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      Hyperhomocysteinemia and pregnancy outcomes in women with polycystic ovary syndrome: A case-control study

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          Abstract

          Background

          One of the reproductive medicine challenges is to determine the role of hyperhomocysteinemia in the pathogenesis of polycystic ovary syndrome (PCOS), especially in women with recurrent pregnancy loss (RPL).

          Objective

          Determine the correlation between hyperhomocysteinemia and pregnancy outcome in women with PCOS.

          Materials and Methods

          This case-control study involved 245 women (20-30 yr) and was conducted in Georgia, Tbilisi from 2019-2022. Of these, 175 were women with PCOS (study group) and 70 were healthy women (control group). Women with PCOS were divided into group I with RPL (n = 90), and group II with live births (n = 85). Group I was divided into subgroups A and B with and without insulin resistance. The investigation measured homocysteine (Hcy), follicle-stimulating, luteinizing, anti-Mullerian hormones, total and free testosterone were determined. To determine the ovarian volume and antral follicle count, participants also underwent an ultrasound examination.

          Results

          In women with PCOS, the average Hcy level was significantly higher than in the controls, p < 0.05. In group I, the average Hcy level was significantly higher than in group II and controls, p < 0.05. There was no significant difference in average Hcy level between group II and controls. The average Hcy level in group I, subgroup A was significantly higher than in subgroup B, p < 0.05. The average total, free testosterone levels, and homeostatic model assessment-insulin resistance levels (HOMA-IR) in group I was significantly higher than in group II and controls. HOMA-IR in group II and controls did not differ significantly. The average anti-Mullerian hormone levels in women with PCOS were significantly higher than controls, p < 0.05. No significant difference was observed in average anti-Mullerian hormone level, ovarian volume, antral follicle count, and body mass index between the comparison groups of PCOS. In group I, a positive correlation between Hcy with HOMA-IR was detected.

          Conclusion

          Serum Hcy levels are elevated in women with PCOS and RPL, which correlates with their insulin resistance status.

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          Most cited references25

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          Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group.

          Bart C.J.M. Fauser, Basil Tarlatzis, Robert W Rebar … (2012)
          Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRM sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health, and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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            Polycystic Ovary Syndrome

            Ricardo Azziz (2018)
            Polycystic ovary syndrome (PCOS) is a highly prevalent disorder, representing the single most common endocrine-metabolic disorder in reproductive-aged women. Currently there are four recognized phenotypes of PCOS: 1) hyperandrogenism+oligo-anovulation+polycystic ovarian morphology; 2) hyperandrogenism+oligo-anovulation; 3) hyperandrogenism+polycystic ovarian morphology; and 4) oligo-anovulation+polycystic ovarian morphology, each with different long-term health and metabolic implications. Clinicians should clearly denote a patient's phenotype when making the diagnosis of PCOS. Polycystic ovary syndrome is a highly inherited complex polygenic, multifactorial disorder. Pathophysiologically abnormalities in gonadotropin secretion or action, ovarian folliculogenesis, steroidogenesis, insulin secretion or action, and adipose tissue function, among others, have been described in PCOS. Women with PCOS are at increased risk for glucose intolerance and type 2 diabetes mellitus; hepatic steatosis and metabolic syndrome; hypertension, dyslipidemia, vascular thrombosis, cerebrovascular accidents, and possibly cardiovascular events; subfertility and obstetric complications; endometrial atypia or carcinoma, and possibly ovarian malignancy; and mood and psychosexual disorders. The evaluation of patients suspected of having PCOS includes a thorough history and physical examination, assessment for the presence of hirsutism, ovarian ultrasonography, and hormonal testing to confirm hyperandrogenism and oligo-anovulation as needed and to exclude similar or mimicking disorders. Therapeutic decisions in PCOS depend on the patients' phenotype, concerns, and goals, and should focus on 1) suppressing and counteracting androgen secretion and action, 2) improving metabolic status, and 3) improving fertility. However, despite significant progress in understanding the pathophysiology and diagnosis of the disorder over the past 20 years, the disorder remains underdiagnosed and misunderstood by many practitioners.
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              Definitions of infertility and recurrent pregnancy loss: a committee opinion

              (2020)
              This document contains the definitions of infertility and recurrent pregnancy loss as defined by the Practice Committee of the American Society for Reproductive Medicine. It replaces the document, "Definitions of Infertility and Recurrent Pregnancy Loss: a Committee Opinion," last published in 2013 (Fertil Steril 2013;99:63).
              Article 0 comments Cited 107 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Reprod Biomed
                Journal ID (iso-abbrev): Int J Reprod Biomed
                Journal ID (publisher-id): IJRM
                Title: International Journal of Reproductive Biomedicine
                Publisher: Knowledge E
                ISSN (Print): 2476-4108
                ISSN (Electronic): 2476-3772
                Publication date Collection: February 2023
                Publication date (Electronic): 8 March 2023
                Volume: 21
                Issue: 2
                Pages: 167-174
                Affiliations
                1Department of Medical Faculty of Teaching University Geomedi, Tbilisi, Georgia.
                2Department of Medical Faculty of Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.
                3University of Toronto, Faculty of Medicine, Physician Assistant Program, Toronto, Canada.
                4Teaching University Geomedi, Tbilisi, Georgia.
                5Tbilisi State Medical University, Tbilisi, Georgia.
                Author notes
                *Elene Asanidze; Teaching University Geomedi, LLC, 4 King Solomon II str. 0114, Tbilisi, Georgia. Postal Code: 0162 Tell: (+995) 599109195 Email: asanidzeelene@yahoo.com
                Author information
                https://orcid.org/0000-0002-8779-7731
                Article
                DOI: 10.18502/ijrm.v21i2.12807
                PMC ID: 10073870
                SO-VID: 47533817-a990-47c2-887d-e292881c17b1
                Copyright © Copyright © 2023 Asanidze et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 June 2022
                Date revision received : 3 September 2022
                Date accepted : 25 December 2022
                Page count
                Figures: 2, Tables: 1, References: 29, Pages: 8
                Categories
                Subject: Original Article

                Keywords: polycystic ovary syndrome, hyperhomocysteinemia, recurrent abortion, insulin resistance.
                Data availability:
                Keywords: polycystic ovary syndrome, hyperhomocysteinemia, recurrent abortion, insulin resistance.

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