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Acupuncture increases whole body glucose uptake during and after stimulation in women with polycystic ovary syndrome
follow-up was possible, approximately 70% remained CC sensitive; after 10 years of follow-up, 7 (50%) of 14 patients were CC sensitive, demonstrating the continuous effect of LOD. Of all the preoperative test values for the patients who experienced a long-term continuous effect, only the FSH values were found to be significantly higher. CONCLUSION: FSH values were significantly related to maintaining longterm spontaneous ovulation after LOD, suggesting that examining preoperative FSH values would be useful in predicting prognosis when deciding whether LOD should be indicated. Moreover, the effect was maintained for >10 years in at least 50% of cases in which long-term follow-up was possible.
O-83 Monday, October 20, 2014 05:30 PM PSYCHOSOCIAL DISTRESS, COPING, AND HEALTH-RELATED QUALITY OF LIFE (HRQL) IN ADULT WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS). R. C. Carron,a R. J. Alvero.b aFay W. Whitney School of Nursing, University of Wyoming, Laramie, WY; bReproductive Endocrinology and Infertility, University of Colorado, Aurora, CO. OBJECTIVE: The objective of this research study was to determine the health-related quality of life (HRQL) in women with PCOS by ascertaining depressive and anxiety symptoms, perceived stress, and coping strategies. DESIGN: A descriptive, correlational study using an online survey with five validated questionnaires. MATERIALS AND METHODS: Descriptive, correlational, and multiple regression procedures were used to analyze the relationships among the variables using the Statistical Package for the Social Sciences, Version 21. A sample of 72 women with PCOS clinically confirmed by the Rotterdam criteria, aged 18-40, not pregnant, and able to read and write in English was recruited from an urban metro area. The study sample was adequate to show significance with a power of 0.8, an alpha of 0.05, and a 0.2 effect size. Variables were measured with the Beck Depression Inventory-II, Spielberger’s Trait Anxiety Scale, Perceived Stress Scale-10, the Ways of Coping Questionnaire, and the Polycystic Ovary Syndrome Questionnaire (PCOSQ). RESULTS: 30.6% of the sample had severe levels of depressive symptoms, anxiety symptoms, or suicidal ideation. Women with severe psychosocial distress used significantly less adaptive coping processes (p < .05) and more maladaptive coping (p < .05). Weight was PCOSQ subscale with lowest mean at 2.87. Depressive symptoms and BMI explained 43.6% of variance in emotions PCOSQ subscale and 38.5% of variance in weight PCOSQ subscale. BMI explained 14% of variance in body hair PCOSQ subscale. Increased depressive and anxiety symptoms in the sample included loss of energy (70.8%), sleep changes (70.9%), excessive worry (77.8%), and lack of self-confidence (80.5%). CONCLUSION: Women with PCOS are at risk for depression, anxiety, and, in a few cases, suicidal ideation. A comprehensive measure captures psychosocial distress better than a single tool. Regular screening for depression and psychosocial distress is indicated in this population. Coping skills should be assessed, and need further examination in women with PCOS. Weight is an area of concern to women with PCOS and should be discussed in relation to HRQL. Supported by: A Jonas Nurse Leader Scholar Award Supported part of the study. O-84 Monday, October 20, 2014 05:45 PM IMPACT OF BODY WEIGHT ON OUTCOME OF OVULATION INDUCTION-INTRAUTERINE INSEMINATION CYCLES IN WOMEN WITH POLYCYSTIC OVARY SYNDROME. M. L. Krohn,a A. Sparks,b D. K. Shah.b aObstetrics and Gynecology, University of Iowa, Iowa City, IA; bDivision of Reproductive Endocrinology and Infertility, University of Iowa, Iowa City, IA. OBJECTIVE: Despite a strong correlation between obesity and polycystic ovary syndrome (PCOS), approximately 25% of women with PCOS are of normal weight. Infertile women with PCOS frequently initiate therapy with ovulation induction (OI), but there is little data examining the impact of body size on the efficacy of this treatment. Our objective was to compare pregnancy outcome between lean, overweight, and obese women with PCOS undergoing OI. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All women with PCOS by Rotterdam criteria undergoing OI with intrauterine insemination at the University of Iowa between January 1, 2000 and November 30, 2013 were categorized by body mass index (BMI) as lean (<25 kg/m2), overweight (25.0-29.9),
FERTILITY & STERILITYÒ
obese (30.0-39.9), or morbidly obese (>40). Patients underwent OI with either oral agents (clomiphene citrate or letrozole), or a combination of oral agents and injectable FSH. Logistic regression was used to estimate the effect of BMI on cycle outcome, adjusting for potential confounders. Results were expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI), using lean women as the referent population. RESULTS: 201 women with PCOS contributed a total of 447 cycles to the analysis: 118 in lean, 88 in overweight, 148 in obese, and 93 in morbidly obese women. In lean PCOS patients undergoing combined OI with oral and injectable agents, the unadjusted clinical pregnancy rate (CPR) was 51%; CPR was comparatively lower in overweight (19%), obese (34%) and morbidly obese (21%) women. Rates of spontaneous abortion, ectopic pregnancy, and multiple gestation were similar across BMI categories although individual comparisons were limited by the rarity of the outcomes. Adjusting for age and duration of infertility, the odds of clinical pregnancy was significantly diminished in overweight (OR¼0.23, CI¼0.09-0.58), obese (OR¼0.45, CI¼0.22-0.90) and morbidly obese women with PCOS (OR¼0.35, CI¼0.16-0.81) as compared to the lean PCOS referent. A similar but non-significant trend was identified in women undergoing OI with oral medications, but analyses were limited by small numbers. CONCLUSION: Lean women with PCOS have higher CPR after combined oral and injectable OI as compared to their overweight, obese, and morbidly obese counterparts. Patients with a lean PCOS phenotype may preferentially benefit from this treatment approach. O-85 Monday, October 20, 2014 06:00 PM ACUPUNCTURE INCREASES WHOLE BODY GLUCOSE UPTAKE DURING AND AFTER STIMULATION IN WOMEN WITH POLYCYA. Benrick,a STIC OVARY SYNDROME. E. Stener-Victorin,a M. Kokosar,a M. Maliqueo,a C. Behre,b K. Højlund,c A. Sazonova.d aDepartment of Physiology, Institute of Neuroscience and Phsyiology, G€oteborg, Sweden; bDepartment of Cardiology, Institute Medicine, G€oteborg, Sweden; c Department of Endocrinology, University Hospital Odense, Odense, Denmark; dDepartment of Obstetrics and Gynecology, Institute of Clinical Science, G€oteborg, Sweden. OBJECTIVE: Impaired glucose regulation, hyperinsulinemia and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). A single acupuncture treatment increases whole body glucose uptake during and after stimulation in IR PCOS rats. If acupuncture has such an effect in women with PCOS is unknown. The aim of the present study was to investigate whether a single acupuncture treatment increase whole body glucose uptake during and after stimulation in women with and without PCOS. DESIGN: A prospective experimental study. MATERIALS AND METHODS: Twenty-one women with PCOS and 21 controls matched for age, weight and BMI were included. After an overnight fast, a euglycemic-hyperinsulinemic clamp was performed. In brief, insulin was infused (40mU/min/kg) for 120 min to reach steady state glucose infusion rates (GIR). At steady-state, acupuncture needles were placed in the abdominal and quadriceps muscles and below the knee in somatic segments corresponding to the innervation of the ovaries and pancreas. Needles were stimulated by manual rotation every 10 min and by 2 Hz electrical stimulation during 45 min. Clamp continued for 60 min after end of acupuncture. The GIR during the steady-state, during acupuncture (last 20 min) and after end of acupuncture (last 30 min) were used to assess insulin sensitivity (M value). The insulin sensitivity index (M/I value) for each period was also calculated. RESULTS: The M value was higher during and after acupuncture compared with steady-state in controls and women with PCOS (P < 0.01). The insulin sensitivity index (M/I value), did not increase during acupuncture. After acupuncture the M/I was increased compared with the effect of insulin per se in women with PCOS (P < 0.01), but not in controls. The lack of changes in the M/I value during acupuncture may be explained by increased insulin concentrations during acupuncture which decreased after stimulation in women with PCOS but not controls. There were no differences between cases and controls. CONCLUSION: This is the first study to demonstrate that a single acupuncture treatment with combined manual and electrical stimulation of the needles improves whole body glucose uptake during and after stimulation in women with and without PCOS. Supported by: Swedish Research Council, Jane and Dan Olsson Foundations, the Swedish government under the LUA/ALF agreement, and the Regional Research and Development Agreement.
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O-83 Monday, October 20, 2014 05:30 PM PSYCHOSOCIAL DISTRESS, COPING, AND HEALTH-RELATED QUALITY OF LIFE (HRQL) IN ADULT WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS). R. C. Carron,a R. J. Alvero.b aFay W. Whitney School of Nursing, University of Wyoming, Laramie, WY; bReproductive Endocrinology and Infertility, University of Colorado, Aurora, CO. OBJECTIVE: The objective of this research study was to determine the health-related quality of life (HRQL) in women with PCOS by ascertaining depressive and anxiety symptoms, perceived stress, and coping strategies. DESIGN: A descriptive, correlational study using an online survey with five validated questionnaires. MATERIALS AND METHODS: Descriptive, correlational, and multiple regression procedures were used to analyze the relationships among the variables using the Statistical Package for the Social Sciences, Version 21. A sample of 72 women with PCOS clinically confirmed by the Rotterdam criteria, aged 18-40, not pregnant, and able to read and write in English was recruited from an urban metro area. The study sample was adequate to show significance with a power of 0.8, an alpha of 0.05, and a 0.2 effect size. Variables were measured with the Beck Depression Inventory-II, Spielberger’s Trait Anxiety Scale, Perceived Stress Scale-10, the Ways of Coping Questionnaire, and the Polycystic Ovary Syndrome Questionnaire (PCOSQ). RESULTS: 30.6% of the sample had severe levels of depressive symptoms, anxiety symptoms, or suicidal ideation. Women with severe psychosocial distress used significantly less adaptive coping processes (p < .05) and more maladaptive coping (p < .05). Weight was PCOSQ subscale with lowest mean at 2.87. Depressive symptoms and BMI explained 43.6% of variance in emotions PCOSQ subscale and 38.5% of variance in weight PCOSQ subscale. BMI explained 14% of variance in body hair PCOSQ subscale. Increased depressive and anxiety symptoms in the sample included loss of energy (70.8%), sleep changes (70.9%), excessive worry (77.8%), and lack of self-confidence (80.5%). CONCLUSION: Women with PCOS are at risk for depression, anxiety, and, in a few cases, suicidal ideation. A comprehensive measure captures psychosocial distress better than a single tool. Regular screening for depression and psychosocial distress is indicated in this population. Coping skills should be assessed, and need further examination in women with PCOS. Weight is an area of concern to women with PCOS and should be discussed in relation to HRQL. Supported by: A Jonas Nurse Leader Scholar Award Supported part of the study. O-84 Monday, October 20, 2014 05:45 PM IMPACT OF BODY WEIGHT ON OUTCOME OF OVULATION INDUCTION-INTRAUTERINE INSEMINATION CYCLES IN WOMEN WITH POLYCYSTIC OVARY SYNDROME. M. L. Krohn,a A. Sparks,b D. K. Shah.b aObstetrics and Gynecology, University of Iowa, Iowa City, IA; bDivision of Reproductive Endocrinology and Infertility, University of Iowa, Iowa City, IA. OBJECTIVE: Despite a strong correlation between obesity and polycystic ovary syndrome (PCOS), approximately 25% of women with PCOS are of normal weight. Infertile women with PCOS frequently initiate therapy with ovulation induction (OI), but there is little data examining the impact of body size on the efficacy of this treatment. Our objective was to compare pregnancy outcome between lean, overweight, and obese women with PCOS undergoing OI. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All women with PCOS by Rotterdam criteria undergoing OI with intrauterine insemination at the University of Iowa between January 1, 2000 and November 30, 2013 were categorized by body mass index (BMI) as lean (<25 kg/m2), overweight (25.0-29.9),
FERTILITY & STERILITYÒ
obese (30.0-39.9), or morbidly obese (>40). Patients underwent OI with either oral agents (clomiphene citrate or letrozole), or a combination of oral agents and injectable FSH. Logistic regression was used to estimate the effect of BMI on cycle outcome, adjusting for potential confounders. Results were expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI), using lean women as the referent population. RESULTS: 201 women with PCOS contributed a total of 447 cycles to the analysis: 118 in lean, 88 in overweight, 148 in obese, and 93 in morbidly obese women. In lean PCOS patients undergoing combined OI with oral and injectable agents, the unadjusted clinical pregnancy rate (CPR) was 51%; CPR was comparatively lower in overweight (19%), obese (34%) and morbidly obese (21%) women. Rates of spontaneous abortion, ectopic pregnancy, and multiple gestation were similar across BMI categories although individual comparisons were limited by the rarity of the outcomes. Adjusting for age and duration of infertility, the odds of clinical pregnancy was significantly diminished in overweight (OR¼0.23, CI¼0.09-0.58), obese (OR¼0.45, CI¼0.22-0.90) and morbidly obese women with PCOS (OR¼0.35, CI¼0.16-0.81) as compared to the lean PCOS referent. A similar but non-significant trend was identified in women undergoing OI with oral medications, but analyses were limited by small numbers. CONCLUSION: Lean women with PCOS have higher CPR after combined oral and injectable OI as compared to their overweight, obese, and morbidly obese counterparts. Patients with a lean PCOS phenotype may preferentially benefit from this treatment approach. O-85 Monday, October 20, 2014 06:00 PM ACUPUNCTURE INCREASES WHOLE BODY GLUCOSE UPTAKE DURING AND AFTER STIMULATION IN WOMEN WITH POLYCYA. Benrick,a STIC OVARY SYNDROME. E. Stener-Victorin,a M. Kokosar,a M. Maliqueo,a C. Behre,b K. Højlund,c A. Sazonova.d aDepartment of Physiology, Institute of Neuroscience and Phsyiology, G€oteborg, Sweden; bDepartment of Cardiology, Institute Medicine, G€oteborg, Sweden; c Department of Endocrinology, University Hospital Odense, Odense, Denmark; dDepartment of Obstetrics and Gynecology, Institute of Clinical Science, G€oteborg, Sweden. OBJECTIVE: Impaired glucose regulation, hyperinsulinemia and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). A single acupuncture treatment increases whole body glucose uptake during and after stimulation in IR PCOS rats. If acupuncture has such an effect in women with PCOS is unknown. The aim of the present study was to investigate whether a single acupuncture treatment increase whole body glucose uptake during and after stimulation in women with and without PCOS. DESIGN: A prospective experimental study. MATERIALS AND METHODS: Twenty-one women with PCOS and 21 controls matched for age, weight and BMI were included. After an overnight fast, a euglycemic-hyperinsulinemic clamp was performed. In brief, insulin was infused (40mU/min/kg) for 120 min to reach steady state glucose infusion rates (GIR). At steady-state, acupuncture needles were placed in the abdominal and quadriceps muscles and below the knee in somatic segments corresponding to the innervation of the ovaries and pancreas. Needles were stimulated by manual rotation every 10 min and by 2 Hz electrical stimulation during 45 min. Clamp continued for 60 min after end of acupuncture. The GIR during the steady-state, during acupuncture (last 20 min) and after end of acupuncture (last 30 min) were used to assess insulin sensitivity (M value). The insulin sensitivity index (M/I value) for each period was also calculated. RESULTS: The M value was higher during and after acupuncture compared with steady-state in controls and women with PCOS (P < 0.01). The insulin sensitivity index (M/I value), did not increase during acupuncture. After acupuncture the M/I was increased compared with the effect of insulin per se in women with PCOS (P < 0.01), but not in controls. The lack of changes in the M/I value during acupuncture may be explained by increased insulin concentrations during acupuncture which decreased after stimulation in women with PCOS but not controls. There were no differences between cases and controls. CONCLUSION: This is the first study to demonstrate that a single acupuncture treatment with combined manual and electrical stimulation of the needles improves whole body glucose uptake during and after stimulation in women with and without PCOS. Supported by: Swedish Research Council, Jane and Dan Olsson Foundations, the Swedish government under the LUA/ALF agreement, and the Regional Research and Development Agreement.
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