Evaluation of relationship between serum levels of anti-müllerian hormone, androgen, and insulin resistant with retrieval oocytes in overweight patients with polycystic ovary syndrome

Aghadavod, Esmat; Zarghami, Nosratollah; Farzadi, Laya; Zare, Mina; Barzegari, Abolfazl; Movassaghpour, Ali Akbar; Nouri, Mohammad

Evaluation of relationship between serum levels of anti-müllerian hormone, androgen, and insulin resistant with retrieval oocytes in overweight patients with polycystic ovary syndrome

Authors

¹ Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz; Research Center for Biochemistry and Nutrition In Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran

² Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

³ Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

⁴ Department of Biochemistry and Clinical Laboratories, Faculty of Medicine; Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

⁵ Research Center for Pharmaceutical Nanotechnology, Research and Development Complex, Tabriz University of Medical Sciences, Tabriz, Iran

⁶ Hematology and Oncology Research Center, Tabriz University of Medical Sciences,Tabriz, Iran

⁷ Women's Reproductive Health Research Center; Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: This study aimed to find a correlation between increased body mass index (BMI), insulin resistance (IR), hyperandrogenism, and anti-mullerian hormone (AMH) serum levels with the number of follicles retrieved in polycystic ovary syndrome (PCOS) patients.
Materials and Methods: The descriptive study was taken on 80 women with average ages of 20-35 years at Alzahra Hospital of Tabriz-Iran who referred for in vitro fertilization. Patients were divided into four groups and serum levels of AMH, testosterone and IR were evaluated at the puncture time.
Results: The mean number of follicle retrieved was higher in PCOS (P < 0.05) group than non-PCOS patients. There was a negative significant correlation of follicle number with BMI (r = −0.26, P < 0.05). The ratio of follicle numbers in PCOS/overweight group decreased in comparison to PCOS/normal weight group (−30%, P < 0.05) while the follicle numbers in non-PCOS/overweight patients decreased in comparison with non-PCOS/normal weight (−26%, P > 0.05). There was a significant negative association between BMI with AMH (r = −0.59, P < 0.05), BMI with the follicle numbers (r = −0.2, P < 0.05) and a positive association BMI with -IR (r = 0.3, P < 0.05), but there wasn't a significant correlation between BMI with testosterone (r = 0.1, P < 0.5).
Conclusion: Our finding provides that increasing BMI with direct effect on AMH levels and IR can affect the number of follicles, which are retrieved in these patients.

Keywords

References

1.	Riccaboni A, Chiaffarino F, Santi G, Iemmello R, Tirelli A, Ragni G. Additional value of serum antimullerian hormone (AMH) in predicting ovarian responsiveness in patients with high levels of serum follicular stimulating hormone (FSH). Fertil Steril 2008;90 Suppl:S264.
2.	Marquard KL, Stephens SM, Jungheim ES, Ratts VS, Odem RR, Lanzendorf S, et al. Polycystic ovary syndrome and maternal obesity affect oocyte size in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril 2011;95:2146-9, 2149.e1.
3.	Beydoun HA, Stadtmauer L, Beydoun MA, Russell H, Zhao Y, Oehninger S. Polycystic ovary syndrome, body mass index and outcomes of assisted reproductive technologies. Reprod Biomed Online 2009;18:856-63.
4.	Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction 2010;140:347-64.
5.	Katsikis I, Karkanaki A, Misichronis G, Delkos D, Kandaraki EA, Panidis D. Phenotypic expression, body mass index and insulin resistance in relation to LH levels in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2011;156:181-5.
6.	Shalom-Paz E, Marzal A, Wiser A, Almog B, Reinblatt S, Tulandi T, et al. Effects of different body mass indices on in vitro maturation in women with polycystic ovaries. Fertil Steril 2011;96:336-9.
7.	McCormick B, Thomas M, Maxwell R, Williams D, Aubuchon M. Effects of polycystic ovarian syndrome on in vitro fertilization-embryo transfer outcomes are influenced by body mass index. Fertil Steril 2008;90:2304-9.
8.	Zhang D, Zhu Y, Gao H, Zhou B, Zhang R, Wang T, et al. Overweight and obesity negatively affect the outcomes of ovarian stimulation and in vitro fertilisation: A cohort study of 2628 Chinese women. Gynecol Endocrinol 2010;26:325-32.
9.	Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I. The relationships between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without polycystic ovary syndrome. Hum Reprod 2009;24:2917-23.
10.	Dickerson EH, Cho LW, Maguiness SD, Killick SL, Robinson J, Atkin SL. Insulin resistance and free androgen index correlate with the outcome of controlled ovarian hyperstimulation in non-PCOS women undergoing IVF. Hum Reprod 2010;25:504-9.
11.	Vlaisavljeviæ V, Kovac V, Sajko MC. Impact of insulin resistance on the developmental potential of immature oocytes retrieved from human chorionic gonadotropin-primed women with polycystic ovary syndrome undergoing in vitro maturation. Fertil Steril 2009;91:957-9.
12.	Landay M, Huang A, Azziz R. Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS. Fertil Steril 2009;92:643-7.
13.	Haghighi Z, Rezaei Z, Es-Haghi Ashtiani S. Effects of women's body mass index on in vitro fertilization success: A retrospective cohort study. Gynecol Endocrinol 2012;28:536-9.
14.	Roe AH, Prochaska E, Smith M, Sammel M, Dokras A. Using the Androgen Excess-PCOS Society Criteria to Diagnose Polycystic Ovary Syndrome and the Risk of Metabolic Syndrome in Adolescents. J Pediatr 2013;162:937-41.
15.	Tsepelidis S, Demeestere I, Delbaere A, Gervy C, Englert Y. Anti-mullerian hormone and its role in the regulation of ovarian function. Review of the literature. Rev Med Brux 2007;28:165-71.
16.	Urman B, Tiras B, Yakin K. Assisted reproduction in the treatment of polycystic ovarian syndrome. Reprod Biomed Online 2004;8:419-30.
17.	Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: An updated systematic review and meta-analysis. Reprod Biomed Online 2011;23:421-39.
18.	Koning AM, Mutsaerts MA, Kuchenbecker WK, Broekmans FJ, Land JA, Mol BW, et al. Complications and outcome of assisted reproduction technologies in overweight and obese women. Hum Reprod 2012;27:457-67.
19.	Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-Mullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: Relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab 2009;296:E238-43.
20.	Thomson RL, Buckley JD, Moran LJ, Noakes M, Clifton PM, Norman RJ, et al. The effect of weight loss on anti-Müllerian hormone levels in overweight and obese women with polycystic ovary syndrome and reproductive impairment. Hum Reprod 2009;24:1976-81.
21.	Dechaud H, Anahory T, Reyftmann L, Loup V, Hamamah S, Hedon B. Obesity does not adversely affect results in patients who are undergoing in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol 2006;127:88-93.
22.	Pangaribuan B, Yusuf I, Mansyur M, Wijaya A. Serum adiponectin and resistin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome. Ther Adv Endocrinol Metab 2011;2:235-45.
23.	Chang CY, Chen MJ, Yang WS, Yeh CY, Ho HN, Chen SU, et al. Hypoadiponectinemia: A useful marker of dyslipidemia in women with polycystic ovary syndrome. Taiwan J Obstet Gynecol 2012;51:583-90.
24.	Gada R, Morbeck D, Amols M, Rollene N, Jensen J, Coddington C. Anti-mullerian hormone (AMH), antral follicle count (AFC) and age predict IVF outcomes significantly better than follicle stimulating hormone (FSH). Fertil Steril 2010;94:S97.
25.	Yin MN, Chen SL. AMH level in follicular fluid and serum may predict outcome of IVF-ET in PCOS patients. Fertil Steril 2008;90 Suppl:S377.
26.	Aleyasin A, Aghahoseini M, Mokhtar S, Fallahi P. Anti-mullerian hormone as a predictive factor in assisted reproductive technique of polycystic ovary syndrome patients. Acta Med Iran 2011;49:715-20.
27.	Kristensen SL, Ramlau-Hansen CH, Andersen CY, Ernst E, Olsen SF, Bonde JP, et al. The association between circulating levels of antimüllerian hormone and follicle number, androgens, and menstrual cycle characteristics in young women. Fertil Steril 2012;97:779-85.
28.	Gleicher N, Weghofer A, Barad DH. The role of androgens in follicle maturation and ovulation induction: Friend or foe of infertility treatment? Reprod Biol Endocrinol 2011;9:116.
29.	Lan KC, Chang SY, Huang FJ, Lin HJ, Lin CY, Huang KE, et al. Analysis of androgen receptor and anti-Müllerian hormone pathways in human granulosa cells under luteinizing hormone treatment. Reprod Biol Endocrinol 2013;11:11.
30.	Doi SA, Al-Zaid M, Towers PA, Scott CJ, Al-Shoumer KA. Steroidogenic alterations and adrenal androgen excess in PCOS. Steroids 2006;71:751-9.
31.	Fica S, Albu A, Constantin M, Dobri GA. Insulin resistance and fertility in polycystic ovary syndrome. J Med Life 2008;1:415-22.
32.	Katsiki N, Hatzitolios AI. Insulin-sensitizing agents in the treatment of polycystic ovary syndrome: An update. Curr Opin Obstet Gynecol 2010;22:466-76.
33.	Motta EL, Domingues TS, Soares Júnior JM. Use of insulin sensitizers in the treatment of infertility in patients with polycystic ovary syndrome (POS). Rev Bras Ginecol Obstet 2012;34:99-101.

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