The prevalence of polycystic ovary syndrome in Iranian women based on different diagnostic criteria

Background: This study aimed to determine the prevalence of polycystic ovary syndrome (PCOS) in Iranian women based on different diagnostic criteria. Material and methods: This cross-sectional study was conducted in 2009 in Isfahan, Iran among females referred to the mandatory pre-marriage screening clinic. Menstrual irregularity was assessed as the presence of chronic amenorrhea or a menstrual cycle length of less than 21 days or more than 35 days, or more than four days of variation between cycles. Clinical hyperandrogenism was assessed as the self-reported degree of hirsutism using the modified Ferriman Gallwey (mF-G) scoring method based on a chart displaying degree of hair growth in nine regions. Those participants who reported menstrual irregularity and/or who had an mF-G score of ≥ 8 were invited for a clinical examination. Those who did not have these criteria were not further evaluated and were deemed not to have PCOS. Participants with abnormal findings underwent blood test and abdominal sonography of their ovaries. In those with hirsutism, serum was obtained on the 22nd–24th day of the cycle for the measurement of progesterone; free testosterone was measured in those with menstrual irregularity. Results: The estimated prevalence of PCOS was 7% based on the NIH criteria, 15.2% under the Rotterdam criteria, and 7.92% according to the AES criteria. Conclusion: The Rotterdam prevalence estimates were double those obtained with the NIH criteria. This study can be used for international comparisons because it was conducted on a representative sample of females using different criteria for the definition of PCOS. (Pol J Endocrinol 2011; 62 (3): 238–242)Background: This study aimed to determine the prevalence of polycystic ovary syndrome (PCOS) in Iranian women based on different diagnostic criteria. Material and methods: This cross-sectional study was conducted in 2009 in Isfahan, Iran among females referred to the mandatory pre-marriage screening clinic. Menstrual irregularity was assessed as the presence of chronic amenorrhea or a menstrual cycle length of less than 21 days or more than 35 days, or more than four days of variation between cycles. Clinical hyperandrogenism was assessed as the self-reported degree of hirsutism using the modified Ferriman Gallwey (mF-G) scoring method based on a chart displaying degree of hair growth in nine regions. Those participants who reported menstrual irregularity and/or who had an mF-G score of ≥ 8 were invited for a clinical examination. Those who did not have these criteria were not further evaluated and were deemed not to have PCOS. Participants with abnormal findings underwent blood test and abdominal sonography of their ovaries. In those with hirsutism, serum was obtained on the 22nd–24th day of the cycle for the measurement of progesterone; free testosterone was measured in those with menstrual irregularity. Results: The estimated prevalence of PCOS was 7% based on the NIH criteria, 15.2% under the Rotterdam criteria, and 7.92% according to the AES criteria. Conclusion: The Rotterdam prevalence estimates were double those obtained with the NIH criteria. This study can be used for international comparisons because it was conducted on a representative sample of females using different criteria for the definition of PCOS. (Pol J Endocrinol 2011; 62 (3): 238–242

Nonalcoholic fatty liver disease in a sample of iranian women with polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women in reproductive age that is associated with insulin resistance (IR) and metabolic abnormalities which are also a part of metabolic syndrome (Met S). This study was aimed to determine the prevalence of nonalcoholic fatty liver disease (NAFLD) women diagnosed with PCOS based on the Rotterdam criteria from January 2013 to June 2014. Methods: In this cross-sectional study, 75 women with PCOS and 75 healthy controls were enrolled. Anthropometric parameters, biochemical and hormonal investigation, were measured in all women. IR was calculated by homeostasis model assessment. Abdominal ultrasonography and biochemical tests were used to determine the NAFLD. Results: The level of triglyceride, cholesterol, low-density lipoprotein, aspartate aminotransferase, alkalin phosphatase, fasting insulin, and homeostatic model assessment index in women with PCOS were significantly higher than women without PCOS. High-density lipoprotein and alanine aminotransferase (ALT) in women with PCOS were significantly lower. The frequency of IR women with or without PCOS was 53.3% and 29.3%, respectively (P = 0.003). The frequency of Met S in women with PCOS was 33.3% and in other was 10.7% (P = 0.001). The prevalence of fatty liver in women with or without PCOS was 38.7% and 18.7%, respectively (0.008). In women with PCOS, body mass index (BMI) (odds ratio [OR] = 4.25; P = 0.046), ALT (OR = 1.62; P = 0.005), fasting insulin (OR = 1.32; P = 0.032), and IR (OR = 58.17; P = 0.025) were associated with a higher fatty liver. Conclusions: NAFLD is frequent in patients with PCOS with combination with other metabolic derangements. BMI, ALT, fasting insulin, and IR are the risk factors for high prevalence of NAFLD in women with PCOS

Can sex-hormone binding globulin considered as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome?

Background: This study aims to evaluate the sex hormone binding globulin (SHBG) level as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome (PCOS). Methods: This study was conducted in 2009-2012 in Isfahan, Iran. Anovulatory women with a diagnosis of PCOSwere studied. Metformin was started at 500 mg three times a day. If no ovulation occurred, Clomiphene citrate was added. Results: The study comprised273 infertile women with PCOS completed the study, 75 (28%) of them became pregnant 6 months after treatment (7.36% with metformin and 20.14% with metformin and clomiphene citrate). Patients who responded to metformin treatment had significantly lower mean SHBG levels compared to those who did not (0.88+0.32vs. 0.2642+0.44 nmol/L, respectively, P<0.0001). The area under the ROC curve (AUC) for prediction the response to treatment was 0.85. The baseline level of 27was the most appropriate cut of point HSBG for the prediction of conception. HSBG had a sensitivity of 88%, and specificity of 73.6%. It had a false positive level of 26.4% and false negative level of 12%. Its positive predictive value was 56.4% and its negative predictive value was 94%. The chance of conception increased for reducing a unit of fpg (OR = 0.69; 95% CI = 0.54-0.86; P = .002), as well as reducing of every unit of HSBG (OR = 0.47; 95% CI = 0.39-0.56; P <0.001), and for reducing each unit of insulin in (OR = 0.082; 95% CI = 1.021-0.33; P <0.001). Conclusion: HSBG test is suggested as an appropriate test for predicting pregnancy achievement of PCOs women after pharmacological treatmen

Heterotopic abdominal pregnancy following ovulation induction with clomiphene citrate

Background: Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges. Case: A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy (IUP). Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra- or post-procedural complications, but the IUP was aborted spontaneously on the second postoperative day. Conclusion: Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively, if they are clinically stable and the abdominal pregnancy is recognized early in gestation

Effect of soy phytoestrogen on metabolic and hormonal disturbance of women with polycystic ovary syndrome

Background: Phytoestrogens are a group of plants derived compounds with weekly estrogen effect that appear to have protective effects on metabolic and hormonal abnormalities of women with polycystic ovary syndrome (PCOS). So the aim of this study was to investigate the effect of soy phytoestrogens on reproductive hormones and lipid profiles in PCOS women. Methods: In this quasi-randomized trial, 146 subjects with PCOS were divided into two groups; the experimental group who received Genistein (Bergamon, Italy) 18 mg twice a day orally and the control group that received similar capsules with cellulose for 3 months. Hormonal features and lipid profiles were measured before and after 3 months of supplement therapy. Results: After 3 months of supplement therapy there were no statistically significant differences in high density lipoprotein cholesterol (HDL) and follicle stimulating hormone (FSH) serum levels in Genistein and placebo group before and after treatment; however serum levels of luteinizing hormone (LH), triglyceride (TG), low density lipoprotein cholesterol (LDL), dehydroepiandrostrone sulfate (DHEAS) and testosterone were significantly decreased after 3 months therapy in Genistein group. Conclusions: Genistein consumption may prevent cardiovascular and metabolic disorders in PCOS patients by improving their reproductive hormonal and lipid profiles

The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females*

Background: Polycystic ovary syndrome (PCOS) is associated with metabolic abnormalities which are also parts of metabolic syndrome (MetS). It is debated whether all women with PCOS should be screened for MetS and Insulin resistance (IR), since they may vary in terms of PCOS phenotype, ethnicity and age. This large scale study aimed to determine the prevalence of MetS among Iranian women diagnosed with different phenotypic subgroups of PCOS based on the Rotterdam criteria. Methods: This study was conducted from January 2006 to June 2008 in Isfahan, Iran. The study population comprised females diagnosed with PCOS referred to the infertility clinic. The subjects were divided into for subgroups according to different phenotypes of PCOS based on the Rotterdam criteria. They underwent metabolic screening according to NCEP ATP III guidelines and IR screening based on homeostasis model assessment (HOMA) of insulin resistance. Results: The prevalence of MetS and IR were 24.9% and 24.3%, respectively. A significant difference in the prevalence of MetS was documented between anovulatory women having PCOS with or without hyperandrogenism (23.1% and 13.9%, respectively; P = 0.001). Likewise, in PCOS women with hyperandrogenism, the MetS prevalence differed among those with or without polycystic ovary (23.1% and 63.8%, respectively; P = 0.001). Conclusions: The prevalence of MetS and IR varies between the phenotypic subgroups of PCOS. Hyperandrogenemia PCOS phenotypes of Iranian women, in particular those without sonographic polycystic ovary, are highly at risk of MetS and IR

Icodextrin reduces adhesion formation following gynecological surgery in rabbits

Background: Adhesion is a common complication of gynecology surgery so different barrier agents and solutions have been used during these operations to separate and protect tissues from adhesion after surgery. Adept is one of these solutions that have been postulated to reduce the chance of adhesion following gynecolgy surgery. Objective: To evaluate the effect of 4% icodextrin in reducing adhesion formation in comparing with sterile water and human amniotic fluid in rabbits. Materials and Methods: In this prospective experimental study 30 white Newzealand female rabbits were selected and randomized in to three treatment groups. The rabbits were anesthetized and an abdominal incison was made, uterine horns were abrated with gauze until bleeding occurred. Before closing the abdomen, the traumatized area was irrigated either by 30cc of sterile water, 30cc of 4% Adept or 30cc of human amniotic fluid. The solutions were labeled only as solutions A (steriel water), B (icodextrin), or C (human amniotic fluid). On the seventh day after surgery, second laparotomy was performed to determine and compare adhesion formation in rabbits. Results: There was significant difference between mean score of adhesions in 4% icodextrin group (2.1 ±0.70) in comparison to sterile water group (10.4 ± 0.60) and amniotic fluid group (8.7 ± 0.84). But the difference between mean score of adhesions in amniotic fluid group in comparison to sterile water group was not significant (8.7 ± 0.84) versus (10.4 ± 0.60). Conclusion: The use of 4% icodextrin solution was more effective than human amniotic fluid and sterile water in reducing adhesion formation in a gynecological surgery model in rabbit

Circulating endothelial cells (CECs) and E-selectin: Predictors of preeclampsia

Background: Circulating endothelial cells (CECs) and E-selectin are known as sensitive and specific markers of en-dothelial dysfunction. This study investigated whether CECs and E-selectin are surrogate biomarkers of preeclampsia and if measurement of CECs and E-selectin, early in the third trimester, could be a means of predicting preeclampsia. Methods: In this prospective, descriptive-analytic study, rollover test was performed on 523 pregnant women during 28-30 weeks of gestation. CECs were measured by anti-CD 146-driven immunomagnetic isolation in women with posi-tive rollover test. They were followed up prospectively until delivery without any active intervention. Women with and without preeclampsia were determined. The number of CECs and level of E-selectin were compared in the two studied groups. Results: From the 47 pregnant women with positive rollover test who were selected and followed up, 22 individuals were diagnosed with preeclampsia while the remainder were normotensive. Mean CEC numbers was significantly high-er in preeclamptic women than normal pregnancies (24.7 cells/mL vs. 13 cells/mL). The best cut-off point for CEC numbers was 6.5 with a sensitivity of 78.9% and a specificity of 69.1%. The level of E-selectin was significantly higher in mothers with preeclampsia (p < 0.05). Conclusions: Higher levels of CECs and E-selectin in women with positive rollover test who developed preeclampsia prior to onset of the complication were predictive of preeclampsia. However, larger studies are needed to confirm these findings

Determinants of Hypovitaminosis D in Pregnant Women and Their Newborns in a Sunny Region

Introduction. This study aims to assess the factors associated with 25-hydroxy vitamin D (25(OH)D) levels in pregnant women and their newborns in a sunny region. Materials and Methods. This cross-sectional study was conducted in 2012 in Isfahan, Iran. It comprised 100 nulliparous singleton pregnant women, selected by random cluster sampling. Laboratory tests were assessed before delivery in mothers and after delivery in their infants’ umbilical cord blood. The P for trend of variables was assessed across the air quality index (AQI) quartiles. The associations of AQI and 25(OH)D were assessed by multiple linear regression after adjustment for age, body mass index, and dietary intake. Results. Sera of 98 mothers and an equal number of newborns were analyzed. The median (interquartile range, IQR) of serum 25(OH)D of mothers and neonates was 15.1(12.6, 18.2) ng/mL in mothers and 15.7(12.0, 18.1) ng/mL in neonates, respectively. AQI had an inverse association with serum 25(OH)D (Beta = −0.58, P=0.04). The corresponding figure was also inverse and significant for newborns (Beta (SE)= −0.51(0.04), P=0.01). Conclusion. The independent inverse association of 25(OH)D with air quality can explain the high prevalence of hypovitaminosis D in pregnant women living in this sunny region