Effect of sustained released metformin therapy on phenotypic and biochemical markers of insulin resistance in polycystic ovary syndrome in South Indian women

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women. Insulin resistance (IR) may play a substantial part in the pathogenesis of PCOS, which leads to type 2 diabetes mellitus (T2DM), cardiovascular disorders and ovarian cancer. Metformin is an insulin sensitizing agent, however its role in PCOS is still controversial.Methods: Sixty women newly diagnosed with PCOS and healthy age matched controls between 18 to 45 years were enrolled after obtaining informed consent. Women in the PCOS group were started on metformin-SR 1gram orally, which was then increased to 1.5 grams after two weeks and continued for 6 months. Fasting blood sugar (FBS), fasting insulin (FI), SHBG, TT, free androgen index (FAI), homeostatic model assessment of Insulin resistance (HOMA-IR), homeostatic model assessment of β- cell function (HOMA-B), homeostatic model assessment of Insulin sensitivity (HOMA-S) and quantitative insulin sensitivity check index (QUICKI) were measured in the control group as well as PCOS group before and after metformin therapy.Results: After six months of metformin-SR therapy, PCOS group showed significant reduction in FI, HOMA-IR, HOMA- β, HOMA-S QUICKI, TT and FAI and significant increase in SHBG levels.Conclusions: Six months of metformin-SR therapy favorably altered markers of IR, TT, SHBG, anovulation and hyperandrogenism in normoglycemic women with PCOS

Pregnancy outcome of assisted reproductive technology cycle in patients with hypogonadotropic hypogonadism

CONTEXT: Ovulation induction in patients with hypogonadotropic hypogonadism (HH) is a challenge to the treating physician. The threshold for ovarian response in HH may differ substantially from that of normal patients. To reach that threshold levels of follicle stimulating hormone, in a step-up protocol longer duration of stimulation is required in some cases so as to prevent multiple pregnancy and to eliminate the risk of ovarian hyperstimulation syndrome. AIM: To evaluate the duration of stimulation, quality of oocytes, and embryo, and the pregnancy outcome in the assisted reproductive technology (ART) cycles in patients with HH. MATERIALS AND METHODS: Over the period of 4 years, we had 14 patients with HH in whom 21 cycles of ovulation induction were done. Of these 7 patients underwent oocyte retrieval and intracytoplasmic sperm injection (ICSI). We present a retrospective study of these 7 patients who underwent ART to evaluate the duration of stimulation, quality of oocytes and embryo, and the pregnancy outcome. RESULTS: In the study group on ovulation induction with gonadotropins, only one patient had the duration of stimulation of the standard 12 days, the remaining 6 patients took ≥12 days to respond to stimulation (maxium being 54 days). Mean ET in these patients was 8.9 mm. Six patients had >70% good quality MII oocytes. One patient responded poorly and had only 2 good quality MII oocytes (50%). After ICSI procedure, resultant embryos were of grade 1 and 2 in all the patients irrespective of the duration of stimulation. Fertilization rate in these patients was 85% (except in one 50% fertilization rate), and the cumulative pregnancy rate was 68.6%. CONCLUSION: In the patients with HH the quality of oocytes and embryos, and the pregnancy rate is not affected even if the duration of stimulation is prolonged

Effect of sustained released metformin therapy on phenotypic and biochemical markers of insulin resistance in polycystic ovary syndrome in South Indian women

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women. Insulin resistance (IR) may play a substantial part in the pathogenesis of PCOS, which leads to type 2 diabetes mellitus (T2DM), cardiovascular disorders and ovarian cancer. Metformin is an insulin sensitizing agent, however its role in PCOS is still controversial.Methods: Sixty women newly diagnosed with PCOS and healthy age matched controls between 18 to 45 years were enrolled after obtaining informed consent. Women in the PCOS group were started on metformin-SR 1gram orally, which was then increased to 1.5 grams after two weeks and continued for 6 months. Fasting blood sugar (FBS), fasting insulin (FI), SHBG, TT, free androgen index (FAI), homeostatic model assessment of Insulin resistance (HOMA-IR), homeostatic model assessment of β- cell function (HOMA-B), homeostatic model assessment of Insulin sensitivity (HOMA-S) and quantitative insulin sensitivity check index (QUICKI) were measured in the control group as well as PCOS group before and after metformin therapy.Results: After six months of metformin-SR therapy, PCOS group showed significant reduction in FI, HOMA-IR, HOMA- β, HOMA-S QUICKI, TT and FAI and significant increase in SHBG levels.Conclusions: Six months of metformin-SR therapy favorably altered markers of IR, TT, SHBG, anovulation and hyperandrogenism in normoglycemic women with PCOS

Does pretrigger echogenic endometrium in assisted reproductive technology cycles reflect raised serum progesterone level?

Background: Serum progesterone is the main hormone of the luteal phase. The hyperechoic pattern of the endometrium in the luteal phase is believed to be induced by raised serum progesterone. Serum progesterone is found to be raised cases of controlled ovarian stimulation (COS) cycle on the day of ovulation trigger. Aim: This study aims to find the association between echogenicity of endometrium and raised serum progesterone Objective: The objective of this study is to determine whether raised pretrigger serum progesterone influences the echogenicity of the endometrium Materials and Methods: In this prospective observational study, we evaluated 221 patients who underwent COS. Echogenic patterns of the endometrium on transvaginal sonography were described as hypoechoic/trilaminar endometrium (Type A), isoechoic (Type B), and hyperechoic (Type C). The endometrial pattern and serum progesterone levels were evaluated on the day of ovulation trigger and value of ≥1 ng/ml was considered as elevated. Results: A total of 168 patients out of 221 patients (76.01%) had elevated serum progesterone levels on the day of ovulation trigger. Type A endometrium was found in a total of 174 patients, of these 132 patients (75.86%) had raised serum progesterone. Type B endometrium was found in 35 patients, of these 27 patients (77.14%) had raised serum progesterone. Type C endometrium was seen in 12 patients, out of these 9 patients (75.00%) had raised serum progesterone level. There was no statistically significant difference in the echogenic patterns of endometrium in patients with raised progesterone (≥1 ng/ml). On intergroup comparison, the difference in the progesterone levels between type A and type C was statistically significant (P = 0.02), and on receiver operating characteristic curve analysis, echogenic endometrium was found to predict progesterone level of 1.57 ng/ml with a sensitivity of 58.3% and specificity of 58.4% only. Conclusion: Echogenicity of the endometrium does not reliably predict raised serum progesterone on the day of ovulation trigger

Prevalence of Metabolic Syndrome in infertile women

Background: Prevalence of Metabolic syndrome is increasing rapidly among the infertile women over the last few years Objective: to evaluate the prevalence of metabolic syndrome (MBS) among the infertile women. Methods: A prospective cross-sectional study was conducted of all infertile women in a tertiary care centre in southern India. These women underwent screening for MBS according to the modified AHA/NHLBI (ATP III 2005) definition. These women were categorized as PCOS and Non PCOS based on Rotterdam criteria (2003). Results: Among 1030 infertile women. The prevalence of MBS among the infertile women was 35.3% and among PCOS and Non PCOS women were 44.7% and 28.9% respectively. Conclusions: The prevalence of MBS among infertile women was 35.3%. It is showing an upward trend among infertile PCOS and Non PCOS women. So early screening for MBS can reduce the long term sequale