The Distribution of Stroma and Antral Follicles Differs between Insulin-Resistance and Hyperandrogenism-Related Polycystic Ovarian Syndrome

Abstract

IntroductionAlthough insulin resistance plays an important pathogenetic role in polycystic ovary syndrome (PCOS), no correlation between ultrasound PCOS pattern and insulin resistance has yet been reported. The aim of this retrospective observational study was to assess whether the ovarian ultrasonographic parameter differed between PCOS women with insulin resistance and those with a hyperandrogenic profile.Materials and methodsWomen who fulfilled the Rotterdam criteria for PCOS were retrospectively studied. Anthropometric, biochemical, and clinical data were recorded. Women were divided into two groups based on specific transvaginal ultrasound parameters: subjects with more than half of the follicles measuring between 5 and 9 mm in diameter, an ultrasonographic determined stroma/total area (S/A) > 0.34 and a “necklace” sign of antral follicles (Group A); and subjects with more than half of the antral follicles measuring between 2 and 4 mm in diameter, an S/A ≤ 0.34; no “necklace” sign but ubiquitously distributed follicles determined by ultrasound (Group B). The association between these ultrasound patterns and the presence of insulin resistance was also evaluated.ResultsSeventy-eight patients were enrolled: 33 with ultrasound sound pattern A and 45 with pattern B. The latter pattern had a sensitivity of 88% and a specificity of 78% in predicting PCOS women with insulin resistance. There were no differences in age, Ferriman–Gallwey score, and serum gonadotropin or androgen levels between the two groups. Body mass index, the waist-to-hip ratio, and homeostasis model assessment were significantly higher in group B than in group A (p < 0.05). Conversely, sex hormone binding globulin levels and ovarian volume were significantly higher in group A (p < 0.05). Insulin resistance was more frequent in group B than in group A (36/41, 87.8% versus 7/32, 21.8%; p < 0.05).ConclusionThese results suggest that insulin resistance could be associated with a specific ultrasound pattern in PCOS patients.

Effect of hyperinsulinaemia and insulin resistance on endocrine, metabolic and fertility outcomes in women with polycystic ovary syndrome undergoing ovulation induction

“…Follicular hyperinsulinaemia promotes androgen biosynthesis in the follicles, and this might impair communication between granulosa cells and inhibit FSH‐induced aromatase activity and impair the development of dominant follicles. The growth of antral follicles is blocked in PCOS patients with IR, and IR leads to poor outcomes in IVF and ICSI and in laparoscopic ovarian diathermy in these women. Previous research has also shown that reducing insulin resistance can improve ovulation and restore ovulatory menstrual cycles …”

Bisphenol A: an emerging threat to female fertility

“…PCOS is a multifactorial metabolic-endocrine disorder characterized by the existence of different phenotypes, affecting women of reproductive age [123]. The diagnosis of PCOS is formulated with the presence of at least two of the three criteria: (1) clinical hyperandrogenism (with hirsutism, acne, seborrhea and alopecia) and/or increased circulating androgens levels; (2) presence of ovarian cysts assessed by ultrasound examination and (3) oligo-amenorrhea with oligoanovulation, according with the Rotterdam criteria [113].…”

Understanding Ovarian Hypo-Response to Exogenous Gonadotropin in Ovarian Stimulation and Its New Proposed Marker—The Follicle-To-Oocyte (FOI) Index

“…In detail, it was hypothesized that oxidative stress and excessive free radicals such as reactive oxygen species (ROS) might influence the quality of oocytes, spermatozoa, and embryos, as well as their environments ( 41 ), thus negatively affecting the outcome of IVF ( 39 , 42 ). In a 2016 pilot study involving women with polycystic ovarian syndrome (PCOS) ( 43 ), in whom oxidative stress seemed to be a relevant pathogenetic factor, we demonstrated that myo-inositol plus active antioxidants (glutathione, selenium, vitamins C and E, and zinc), given twice a day for 5 months preceding OS, had a favorable effect on the outcome of IVF by increasing the number of mature oocytes ( 44 ). Recently, in 2018, Xu et al reported the results of a randomized controlled trial with the use of coenzyme Q10 as a pretreatment to OS in patients with low prognosis in ART ( 45 ).…”