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A Comparison of Insulin Action Between Women With 21-Hydroxylase-Deficient Nonclassic Adrenal Hyperplasia (NCAH) and Polycystic Ovary Syndrome (PCOS)
2003 ASRM/ESHRE consensus meeting guideline and 70 normal controls. Comparison was done between PCOS patients and controls concerning CYP11␣ (tttta)n microsatellite polymorphism genotype or allele frequencies. Two sample Student t-test and chi square test were used for statistical analyses. RESULTS: Genotype analysis of PCOS patients and controls for the CYP11␣ (tttta)n microsatellite polymorphism revealed five different alleles: corresponding to four to nine repeat units except seven. The allele frequencies observed in the whole subjects were 22.5%, 0.3%, 65.0%, 11.7%, 0.6% for the 4-,5-,6-,8-,9-repeat-units alleles respectively, and the most frequent allele observed in the whole subjects was six repeat units. In contrast, previous studies in a group of Caucasians reported that the most frequent allele observed in the whole subjects was four repeat units. Based on the findings of some reports, both PCOS patients and controls were allocated to the two groups according to their genotype: those having at least one allele of four repeat units (4R (⫹) genotype) and those having no four-repeat-units allele (4R (-) genotype). The difference in the 4R (-) genotype distribution between PCOS patients and controls was significant (66.0% vs. 34.0% with 4R (-) genotype, p⫽0.038, odds ratio⫽1.939, 95% confidence interval 1.034-3.639). But no significant correlation was observed with the serum levels of total testosterone or free testosterone between 4R (⫹) genotype and 4R (-) genotype among PCOS patients. CONCLUSION: The allelic distribution of CYP11␣ (tttta)n microsatellite polymorphism in Korean subjects was different from that of Caucasians. CYP11␣␣(tttta)n microsatellite repeat polymorphism was associated with PCOS in the Korean population. Supported by: Seoul National University Hospital grant (04-2004-049-0)
CONCLUSION: Serum concentration of triglyceride, Cholesterol, HDL and LDL are increased with increasing body mass index and consequently a decrease in the pregnancy rate in women with BMI⬎25kg/m2 was shown. Additional research is needed to further clarify the clinical relevance of lipid concentration in heavy weight and obese women. Supported by: None
P-738 A Comparison of Insulin Action Between Women With 21-Hydroxylase-Deficient Nonclassic Adrenal Hyperplasia (NCAH) and Polycystic Ovary Syndrome (PCOS). M. Pall, D. Pignatelli, J. Beires, R. Azziz. Cedars-Sinai Medical Center, Los Angeles, CA; Faculty of Medicine of Porto, Porto, Portugal. OBJECTIVE: PCOS and NCAH represent two hyperandrogenic disorders that are difficult to distinguish clinically. As androgens can lead to decreased insulin sensitivity, we hypothesized that both disorders will have similar abnormalities of insulin action. DESIGN: Prospective cohort study. MATERIALS AND METHODS: We compared 22 women with NCAH with 22 age and body mass index-matched women with PCOS. All had a complete evaluation, including a modified Ferriman-Gallwey (mFG) hirsut-
P-737 Relationship Between Body Mass Index (BMI) and Plasma Lipid Concentration and Their Effect on IVF/ICSI Outcome. M. E. Hammadeh, A. Sykoutris, A. S. Amer, W. Schmidt. University of Saarland, Homburg, Germany; Chelsea and Westminster Hospital,, London, United Kingdom; Dept of Obstet. and Gynaecology, Al Azhar University, Cairo, Egypt; Dept. of Obstet. and Gynaecology, University of Saarland,, Homburg/Saar, Germany. OBJECTIVE: The purpose of this study was to determine the relationship between body mass index and lipid (triglyceride, Cholesterol, High density lipoprotein (HDL), Low density lipoprotein (LDL) concentration in serum of patients undergoing controlled ovarian hyperstimulation (COH) for ICSI therapy and to find out whether these lipid parameters could affect ICSI outcome. DESIGN: Prospective designed study MATERIALS AND METHODS: 52 patients were enrolled in this study. All patients underwent an ovarian hyperstimulation (COH) either with recombinant follicle stimulating hormone (rFSH-gonal-F), or human menopausal gonadotrophin (Menogon) after pituitary down regulation with gonadotrophin releasing hormone (Gn-RHa). Five blood samples were taken from each patient as follows: before treatment, at the beginning of ovarian stimulation, on the day of HCG injection, on the day of follicle aspiration and 14 days after embryo transfer. Lipid levels were measured in all blood samples. The patients were divided according to the BMI into two groups BMIⱕ25kg/m2 (G.1; n⫽28) and BMI⬎25kg/ m2 (G. II⫽24).The results of lipid concentration and ICSI outcome were compared between the two groups. RESULTS: In both groups the serum concentrations of lipids increased slightly during controlled ovarian hyperstimulation and at 14 days after transfer. Table.1. Summarize the lipid concentration in both groups. Moreover, the mean number of retrieved, fertilized and transferred oocytes in the first group was (10.8⫾4.3; 5.3 ⫾3.0 and 2.8⫾0.2 respectively) and the corresponding value in group II was (9.2⫾4.6; 4.0⫾2.2 and 2.7⫾0.3). The pregnancy rate in women with BMIⱕ25kg/ m2 was 46.4% and in women with BMI⬎25kg/m2 33.1% (p⫽0.34).
ism score and a 2-hr oral Glucose Tolerance Test (oGTT). When compared to PCOS, women with NCAH had significantly higher total T (TT), free T (FT), androstenedione (A4), and 17-hydroxyprogesterone (17-HP) levels (Table, values in mean⫾SD). RESULTS: No differences were seen in basal IGF-1, fasting insulin or glucose, or maximum oGTT insulin or glucose levels, or oGTT insulin area under the curve (AUC). Insulin resistance, as assessed by the homeostatic model assessment (HOMA-IR), was also not different. CONCLUSION: In conclusion, we did not observe any significant differences in measures of insulin action between women with PCOS and NCAH, suggesting that androgens may play a significant role in determining IR in hyperandrogenic women. Further studies are required to confirm this finding. Supported by: None
P-739 Influence of Body Mass Index (BMI) on Successful Ovulation Triggering by Urinary hCG (u-hCG) Versus Recombinant hCG (r-hCG). B. Bsta¨ndig, C. Schumaker, V. Isnard, V. Isnard, P. Ferrari, A. Bongain. Hoˆpital Archet 2, Nice, France; Hoˆpital St. Rock, Laboratoire de Hormonologie, NICE, France. OBJECTIVE: The objective of this study was to assess whether 250 g r-hCG subcutaneous (SC) is as effective to trigger ovulation as 5000 or 10000 IU u-hCG intramuscular (IM) according to BMI. DESIGN: In overweight women, reduced bioavailability of hCG and possibly lower concentrations into the follicle might reduce final oocyte maturation. Furthermore, when body weight increases, absorption of hCG
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Abstracts
Vol. 84, Suppl 1, September 2005
CONCLUSION: Serum concentration of triglyceride, Cholesterol, HDL and LDL are increased with increasing body mass index and consequently a decrease in the pregnancy rate in women with BMI⬎25kg/m2 was shown. Additional research is needed to further clarify the clinical relevance of lipid concentration in heavy weight and obese women. Supported by: None
P-738 A Comparison of Insulin Action Between Women With 21-Hydroxylase-Deficient Nonclassic Adrenal Hyperplasia (NCAH) and Polycystic Ovary Syndrome (PCOS). M. Pall, D. Pignatelli, J. Beires, R. Azziz. Cedars-Sinai Medical Center, Los Angeles, CA; Faculty of Medicine of Porto, Porto, Portugal. OBJECTIVE: PCOS and NCAH represent two hyperandrogenic disorders that are difficult to distinguish clinically. As androgens can lead to decreased insulin sensitivity, we hypothesized that both disorders will have similar abnormalities of insulin action. DESIGN: Prospective cohort study. MATERIALS AND METHODS: We compared 22 women with NCAH with 22 age and body mass index-matched women with PCOS. All had a complete evaluation, including a modified Ferriman-Gallwey (mFG) hirsut-
P-737 Relationship Between Body Mass Index (BMI) and Plasma Lipid Concentration and Their Effect on IVF/ICSI Outcome. M. E. Hammadeh, A. Sykoutris, A. S. Amer, W. Schmidt. University of Saarland, Homburg, Germany; Chelsea and Westminster Hospital,, London, United Kingdom; Dept of Obstet. and Gynaecology, Al Azhar University, Cairo, Egypt; Dept. of Obstet. and Gynaecology, University of Saarland,, Homburg/Saar, Germany. OBJECTIVE: The purpose of this study was to determine the relationship between body mass index and lipid (triglyceride, Cholesterol, High density lipoprotein (HDL), Low density lipoprotein (LDL) concentration in serum of patients undergoing controlled ovarian hyperstimulation (COH) for ICSI therapy and to find out whether these lipid parameters could affect ICSI outcome. DESIGN: Prospective designed study MATERIALS AND METHODS: 52 patients were enrolled in this study. All patients underwent an ovarian hyperstimulation (COH) either with recombinant follicle stimulating hormone (rFSH-gonal-F), or human menopausal gonadotrophin (Menogon) after pituitary down regulation with gonadotrophin releasing hormone (Gn-RHa). Five blood samples were taken from each patient as follows: before treatment, at the beginning of ovarian stimulation, on the day of HCG injection, on the day of follicle aspiration and 14 days after embryo transfer. Lipid levels were measured in all blood samples. The patients were divided according to the BMI into two groups BMIⱕ25kg/m2 (G.1; n⫽28) and BMI⬎25kg/ m2 (G. II⫽24).The results of lipid concentration and ICSI outcome were compared between the two groups. RESULTS: In both groups the serum concentrations of lipids increased slightly during controlled ovarian hyperstimulation and at 14 days after transfer. Table.1. Summarize the lipid concentration in both groups. Moreover, the mean number of retrieved, fertilized and transferred oocytes in the first group was (10.8⫾4.3; 5.3 ⫾3.0 and 2.8⫾0.2 respectively) and the corresponding value in group II was (9.2⫾4.6; 4.0⫾2.2 and 2.7⫾0.3). The pregnancy rate in women with BMIⱕ25kg/ m2 was 46.4% and in women with BMI⬎25kg/m2 33.1% (p⫽0.34).
ism score and a 2-hr oral Glucose Tolerance Test (oGTT). When compared to PCOS, women with NCAH had significantly higher total T (TT), free T (FT), androstenedione (A4), and 17-hydroxyprogesterone (17-HP) levels (Table, values in mean⫾SD). RESULTS: No differences were seen in basal IGF-1, fasting insulin or glucose, or maximum oGTT insulin or glucose levels, or oGTT insulin area under the curve (AUC). Insulin resistance, as assessed by the homeostatic model assessment (HOMA-IR), was also not different. CONCLUSION: In conclusion, we did not observe any significant differences in measures of insulin action between women with PCOS and NCAH, suggesting that androgens may play a significant role in determining IR in hyperandrogenic women. Further studies are required to confirm this finding. Supported by: None
P-739 Influence of Body Mass Index (BMI) on Successful Ovulation Triggering by Urinary hCG (u-hCG) Versus Recombinant hCG (r-hCG). B. Bsta¨ndig, C. Schumaker, V. Isnard, V. Isnard, P. Ferrari, A. Bongain. Hoˆpital Archet 2, Nice, France; Hoˆpital St. Rock, Laboratoire de Hormonologie, NICE, France. OBJECTIVE: The objective of this study was to assess whether 250 g r-hCG subcutaneous (SC) is as effective to trigger ovulation as 5000 or 10000 IU u-hCG intramuscular (IM) according to BMI. DESIGN: In overweight women, reduced bioavailability of hCG and possibly lower concentrations into the follicle might reduce final oocyte maturation. Furthermore, when body weight increases, absorption of hCG
S422
Abstracts
Vol. 84, Suppl 1, September 2005