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Plasma Homocysteine and Insulin Resistance in Women With Polycystic Ovary Syndrome
MATERIALS AND METHODS: All patients (n⫽288) between 26-42 years old, who received hCG to induce ovulation in the treated CC/IUI cycles from 01/07/2003 to 12/14/2003, were included in the study. Patients have documented normal tubes (one or both) by hysterosalpingogram. The diagnoses in the Ovulation Enhanced patients were: Unexplained or Primary infertility (96), Secondary (69), Amenorrhea or Oligoovulation (25) Male factor (10), Endometriosis (5), Tubal factor (14), Fibroids or Myoma (7), Advanced Maternal age or Diminished ovarian reserved (9), and Asherman’s syndrome (3). Starting on days 3-7 or days 5-9 of the menstrual cycle patients were treated for 5 days with 50 or 100 mg of Clomiphene Citrate. Patients were selected into two treatment groups; the P (PCOS) (n⫽44), and the E (Ovulation Enhanced) (n⫽242). Patients were examined in the office using transvaginal ultrasound at mid cycle day 10 or day 11. When follicles were determined to be 18-22mm size, 5,000 (greater than 3 mature follicles) or 10,000 (fewer than 3 mature follicles) USP units of uhCG was administered intramuscularly that same day, scheduling IUI for the next day. Data collected include age, BMI, CC dosage, follicle development and pregnancy results. Statistical analyses were performed using Student’s two-tailed ttests or Chi square as required, with P ⬍ 0.05 indicating statistical significance. RESULTS: The P and E groups did not differ significantly (p⬎0.05) by age 34.6⫾3.7 vs 32.0⫾3.8, BMI 23.0⫾5.7 vs 23.7⫾4.6 kg/m2 or CC dosage, 80% treated with 100mg and 20% with 50mg. The amount of follicles ⬎14mm were 2.23⫾1.06 for E and 1.78⫾0.8 for P groups. Clinical pregnancy rate (per insemination cycle) in E group was 22.73% (55/242), while in the P group was 40.9% (18/44). The difference in follicles ⬎ 14mm and pregnancy rate between group E and P showed statistical significance, p-value⫽0.04 and 0.01. CONCLUSION: Our data suggests PCOS patients have achieved significantly higher pregnancy rates than the Enhanced group. In addition, our study has demonstrated that careful monitoring of these two groups of patients ( PCOS and Non PCOS) have contributed to higher pregnancy rates (40.9% and 22.73% respectively) when compared with a published {1} pregnancy rates of (8-15%) for patients with similar treatment protocol. Supported by: None
P-764 Comparing a Microdose Flare to a GnRH Antagonist Protocol for Poor Responder Patients Undergoing In-Vitro Fertilization. J. Hollett-Caines, V. Feyles, M. Rebel, S. Power, F. Tekpetey, B. Abu-Rafea. London Health Sciences Center, University of Western Ontario, London, ON, Canada. OBJECTIVE: To evaluate a microdose flare and a GnRH antagonist treatment protocol in poor responder patients undergoing stimulated in-vitro fertilization (IVF) cycles. DESIGN: Prospective cohort of poor responder patients participating in a stimulated IVF treatment cycle. MATERIALS AND METHODS: From January 2001 to December 2004, seventy-two women designated as poor responders had IVF therapy performed using either a microdose flare (n⫽44) or a GnRH antagonist (n⫽28) stimulation protocol. Main outcomes measured were number of days and amount of gonadotropin stimulation, estradiol level on day of HCG administration, number of oocytes retrieved and fertilized, number of day 3 embryos available for transfer, and pregnancy rate. RESULTS: Forty-four patients had a microdose flare stimulation while twenty-eight had a GnRH antagonist treatment cycle. There were no statistical differences in age, BMI, number of days or amount of gonadotropin stimulation, estradiol levels, number of oocytes retrieved or fertilized, number of day 3 embryos, or pregnancy rate. When the patients were subdivided to age less than 35 years, there was a trend towards a higher pregnancy rate in the antagonist group, with three of fourteen women achieving pregnancy (21.4%), than in the microdose flare protocol which had only two of fifteen women become pregnant (13.3%). However, this trend was not statistically significant. When patients 40 years of age or older were analyzed, there was a trend towards a higher pregnancy rate in the microdose flare protocol, with three of eleven women pregnant (27.3%), while none of the patients having antagonist stimulation achieved pregnancy. Again, this was not statistically significant. CONCLUSION: There is no universally agreed definition of a poor responder in assisted reproduction. It is accepted that patients designated as poor responders have reduced success in assisted reproductive technology. There is a trend towards improved pregnancy rates in women less than age 35 years with the GnRH antagonist protocol, and women 40 years of age or older using the microdose flare protocol. Supported by: None
P-763 Plasma Homocysteine and Insulin Resistance in Women With Polycystic Ovary Syndrome. M. S. Ardawi, A. A. Rouzi. King Abdulaziz University, Jeddah, Saudi Arabia. OBJECTIVE: To determine the levels of plasma homocysteine in women with and without polycystic ovary syndrome (PCOS) in relation to measures of insulin resistance (IR). DESIGN: Case Control Study. MATERIALS AND METHODS: Two hundreds selected women were classified as follows: 50 obese (BMI ⬎30 kg/ m2) with PCOS; 50 lean (BMI ⬍25 kg/ m2) with PCOS; 50 obese (BMI ⬎30 kg/ m2) without PCOS and 50 lean (BMI ⬍25 kg/ m2) without PCOS. Blood samples were collected from all women with or without PCOS between 8: 00 - 10: 00 a.m., after an overnight fast. Serum levels of LH, FSH, TSH, FT4, T, 17-OHP, ⌬4-A, DHEA, DHEAS, SHBG, insulin and plasma levels of homocysteine and glucose were determined. Measures of IR included: fasting serum insulin, glucose-to-insulin ratio (GIR) and homeostasis model assessment (HOMA). RESULTS: Plasma homocysteine levels were found to be significantly increased in women with PCOS 13.65 ⫾ 4.82 umol/L (mean ⫾SD) and in obese women without PCOS 11.91 ⫾ 3.56 umol/L as compared to lean women without PCOS 7.42 ⫾ 2.30 umol/L. Plasma homocysteine levels correlated with all indices of IR including serum insulin (r ⫽ 0.34, P ⬍ 0.001), GIR (r ⫽ -0.31, P ⬍ 0.01) and HOMA (r ⫽ 0.29, P ⬍ 0.01). Multiple logistic regression analysis showed that IR was a major factor that influenced the levels of plasma homocysteine. CONCLUSION: Hyperhomocysteinaemia is evident in obese and lean women with PCOS with variable degree of IR regardless of body weight. These findings indicate the importance of controlling the hyperhomocysteinaemia in relation to short- and long-term complications associated with IR of PCOS. Supported by: None.
S432
Abstracts
P-765 Steroidogenesis in Women With Various Features of Polycystic Ovarian Syndrome: A Phenotype Representing Insulin Resistance-Related Over-Activities in Different Follicular Compartments. X. Wu Sr., J. Qu, L. Hou. Department of Obstetrics and Gynecology, The First Fffiliated Hospital, Heilongjiang University of Chinese Medicine, and Jinling Hospital of Nanjing University, Harbin 150040, China; Department of Obstetrics and Gynecology, Jinling Hospital of Nanjing University, Nanjing 210002, China; Department of Obstetrics and Gynecology, The First Fffiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China. OBJECTIVE: Women with polycystic ovary syndrome (PCOS) are characterized by chronic anovulation and hyperandrogenism, and frequently have abnormal lipid profiles and insulin resistance that increase their lifetime risk for NIDDM and cardiovascular disease. The 2003 Rotterdam consensus workshop concluded that any two out of the three parameters (oligo- anovulation, polycystic ovary morphology, clinical and/or biochemical signs of hyperandrogenism, and) was sufficient to diagnose PCOS after exclusion of other definite etiologies. In accordance with this conclusion, clinically some previous women with irregular cycles and polycystic ovaries (PCO) on ultrasonography could now be diagnosed as PCOS even without clinical/biochemical hyperandrogenisn, and contrariwise, some have ovarian hyperandrogenism (OHA) and abnormal cycles without altered ovarian morphology could be diagnosed as PCOS too. Because these two conditions, namely PCO and OHA constitute a large segment of the general population, we prospectively characterized PCO women and OHA women by steroidogenesis and carbohydrate metabolism. DESIGN: Controlled clinical study in university affiliated department MATERIALS AND METHODS: We prospectively characterized 17 PCO women and 14 OHA women by steroidogenesis and carbohydrate
Vol. 84, Suppl 1, September 2005
P-764 Comparing a Microdose Flare to a GnRH Antagonist Protocol for Poor Responder Patients Undergoing In-Vitro Fertilization. J. Hollett-Caines, V. Feyles, M. Rebel, S. Power, F. Tekpetey, B. Abu-Rafea. London Health Sciences Center, University of Western Ontario, London, ON, Canada. OBJECTIVE: To evaluate a microdose flare and a GnRH antagonist treatment protocol in poor responder patients undergoing stimulated in-vitro fertilization (IVF) cycles. DESIGN: Prospective cohort of poor responder patients participating in a stimulated IVF treatment cycle. MATERIALS AND METHODS: From January 2001 to December 2004, seventy-two women designated as poor responders had IVF therapy performed using either a microdose flare (n⫽44) or a GnRH antagonist (n⫽28) stimulation protocol. Main outcomes measured were number of days and amount of gonadotropin stimulation, estradiol level on day of HCG administration, number of oocytes retrieved and fertilized, number of day 3 embryos available for transfer, and pregnancy rate. RESULTS: Forty-four patients had a microdose flare stimulation while twenty-eight had a GnRH antagonist treatment cycle. There were no statistical differences in age, BMI, number of days or amount of gonadotropin stimulation, estradiol levels, number of oocytes retrieved or fertilized, number of day 3 embryos, or pregnancy rate. When the patients were subdivided to age less than 35 years, there was a trend towards a higher pregnancy rate in the antagonist group, with three of fourteen women achieving pregnancy (21.4%), than in the microdose flare protocol which had only two of fifteen women become pregnant (13.3%). However, this trend was not statistically significant. When patients 40 years of age or older were analyzed, there was a trend towards a higher pregnancy rate in the microdose flare protocol, with three of eleven women pregnant (27.3%), while none of the patients having antagonist stimulation achieved pregnancy. Again, this was not statistically significant. CONCLUSION: There is no universally agreed definition of a poor responder in assisted reproduction. It is accepted that patients designated as poor responders have reduced success in assisted reproductive technology. There is a trend towards improved pregnancy rates in women less than age 35 years with the GnRH antagonist protocol, and women 40 years of age or older using the microdose flare protocol. Supported by: None
P-763 Plasma Homocysteine and Insulin Resistance in Women With Polycystic Ovary Syndrome. M. S. Ardawi, A. A. Rouzi. King Abdulaziz University, Jeddah, Saudi Arabia. OBJECTIVE: To determine the levels of plasma homocysteine in women with and without polycystic ovary syndrome (PCOS) in relation to measures of insulin resistance (IR). DESIGN: Case Control Study. MATERIALS AND METHODS: Two hundreds selected women were classified as follows: 50 obese (BMI ⬎30 kg/ m2) with PCOS; 50 lean (BMI ⬍25 kg/ m2) with PCOS; 50 obese (BMI ⬎30 kg/ m2) without PCOS and 50 lean (BMI ⬍25 kg/ m2) without PCOS. Blood samples were collected from all women with or without PCOS between 8: 00 - 10: 00 a.m., after an overnight fast. Serum levels of LH, FSH, TSH, FT4, T, 17-OHP, ⌬4-A, DHEA, DHEAS, SHBG, insulin and plasma levels of homocysteine and glucose were determined. Measures of IR included: fasting serum insulin, glucose-to-insulin ratio (GIR) and homeostasis model assessment (HOMA). RESULTS: Plasma homocysteine levels were found to be significantly increased in women with PCOS 13.65 ⫾ 4.82 umol/L (mean ⫾SD) and in obese women without PCOS 11.91 ⫾ 3.56 umol/L as compared to lean women without PCOS 7.42 ⫾ 2.30 umol/L. Plasma homocysteine levels correlated with all indices of IR including serum insulin (r ⫽ 0.34, P ⬍ 0.001), GIR (r ⫽ -0.31, P ⬍ 0.01) and HOMA (r ⫽ 0.29, P ⬍ 0.01). Multiple logistic regression analysis showed that IR was a major factor that influenced the levels of plasma homocysteine. CONCLUSION: Hyperhomocysteinaemia is evident in obese and lean women with PCOS with variable degree of IR regardless of body weight. These findings indicate the importance of controlling the hyperhomocysteinaemia in relation to short- and long-term complications associated with IR of PCOS. Supported by: None.
S432
Abstracts
P-765 Steroidogenesis in Women With Various Features of Polycystic Ovarian Syndrome: A Phenotype Representing Insulin Resistance-Related Over-Activities in Different Follicular Compartments. X. Wu Sr., J. Qu, L. Hou. Department of Obstetrics and Gynecology, The First Fffiliated Hospital, Heilongjiang University of Chinese Medicine, and Jinling Hospital of Nanjing University, Harbin 150040, China; Department of Obstetrics and Gynecology, Jinling Hospital of Nanjing University, Nanjing 210002, China; Department of Obstetrics and Gynecology, The First Fffiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China. OBJECTIVE: Women with polycystic ovary syndrome (PCOS) are characterized by chronic anovulation and hyperandrogenism, and frequently have abnormal lipid profiles and insulin resistance that increase their lifetime risk for NIDDM and cardiovascular disease. The 2003 Rotterdam consensus workshop concluded that any two out of the three parameters (oligo- anovulation, polycystic ovary morphology, clinical and/or biochemical signs of hyperandrogenism, and) was sufficient to diagnose PCOS after exclusion of other definite etiologies. In accordance with this conclusion, clinically some previous women with irregular cycles and polycystic ovaries (PCO) on ultrasonography could now be diagnosed as PCOS even without clinical/biochemical hyperandrogenisn, and contrariwise, some have ovarian hyperandrogenism (OHA) and abnormal cycles without altered ovarian morphology could be diagnosed as PCOS too. Because these two conditions, namely PCO and OHA constitute a large segment of the general population, we prospectively characterized PCO women and OHA women by steroidogenesis and carbohydrate metabolism. DESIGN: Controlled clinical study in university affiliated department MATERIALS AND METHODS: We prospectively characterized 17 PCO women and 14 OHA women by steroidogenesis and carbohydrate
Vol. 84, Suppl 1, September 2005