Criteria, prevalence, and phenotypes of polycystic ovary syndrome

Due to the comprehensive examination of 50 patients with ovarian polycystosis the authors suggested that ultrasound, laparoscopic, hormonal and endometrial parameters should be employed as diagnostic criteria.

Diagnostic criteria for polycystic ovary syndrome

Ovarian reserve testing: a user's guide.

The aim of this narrative review is to provide current evidence for the interaction between obesity, metabolic syndrome (MS) and reproductive axis. Gonadotropin-releasing hormone (GnRH) pulses and, consequently, normal function of reproductive (hypothalamus–pituitary–gonadal) axis depend on normal energy balance, which presupposes sufficient food intake, reasonable energy consumption and average thermoregulatory costs. In case of an energy imbalance, reproductive dysfunction may occur. In young women, excessive leanness is accompanied by puberty delay, whereas premature puberty might be a manifestation of obesity. In a similar way, obesity in men affects fertility. Excess adipose tissue results in increased conversion of testosterone to estradiol, which may lead to secondary hypogonadism through reproductive axis suppression. Moreover, oxidative stress at the level of the testicular micro-environment may result in decreased spermatogenesis and sperm damage. Products of the adipocyte, such as leptin, adiponectin and resistin, and gut peptides, such as ghrelin, are considered to be crucial in the interaction between energy balance and reproduction. Finally, an indirect evidence for the interplay between MS and reproductive axis is the fact that when treating components of one, parameters of the other can be improved as well. These therapeutic interventions include lifestyle modifications, pharmacological agents, such as sex hormone replacement therapy, and surgical procedures. Although many issues remain unclear, the elucidation of the complex interaction between MS and reproductive axis will have obvious clinical implications in the therapeutic approach of both entities.

The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review.

Polycystic ovary syndrome (PCOS) is a common infertility disorder affecting a significant proportion of the global population. It is the main cause of anovulatory infertility in women and is the most common endocrinopathy affecting reproductive-aged women, with a prevalence of 8-13% depending on the criteria used and population studied. The disease is multifactorial and complex and, therefore, often difficult to diagnose due to overlapping symptoms. Multiple etiological factors have been implicated in PCOS. Due to the complex pathophysiology involving multiple pathways and proteins, single genetic diagnostic tests cannot be determined. Progress has been achieved in the management and diagnosis of PCOS; however, not much is known about the molecular players and signaling pathways underlying it. Conclusively PCOS is a polygenic and multifactorial syndromic disorder. Many genes have been associated with PCOS, which affect fertility either directly or indirectly. However, studies conducted on PCOS patients from multiple families failed to find a fully penetrant variant(s). The present study was designed to review the current genetic understanding of the disease. In the present review, we have discussed the clinical spectrum, the genetics, and the variants identified as being associated with PCOS. The mechanisms by which variants in the genes confer risk to PCOS and the nature of the physical and genetic interaction between the genetic elements underlying PCOS remain to be determined. Elucidation of genetic players and cellular pathways underlying PCOS will certainly increase our understanding of the pathophysiology of this syndrome. The study also discusses the current status of the treatment modalities for PCOS, which is important to find new ways of treatment.

/pdf/genetic-basis-of-polycystic-ovary-syndrome-pcos-current-qon1ex5op3.pdf

Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives.

Serum anti-mullerian hormone levels in the main phenotypes of polycystic ovary syndrome

Objective
To determine the possible role of anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS) with a larger population of women and to evaluate its role as a new diagnostic marker

Design
Cross-sectional study

Setting
University hospital

Population
A total of 570 women, with PCOS (n = 419) and without PCOS (n = 151)

Methods
Serum basal hormone; AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) levels were measured Mean hormone levels were compared and the predictive value of serum AMH level was evaluated with the use of the receiver operating characteristic (ROC) curve analysis

Results
No statistically significant differences were found between PCOS women and control groups in terms of age, body mass index and TSH levels Differences between mean serum, FSH, LH and estradiol levels and LH/FSH ratio were found to be statistically significant (p < 0001) Mean serum AMH level was higher in PCOS women than in controls (734 vs 224 ng/mL, p < 0001) The area under the ROC curve assay yielded a satisfactory result of 0916 (95% confidence interval 0897–0935, p < 00001) The best compromise between 898% specificity and 80% sensitivity was obtained with a cut-off value of 394 ng/mL for PCOS diagnosis

Conclusions
Serum AMH measurement is very valuable in the diagnosis of PCOS women The serum AMH level in women with hyperandrogenism or oligo-anovulation could indicate the diagnosis of PCOS when reliable ultrasonography data are not available or when typical clinical and laboratory findings are not available The serum AMH level is a new and useful diagnostic tool in PCOS diagnosis

Elevated serum levels of anti‐Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome

Mammographic density increase in women receiving different hormone replacement regimens.

Objective The aim was to evaluate changes in bone mineral density (BMD) with age and body mass index (BMI) in healthy pre- and postmenopausal women living in the urban areas of Turkey.Design The study was prospective, carried out from 1993 to 1997.Setting The study was carried out at a university hospital, the Istanbul University Cerrahpasa School of Medicine, Turkey.Patients The study group consisted of 849 healthy women of ages 20–84 years, admitted to the Istanbul University Cerrahpasa School of Medicine. The cases were divided into age groups, starting with 20–29 years and ending with 70 years and over. For regression analysis, the cases were further regrouped as 20–39, 40–59 and 60 years and over. Dual energy X-ray absorptiometry (DEXA) was used to measure BMD in the lumbar vertebrae (L2–L4) and in the classical locations of the proximal femur such as the femoral neck, the Ward's triangle and the trochanter. Multiple regression analysis was performed for the evaluation of annual changes in BMD with r...

Changes in bone mineral density with age, menopausal status and body mass index in Turkish women.

Mammographic changes in women on hormonal replacement therapy.

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