Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women

Recently, myoinositol (myo-ins) and folic acid combination has gained an important role for treating Polycystic Ovary Syndrome (PCOS), in addition to combined oral contraceptives (COC). We aimed to examine myo-ins effects on anti-Mullerian hormone (AMH) levels and compare them with those ones obtained administering COC. In this prospective study, 137 PCOS patients, diagnosed according to Rotterdam criteria and admitted to the Reproductive Endocrinology and Infertility Outpatient Clinic at Dokuz Eylul University (Izmir, Turkey), were included. After randomization to COC (n=60) and myo-ins (n=77) arms, anthropometric measurements, blood pressure, Modified Ferriman Gallwey scores were calculated. Biochemical and hormonal analysis were performed, and LH/FSH and Apo B/A1 ratios were calculated. Data analysis was carried out in demographically and clinically matched 106 patients (COC = 54; myo-ins = 52). After 3-month treatment, increase in HDL and decreases in LH and LH/FSH ratio were statistically more significant only in COC group when compared with baseline (in both cases p>0.05). In myo-ins group, fasting glucose, LDL, DHEAS, total cholesterol, and prolactin levels decreased significantly (for all p<0.05). Progesterone and AMH levels, ovarian volume, ovarian antral follicle, and total antral follicle counts lessened significantly in both groups (for all p<0.05). In PCOS treatment, MYO is observed more effective in reductions of total ovarian volume and AMH levels

Comparison of Anti-müllerian Hormone (AMH) and Hormonal Assays for Phenotypic Classification of Polycystic Ovary Syndrome

Objectives: The aim is to compare the hormonal status and anti-müllerian hormone (AMH) levels of patients who have different polycystic ovary syndrome (PCOS) phenotypes, polycystic ovarian morphology (PCOM) and healthy women. Material and methods: A total of 350 PCOS women, 71 women with PCOM and 79 healthy women with normal ovarian morphology (NOM) were observed. PCOS patients were divided into groups according to the phenotypes. Phenotype A- characterized by anovulation, hyperandrogenism and PCOM; phenotype B- defined as anovulation, hyperandrogenism; Phenotype C- identified as hyperandrogenism and PCOM; Phenotype D- outlined as anovulation and PCOM. AMH levels were compared for each group. Results: Among 350 PCOS patients the highest number belonged to phenotype A (n = 117, 33.4%). The rest were distrubuted as follows: phenotype B (n = 89, 25.4%), phenotype C (n = 72, 20.6%), phenotype D (n = 72, 20.6%). Phenotype A (9.17 ± 4.56) had the highest mean AMH levels in our study. Comparison of AMH levels showed a statistically significant difference between phenotypes A and D. There was a statistically significant difference on comparison of AMH between NOM, PCOM and all PCOS phenotypes. Conclusions: Phenotype A is the most serious form of PCOS and these patients has all three features which are hyperandrogenism, anovulation and ultrasound findings of polycystic ovary (PCO). AMH reflects the severity of PCOS and patients with Phenotype A have higher AMH levels

Osteoporosis in Turner's syndrome and other forms of primary amenorrhoea

Objective: Osteopenia in Turner's syndrome is well recognized. This study is aimed to elucidate whether this is an intrinsic feature of the disorder, or is a non specific feature resulting from oestrogen deficiency. Design: Comparison of bone mineral density and fracture rate in Turner's patients and in 46,XX women with equivalent oestrogen deprivation from other causes. Subjects: One hundred and twenty women in the reproductive age range (16-45 years): 40 with Turner's syndrome, 40 with other forms of primary amenorrhoea, and 40 healthy controls matched to patients for duration of oestrogen usage. Measurements: Measurement of bone mineral density in the lumbar spine (and femoral neck in some subjects) by dual-energy X-ray absorptiometry, and reported history of fracture. Results: Vertebral bone mineral density was similar in women with Turner's syndrome (mean 0.84, SD 0.11 g/cm2) and those with other causes of primary amenorrhoea (mean 0.81, SD 0.11 g/cm2; P = 0.26). Both groups had severe osteopenia compared with healthy controls (mean 1.06, SD 0.09 g/cm2, P < 0.0005, confirmed after correction for height and weight). Fractures had been sustained by 45% (10/22) of Turner's patients for whom information was available, a high frequency compared with controls (P = 0.014); half of these were at 'osteoporotic' sites of fracture (wrist, vertebra, femoral neck). Conclusion: Osteopenia in Turner's syndrome is not an intrinsic feature specific to this disorder, but results from extreme oestrogen deprivation. Early treatment with oestrogen is therefore recommended

Effect of treatment on established osteoporosis in young women with amenorrhoea

Background and Objective - Amenorrhoea in women of reproductive age causes loss of bone mineral. This study assessed the effect of treatment of amenorrhoea on bone mineral density. Design - Serial measurements of bone mineral density were obtained in women receiving treatment for amenorrhoea. Patients - Eighty-five women aged 17-40 with a past or current history of amenorrhoea, from various causes, with median duration of 46.5 months (range 8 months-21 years). Measurements - Bone mineral density in the lumbar spine was measured by dual-energy X-ray absorptiometry. Results - Initial vertebral bone mineral density was low, mean 0.85 (SD 0.10) g/cm2. After an interval of 19.6 (SD 7.5) months on treatment there was a highly significant increase to 0.89 (SD 0.10) g/cm2 (P < 0.0005). This was equivalent to a gain in bone mass of 2.1% per year (95% confidence interval 1.5-2.8%). Improvement was seen in all diagnostic groups (except polycystic ovary syndrome) and with all types of therapy. We observed no difference in the response of previously untreated patients compared with those already on treatment, nor any change in response with increasing duration of treatment. No new fractures were reported during the study. Conclusions - Bone mineral density in young women with amenorrhoea is improved by appropriate treatment, but recovery is not substantial. Hence early diagnosis and therapy is essential to prevent bone loss

The place of ultrasonographical endometrial echo evaluation in the detection of luteal phase deficiency

WOS: A1997YD9760043

Accuracy of ovarian reserve tests

Several tests predict ovarian reserve in women undergoing assisted reproductive technologies. However, the accuracy of these tests in assessing the number of the remaining follicles within the ovary (ovarian reserve) has not been previously validated. The aim of this study was to assess the accuracy of ovarian reserve tests, namely basal and clomiphene-stimulated follicle stimulating hormone (FSH) concentrations and gonadotrophin-releasing hormone (GnRH) agonist stimulation test in predicting the number of the follicles within the ovaries. The ovaries of 22 parous women over 35 years of age who underwent oophorectomy were examined histologically for follicle number. Early follicular phase serum FSH, clomiphene citrate challenge tests (CCCT) and GnRH agonist stimulation test (GAST) were performed in the menstrual cycle prior to the surgery, The predictive value of these tests was then assessed. A positive correlation was detected between basal serum oestradiol concentrations and follicles per unit tissue but no significant correlation was detected between basal and clomiphene-stimulated FSH and follicles per unit tissue. The receiver operator characteristic curves indicated that the clomiphene citrate challenge test was the most accurate of the three tests assessed. In conclusion, none of the tests in this study accurately reflects ovarian reserve