challenge, aortic-femoral pulse wave velocity, flow mediated vasodilation, adrenergic response to Valsalva, as well as uterine, renal and cardiac hemodynamics. Complete blood counts, metabolic and lipid profiles were assessed. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was calculated as an index of insulin resistance. All studies were conducted during the follicular phase of the menstrual cycle, or following a withdrawal bleed (mean 9.4±3.5 days).
Results: There was no difference in age between groups. We identified differences in BMI, total fat and fat distribution, all showing statistically significant increases in PCOS. Renal and cardiac volumetrics, as well as laboratory markers also differed in PCOS (Tables 1). We saw no differences between healthy and PCOS subjects in adrenergic response, plasma volume, blood pressure, vessel compliance in response to volume challenge, uterine blood flow, pulse wave velocity and lipid profile. Angiotensin II, urine sodium and creatinine statistically differed between the two groups. Fasting glucose, insulin and HOMA-IR trended higher in PCOS, although not all significantly.
Conclusions: Although our sample size is small, our results suggest that physiology of women with PCOS differs from that of healthy women. These differences may help explain clinical trajectories, both pregnancy related, as well as long term health risks associated with PCOS.
Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh
Hurjahan Banu is presently working in the PCOS Study Group and holds an FCPS Degree in Endocrinology. She is currently a Post-graduate Fellow and a permanent Staff Researcher in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Her research interests are in PCOS, Infertility, Obesity, Diabetes and Thyroid Disorders. She has already published few articles in national and international journals
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder of uncertain etiology.
Objectives: To see the phenotypes and frequencies of insulin resistance and metabolic syndrome in PCOS.
Materials & Methods: This study included 100 PCOS women (age, mean±SD: 23±5 years; body mass index, BMI: 27.6±4.6 kg/m2), recruited on the basis of Rotterdam criteria and 25 healthy controls (age, mean±SD: 24±5 years; BMI: 24.2±4.9 kg/m2). Hormonal analysis was done using chemiluminescent immunoassay. PCOS phenotypes were defined as: A (oligo-anovulation + hyperandrogenism + PCO), B (oligo-anovulation + hyperandrogenism), C (hyperandrogenism + PCO) and D (oligo-anovulation + PCO).
Results: Frequency of PCOS phenotypes were highest for A (57%), followed by D (16%), B (14%) and C (13%). BMI, waist circumference (WC), waist/hip ratio and Ferriman-Gallwey (FG) score showed statistically significant difference when control group was included, but not among the PCOS phenotypes. Highest value of fasting insulin was observed in A followed by D, B and C, and all were higher than control. Frequencies for pre-diabetes, insulin resistance and metabolic syndrome were significantly higher in PCOS. Phenotypes (A vs. B vs. C vs. D) also showed difference for total testosterone (85.82±28.44 vs. 82.84±22.7 vs. 76.09±27.5 vs. 34.35±5.17 ng/dl; p<0.001); testosterone was higher in A, B, C but all had significantly higher level than D (p<0.001 for all). Homeostatic model assessment (HOMA-IR) significantly correlated with BMI, fasting blood glucose, 2-h glucose, total cholesterol and triglyceride in PCOS. Logistic regression showed that age>25 years, WC>80 cm, BMI>25 kg/m2 and FG score were risk factors for metabolic syndrome. Using IR as a dependent variable, A and C was associated with 17-fold, 13-fold and 11-fold increased risk of developing insulin resistance, while phenotype D with 9-fold compared to control.
Conclusions: Phenotype A is the most common, followed by others, while A and B have adverse metabolic outcome
Nanjing University, China
Yong Wang is a Professor at Medical School, Nanjing University, China whose research interest focuses on Polycystic Ovary Syndrome. He is dedicated to the teaching of Histology and Embryology
Androgen excess is generally considered as one of the major characteristics of polycystic ovarian syndrome (PCOS). Evidence from clinical research has revealed increased levels of oxidative stress (OS) in PCOS patients. Recent research showed that androgen induced PCOS rat existed over fibrosis, which may have influence on ovary function. Our study aimed to investigate the possible inhibition of hyperandrogenic ovarian fibrosis by preventing p66shc-induced oxidative stress. Our data demonstrated that inhibiting the expression of p66shc could suppress ovarian oxidative stress, thereby restraining further fibrosis. In ovarian tissues, reduced fibrosis together with lowered expression of p66shc and ROS was observed in resveratrol- and metformin-treated rats. Down-regulation of fibrogenic factors including collagens, TGF-β, CTGF, β-catenin and α-SMA as a result of the inhibition of p66shc was confirmed by western blot, Q-PCR, immunofluorescence and immunohistochemistry. We also observed that p66shc was mainly expressed in the nuclei of granulosa cells (GC) and theca cells (TC). Knockdown of p66shc resulted in dramatic down-regulation of ROS and fibrogenic factors such as TGF-β, CTGF, β-catenin and α-SMA in ovarian granulosa cells and theca cells. Furthermore, inhibition of fibrosis was accompanied with markedly improved ovarian morphology, increased luteal cell number and lowered levels of androgen. These findings suggest that p66shc may be a direct target of SIRT1 for inducing ROS and thus promoting fibrosis. We believe that further exploration of the mechanisms of p66shc in both fibrosis and oxidative stress may provide therapeutic strategies in improving PCOS symptoms and reproductive PCOS
Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh
Sukanti Shah is a Resident Doctor studying MD in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. She has attended and presented posters in reputed national and international conferences. She is also working as a member in PCOS Study Group. Her research interests are in PCOS, Infertility and Obesity
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder encompassing hyperandrogenism and metabolic disturbances. Androgen excess may correlate with metabolic risk; a lack of clarity persists regarding the specific androgen to be measured.
Aims & Objectives: To determine the association of total testosterone (TT) to dihydrotestosterone (DHT) ratio in assessing the adverse metabolic parameters in PCOS.
Material and method: This study included 44 PCOS women (age, mean±SD: 23.1±4.86 years; body mass index, BMI: 25.78±4.38 kg/m2), recruited on basis of Rotterdam criteria and 44 healthy age matched controls (age, mean±SD: 23.02±4.28 years; BMI: 20.80±3.33 kg/m2). After taking the history, physical examination and anthropometric data in all participants, TT, sex hormone binding globulin (SHBG) and insulin were measured by chemiluminescent immunoassay while DHT by ELISA. TT/DHT ratio, free androgen index (FAI) (TT/SHBG*100) and insulin resistance (homeostatic model assessment (HOMA-IR)) were calculated.
Results: PCOS patients showed significantly higher levels of TT (70.46±27.54 vs. 31.31±13.84 ng/dl; p<0.001), and FAI (11.24±9.00 vs. 3.03±2.30; p<0.001), and a low SHBG (35.00±31.99 vs. 47.07±23.86 nmol/l; p=0.048) compared to healthy controls. The TT/DHT ratio was significantly higher in PCOS patients (3.62±2.53 vs. 2.06±1.19; p<0.001), no significant difference were found for DHT (p=0.282). In PCOS patients, TT/DHT ratio was significant for impaired glucose tolerance (IGT) (P=0.038) but not for metabolic syndrome (p=0.931), obesity (p=0.094) and insulin resistance (p=0.886). Furthermore, the TT/DHT ratio was found to be high for obese (p=0.004), insulin resistant (p=0.026) and high waist circumference (WC, p=0.002) subjects, irrespective of any group.
Conclusion: TT/DHT ratio may be a useful surrogate marker for adverse metabolic parameters in PCOS.