New standard for PCOS diagnosis

PCOS may be over-diagnosed by new, more sensitive ultrasounds.

A new study by French researchers suggest the diagnoses for polycystic ovary syndrome (PCOS) may be outdated.  The old criterion: more than 12 follicles per ovary, detected with ultrasound, may no longer be valid given new tools.  In their study of 240 women, Dewailly et al. found that a serum anti-Mullerian hormone (AMH) level of more than 5 ng/ml is much more predictive of polycystic ovary morphology than even a follicle number of greater than 19.

This new tool  is less expensive to perform and would be available to a greater variety of women seeking diagnosis for infertility or mentrual disorders.

Clomiphene (Clomid/ Serophene) versus Metformin

Clomiphene (Clomid/ Serophene) has been preferred over metformin in the treatment of annovulation due to polycystic ovarian syndrome (PCOS).

New results indicate metformin may be a viable treatment for non-obese women who do not respond to clomiphene.   Johnson et al.‘s randomized controlled study shows that non-obese women (BMI < 32) were significantly more likely to become pregnant while taking metformin compared to placebo (p=0.039). However, metformin did not have a significant effect on the pregnancy rates of obese women (BMI > 32).  Metformin also did not enhance pregnancy rates above those with clomiphene alone when given in combination (metformin/clomiphene treatment).

This study suggests metformin may have a niche where clomiphene is ineffective.

Vitamin D deficiency and PCOS

Vitamin D deficiency may be more common in women with polycystic ovary syndrome (PCOS).   Li et al. found that significantly more women with PCOS had severe vitamin D deficiency (44%), compared to women who did not have PCOS (11.2%).  As well, vitamin D deficiency in PCOS women was correlated with high: body mass index (BMI), free androgens, insulin insensitivity and HDL cholesterol level.

Lack of vitamin D contributes to “metabolic disturbances” like glucose intolerance, obesity, hypertension and inflammation.  Women with PCOS are at risk for abnormal follicle development, insulin resistance and abdominal obesity.  Does the disease state of PCOS contribute to a vitamin D deficiency or could some symptoms of PCOS be alleviated with vitamin D supplementation?  More studies are needed.

News on insulin resistance and PCOS

Polycystic ovary syndrome (PCOS) is considered the most common reproductive disorder, affecting 8-18% of women of reproductive age (March et al.).  Insulin resistance and PCOS are tightly linked (Dunaif).  Here’s some news in the field, on research published in the last month.

Insulin resistance is a symptom of polycystic ovary syndrome (PCOS), independent of obesity.  A polymorphism in human Tribbles 3 (TRB3) gene is associated with insulin resistance.  However, the TRB3 polymorphism genotype is no more prevalent in women with PCOS versus control (n= 336 women with PCOS and n=116 women undergoing infertility treatments who do not have PCOS) when body mass index is controlled for (Zhang et al.).  TRB3 gene does not appear to be a candidate for further investigation into PCOS causes.

A polymorphism of melatonin receptor 1A (SNP rs2119882) was found to be more prevalent in women with insulin resistant PCOS versus healthy and non-IR PCOS controls in Li et al‘s study published last week.

Polymorphisms in the human lipin 1 gene (SNPs rs11693809 and rs2716610) are no more prevalent in women with PCOS versus controls.  However, women with PCOS that have the rs11693809 polymorphism are less likely to experience alterations in glucose and lipid metabolism (Mlinar et al.), and presumably the after effects of altered metabolism.

Neurotransmission of endogenous opiods in the limbic system (nucleus accumbens, ventral pallidum and amygdala) is disrupted in some women with PCOS, particularly when they are also insulin resistant (Farrell and Antoni).  Using PET scans and anatomical MRIs Berent-Spillson et al.‘s new study showed that insulin-resistant PCOS women had significantly fewer opiod-bound receptors in their limbic systems versus women with PCOS who were not insulin resistant.  This was successfully treated with a 4 month metaformin protocol.  The study size was small (n=12), but opens a potentially important avenue for understanding and treating alterations in apetite and mood in women with PCOS.