Background: The effects of Lead and other essential metal like zinc and copper on the reproductive system have been previously reviewed. Objective: Our goal in this study was to estimate the levels of Lead, Zinc and Copper in patients with polycystic ovary syndrome and to confirm the effect of such metals on the female reproductive system at environmental exposure. Materials and Method: Fifty two women in their reproductive age (20-40) years old, which had been diagnosed as PCOS. Venous blood sample were taken from each patient and control, blood lead, zinc and copper were determined by atomic absorption spectrophotometer. Hormone assay were determined by ELISA (Enzyme Linked Immune Sorbet Assay) technique. Results: This study showed a significant increase of blood lead and serum zinc, copper (p<0.01), in addition to testosterone, lutenizing hormone, LH/FSH ratio and body mass index (BMI) (p<0.05) in patients with polycystic ovary syndrome when compared with control. Conclusions: On the basis of the observations of the present study, it can conclude that the increased levels of Lead as a result of the exposure to this metal may be a risk factor for the development of polycystic ovary syndrome in women and has adverse effects on female endocrine and reproductive function.
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Polycystic ovary syndrome signs and symptoms often begin soon after menarche. In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. The PCOS produces symptoms in about 5-10% of women of reproductive age(12-45 years) and it is one of the leading causes of female subfertility.Women with PCOS suffer not only from subfertility, but also from a high rate of early pregnancy loss. About 30-50% of clinically confirmed early pregnancy loss are associated with PCOS.In addition to early pregnancy loss, women with PCOS have increased risk of recurrent miscarriage ,which defined as 3 or more consecutive pregnancy loss before 20 week. Metformin hydrochloride, an insulin sensitizing agent, has been shown to have encouraging effects on several aspect of PCOS like insulin sensitivity, plasma glucose concentration & lipid profile.It is found that using Metformin during pregnancy in women with PCOS may reduce the pregnancy loss and also reduce the risk of gestational diabetes,intrauterine growth retardation(IUGR) & preterm labor. Aim of study: To evaluate the role of Metformin in women with recurrent miscarriage & its effect on other pregnancy complications in women with PCOS. Patients, Materials & Methods: A prospective study done at gynecology outpatient clinic of AL-Batool Teaching Hospital in Baquba-Diyala -Iraq, from September 2012 to September 2016. A total of 100 cases were studied, all have aconfirmed diagnosis of PCOS depending on the following criteria:1)Oligo or amenorrhea (8 or fewer cycles per a year) , 2) signs of hyperandrogenism 3)ultrasound features of PCOS.All should have history of 3 or more recurrent first trimester miscarriage & they were invistigated for other causes of recurrent miscarriage. All cases were followed before getting pregnant and received Metformin for enhancing fertility & when they become pregnant, they were divided into two groups: the 1st group stopped using Metformin once they get pregnant while the 2nd group continued to use Metformin in a dose of 500-1000mg per day throughout pregnancy .Both groups are followed to determine pregnancy outcome. Results: Patients who continued to receive Metformin during pregnancy had better pregnancy outcome regarding early pregnancy loss and recurrent miscarriage, gestational diabetes development, IUGR & preterm labor. Conclusions: Metformin use during pregnancy improve pregnancy outcome in patients with polycystic ovary syndrome.
Background: Elevated serum concentrations of testosterone is common in women with polycystic ovary syndrome (PCOS)but it'srelationto body mass in dex(BMI), isstillunknown. Objective: The present study was conducted to investigate the relationship between testosterone level and body massindexin womenwith polycysticovary syndrome. Methods: A total of eighty PCOS women with average age 27.6±0.7 and BMI 31.9±0.5 were compared with twenty-two healthy women considered as a control group (age 28.2±1.1, BMI 28.8±1.0). Patients and controls were grouped according to (BMI: Lean, overweight and obese. Allwomen in both groups were subjected to the following investigations: evaluation of luteinizing hormone (LH), follicle stimulating hormone (FSH.), prolactin (PRL), testosterone levels and ultrasonography. Results: The serum levels of LH, LH/FSH and testosterone were significantly higher (P< 0.05) in PCOS compared to control women,while in FSH and PRL the difference was non significant. Obese women with PCOS also had a significantly higher (P<0.05) mean level of testosterone (1.33±0.28ng/ml) compared to lean and overweight patients (0.53±0.17, 0.61±0.08 ng/ml respectively). Uitrasound examination was performed in the ovulatory phase during (12-14) days of the cycle in both PCOS patients and controls, and all women with PCOS with evidence of polycystic ovaries on ultrasonography. Conclusion: Testosterone levelwas significantly elevated in obesecompared to overweightand lean women with PCOS.The role of weight reduction is more beneficial in the management of PCOS and improvementoftestosteronelevel.
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder with symptoms and diverse clinical manifestations. Obesity, a common comorbidity in PCOS, may exacerbate and lead to varied hormonal and inflammatory profiles. This study aimed to compare serum DHEAS, TNF-α, and IL-10 levels between obese and non-obese women with PCOS, providing insights into the intricate interplay between obesity, hormonal imbalances, and inflammation in this condition and offering potential pathways for enhancing fertility treatment outcomes in this challenging patient population. In this cross-sectional study, the data was analyzed from sixty -five women diagnosed with PCOS, categorized into two groups based on their Body Mass Index (BMI): Thirty-eight were non-obese (BMI < 30) and twenty-seven obese women (BMI ≥ 30). Serum samples were collected to measure DHEAS, TNF-α, and IL-10 levels using the ELIZA kit. These measures were then compared between the two groups to ascertain any significant differences. The study found significantly higher serum DHEAS levels in non-obese PCOS patients compared to their obese counterparts (p = 0.01). However, no significant difference was observed in serum TNF-α and IL-10 levels between the two groups (TNF-α p = 0.58; IL-10 p = 0.13). Serum DHEAS were significantly higher in non-obese compared to their obese counterparts’ women with PCOS. In contrast, no significant variance was found regarding S.TNF-α and S.IL-10 between the two groups
Background: Polycystic ovary syndrome (PCOS) is the most common and prevalent endocrinopathy in women, and the most common cause of anovulatory infertility. An altered lipid profile is common in polycystic ovary syndrome (PCOS) and is usually characterized by increased total cholesterol, triglycerides, low-density lipoproteins and very low density lipoprotein levels with low high-density lipoprotein. PCOS is associated with a higher frequency of cardiovascular disease because of dyslipidemia. Which are potent markers for cardiovascular risk factors. Metformin, is a widely used antihyperglycemic agent. It decreases insulin resistance and reduces hyperglycemia through a reduction of the hepatic glucose production. Objectives: Determine the beneficial effect of metformin in PCOS patients in reducing lipid profile and subsequently reduction in cardiovascular disease. Method: Measurements and analysis levels of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoprotein and high-density lipoprotein were samples collected at the Institute of embryo research and infertility treatment, Al-Nahrain University. PCOS patients were recruited at the consultant clinic Patients: forty three women with PCOS were studied. Anthropometric data, lipid profile, were evaluated, before oral metformin (500mg/twice daily) treatment and after three months of use. Results: Patients with PCOS after oral metformin treatment, revealed a significant lowering serum concentrations of total cholesterol, triglyceride, low-density lipoproteins and very low density lipoprotein and elevated high-density lipoprotein compared to before treatment. Conclusions: dyslipidemia is common finding in PCOS women, in this study we found that the use of oral metformin tablets 500mg/twice daily for three months will correct lipid profile level (cholesterol, triglyceride, LDL, VLDL and HDL) which is considered as cardiovascular risk factors and this lead to reduce risk of cardiovascular diseases.
Reactive oxygen species (ROS) are believed to play an important role in the function of the male and female reproductive system, as well as in embryonic development. If the balance between production and elimination of ROS is disturbed, pathogenic consequences would happen. Reactive oxygen species can sometimes exert damaging effects when overabundant, oxidative stress is hypothesized to have a negative impact on, for example, folliculogenesis, embryo development, oocyte maturation, oocyte fertilization, endometriosis, polycystic ovary syndrome and unexplained infertility .8-Hydroxy2-desoxy guanosine (8‐OHdG) is a sensitive indicator of DNA damage as a result of oxidative stress. The study aim was to evaluate follicular fluid levels of 8-Hydroxy2-desoxy guanosine in patients undergoing Intracytoplasmic Sperm Injection (ICSI) and compared the results between both pregnant and non-pregnant patients . One hundred and twenty-seven women included in this study, they underwent controlled ovarian hyper stimulation, program followed by ova pick up, at that time follicular fluid were obtained and freezes till the time of analysis for reactive oxygen species (ROS), patient injected oocyte was cultured in CO2 incubator, then embryo grading, embryo transfer, pregnancy rate and reactive oxygen species level were determined. Follicular fluid 8-OHdG was significantly lower in pregnant females (p < 0.001), 8-OHdG had negative correlations with grade 1 and grade 2 embryos and negative correlation with total blastocyst count. Follicular fluid levels of 8-OHdG provides sensitive tool to predict positive pregnancy outcome in women undergoing ICSI.
Due to malfunction of the hypothalamus-pituitary-ovary axis and probable dysregulation of ovarian activities, ovary has a large number of small follicles but no developed follicles. L-Carnitine is a tiny, water-soluble chemical that plays a critical role in fat metabolism. It is required for appropriate mitochondrial fatty acid oxidation and acyl-CoA ester excretion, as well as affecting ATP levels. The current study was aiming at evaluating the protective effect of L-Carnitine (LC) against deleterious substances present in serum of patients with PCOS, which may affect the oocyte maturation. 60 infertile women diagnosed with polycystic ovarian syndrome have been enrolled in this study and enter their Intracytoplasmic Sperm Injection (ICSI) cycle; they were informed about the study and signed a written informed consent. They were grouped into treatment group (n=30) who were treated with L-Carnitine® tablet for two months and placebo group (n=30). All enrolled women underwent flexible antagonist protocol for ICSI. Significant increase in mean mature metaphase II (MII) oocyte count in study group than placebo group, oocyte maturity rate was significantly higher in study group in comparison with placebo group. In addition, mean fertilized (2PN) oocyte count was increased significantly in study group in comparison with placebo group. Mean fertilization rate was significantly higher in study group in comparison with placebo group. Treatment with of patients with polycystic ovary syndrome of L-Carnitine resulted better oocyte quality and the improvement in oocyte quality is reflected by mature MII oocytes, maturity rate and fertilized rate with eventual improvement in embryo quality.
Background: Polycystic ovary syndrome is the most common, yet complex, endocrine disorder with principal features of anovulation, amenorrhea, ovulation-related infertility, polycystic ovaries, and obesity. Number of metabolic aberrations is now well recognized as a growing public health problem in PCOS as glucose intolerance, hyperinsulinemia and dyslipidemia. Objective: To investigate and analyze the anthropometric, hormonal profile and metabolic abnormalities of obese and non-obese women with this disorder. Materials and Methods: Sixty-five healthy Iraqi women serves as the control group and eighty-four infertile women divided into two subgroups depending on the BMI (< and ≥30 kg/m2) were studied. BMI, waist to hip ratio and waist to thigh ratio were measured. Serum levels of luteinizing hormone, follicle stimulating hormone, estradiol, testosterone, fasting blood glucose, and oral glucose tolerance test, and total lipid profile were measured. Results: BMI, waist/hip, waist/thigh ratio were significantly higher in PCOS than control women. Lower FSH level, higher LH and E2 levels, LH/FSH ratio, and lower E2/testosterone ratio was found in obese and non-obese PCOS. Higher blood sugar level, high cholesterol, triglyceride, LDL, VLDL and lower HDL levels in PCOS compared to control women. Conclusion: Obesity is a common finding of women with PCOS, but it is not part of the diagnostic criteria. Women with PCOS usually have the so-called centralobesity (Visceral adiposity), and therefore tend to have an increased waist-hip ratio (WHR) and waist to thigh ratio, regardless of the weight factor (i.e., in obese and non-obese). PCOS patients exhibited abnormal hormonal status and biochemical indices also regardless of obesity.
Background: Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenism anovulatory infertility; it affects 510-% of females in the reproductive age. PCOS is a risk disease; it has an association with gynecological malignancy. Objectives: To determine whether Cancer Antigen 125 (CA125) and Cancer Antigen 153-(CA153-) levels are increased in PCOS and possibility of CA125 and CA153- to be used as a diagnostic marker of PCOS. Methods: Seventyfemales with PCOS diagnosed depending on threecriteria: Menstrualhistoryofoligomenorrhea ultrasound examinations revealed polycystic ovaries and biochemical hyperandrogenism. Twenty normal fertile females serve as control group. Blood samples were obtained from all individuals from 2nd-4th day of menstrual cycle to measure levels of FSH, LH and testosterone.Second blood samples were collected from the same patients during late follicular phase to measure CA153- and CA125( by ELISA). Results: Females with PCOS and controls differed significantly(p< 0.05) in total serum testosterone (p). Females with PCOS and controls have highly significant difference (p < 0.001) in LH mean level (7.881.83+ vs 3.900.73+) respectivelyand, highly significant difference (p < 0.001) in LH/FSH ratio and BMI parameters. No significant differences (p > 0.05) were found in FSH, CA125 and CA153- between PCOS patients and the controls.There were positive correlation between testosterone and CA125.Negative correlation between testosterone and CA153- serum values. Conclusion: There were no changes in the serum levels of CA125andCA153- in PCOS patient at the age of reproduction and those cancer antigens could not be used as diagnostic markers for polycystic ovarian syndrome.
Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility and is associated with an increased risk of premature luteinizing hormone (LH) surges during controlled ovarian stimulation. Progestin-primed ovarian stimulation (PPOS) using Medroxyprogesterone Acetate (MPA) has emerged as a convenient alternative to conventional gonadotropin-releasing hormone (GnRH) antagonist protocols. This study aimed to compare the effects of MPA-based PPOS and GnRH antagonist protocols on oocyte yield, maturation, fertilization, and embryo quality in women with PCOS undergoing ICSI . This prospective, randomized, open-label controlled clinical trial included 108 women with PCOS undergoing ICSI at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq, between 2023 and 2024. Participants were allocated to an MPA-based PPOS group (n=49) or a flexible GnRH antagonist group (n=59). Oocyte yield, metaphase II (MII) oocytes, fertilization rate, embryo quality, ovarian sensitivity index (OSI), gonadotropin consumption, stimulation duration, and LH profiles were evaluated.No significant differences were observed in baseline characteristics or hormonal profiles between groups. The MPA group showed a numerically higher number of retrieved oocytes (20.65 ± 7.50 vs. 13.39 ± 4.41; p=0.083) and MII oocytes (15.10 ± 5.20 vs. 11.24 ± 4.12; p=0.09), although these differences were not statistically significant. Fertilization rates were comparable between groups (72.4 ± 10.6% vs. 71.2 ± 11.3%; p=0.68), as were embryo quality, OSI, gonadotropin consumption, and stimulation duration. Both protocols effectively suppressed premature LH surges without premature ovulation or cycle cancellation. MPA-based PPOS appears to be an effective and practical alternative to GnRH antagonist protocols for PCOS patients undergoing ICSI, providing comparable fertilization and embryological outcomes with effective LH suppression. Its oral administration and potential cost advantages may be particularly valuable in resource- limited ART settings.