Aram Rojanasakul

Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome

Objectives: To determine the prevalence of abnormalities of glucose metabolism in Asian women with polycystic ovary syndrome (PCOS) and to assess the different impacts of the 1985 and 1999 WHO consultations and the ADA criteria for the diagnosis of type 2 diabetes mellitus (DM). Methods: Eighty‐five women with PCOS were consecutively included in the study at the Reproductive Endocrinology Unit, Department of Ob‐Gyn, Ramathibodi Hospital, Mahidol University. All women underwent a standard oral glucose tolerance test (OGTT). Fasting insulin and testosterone levels were also measured. Results: Seventy‐nine women consented to the OGTT. The prevalence of impaired glucose tolerance (IGT) and type 2 DM was 22.8 and 15.2% with the 1985 WHO criteria, and 20.3 and 17.7% according to the 1999 WHO consultation criteria, respectively. The recommendation of the ADA using the fasting glucose levels could only determine a prevalence of 6.3% for type 2 DM. The fasting insulin and testosterone levels were significantly higher in DM than IGT and normal glucose tolerance (NGT) subgroups. The PCOS women with abnormalities of glucose metabolism had a greater body mass index (BMI), higher fasting glucose and 2‐h post‐load glucose levels than those with NGT. The prevalence of glucose intolerance significantly increased with BMI. Conclusions: Similar to other ethnic populations, Asian women with PCOS are at risk of developing IGT and type 2 DM especially if obese. The recommendation of the ADA is not appropriate for the diagnosis of type 2 DM in PCOS women.

HORMONAL PROFILES AND PREVALENCE OF POLYCYSTIC OVARY SYNDROME IN WOMEN WITH ACNE

One of the important etiologic factors in acne is an increase in sebaceous gland activity, which is androgen dependent. Acne is a common manifestation of hyperandrogenemia. Therefore, acne may not only cause cosmetic concern but may also be a sign of underlying disease. In females, the most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS). The purpose of this study was to determine the hormonal profiles of women with acne and the prevalence of PCOS in women attending the dermatological clinic with acne problems.

Prevalence of gestational diabetes mellitus and pregnancy outcomes in Asian women with polycystic ovary syndrome

The aim of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and the pregnancy outcomes in Asian women with polycystic ovary syndrome (PCOS). The retrospective cohort study was performed to compare pregnancy outcomes of 47 pregnancies in 41 PCOS women with 264 pregnancies in 222 women with normal menstruation. Logistic regression was used to assess the risk of PCOS on GDM, hypertensive disorder in pregnancy (HDP) and premature delivery. The mean age of both groups was 31 years. The mean body mass index (BMI) and proportion of BMI of > 25 kg/m2 were significantly higher in the PCOS than in the control group. There was no difference in the prevalence of GDM between the PCOS women and the high-risk group of the controls. The prevalence of HDP and premature delivery was significantly greater in PCOS women (21.3 and 13.3%) than in the controls (6.4 and 5.4%), respectively. PCOS was demonstrated as a risk factor for GDM and HDP with borderline statistical significance, but not for premature birth. The Cesarean section rate was higher in the PCOS than in the control group. In conclusion, the prevalence of GDM in Asian women with PCOS is high and comparable to those of a high-risk group.

Acanthosis nigricans: Clinical predictor of abnormal glucose tolerance in Asian women with polycystic ovary syndrome

The aim of this retrospective study was to assess whether acanthosis nigricans is a predictive factor for abnormal glucose tolerance (AGT) in Asian women with polycystic ovary syndrome (PCOS). Data from the record forms and electronic form of 121 PCOS women who consecutively attended the Reproductive Endocrinology and Infertility Unit were reviewed. In accordance with the units guidelines, all women received a physical examination, had anthropometric measurements taken and underwent as a 75-g oral glucose tolerance test after diagnosis. Their age, body mass index (BMI) and waist/hip ratio (WHR) was 29.1±6.1 years, 27.4±6.8 kg/m2 and 0.84±0.6 (mean±standard deviation), respectively. The prevalence of AGT was 42.9%, with 1.6% having impaired fasting glucose, 32.3% having impaired glucose tolerance and 9.1% having type 2 diabetes mellitus. The PCOS women with acanthosis nigricans had significantly higher BMI, WHR, fasting glucose, 2-h post-load glucose, fasting insulin, 2-h post-load insulin and prevalence of AGT compared with those without acanthosis nigricans. By logistic regression analysis, acanthosis nigricans and WHR were independent predictors for AGT, with an odds ratio (95% confidence interval) of 2.7 (1.1–7.1) and 10.1 (1.8–20.7), respectively. In conclusion, acanthosis nigricans was demonstrated as a predictive factor for AGT in Asian women with PCOS.

Cost-effectiveness of IVF in women 38 years and older.

Objective: To compare the cost per delivery in women younger than 38 years with women equal to or older than 38 years of age attempting IVF. Methods: All couples undergoing IVF treatment between October 1991 and September 1998 were enrolled in this study. A standard protocol of controlled ovarian hyperstimulation was employed throughout the study. Four hundred and seven cases were allocated to two groups — group I composed of patients younger than 38 years of age and group II of patient equal to or older than 38 years of age. The total cost of each successful outcome was the goal of our study. Results: A total of 407 women underwent 722 stimulated cycles for IVF of which 122 cycles (16.89%) did not proceed to oocyte retrieval. We found statistically significant differences in the cancellation rate, the number of hMG ampoules, the number of oocytes retrieved, the number of oocytes fertilized, the number of embryos transferred, the clinical pregnancy rate, the rate of multiple pregnancy, the delivery per initiated cycle and the cost per delivery between the two groups (P<0.05, significant). The cost per delivery in group II was approximately 3.6 times that of group I. Conclusions: Women age 38 years or more have less chance of a successful outcome from IVF treatment. Couples contemplating IVF should be provided with accurate information about prognosis for the pregnancy and the financial costs.

Serum lipids and lipoproteins in women with polycystic ovarian disease with different body mass index

A study to determine serum lipids and lipoproteins in 54 women with polycystic ovarian disease (PCOD) who had varying body mass index (BMI) compared to the normal regular menstruating women was carried out. All patients had similar hormonal profiles of PCOD and differed from the control group. The significant observations were high level of triglyceride and low percentage of alpha lipoprotein in obese PCOD. The BMI was positively correlated with serum triglyceride level, beta and prebeta lipoproteins but inversely correlated with high density lipoprotein (HDL) cholesterol, the low density lipoprotein (LDL) cholesterol/HDL cholesterol ratio and alpha lipoprotein. No significant correlation between lipids, lipoproteins and testosterone levels was observed. It appeared that the alteration of serum lipids and lipoproteins in PCOD is due to the effect of obesity.

Chemiluminescence immunoassay versus radioimmunoassay for the measurement of reproductive hormones

OBJECTIVES: To compare the hormonal values determined by chemiluminescence immunoassay (CIA) and radioimmunoassay (RIA). METHODS: Blood samples, drawn from eight volunteers during one menstrual cycle, were assayed for estradiol, progesterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin by CIA and RIA methods. The values obtained from these two assay techniques were compared. Statistical analysis were performed using the t‐test, Pearson correlation coefficient and simple linear regression analysis. RESULTS: CIA yielded lower mean values of LH, FSH, progesterone, but higher mean values of prolactin than RIA. Mean estradiol levels assayed by the two methods were similar. There was a good correlation between the hormonal values performed by the two methods. By calculation, the CIA hormonal value could accurately predict the RIA value by 96.6, 93.9, 89.9 and 66.0% for progesterone, LH, FSH and prolactin, respectively. CONCLUSIONS: The disparity in the hormonal values obtained from different assay methods warrants clinicians to be aware of their clinical interpretation. Using the same reference range for different assay methods is not appropriate. A comparative study between the new and standard assays is essential.

Effects of combined desogestrel-ethinylestradiol treatment on lipid profiles in women with polycystic ovarian disease *

A longitudinal study was conducted to determine the effect of combined desogestrel-ethinylestradiol treatment on lipid profiles in 28 women with polycystic ovarian disease. Mean patient age was 26.3 years (range, 16 to 36 years). Mean patient weight and height were 59.2 kg and 153.8 cm, respectively. After initial assessment, all patients were treated with a cyclical pill containing 150 micrograms desogestrel and 30 micrograms ethinylestradiol. Clinical, hormonal, and lipid determinations were evaluated after 3 and 6 cycles of treatment. The results revealed that, during the treatment course, serum luteinizing hormone, testosterone (T), free testosterone, and dehydroepiandrosterone sulfate decreased significantly, while serum follicle-stimulating hormone and prolactin levels did not change. Increased levels of total triglyceride, alpha, and prebeta lipoproteins, and decreased levels of beta lipoproteins, were observed. The ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol, although showing no significant change, had a tendency to decrease. This lipoprotein change seems to have a favorable rather than an adverse effect on the patients.

Efficacy of metformin on ovulation induction in Asian women with polycystic ovary syndrome.

The aim of this study was to assess the efficacy of metformin on induction of ovulation in Asian women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). Twenty PCOS women who did not respond to CC were enrolled in the study. All received 500-1500 mg/day of metformin for 4 weeks. If no dominant follicle was observed with monitoring by transvaginal ultrasound, 50-150 mg of CC per day for 5 days were added. Timing of sexual intercourse was determined or intrauterine insemination was carried out 36 h after administration of human chorionic gonadotropin. A total of six cycles, pregnancy or anovulation despite taking 150 mg of CC were considered as completion of the study. Blood samples were obtained before and at the end of the 4th week of treatment for hormonal assay. Ovulation was observed in 68 (89.5%) of 76 cycles, of which 34 (44.7%) occurred with metformin alone. Twelve women conceived; therefore, the pregnancy rate was 17.6% per ovulated cycle and 60% per woman. One (8.3%) had an abortion. Four women had minimal adverse effect, but one experienced a severe gastrointestinal effect during the fourth cycle. Insulin and androstenedione levels were significantly decreased after 4 weeks of treatment. In conclusion, these series demonstrated the excellent efficacy of metformin on induction of ovulation and pregnancy in Asian women with CC-resistant PCOS.

Comparison of outcomes and direct cost between minimal stimulation and conventional protocols on ovarian stimulation in in vitro fertilization

Aim: To determine whether minimal stimulation with clomiphene and gonadotropin provides outcomes and direct costs comparable with those of a conventional GnRHa‐gonadotropin stimulation protocol for infertile patients undergoing in vitro fertilization.