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Summary: Objective: This study explores the role of anti‐Mullerian hormone (AMH) and LH/FSH ratio in diagnosis of polycystic ovary syndrome (PCOS). Methods: In this multicentre cross‐sectional descriptive study, a total of 863 infertile women between 18 and 45 years were evaluated at three infertility centres in Vietnam and were recruited from June 2016 to June 2017. The patients were classified into two groups: Group I included 441 patients with PCOS (based on Rotterdam criteria consensus) and Group II included 422 non‐PCOS women. Diagnosis of PCOS was established based on Rotterdam 2003 consensus, and exclusion criteria were ovarian disease (ovary cyst/tumour), history of ovarian surgery and ovarian failure. Results: At an optimum cut‐off level of 32.79 pmol/L, AMH showed sensitivity and specificity of 78.50% and 75.83%, respectively, with the AUC 0.852 (95% CI: 0.826‐0.875). The LH/FSH ratio had a similar AUC at the optimum cut‐off of 1.33 (AUC = 0.867, 95% CI 0.842‐0.889), which demonstrated a similar diagnosis value to AMH (P = 0.340). By using multiple logistic regression analysis, 1 ng/mL increase in AMH levels was associated with an increased risk of PCOS (OR = 1.63, 95% CI: 1.506‐1.764; P < 0.001). Similarly, one unit increase in LH/FSH ratio was associated with 14.433 times increased (95% CI: 9.302‐22.395; P < 0.001) risk of PCOS. There were no significant differences between values of AMH and LH/FSH ratio in PCOS diagnosis, as the difference between the two AUCs was 0.013, 95% CI: −0.024 to 0.028 and P = 0.897. Conclusion: The value of serum AMH concentration has been found not significantly superior to LH/FSH ratio in PCOS diagnosis. Although these biomarkers separately are not adequate for PCOS diagnosis based on their own value, the combination of different endocrine factors including AMH, LH and LH/FSH ratio together with BMI and other anthropometric and clinical characteristics may offer extra value to establish the diagnosis of PCOS. [ABSTRACT FROM AUTHOR]

Poly cystic ovarian syndrome (PCOS) is one of the commonest endocrine disorders in young age group female (with a prevalence of 6–10% in the general population). “PCOS is characterized by the following: ovulatory dysfunction resulting in oligo-amenorrhea and/or anovulation, hyperandrogenism and/or hirsutism and the presence of polycystic ovarian morphology by ultrasound”. “Vitamin D also plays a physiologic role in reproduction including” ovarian follicular development and luteinization via altering anti Müllerian hormone (AMH)”, signaling, “follicle-stimulating hormone sensitivity and progesterone production in human granulosa cells.” the aim of this study was to determine” whether “serum levels of vitamin D” were different between diseased (PCOS) and non-diseased women and; to determine whether its deficiency is associated with, metabolic and endocrine dysregulations “in PCOS affected females”.a case-control prospective descriptive clinical study. Study setting: Obstetric and Pediatric Teaching Hospital in Al-Ramadi/Iraq. Patient and Methods: during the period from JAN 2018 to SEP 2018. It was included 80 women diagnosed with PCOS based on Rotterdam criteria and 20 fertile women without PCOS. The patient’s age were 18-45 years excluding the patients who were on hormonal replacement therapy for last 3months, had endocrine or chronic hepatic or renal disorders, and women that take vitamin D for last six months. Other parameters were recorded; the weight and height of all patients and control group (calculating the BMI) and investigated for serum random blood sugar and vitamin D level using ELISA technique. Results: the PCOS group had higher “body mass index (BMI)” and “random blood sugar(RBS)” value and the differences are both significant where the p values are 0.024 and 0.045 respectively. While the two groups were comparable in their ages and the difference where non-significant, p value is 0.10 (p value >0.05). large percentage of women were had low level of Vitamin D (91.25%) and (94.9%) of the, control group. The diferences between all level of vit D of both group are not significant (the P value is 0.63 calculated using chi-sequare test). There is (no, significant differences) in the Vitamin D, levels “between obese and non –obese PCOS patients as the P value is 0.4552 and” the distribution of patients according to their Vitamin D levels graded as deficient, insufficient and normal values. Conclusion: our result demonstrated (no difference) in serum vitamin D between (women with PCOS and control group) which suggesting that no clear correlations between “the role of vitamin D and the pathogenesis of PCOS”. [ABSTRACT FROM AUTHOR]

Background: polycystic ovary syndrome (PCOS) is the major cause of anovulatory infertility. Letrozole and other aromatase inhibitors (AIs) have been introduced as a new treatment option could challenge clomiphene citrate (CC) for ovulation induction in this group. Objective: to compare the efficacy of short vs extended courses of letrozole therapy for ovulation induction in PCOS women. Patients and Methods: this is prospective randomized comparative study done on 60 patients attended El-Hussein Hospital and previously diagnosed as having PCOS, based on the revised Rotterdam criteria (2003). Patients were divided randomly into 2 treatment groups, group I, short letrozole therapy (30 patients, received 5mg of letrozole from 1st to 5th day of menstrual bleeding) and group II, long letrozole therapy (30 patients, received 2.5mg of letrozole from 1st to 10th day of menstrual bleeding). All patients of both groups monitored by trans-vaginal ultrasound on day 10 of the cycles. HCG injection (5,000 IU IM) was given when at least one follicle measured ≥ 18mm. Intercourse were advised for 24-36h after HCG injection. Serum HCG and trans-vaginal ultrasound were done 2 weeks after HCG injection in the absence of menstruation for diagnosis of pregnancy. Results: in long letrozole therapy, total number of follicles, mean number of mature follicles, endometrial thickness, percentage of patients ovulated after treatment, occurrence of pregnancy were greater when compared to results of short letrozole therapy. Conclusion: long letrozole therapy can produce more mature follicles and subsequently more pregnancies than short letrozole therapy. [ABSTRACT FROM AUTHOR]

Background & objectives: Polycystic ovary syndrome (PCOS) is an endocrinopathy warranting lifelong individualized management by lifestyle and pharmacological agents mainly oral contraceptive pills (OCPs). This study was aimed to report the impact of six-month OCP use on plasminogen activator inhibitor-1 (PAI-1) and factor VIII (FVIII) in women with PCOS. Methods: PCOS women diagnosed on the basis of Rotterdam 2003 criteria, either treated with OCPs (ethinyl estradiol-0.03 mg, levonorgestrel-0.15 mg) for a period of six months (n=40) or drug-naïve (n=42), were enrolled in this study. Blood was drawn to estimate glucose, insulin levels and lipid profile. Chemiluminescence immunoassays were used to measure hormones (LH, FSH, PRL, T4). Plasma levels of PAI-I and FVIII were measured by commercially available kits. Results: Menstrual regularity, Ferriman-Gallwey score and serum total testosterone significantly improved in the OCP group compared to drug-naïve group (P<0.01). No significant difference was observed in PAI-1 levels of the two groups; however, significant decrease in FVIII levels was observed in OCP group as compared to drug-naïve group. PAI-1 levels of OCP group correlated positively with blood glucose two hours, triglycerides and insulin two hours, while FVIII levels of OCP group correlated negatively with fasting insulin and homoeostatic model assessment-insulin resistance. Interpretation & conclusions: OCPs use has differential effect on pro-coagulant markers among women with PCOS. Well-designed, long-term, prospective, large-scale studies are prerequisite to elucidate the efficacy and safety of OCP in the treatment of PCOS. [ABSTRACT FROM AUTHOR]

The Rotterdam criteria for polycystic ovary syndrome (PCOS) are used by a wide range of medical professionals and researchers. However, the development of these criteria was based on expert meetings and not on evidence-based treatment guidance. Over the last decade, the Rotterdam criteria have been useful in guiding research, and a number of clinical studies on PCOS have been published consequently. We plead to revisit the Rotterdam criteria based on the available evidence in prognostic studies and randomized controlled trials. In this opinion paper, we provide arguments of the strengths and limitations of the Rotterdam criteria in guiding treatment selections and predicting prognoses in women with infertility. While the Rotterdam criteria have shown their advantages in predicting reproductive prognosis, the next step is to evaluate whether they can guide treatment choices in infertility as well as other health aspects of the syndrome. Based on available data in clinical studies, we should be able to determine whether the Rotterdam criteria are evidence-based criteria. [ABSTRACT FROM AUTHOR]

Background: Women with Polycystic Ovary Syndrome (PCOS) present a heterogeneous reproductive and metabolic profile with an increased lifetime risk of Type 2 Diabetes (T2D). Early biomarkers of these metabolic disturbances in PCOS women have not been identified. The abundance of circulating insulin gene promotor cell-free DNA (INS cfDNA) was shown to be valuable as a predictive biomarker of β-cell death in individuals with Type 1 diabetes (T1D) as well as with gestational diabetes. Since β-cell death is common to the development of T1D as well as in T2D, we aimed to investigate if insulin-coding DNA is more abundant in circulation of PCOS women (vs Controls) and if their levels change after 6 yr. follow-up as a potential measure to predict future T2D. Methods: A cohort of 40 women diagnosed with PCOS according to Rotterdam 2003 criteria and eight healthy controls were examined at baseline and 6 years follow-up. Clinical measurements for evaluation of glucose homeostasis as well as blood/serum samples were obtained at each visit. Methylated and unmethylated INS cfDNA were quantified using droplet digital PCR. Differences between groups were assessed using Kruskall-Wallis test and Wilcoxon Signed rank test. Results: At baseline, there was no detectable difference in copy number (copies/μL) of methylated (p = 0.74) or unmethylated INS cfDNA (p = 0.34) between PCOS and Control groups. At follow up, neither methylated (p = 0.50) nor unmethylated INScfDNA levels (p = 0.48) differed significantly between these groups. Likewise, when pooling the groups, there was no difference between baseline and follow up, in terms of copies of methylated or unmethylated INS cfDNA (p = 0.38 and p = 0.52, respectively). There were no significant correlations between counts of unmethylated or methylated cfDNA and the clinical measurements of β-cell function and pre-diabetes. Conclusion: The circulating level of unmethylated and methylated INScfDNA is similar between PCOS and Controls and cannot be used to predict islet β-cell loss and progression to Type 2 diabetes in a 6-year follow-up. Trial registration: The Danish Data Protection Agency (REG-31-2016. Approval: 01-12-2015) and by the Danish Scientific Ethical committee of Region Zealand (Journal no. SJ-525. Approval: 13-06-2016), Clinicaltrials.gov, (NCT03142633, registered 1. March, 2017, Retrospectively registered). [ABSTRACT FROM AUTHOR]

: BACKGROUND Polycystic ovary syndrome (PCOS) is associated with metabolic abnormalities. It is debated whether all women with PCOS should be screened for metabolic abnormalities as these may vary with PCOS phenotype, age and ethnicity. The aims of this study were to assess the prevalence of metabolic abnormalities in Dutch anovulatory PCOS women and to define criteria for metabolic screening. : METHODS Anovulatory patients, diagnosed with PCOS according to the Rotterdam consensus criteria, underwent metabolic screening. Through stepwise multivariate analysis patient characteristics associated with metabolic syndrome (MetS) and insulin resistance (IR) were evaluated for their use as selection parameters for metabolic screening. : RESULTS Overall, prevalence of MetS and IR was 15.9% (n = 25) and 14% (n = 22), respectively, in 157 PCOS women (age 29.0 ± 4.8 years, BMI 26.1 ± 6.7 kg/m2). Anovulatory hyperandrogenic women (with or without polycystic ovaries) had more often MetS and IR (with, 20.8 and 19.8%; without, 100 and 40%, respectively) than non-hyperandrogenic PCOS women (0 and 1.8%; P < 0.001). Waist circumference >83.5 cm along with increased free androgen index (FAI) had the most powerful association with the presence of MetS and IR (area under the receiver operating characteristic curve 0.912) and offered a reduction in the necessity of screening for metabolic derailments of about 50%. : CONCLUSIONS The hyperandrogenic PCOS phenotypes are highly linked to the presence of MetS and IR in Dutch PCOS women. Waist circumference combined with FAI was identified as an efficient combination test to select those PCOS women who should be screened for the presence of MetS and/or IR. [ABSTRACT FROM AUTHOR]