DECIPHERING THE INTRICATE NETWORK OF POLY CYSTIC OVARIAN SYNDROME: A THOROUGH EXAMINATION OF HORMONAL AND DEMOGRAPHIC INFLUENCES
DOI:
https://doi.org/10.55766/sujst-2024-02-e03383Keywords:
Anti-Müllerian Hormone, hirsutism, hormonal disorders, insulin resistance, metabolic diseases, polycystic ovary syndromeAbstract
One of the most prevalent hormonal disorders affecting women who are of reproductive age is PCOS, a serious public health concern. Insulin resistance is significantly more common together with hirsutism, polycystic ovaries, and oligo/anovulatory periods as typical symptoms and other multitude of chronic health issues that impact quality of life are linked to PCOS.PCOS patient and control group (non-PCOS) hormonal profiles are compared in this study.TSH, FSH, LH, and AMH are measured in this research. The results clarify the hormonal irregularities and consequences of PCOS.The data shows that women with PCOS had significantly greater AMH than controls, with a sensitivity and specificity of 93%.AMH has an NPV and PPV of 83% and 97%, respectively.The majority of PCOS patients reported higher LH levels than the control group, which had 86% sensitivity and 88% specificity. The LH level is impacted by PCOS, as seen by the 95% of PPV and 69%, of NPV.The FSH levels of controls and PCOS patients are comparable. Since FSH levels are comparable, the primary hormonal imbalance in PCOS is probably elevated LH and AMH. PCOS patients showed higher TSH levels than the control group, which may cause thyroid issues since 43% of PCOS patients had elevated TSH.These findings illuminate PCOS hormone abnormalities. Furthermore, people with PCOS are more prone than the general population to suffering from the morbidity related to metabolic and cardiovascular diseases.Understanding the hormonal imbalances linked to PCOS makes future research easier, which is required to understand the etiology of PCOS and hormone-regulated PCOS treatment.
References
Abdelghany, A., Abohashim, M.F., Aemmaar, W.A.E., Elsayed, R.A., and Saleh, S. (2023). Predictive value of follicular stimulating hormone on luteinizing hormone ratio for ovarian response to simple ovulation induction in patients with polycystic ovarian syndrome. The Egyptian Journal of Hospital Medicine, 92(1):5474-5477. https://doi.org/ 10.21608/ejhm.2023.305784
Barber, T.M. and Franks, S. (2021). Obesity and polycystic ovary syndrome. Clinical Endocrinology, 95(4):531-541. https://doi.org/10.1111/cen.14421
Barber, T.M., Hanson, P., Weickert, M.O., and Franks, S. (2019). Obesity and polycystic ovary syndrome: implications for pathogenesis and novel management strategies. Clinical Medicine Insights: Reproductive Health, 13:1-9 https://doi.org/10.1177/1179558119874042
Barber, T.M., Joharatnam, J., and Franks, S. (2017). Pathogenesis and Management of Adiposity and Insulin Resistance in Polycystic Ovary Syndrome (PCOS). In: Freemark, M. (eds). Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-68192-4_36
Bassiouny, Y.A., Rabie, W.A., Hassan, A.A., and Darwish, R.K. (2014). Association of the luteinizing hormone/ choriogonadotropin receptor gene polymorphism with polycystic ovary syndrome. Gynecological Endocrinology, 30(6):428-430. https://doi.org/10.3109/09513590.2014.895982
Bozdag, G., Mumusoglu, S., Coskun, Z.Y., Yarali, H., and Yildiz, B.O. (2019). Anti-Müllerian hormone as a diagnostic tool for PCOS under different diagnostic criteria in an unselected population. Reproductive BioMedicine Online, 39(3):522-529. https://doi.org/ 10.1016/j.rbmo.2019.04.002
Califf, R.M. (2018). Biomarker definitions and their applications. Experimental Biology and Medicine, 243(3):213-221. https://doi.org/10.1177/1535370217750088
Carslake, H.B., Pinchbeck, G.L., and McGowan, C.M. (2017). Evaluation of a chemiluminescent immunoassay for measurement of equine insulin. Journal of Veterinary Internal Medicine, 31(2):568-574. https://doi.org/10.1111/ jvim.14657
Catteau, A., Bach-Ngohou, K., Blin, J., Barrière, P., Fréour, T., and Masson, D. (2019). Abnormally Elevated Follicle-Stimulating Hormone (FSH) Level in an Infertile Woman. Case Reports in Endocrinology, 2019:3071649. https://doi.org/10.1155/2019/3071649
Chauhan, N., Pareek, S., Rosario, W., Rawal, R., and Jain, U. (2024). An insight into the state of nanotechnology-based electrochemical biosensors for PCOS detection. Analytical Biochemistry, 687:115412. https://doi.org/ 10.1016/j.ab.2023.115412
Conforti, A., Esteves, S.C., Humaidan, P., Longobardi, S., D’Hooghe, T., Orvieto, R., Vaiarelli, A., Cimadomo, D., Rienzi, L., Ubaldi, F.M., Zullo, F., and Alviggi, C. (2021). Recombinant human luteinizing hormone co-treatment in ovarian stimulation for assisted reproductive technology in women of advanced reproductive age: A systematic review and meta-analysis of randomized controlled trials. Reproductive Biology and Endocrinology, 19(1):91. https://doi.org/10.1186/s12958-021-00759-4
Deswal, R., Nanda, S., and Dang, A.S. (2019). Association of Luteinizing hormone and LH receptor gene polymorphism with susceptibility of Polycystic ovary syndrome. Systems Biology in Reproductive Medicine, 65(5):400-408. https://doi.org/10.1080/19396368.2019.1595217
Dumesic, D.A., Oberfield, S.E., Stener-Victorin, E., Marshall, J.C., Laven, J.S., and Legro, R.S. (2015). Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocrine Reviews, 36(5):487-525. https://doi.org/10.1210/er.2015-1018
Dumont, A., Robin, G., Catteau-Jonard, S., and Dewailly, D. (2015). Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of Polycystic Ovary Syndrome: A review. Reproductive Biology and Endocrinology, 13(1):137. https://doi.org/10.1186/ s12958-015-0134-9
Escobar-Morreale, H.F. (2022). Defining PCOS: A syndrome with an intrinsic heterogeneous nature. Polycystic Ovary Syndrome, 2022:3-13. https://doi.org/10.1016/b978-0-12-823045-9.00012-2
Fan, H., Ren, Q., Sheng, Z., Deng, G., and Li, L. (2023). The role of the thyroid in polycystic ovary syndrome. Frontiers in Endocrinology, 14:1242050. https://doi.org/10.3389/ fendo.2023.1242050
Fu, W. and Kuang, Y. (2023). Role of luteinizing hormone elevation in outcomes of ovulation induction with letrozole for polycystic ovary syndrome. Frontiers in Medicine, 10:1113840. https://doi.org/10.3389/fmed. 2023.1113840
He, Y.-C., Su, K.-Z., Cai, J., Meng, Q.-X., Wu, Y.-T., and Huang, H.-F. (2023). Serum Anti-Müllerian hormone levels are associated with perinatal outcomes in women undergoing IVF/ICSI: A multicenter retrospective cohort study. Frontiers in Endocrinology, 14:1081069. https://doi.org/ 10.3389/fendo.2023.1081069
Hosseinzadeh, P., Barsky, M., Gibbons, W.E., and Blesson, C.S. (2021). Polycystic ovary syndrome and the forgotten uterus. F&S Reviews, 2(1):11-20. https://doi.org/ 10.1016/j.xfnr.2020.12.001
Jiang, S., Chen, L., Gao, Y., Xi, Q., Li, W., Zhao, X., and Kuang, Y. (2022). The effect of spontaneous LH surges on pregnancy outcomes in patients undergoing letrozole-HMG IUI: a retrospective analysis of 6,285 cycles. Frontiers in Endocrinology, 13:880538. https://doi.org/ 10.3389/fendo.2022.880538
Jozkowiak, M., Piotrowska-Kempisty, H., Kobylarek, D., Gorska, N., Mozdziak, P., Kempisty, B., Rachon, D., and Spaczynski, R.Z. (2023). Endocrine disrupting chemicals in polycystic ovary syndrome: the relevant role of the theca and granulosa cells in the pathogenesis of the ovarian dysfunction. Cells, 12(1):174. https://doi.org/10.3390/ cells12010174
Kicińska, A.M., Stachowska, A., Kajdy, A., Wierzba, T.H., and Maksym, R.B. (2023). Successful implementation of menstrual cycle biomarkers in the treatment of infertility in polycystic ovary syndrome-case report. Healthcare, 11(4):616. https://doi.org/10.3390/healthcare11040616
Lizneva, D., Suturina, L., Walker, W., Brakta, S., Gavrilova-Jordan, L., and Azziz, R. (2016). Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertility and Sterility, 106(1):6-15. https://doi.org/10.1016/j.fertnstert. 2016.05.003
Makoui, M.H., Fekri, S., Makoui, R.H., and Ansari, N. (2023). Individual effects of GSTM1 and GSTT1 polymorphisms on the risk of polycystic ovarian syndrome: A systematic review and meta-analysis. Journal of Turkish Society of Obstetric and Gynecology, 20(4):314-319. https://doi.org/ 10.4274/tjod.galenos.2023.66263
Malhotra, N., Arora, T., Suri, V., Jena, S.K., Verma, A., Gowri, M., Kapoor, N., Chalga, M.S., Kulkarni, B., and Kamath, M.S. (2023). Publisher Correction: Individualized lifestyle intervention in PCOS women (IPOS): a study protocol for a multicentric randomized controlled trial for evaluating the effectiveness of an individualized lifestyle intervention in PCOS women who wish to conceive. Trials, 24(1):486. https://doi.org/10.1186/s13063-023-07535-2
Morley, L.C., Tang, T., Yasmin, E., Norman, R.J., and Balen, A.H. (2017). Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database of Systematic Reviews, 11:CD003053. https://doi.org/10.1002/14651858.cd003053.pub6
Morote, J., Comas, I., Ferrer, R., Planas, J., Celma, A., and Regis, L. (2017). Accuracy of serum luteinizing hormone and serum testosterone measurements to assess the efficacy of medical castration in prostate cancer patients. Journal of Biomedical Science, 24(1):81. https://doi.org/10.1186/ s12929-017-0386-0
Nguyen, H.D. (2023). Exposure to mixed chemicals elevated triiodothyronine (T3) and follicle-stimulating hormone (FSH) levels: Epidemiology and in silico toxicogenomic involvement. Environmental Science and Pollution Research, 30(38):88803-88823. https://doi.org/10.1007/ s11356-023-28704-5
Ollila, M.-M.E., Piltonen, T., Puukka, K., Ruokonen, A., Järvelin, M.-R., Tapanainen, J.S., Franks, S., and Morin-Papunen, L. (2016). Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: prospective cohort study. The Journal of Clinical Endocrinology and Metabolism, 101(2):739-747. https://doi.org/10.1210/jc.2015-3543
Ran, Y., Yi, Q., and Li, C. (2021). The relationship of anti-mullerian hormone in polycystic ovary syndrome patients with different subgroups. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14:1419-1424. https://doi.org/10.2147/dmso.s299558
Recchia, K., Jorge, A.S., Pessôa, L.V. de F., Botigelli, R.C., Zugaib, V.C., De Souza, A.F., Martins, D. dos S., Ambrósio, C.E., Bressan, F.F., and Pieri, N.C.G. (2021). Actions and roles of FSH in germinative cells. International Journal of Molecular Sciences, 22(18): 10110. https://doi.org/10.3390/ijms221810110
Robb, M.A., McInnes, P.M., and Califf, R.M. (2016). Biomarkers and surrogate endpoints. JAMA, 315(11): 1107-1108, 1107. https://doi.org/10.1001/jama.2016.2240
Rudnicka, E., Kunicki, M., Calik-Ksepka, A., Suchta, K., Duszewska, A., Smolarczyk, K., and Smolarczyk, R. (2021). Anti-Müllerian Hormone in pathogenesis, diagnostic and treatment of PCOS. International Journal of Molecular Sciences, 22(22):12507. https://doi.org/ 10.3390/ijms222212507
Rushing, J.S. and Santoro, N. (2021). Fertility issues in polycystic ovarian disease. Endocrinology and Metabolism Clinics of North America, 50(1):43-55. https://doi.org/10.1016/j.ecl.2020.10.004
Saxena, U., Ramani, M., and Singh, P. (2017). Role of AMH as diagnostic tool for polycystic ovarian syndrome. The Journal of Obstetrics and Gynecology of India, 68(2):117-122. https://doi.org/10.1007/s13224-017-1066-4
Shirin, S., Murray, F., Goshtasebi, A., Kalidasan, D., and Prior, J.C. (2021). Cyclic progesterone therapy in androgenic polycystic ovary syndrome (PCOS)-A 6-month pilot study of a single woman’s experience changes. Medicina, 57(10):1024. https://doi.org/10.3390/medicina57101024
Silvestris, E., De Pergola, G., Rosania, R., and Loverro, G. (2018). Obesity as disruptor of the female fertility. Reproductive Biology and Endocrinology, 16(1):22. https://doi.org/10.1186/s12958-018-0336-z
Sivanandy, M.S. and Ha, S.K. (2023). The role of serum anti-mullerian hormone measurement in the diagnosis of polycystic ovary syndrome. Diagnostics, 13(5):907. https://doi.org/10.3390/diagnostics13050907
Suresh, S. and Vijayakumar, T. (2014). Correlations of insulin resistance and serum testosterone levels with lh:fsh ratio and oxidative stress in women with functional ovarian hyperandrogenism. Indian Journal of Clinical Biochemistry, 30(3):345-350. https://doi.org/10.1007/ s12291-014-0447-z
Tal, R., Seifer, C.M., Khanimov, M., Seifer, D.B., and Tal, O. (2020). High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology. Reproductive Biology and Endocrinology, 18(1):20. https://doi.org/10.1186/s12958-020-00581-4
Taraborrelli, S. (2015). Physiology, production and action of progesterone. Acta Obstetricia Et Gynecologica Scandinavica, 94(s161):8-16. https://doi.org/10.1111/ aogs.12771
Unluhizarci, K., Karaca, Z., and Kelestimur, F. (2021). Role of insulin and insulin resistance in androgen excess disorders. World Journal of Diabetes, 12(5):616-629. https://doi.org/ 10.4239/wjd.v12.i5.616
Vural, F., Vural, B., Kardaş, E., Coşkun, A. D. E., and Yildirim, İrem. (2022). The diagnostic performance of antimullerian hormone for polycystic ovarian syndrome and polycystic ovarian morphology. 16 August 2022, PREPRINT (Version 1) available at Research Square. https://doi.org/ 10.21203/rs.3.rs-1895155/v1
Washington, J.K., Manivasakan, J., Kala, P.G., and Sasikala, R. (2022). Association of anti-mullerian hormone and free androgen index level on response to clomiphene citrate in PCOS infertile women. Gynecology and Obstetrics Clinical Medicine, 2(4):203-207. https://doi.org/10.1016/ j.gocm.2022.11.003
Wekker, V., Van Dammen, L., Koning, A., Heida, K.Y., Painter, R.C., Limpens, J., Laven, J.S.E., Roeters van Lennep, J.E., Roseboom, T.J., and Hoek, A. (2020). Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis. Human Reproduction Update, 26(6):942-960. https://doi.org/ 10.1093/humupd/dmaa029
Wongwananuruk, T., Panichyawat, N., Indhavivadhana, S., Rattanachaiyanont, M., Angsuwathana, S., Techatraisak, K., Pratumvinit, B., and Sa-nga-areekul, N. (2018). Accuracy of Anti-Müllerian hormone and total follicles count to diagnose polycystic ovary syndrome in reproductive women. Taiwanese Journal of Obstetrics and Gynecology, 57(4):499-506. https://doi.org/10.1016/ j.tjog.2018.06.004
Xia, Q., Xie, L., Wu, Q., Cong, J., Ma, H., Li, J., Cai, W., and Wu, X. (2023). Elevated baseline LH/FSH ratio is associated with poor ovulatory response but better clinical pregnancy and live birth in Chinese women with PCOS after ovulation induction. Heliyon, 9(1):e13024. https://doi.org/10.1016/j.heliyon.2023.e13024
Xu, S., Zhang, Y., Qiang, C., and Zhang, C. (2022). Effect of TSH on oocyte maturation of PCOS patients with normal thyroid function in IVF. Reproductive Biology and Endocrinology, 20(1):133. https://doi.org/10.1186/s12958-022-01005-1
Zhao, L., Zhu, C., Chen, Y., Chen, C., Cheng, J., Xia, F., Wang, N., and Lu, Y. (2018). LH/FSH ratio is associated with visceral adipose dysfunction in chinese women older than 55. Frontiers in Endocrinology, 9:419. https://doi.org/ 10.3389/fendo.2018.00419
Zheng, Q., Zhou, F., Cui, X., Liu, M., Li, Y., Liu, S., Tan, J., and Yan, Q. (2018). Novel Serum Biomarkers Detected by Protein Array in Polycystic Ovary Syndrome with Low Progesterone Level. Cellular Physiology and Biochemistry, 46(6):2297-2310. https://doi.org/10.1159/ 000489619
