3.5 MHz linear transducer. Polycystic ovaries were diag nosed using Adam's criteria,S namely the presence of 1 0 or more peripheral small follicles. Ultrasound is a highly reli able method for diagnosing PCO.9 Subjects were then sent a questionnaire which asked the subjects and their mothers about their birth details, feeding history, childhood illnesses and immunization as well as their exercise pattern from birth till 20 years of age. Exercise activities included running, swimming, and sport, and scoring was based on the fre quency of exercise performance. Seventy-seven subjects (82%) returned the questionnaire. All the subjects were between IS to 45 years of age. Subjects were divided into 2 groups based on an ultrasound diagnosis of PC 0; a group of subjects with normal ovaries (n= 40) and a group of sub jects with scan evidence of PCO (n= 37). Within these 2 groups, there were 7 pairs of scan-discordant twins (that is one twin had US-PCO and the co-twin was US-normal); 3 MZ and 4 DZ pairs. Fisher's exact test was used to com pare any two variables. ANOVA test was used when more than two groups were compared. A p-value of 0.05 or less was considered significant.
In summary, our results provide additional evidence of significant vascular dysfunction in women with polycystic ovaries and highlight the need to confirm or refute the present discrepancy between cardiovascular risk and mortality in these women. Studies are also required to determine the mechanisms responsible for the wide range of vascular abnormalities and potential cardioprotective factors associ- ated with this condition, which affects at least 20% of the female population.
polycystic ovarian morphology. In the current study, determination of follicle pattern among observers was poor. Difficulty assigning follicle pattern may have related to confusion over the most appropriate ovarian cross-sec- tion in which to make the determinations since observers were analyzing digital recording rather than static images. Moreover, there may have been reluctance to assign folli- cle pattern in the presence of a dominant follicle or CL. We were unable to find any study reporting specific relia- bility coefficients when assigning follicle pattern using static or dynamic transvaginal ultrasonography . While the current ultrasound criteria for polycystic ovaries exclude an assessment of follicle pattern, the appropriate- ness of its omission as a diagnostic criterion is questiona- ble. Recently, a surrogate and more objective measure of follicle pattern, called the stromal-total area ratio, was shown to have 100% specificity and 100% sensitivity in diagnosing polycystic ovaries . This group also recently reported good reliability among observers when making calculations of the stromal-total area ratio . We suspect that wider adoption of this criterion may occur in light of favorable reports pertaining to its ease of use in clinical practice .
The average plasma testosterone concentration of women with either hirsutism or polycystic ovaries and hirsutism was higher (p < 0.01) than that of normal women although the ranges overlapped. Testosterone blood production rates averaged 830 ± 120 SE and 1,180 ± 310 SE µg per day in the two groups of hirsute women and 230 ± 33 SE µg per day in normal women. The ranges did not overlap.
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There are numerous animal models available for PCOS study. However, fully convincing rat model for PCOS reflecting all pathologic condition of PCOS in women is not available due to difficulties in inducing all pathologies in one rat model. In estradiol valerate rat model anatomy and physiology of the ovary were same as of the human PCOS 6 . However, in this model progressive degeneration of hypothalamus and altered response of pituitary to LHRH made it inappropriate for human PCOS. Mahajan (1988) studied PCOS in rats after continuous administration dehydroepiandrosterone (DHA) and came out with DHA metabolites interfered in many experimental conditions. In neonatally androgenized female rat model, ovaries were smaller than that of controls and normal tunica albuginea and no hyperthecosis were found. Moreover, because testosterone administered prior to differentiation of hypothalamus and pituitary cells, these organs were rendered nonresponsive to steroids, luteinizing hormone-releasing hormone (LHRH) and FSH 6 . Although anatomic features consequent to PCOS resulted from constant-light similar to human PCOS and ovarian cells still retained the ability to respond to FSH and LHRH, no increment in levels of LH and androgens that have a pivotal role in PCOS rendered this model different from human PCOS 6 .
(CO), some were intact and some were decomposed and large. Follicle cavity (An) expansion, occurred with the absence of a theca interna, whereas the theca externa remained, preparing to form the ovarian cyst. In others the follicle cells were proliferated inside the lumen ready to form the atritic follicles (Af). In some areas, the follicle cells replicated abnormally whereas in other areas, the follicle cells were few in number because of decomposition (figure 25). The Graafian follicles (Gf) appear close to the surface of the ovary in the cortex (C), with large size, but destruction was observed at the structure where they lost the oocytes and the follicle cell forming the ovarian follicles. However, other Gf appeared to contain their oocytes (Po), but lacked the proper and natural composition, where the cavity was filled with cumulus cells and vacuoles, and the surrounding cells showed reduced thickness due to decomposition (figure 24). In other areas the Gf had completely disappeared. The corpus luteum (Cl) in some areas appeared to be composed of granular lutein granulosa cells, but at a rate lower than that observed in the normal group, with bleeding between these cells and the gaps in it (figure 25b). In other areas, the (Cl) had completely disappeared. Anatomical examination and histology of the ovaries in herbal treated groups
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World Health Organization (WHO) estimates that PCOS has affected 116 million women (3.4%) worldwide in 2012 . Globally, prevalence estimates of PCOS are highly variable, ranging from 2.2% to as high as 26%. In India, experts claim 10% of the women to be affected by PCOS and yet no proper published statistical data on the prevalence of PCOS in India is available. Polycystic Ovary Syndrome (PCOS) is an endocrine metabolic disorder characterized by multiple hormonal imbalances representing diverse clinical presentations dominated by clinical and biochemical signs of hyperandrogenism which results in short and long term consequences in female health. A defect of the ovarian cells (most likely theca cells) is the underlying cause of PCOS, resulting in excessive androgen synthesis and the clinical and biochemical symptoms of the disease. In the literature, reference is made to the participation of genetic factors, including ethnicity; there is a higher frequency of PCOS in Spanish, Native American and Mexican women. The patient seeks a dermatology consultation for one or more complaints like acne, hirsutism, alopecia, acanthosis nigricans, skin tags and occasionally, darkening of complexion with weight gain. . If irregular menstrual cycles or primary infertility are the main complaints, the patient may consult a gynaecologist. Polycystic ovaries found on ultrasound scanning will often have no clinical effects, but PCOS is the most common diagnosis made in women presenting with amenorrhoea, oligomenorrhoea or heavy, irregular and prolonged periods. It is the commonest cause of hirsutism and of infertility due to anovulation. Women with PCOS have increased concentrations of circulating androgens and there is a marked association with insulin resistance, dyslipidaemia, obesity, gestational diabetes, type 2 diabetes and heart disease
Phenotyping women recruited into UK biobank, into a diagnosis of PCOS or not, should be possible given the availability of data on menstrual history, testosterone and SHBG levels in UK biobank. With linkage to GP records, it should be possible to exclude the other causes of hyperandrogenism or oligo / anovulation as required by gold standard diagnostic criteria. The diagnosis would however have to rely on the Androgen Excess Society (AES-2006) criteria given that ovarian images (required for the Rotterdam criteria), have not been classified into having polycystic ovaries or not and the fact that only 5000 (1%) of all the participants in UK biobank have had MRI scans.
Note: Group A = hyperandrogenism, ovulatory dysfunction and polycystic ovaries; Group B = hyperandrogenism and ovulatory dysfunction but normal ovaries; Group C = hyperandrogenism and polycystic ovaries but ovulatory cycles; Group D = ovulatory dysfunction and polycystic ovaries but no clinical or bio- chemical hyperandrogenism; Group E = healthy control group; BMI = body mass index; WHR = waist-to-hip ratio; SBP = systolic blood pressure; DBP = diastolic blood pressure; F-G score = Ferriman-Gallwey score; OGTT = Oral Glucose Tolerance Test; HOMA-IR = homeostasis model assessment; G/I ratio = Glucose to insulin ratio. Data are shown as mean ± SD. P-values were calculated using ANOVA and post hoc Bonferroni tests. a P < 0.05 compared with A; b P < 0.05
Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism&polycystic ovaries. The incidence varies between 0.5 – 4 % more common amongst infertile women. It is prevalent in young reproductive age group (20 – 30 %). The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include oligomenorrhea or amenorrhea, hirsutism & frequently infertility. Risk factor for PCOS in adults includes type I & II diabetes and gestational diabetes. Insulin resistance affects 50%–70% of women with PCOS leading to a number of comorbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance &diabetes. Studies show that women with PCOS are more likely to have increased coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS. Weight loss improves menstrual irregularities, symptoms of androgen excess and infertility. Management of clinical manifestations of PCOS includes Oral Contraceptives for menstrual irregularities and hirsutism. Spironolactone &Finasterideare used to treat symptoms of androgen excess. Treatment options for Infertility include Clomiphene, Laparoscopic Ovarian Drilling, Gonadotropins&Assisted Reproductive Technology. Recent data suggest that Metformin, Letrozole (Femara)andAnastrozole (Arimidex)may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns butalso to prevent future metabolic, endocrine, psychiatric andcardiovascular complications.
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Both ovarian enlargement and ovarian cysts are associated with hypothyroidism. A decrease in ovarian volume, resolution of ovarian cysts and reversal of the polycystic ovary syndrome-like appearance, together with improve- ment in serum hormone levels, has been shown to occur after the achievement of euthyroidism (11). Although polycystic ovaries are more commonly associated with primary hypothyroidism, our patient was found to have a large multiseptated ovarian cyst, and consistent regression of the ovarian cyst after thyroid hormone replacement therapy supports a causal relationship between hypothyr- oidism and ovarian stimulation in the present case.
DOI: 10.4236/ojog.2018.81005 40 Open Journal of Obstetrics and Gynecology order with a prevalence of 5% to 15% worldwide , for the women of active re- productive age, but the prevalent rate varies depending on the criteria used for the diagnosis  . According to the Rotterdam diagnostic criteria, the preva- lence rate of PCOS accounts up to 18% of reproductive-aged women  , whilst the prevalence rate is 10% when using NIH criteria for diagnosis criteria  but the prevalence is still unknown in children  . Three different crite- ria have been implemented for the diagnosis of PCOS: the NIH criteria (1990), the Rotterdam criteria (2003) and the Androgen and PCOS society (AE-PCOS) criteria (2006)  . Amongst the three criteria, the Rotterdam criterion was adopted as the Practice Guidelines of the Endocrine Society  . The Rotter- dam criteria comprise features as, chronic menstrual dysfunction, clinical or bi- ochemical hyperandrogenism and polycystic ovaries confirmed by ultrasono- graphy (≥10 follicles and ≥10 ml ovarian volume) . The etiology of PCOS still remains unclear but various predisposing genes interfere with environmental and lifestyle manners  , makes PCOS a complex genetic disorder. The con- stellations of symptoms significantly affect the quality of life of PCOS women and the syndrome is associated with an increased long term risk factors such as cardiovascular disease, diabetes mellitus, infertility, cancer and psychological disorders .
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In this experiment, there were significant differences in ovary weights and morphology between controls and rats treated with androgens during the first and second halves of pregnancy. Significant morphologic differences between the androgen-treated groups and the control group were observed by light microscopy while changes in organelle structures were observed by electron mi- croscopy (Figure 1, 2, 3). In addition, excessive theca cells caused an elevation in serum sex hormones (Table 1). Since organ morphology is always linked with its function, the PCOS resembling histopathological alterations in ovaries of prenatal androgenized female rats suggested that androgen affects the ovary develop- ment first and consequent functions later. Because the aggregation of follicles and the morphologic changes are important characteristic in PCOS develop, our observa- tion supported that these morphologic changes might re- sult from androgen excess.
Polycystic ovary syndrome (PCOS) is a major health problem in reproductive-aged women worldwide, which was first reported by Stein and Leventhal in 1935. In clinical practice, 75% of women with PCOS suffer from anovulation infertility [1-3], and 50% of them experience recurrent pregnancy loss [4-7], but the precise mechanism remains unclear. Our previous studies have indicated that hypoxia inducible factor (HIF)-1a-mediated endothelin (ET)-2 sig- naling plays a key role in the mammalian ovari- an ovulation [8-13], which may also be an important mechanism regulating this disease. However, no any report was found at present about the expression changes of protein kinase B (Akt/PKB)/HIF-1a in the ovary of PCOS rats after dimethylbiguanide (DMBG) treatment. Clinically, DMBG is widely used to improve PCOS symptoms [11, 14-19], break the vicious cycle of the PCOS endocrine environment, and
France) was injected intramuscularly on day 16 of taking Marvelon. Stimulation with recombinant follicle-stimulat- ing hormone (Puregon; N.V.Organon) was started sub- cutaneously after 16 days’ down-regulation. Human chorionic gonadotropin (HCG) 5,000 IU was injected when the maxium follicle diameter reached 20 mm. The IVF procedure was performed at another center; therefore, details of estrogen and follicle development could not be traced. Transvaginal oocyte retrieval was uneventful and yielded 24 mature oocytes. Two blastocysts were trans- ferred 4 days later. The patient had severe OHSS 10 days after oocyte retrieval, for which paracentesis was per- formed three times, with an average of 1,500 mL abdom- inal effusion drained each time. She was also suspected to have vein thrombosis of the right lower limbs. The patient became pregnant, and the follow-up was performed at another center. Throughout her perinatal examinations, both the ovaries did not become smaller. The patient de- livered a healthy newborn via cesarean at term, a biopsy of the enlarged ovary was performed with benign pathology. No intervention was performed due to the expectation that the hyperstimulated ovaries would shrink during the postpartum period, at the same time she was concerned about the side-effects of those medicines in lactation. Her menstrual period resumed 14 months after delivery, and the child was weaned from breastfeeding at 24 months. However, the size of both the ovaries were still not reduced by then. Three months of oral contraceptives (Marvelon; N.V. Organon) were prescribed.
Abstract: Aim: To investigate the expression of silent information regulator 1 (SIRT1) in rats with polycystic ovary syndrome (PCOS) and its alteration after exenatide treatment. Methods: PCOS rat model was established by de- hydroepiandrosterone induction. The animals were randomly divided into exenatide treatment group (EX group, n = 10), metformin treatment group (MF group, n = 10), PCOS group (PCOS group, n = 9) and normal control group (NC group, n = 10). Histological changes of the ovarian tissues were examined by HE staining. SIRT1 expression in the ovarian tissue was detected by RT-PCR and immunohistochemistry. Results: Rats in the PCOS group lost their estrous cycle. Histological observation of the ovary showed saccular dilatation of the follicle, decreased number of corpora lutea, fewer layers of granulosa cells aligned loosely, and thickened layer of theca cells. The changes in reproductive hormones and the development of insulin resistance suggested the successful establishment of the animal models. Immunohistochemistry and Q-PCR detected the mRNA and protein expressions of SIRT1 in the ovary tissues of rats in the normal control group. The SIRT1 expression was significantly lower in PCOS group than in control group (P < 0.05); after drug intervention, the SIRT1 expression significantly increased in EX and MF groups (compared with the PCOS group), whereas no significant difference was noted between the EX group and MF group. Conclusions: The SIRT1 expression in the ovary tissue decreases in PCOS rats (compare with the normal rats) but can be up-regulated after Ex or MF treatment. These drugs may affect the process and development of PCOS by regulating the SIRT1 expression. Exenatide may be therapeutic for PCOS by up-regulating the SITR1 expression.
The human ovary can be the target of an autoimmune attack in various circumstances, including several organ-specific or systemic autoimmune diseases. Clinically, the ensuing ovarian dysfunction often results in premature ovarian failure (POF), but other pathologies involving the ovaries, such as unexplained infertility, polycystic ovary syndrome (PCOS) and endometriosis have been associated with anti-ovarian autoimmunity. 
Polycystic kidney disease (PKD) is the most common monogenic cause of kidney failure, and is characterised by the development of hundreds of ﬂ uid- ﬁ lled cysts in the kidney, which contain chloride-rich ﬂ uid and are lined by a single layer of cystic epithelial cells (CECs). 1 The two most common forms of PKD, autosomal domi- nant (ADPKD) (1:1000 population prevalence) and autosomal recessive (ARPKD) (1:20,000 population prevalence), 2 are both characterised by progressive cyst enlargement and interstitial ﬁ brosis which replaces the normal renal parenchyma and leads to end-stage kidney disease (ESKD). 3 In ARPKD, kidney cysts form from the synchronised fusiform dilatation of the collecting duct development in utero or during the early postnatal period. In contrast, in ADPKD, cyst formation arises
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The appropriate ethics committee approval was ob- tained for using animals' ovarian tissues in this study. Five non-parturient female mature hamsters (about 100 g weight) were selected and euthanized by ether under animal right condition. Then, abdominal cavity was opened and ovaries were removed. First, length, width, and thickness of ovaries were measured by Vernier. Then, ovaries were fixed by 10% formalin. Samples were processed by routine histological methods by auto- technicon (JUNG HISTOKINET 2000 Leica). Paraffin ovarian blocks were sectioned as serial section with 7 µm thickness. The sections were stained by Hematoxy- lin & Eosin and PAS staining method. The obtained ovaries tissue slides were studied by light fluorescent
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The mitochondrial organization, cytoskeletal arrange- ment and vacuolization are necessary key for cryopre- servation assessment . The mitochondria are very important to the energy producing, metabolic activa- tion and regulating cell survival. In the ovaries vitrified by single cryoprotectant, we showed that elongated and swollen mitochondria consistently present in all the follicu- lar developmental stages, suggesting that the mitochondria were going through an apoptosis process. Wherever Green and Reed demonstrated the mitochondria alternations are the central regulator of apoptosis .