A survey of metabolic syndrome in first-degree relatives (fathers) of patients with polycystic ovarian syndrome

Objectives: Women with polycystic ovarian syndrome (PCOS) are at twice the risk of developing metabolic syndrome, compared to women from the general population. The aim of this study was to assess the prevalence of metabolic syndrome in the first-degree relatives (fathers) of patients suffering from PCOS.Design: This was a case control study.Setting and subjects: The study was conducted on 34 fathers of women with PCOS who presented at gynaecological clinics in Shiraz, Iran (as the case group), and 34 fathers of healthy women (as the control group).Outcomes measures: Metabolic syndrome was determined according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) indices. A blood sample was obtained to assay serum insulin, blood sugar, testosterone and lipoproteins. The data were analysed using independent t-test, Fisher’s exact test and the chisquare test.Results: According to the ATP III index, the prevalence of metabolic syndrome was 29.35% in the fathers of the PCOS patients and 8.8% in the fathers of women in the control group (p-value < 0.05). According to the IDF index, this rate was 17.41 in the fathers of patients with PCOS (p-value < 0.05). According to the quantitative insulin sensitivity check and homeostasis model insulin resistance indices, the prevalence of insulin resistance, hypertension, type 2 diabetes and hypercholesterolaemia was higher in the fathers of patients with PCOS than in the control group, but the difference was not significant (p-value > 0.05).Conclusion: The fathers of the women with PCOS were at a higher risk of developing metabolic syndrome, hypertension, dyslipidaemia, impaired glucose tolerance and diabetes.Keywords: metabolic disorders, polycystic ovarian syndrome, Insulin resistance, impaired glucose toleranc

The risk of menstrual abnormalities after tubal sterilization: a case control study

BACKGROUND: Tubal sterilization is the method of family planning most commonly used. The existence of the post-tubal-ligation syndrome of menstrual abnormalities has been the subject of debate for decades. METHODS: In a cross-sectional study, 112 women with the history of Pomeroy type of tubal ligation achieved by minilaparatomy as the case group and 288 women with no previous tubal ligation as the control group were assessed for menstrual abnormalities. RESULTS: Menstrual abnormalities were not significantly different between the case and control groups (p = 0.824). The abnormal uterine bleeding frequency differences in two different age groups (30–39 and 40–45 years old) were statistically significant (p = 0.0176). CONCLUSION: Tubal sterilization does not cause menstrual irregularities

Clinical approach for the classification of congenital uterine malformations

A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field

Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

BACKGROUND: Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence. PURPOSE: To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence. STUDY SELECTION: Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013. DATA EXTRACTION: Two authors independently extracted data from identified studies. DATA SYNTHESIS: A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated. RESULTS AND LIMITATIONS: A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes. CONCLUSIONS: There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed

Quantitative Serial MRI of the Treated Fibroid Uterus

There are no long-term medical treatments for uterine fibroids, and non-invasive biomarkers are needed to evaluate novel therapeutic interventions. The aim of this study was to determine whether serial dynamic contrast-enhanced MRI (DCE-MRI) and magnetization transfer MRI (MT-MRI) are able to detect changes that accompany volume reduction in patients administered GnRH analogue drugs, a treatment which is known to reduce fibroid volume and perfusion. Our secondary aim was to determine whether rapid suppression of ovarian activity by combining GnRH agonist and antagonist therapies results in faster volume reduction.Forty women were assessed for eligibility at gynaecology clinics in the region, of whom thirty premenopausal women scheduled for hysterectomy due to symptomatic fibroids were randomized to three groups, receiving (1) GnRH agonist (Goserelin), (2) GnRH agonist+GnRH antagonist (Goserelin and Cetrorelix) or (3) no treatment. Patients were monitored by serial structural, DCE-MRI and MT-MRI, as well as by ultrasound and serum oestradiol concentration measurements from enrolment to hysterectomy (approximately 3 months).A volumetric treatment effect assessed by structural MRI occurred by day 14 of treatment (9% median reduction versus 9% increase in untreated women; P = 0.022) and persisted throughout. Reduced fibroid perfusion and permeability assessed by DCE-MRI occurred later and was demonstrable by 2-3 months (43% median reduction versus 20% increase respectively; P = 0.0093). There was no apparent treatment effect by MT-MRI. Effective suppression of oestradiol was associated with early volume reduction at days 14 (P = 0.041) and 28 (P = 0.0061).DCE-MRI is sensitive to the vascular changes thought to accompany successful GnRH analogue treatment of uterine fibroids and should be considered for use in future mechanism/efficacy studies of proposed fibroid drug therapies. GnRH antagonist administration does not appear to accelerate volume reduction, though our data do support the role of oestradiol suppression in GnRH analogue treatment of fibroids.ClinicalTrials.gov NCT00746031

Insulin Resistance in First Degree Relatives of Patients with Polycystic Ovarian Syndrome

Introduction & objective: Polycystic ovarian syndrome is one of the most common hyper androgenic disorders with hyperandrogenemia and insulin resistance affecting women. Approximately 40% of sisters of patients with polycystic ovarian syndrome have hyperandrogenemia phenotype. The current study was conducted to survey the abnormal glucose tolerance, insulin resistance, and incidence of diabetes type2 in first degree relatives of patients with polycystic ovarian syndrome. Materials & Methods: This was a case-control study which was conducted at Shiraz University of Medical Sciences in 2008. One hundered and seven individuals as case group and 107 individuals as control group were evaluated. After registering their height and weight, a blood sample was obtained from all participants in order to assay both their serum insulin and blood sugar. Then participants were asked to drink 75 gr glucose solutions, and after lapsing for 2 hours, a blood sample was taken from all participants again. After doing biochemical tests, data were gathered and analyzed by means of independent t-test and Fisher's exact test as well as chi-square. Analysis was done by using SPSS software, version 11.5. Results: Insulin resistance with fasting insulin, glucose intolerance and obesity of control group were much different from case group and these differences were statistically significant (p<0.05). Conclusion: The first degree relatives of women suffering from polycystic ovarian syndrome are exposed to impaired tolerance glucose, Insulin resistance and diabetic mellitus. Keywords: polycystic ovarian syndrome, Insulin resistance, impaired glucose toleranc

The effects of metformin on ovum implantation and pregnancy outcome in rats with induced PCOS

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Metformin which is effectively used for the treatment of anovulatory PCOS improves pregnancy rate and endometrial receptivity and reduces the risk of miscarriage. The aim of this study was to evaluate the effects of metformin on the endometrium, the number of fetuses and hormonal levels of PCOS rats.&quot;n&quot;nMethods: Forty female adult Sprague-Dawley rats were assigned randomly into four equal groups. Group I: control rats, group II: rats receiving metformin (150 mg/kg/day), group III: Estradiol Valerate-induced PCOS rats (4 mg/rat) and group IV: induced PCOS rats receiving metformin. Body weight and serum levels of glucose, LH, FSH, testosterone, progesterone and estradiol were measured. Following mating, each group was divided into two subgroups and the rats were sacrificed on the 5th and 15th day of gestation to evaluate endometrial reaction to implantation and fetus count, respectively.&quot;n&quot;nResults: Hormone assay showed a significant increase in testosterone, estradiol, LH, FSH and blood glucose levels in group III compared to the controls (P&amp;le;0.01) and a significant decrease in blood glucose in group IV versus group III (P&amp;le;0.01). Progesterone concentration had no significant differences between groups III and the controls. Weight was higher in group III than group I but it had no decrease after metformin administration. No significant differences were detected regarding implantation rate and number of fetuses in all rats.&quot;n&quot;nConclusion: Metformin has significant effects on pregnancy rate and the hormonal and blood glucose levels of Estradiol Valerate-induced PCOS rats