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Objective: To study the frequency of CD4+CD28null T cells, which are aggressive T lymphocytes associated with recurrent coronary instability and type 2 diabetes mellitus, in different polycystic ovary syndrome (PCOS) phenotypes and in age- and body mass index–matched healthy women. Design: Retrospective cohort observational study. Setting: Unit of human reproductive pathophysiology, university hospital. Patient(s): A total of 167 PCOS patients and 102 control subjects. Intervention(s): None. Main Outcome Measure(s): CD4+CD28null T cell frequency, high-sensitive C-reactive protein levels, and other glucose-metabolic parameters. Result(s): CD4+CD28null frequency was significantly higher in all PCOS groups than in control subjects. CD4+CD28null frequency was significantly higher in nonhyperandrogenic phenotype (5.7%, range 3.2–7.1) than in phenotypes with hyperandrogenism (H) + oligoamenorrhea (O) + polycystic ovary (PCO) (3.5%, range 1–5.8), H + O (3%, range 1.8–4.7), and H + PCO (2.63%, range 1.2–4.1). The relative risk of non-H phenotype for PCOS women in the highest quartile for CD4+CD28null frequency compared with PCOS women with the lowest quartile was 3.2 (95% confidence interval 1.9–5.8). Conclusion(s): Cardiovascular risk evaluation should be performed in all PCOS phenotypes. In particular, we demonstrated that the non-H phenotype has potentially increased cardiovascular risk in terms of CD4+CD28null frequency. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the noninferiority of highly purified menotropin (HP-hMG) compared with recombinant FSH (rFSH) regarding clinical pregnancy rate (PR) in intrauterine insemination (IUI) cycles. Design: Prospective randomized noninferiority trial. Setting: Unit of physiopathology of human reproduction, university hospital. Patient(s): Five hundred twenty-three patients with unexplained infertility or mild male infertility undergoing controlled ovarian hyperstimulation for IUI. Intervention(s): Patients were randomized for treatment with rFSH (262 patients) or HP-hMG (261 patients). Insemination was performed 34–36 hours after hCG injection. Main Outcome Measure(s): The primary outcome was clinical pregnancy rate (PR). The secondary outcome was the number of interrupted cycles for high risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. Result(s): The clinical PR was 19.7% (95% confidence interval [CI] 15.3%–25.1%) in the HP-hMG group and 21.4% (95% CI 16.9%–26.8%) in the rFSH group [absolute difference −1.7% (95% CI −8.6%–5.2%)]; therefore, the noninferiority was demonstrated. The number of interrupted cycles for OHSS risk and multiple pregnancy was significanty higher in the rFSH group, 8.4% (95% CI 5.6%–12.4%) than in the HP-hMG group 1.2% (95% CI 0.4%–3.3%) [absolute difference −7.27% (95% CI −11.3 to −3.7)]. Conclusion(s): HP-hMG is not inferior compared with rFSH regarding clinical PR. [ABSTRACT FROM AUTHOR]

Women affected by polycystic ovary syndrome (PCOS) have an increased risk of cardiovascular disease. We demonstrated that women with PCOS showed an expansion of CD4+CD28null T cells, an aggressive population of T lymphocytes that has been recently associated with recurrent coronary instability and type 2 diabetes mellitus. This sheds new light on possible mechanisms responsible for the higher rate of cardiovascular disease among women with PCOS. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a specific simple measure of insulin sensitivity using oral glucose tolerance test (OGTT) values for lean polycystic ovary syndrome (PCOS) women. Design: Retrospective study. Setting: Gynecologic Outpatient Clinic of University Hospital, affiliated with Unit of Gynecologic Endocrinology. Patient(s): Totals of 201 lean and 198 overweight/obese (ov-ob) nondiabetic PCOS patients were retrospectively selected. Intervention(s): None. Main Outcome Measure(s): All patients underwent OGTT, euglycemic-hyperinsulinemic clamp, and androgenic and biochemical assays. The predictive performance of each insulin resistance (IR) index was analyzed with the use of receiver operating characteristic (ROC) curves. Result(s): Higher correlation coefficients with clamp studies were obtained with the Belfiore Area (R S = 0.579) and the homeostasis-model assessment (HOMA)-M120 (R S = −0.576) in lean PCOS patients and with the Sib (R S = 0.697) in ov-ob PCOS patients. The best predictive index of IR in lean PCOS was a HOMA-M120 value of ≥12.8 or more (area under the ROC curve [AUC] 92.4%). In the ov-ob PCOS population, the best predictive performance was obtained by a Sib of ≤10.2 or less (AUC 85.7%). Conclusion(s): IR should be assessed in all PCOS women, both lean and ov-ob subjects. The HOMA-M120 resulted as a very simple tool, validated specifically for the lean PCOS woman whose cardiometabolic impairment is more frequently misunderstood. [ABSTRACT FROM AUTHOR]