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Comparison of clinical and hormonal characteristics among four phenotypes of polycystic ovary syndrome based on the Rotterdam criteria

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
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Abstract

Purpose

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disturbances in women and is divided into different phenotypes. The aim of study is to compare the clinical and hormonal parameters among the four phenotypes of PCOS based on the Rotterdam criteria and with control group.

Methods

Women with PCOS (n = 263) confirmed based on the Rotterdam criteria and 263 women with no evidence of PCOS were recruited as controls using observational case–control study. Evaluation of clinical and hormonal parameters, and differences in anti-Mullerian hormone (AMH) were compared between four phenotypes of PCOS and controls.

Results

Women with phenotype A (olig-anovulation (O) + hyperandrogenism (H) + polycystic ovary morphology (P)) had significantly larger waist than phenotype D (O + P) and higher body mass index than phenotype C (H + P). The LH/FSH ratio was significantly higher in phenotype A than phenotype D and controls along with significantly higher serum total testosterone levels in phenotype A compared to the phenotype B (O + H), C, D, and controls. AMH was significantly higher with phenotype A, C, and D than in women phenotype B and controls.

Conclusions

The highest AMH levels were found in phenotype A. Phenotype B similar to controls had significantly low AMH compared to other three PCOS phenotypes. Women in the phenotypes D and controls showed significantly lower levels of LH/FSH ratio, total testosterone, and free androgen index, and higher levels of FSH and SHBG compared with phenotype A (P < 0.001). In logistic regression analysis, AMH and LH were predictors for PCOS.

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References

  1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol and Metab 89:2745–2749

    Article  CAS  Google Scholar 

  2. Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25

    Google Scholar 

  3. Xu X, Shi Y, Cui Y, Ma J, Che L, Chen ZJ (2012) Endocrine and metabolic characteristics of polycystic ovary syndrome in Chinese women with different phenotypes. Clin Endocrinol (Oxford) 76:425–430

    Article  CAS  Google Scholar 

  4. Zawadzki JK, Dunaif A (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rationale approach. In: Dunaif A, Givens JR, Haseltine F, Merriam GR (eds) polycystic ovary syndrome. Blackwell Scientific, Boston, pp 377–384

    Google Scholar 

  5. National Institute of Health (NIH) (2012). Evidence-based methodology workshop on polycystic ovary syndrome, http://preventionnih.gov/doc/programs/pcos/Finalreport.pdf. Accessed 22 Jan 2014

  6. Findlay JK, Drummond AE, Dyson ML, Baillie AJ, Robertson DM, Ethier JF (2002) Recruitment and development of the follicle; the roles of the transforming growth factor-beta superfamily. Mol Cell Endocrinol 191:35–43

    Article  PubMed  CAS  Google Scholar 

  7. Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D (2009) 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 296:E238–E243

    Article  PubMed  CAS  Google Scholar 

  8. Sahmay S, Atakul N, Oncul M, Tuten A, Aydogan B, Seyisoglu H (2013) Serum anti-mullerian hormone levels in the main phenotypes of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 170:157–161

    Article  PubMed  CAS  Google Scholar 

  9. Welt CK, Gudmundsson JA, Arsson G, Adams J, Palsdottir H, Gudlaugsdottir G et al (2006) Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab 91:4842–4848

    Article  PubMed  CAS  Google Scholar 

  10. Dewailly D, Catteau-Jonard S, Reyss AC, Leroy M, Pigny P (2006) Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metabol 91:3922–3927

    Article  CAS  Google Scholar 

  11. Pehlivanov B, Orbetzova M (2007) Characteristics of different phenotypes of polycystic ovary syndrome in a Bulgarian population. Gynecol Endocrinol 23:604–609

    Article  PubMed  CAS  Google Scholar 

  12. Yilmaz M, Isaoglu U, Delibas IB, Kadanali S (2011) Anthropometric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. J Obstet Gynecol Research 37:1020–1026

    Article  Google Scholar 

  13. Katz AS, Goff DC, Feldman SR (2000) Acanthosis nigricans in obese patients: presentations and implication for atherosclerotic vascular disease. Dermatol Online J 6(1):1–24

    PubMed  CAS  Google Scholar 

  14. Hatch R, Rosenfield RL, Kim MH, Tredway D (1981) Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 140:815–830

    PubMed  CAS  Google Scholar 

  15. Van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J (2000) Polycystic ovaries in adolescents and the relationship with menstrual cycle patterns, luteinizing hormone, androgens and insulin. Fertil Steril 74(1):49–58

    Article  PubMed  Google Scholar 

  16. Balen AH, Dresner M, Scott EM, Drife JO (2006) Should obese women with polycystic ovary syndrome receive treatment for infertility? Br Med J 332:434–435

    Article  Google Scholar 

  17. WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403):157–163

    Article  Google Scholar 

  18. Carter GD, Holland SM, Alaghband-Zadeh J, Rayman G, Dorrington-Ward P, Wise PH (1983) Investigation of hirsutism: testosterone is not enough. Ann Clin Biochem 20:262–263

    Article  PubMed  Google Scholar 

  19. Balen AH, Laven JS, Tan SL, Dewailly D (2003) Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 9:505–514

    Article  PubMed  Google Scholar 

  20. Baldani DP, Skrgatić L, Simunić V, Zlopasa G, Canić T, Trgovcić I (2013) Characteristics of different phenotypes of polycystic ovary syndrome based on the Rotterdam criteria in the Croatian population. Collegium Antropologicum 37(2):477–482

    PubMed  CAS  Google Scholar 

  21. Kar S (2013) Anthropometric, clinical, and metabolic comparisons of the four Rotterdam PCOS phenotypes: a prospective study of PCOS women. J Hum Reprod Sci 6:194–200

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kavardzhikova S, Pechlivanov B (2010) Clinical, hormonal and metabolic characteristics of different phenotypes of polycystic ovary syndrome, Bulgarian population. Akush Ginekol (Sofiia) 49(4):32–37

    CAS  Google Scholar 

  23. Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A (2007) Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril 88(5):1389–1395

    Article  PubMed  CAS  Google Scholar 

  24. Mehrabian F, Khani B, Kelishadi R, Kermani N (2011) The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females. J Res Med Sci 16(6):763–769

    PubMed  CAS  PubMed Central  Google Scholar 

  25. Zhang HY, Guo CX, Zhu FF, Qu PP, Lin WJ, Xiong J (2013) Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case-control study. Arch Gynecol Obstet 287:525–531

    Article  PubMed  Google Scholar 

  26. Kauffman RP, Baker TE, Baker VM, DiMarino P, Castracane VD (2008) Endocrine and metabolic differences among phenotypic expressions of polycystic ovary syndrome according to the 2003 Rotterdam consensus criteria. Am J Obstet Gynecol 198:670

    Article  PubMed  Google Scholar 

  27. Barber TM, Wass JA, McCarthy MI, Frank S (2007) Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome. Clin Endocrinol 66:513–517

    CAS  Google Scholar 

  28. Carmina E, Chu MC, Longo RA, Rini GB, Lobo RA (2005) Phenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters. J Clin Endocrinol Metab 90:2545–2549

    Article  PubMed  CAS  Google Scholar 

  29. Huber-Buckholz MM, Carey DG, Norman RJ (1999) Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 84:1470–1474

    Google Scholar 

  30. Carmina E, Legro RS, Stamets K, Lowell J, Lobo RA (2003) Difference in body weight between American and Italian women with polycystic ovary syndrome: influence of the diet. Hum Reprod 11:2289–2293

    Article  Google Scholar 

  31. Di Fede G, Mansueto P, Longo RA, Rini G (2009) Carmina E (2009) Influence of socio-cultural factors on the ovulatory status of polycystic ovary syndrome. Fertil Steril 91:1853–1856

    Article  PubMed  Google Scholar 

  32. Pasquali R, Gambineri A, Pagotto U (2006) The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 113:1148–1159

    Article  PubMed  CAS  Google Scholar 

  33. Guastella E, Longo RA, Carmina E (2010) Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril 94:2197–2201

    Article  PubMed  CAS  Google Scholar 

  34. Hickey TE, Marrocco DL, Amato F, Ritter LJ, Norman RJ, Gilchrist RB et al (2005) Androgens augment the mitogenic effects of oocyte-secreted factors and growth differentiation factor 9 on porcine granulosa cells. Biol Reprod 73:825–832

    Article  PubMed  CAS  Google Scholar 

  35. Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC (2004) Anti-Mullerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 89:318–323

    Article  PubMed  CAS  Google Scholar 

  36. Cook CL, Siow Y, Brenner AG, Fallat ME (2002) Relationship between serum Müllerian inhibiting substance and other reproductive hormones in untreated women in PCOS and normal women. Fertil Steril 77:141–146

    Article  PubMed  Google Scholar 

  37. Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S et al (2003) Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab 88:5957–5962

    Article  PubMed  CAS  Google Scholar 

  38. Broekmans FJ, Visser JA, Laven JS, Broer SL, Themmen AP, Fauser BC (2008) Anti-Mullerian hormone and ovarian dysfunction. Trends Endocrinol Metab 19:340–347

    Article  PubMed  CAS  Google Scholar 

  39. Caglar GS, Kahyaoglu I, Pabuccu R, Demirtas S, Seker R (2013) Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS. Arch Gynecol Obstet 288:905–910

    Article  PubMed  CAS  Google Scholar 

  40. De Vet A, Laven JS, de Jong F, Themmen A, Fauser BC (2002) Anti- Müllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril 77:357–362

    Article  PubMed  Google Scholar 

  41. Duijkers IJ, Klipping C (2010) Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women. Gynecol Endocrinol 26:152–160

    Article  PubMed  Google Scholar 

  42. Casser S, Teede HJ, Moran LJ, Joham AE, Harrison CL, Strauss BJ et al (2014) Polycystic ovary syndrome and anti-Mullerian hormone: role of insulin resistance, androgens, obesity and gonadotrophins. Clin Endocrinol 81:899–906

    Article  Google Scholar 

  43. Ramanand SJ, Ghongane BB, Ramanand JB, Patwardhan MH, Ghanghas RR, Jain SS (2013) Clinical characteristics of polycystic ovary syndrome in Indian women. Indian J Endocrinol Metab 17:138–145

    Article  PubMed  PubMed Central  Google Scholar 

  44. Thathapudi S, Kodati V, Erukkambattu J, Katragadda A, Addepally U, Hasan Q (2014) Anthropometric and biochemical characteristics of polycystic ovarian syndrome in south indian women using AES-2006 criteria. Int J Endocrinol Metab 12(1):e12470

    Article  PubMed  PubMed Central  Google Scholar 

  45. Farhan YM, Taher MA, Alhadithy EM (2012) Comparative study on cardiovascular risk factors in newly diagnosed patients with polycystic ovary syndrome (PCOS) and PCOS patients who are on drug metformin. Internat J Sci Nat 3(1):24–29

    CAS  Google Scholar 

  46. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar- Morreale HF, Futterweit W et al (2009) The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 91(2):456–488

    Article  PubMed  Google Scholar 

  47. Woo HY, Kim KH, Rhee EJ, Park H, Lee MK (2012) Differences of the association of anti- Mullerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome. Endocr 59:781–790

    Article  CAS  Google Scholar 

  48. Jamil AS, Alalaf SK, Al-Tawil NG, Al-Shawaf T (2015) A case-control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. Reprod Health 12:7

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge the efforts of the doctors, nursing, and laboratory staff working at Maternity Teaching Hospital in Erbil/Iraq during the study period.

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Correspondence to Avin S. Jamil.

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Jamil, A.S., Alalaf, S.K., Al-Tawil, N.G. et al. Comparison of clinical and hormonal characteristics among four phenotypes of polycystic ovary syndrome based on the Rotterdam criteria. Arch Gynecol Obstet 293, 447–456 (2016). https://doi.org/10.1007/s00404-015-3889-5

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  • DOI: https://doi.org/10.1007/s00404-015-3889-5

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