Polikistik Over Sendromunda Obezite ve Metabolik Durumun Fertil ve İnfertil Gruplarda Değerlendirilmesi

Yıl 2019, , 44 - 48, 15.06.2019

Vuslat Lale Bakır , Gül Karahan

https://doi.org/10.16948/zktipb.558143

Öz

AMAÇ : Polikistik
over sendromunda(PKOS) fertil ve infertil gruplarin BKİ ve metabolik değerleri
karşılaştırılarak obezite ve metabolik durumun fertilite üzerine  etkisini belirlemektir.

Polikistik over sendromunda(PKOS)
fertil ve infertil grupların beden kitle indeksi (BKİ) ,metabolik değerleri
karşılaştırılarak obezite ve metabolik durumun fertilite üzerine  etkisini belirlemektir.

YÖNTEM ve GEREÇLER: 2013- 2018 döneminde Rotterdam Tanı Kriterlerine göre PKOS tanısı alan
230  hastanın, klinik ve metabolik
verileri retrospektif olarak değerlendirilmiştir. Beden kitle indeksi (BKİ), bel
–kalça oranı , mensturasyon süreleri , fertilite durumu , fertilite süresi
,parite durumu , hirsutizm varlığı ve derecesi ile  hastalara uygun diyet ve  açlık süresini takiben 75 gr oral glikoz  tolerans testi (OGTT) yapılmıştır.İnsulin direnci
HOMA-IR ile belirlenmiştir. Total kolesterol,HDL ve LDL kolesterol düzeyleri
belirlenmiştir. BKİ’ne göre hastalar ; normal kilolu,fazla kilolu ve obez  olarak gruplara ayrılmış ve fertilite
durumuna göre sonuçlar değerlendirilmiştir.Metabolik bozukluklar BKİ ve
fertilite durumlarına uygun olarak karşılaştırılmıştır.

 

Rotterdam tanı kriterlerine göre
PKOS tanılı 230 hastanın klinik ve metabolik verileri retrospektif olarak
değerlendirildi.Beden kitle indeksi (BKİ), bel / kalça
oranı,mensturasyon,fertilite durumu, infertilite süresi,parite, hirsutizm, 75 g
oral glukoz tolerans testi (OGTT), HOMA –IR değeri, total kolesteroll, HDL, LDL
kolesterol düzeyleri belirlendi.BKİ'ne göre; normal kilolu, fazla kilolu ve
obez gruplar fertilite durumuna göre gruplandırıldı ve değerlendirildi.
Metabolik bozukluklar BMI ve fertilite durumuna göre karşılaştırıldı.

 

BULGULAR: Yaş
ortalaması 26,7’dir. BKİ ortalaması  28.92±5.95
kg/m2 ‘dir. Olguların %25’i normal kiloda olup,%73’ü normalden fazla kilodadır.
Olguların 181’i (%78.5) infertildir, 49’u (%21,5) fertildir. İnfertilite
süreleri 12 ile 196 ay arasında değişmekte olup, ortalaması 33.92±24.25 ay,
medyanı 24 aydır. Bel çevresi 62 ile 135 cm arasında değişmekte olup,
ortalaması 87.76±13.48 cmdir. Bel/kalça oranı 0.65 ile 0.98 arasında değişmekte
olup, ortalaması 0.80±0.06 saptanmıştır. BKİ dağılımı fertil ve infertil grupta
da benzerdir. Olguların 99’unda (%43.1) insülin direnci, 77’sinde (%33.5)
bozulmuş glikoz toleransı, 12’sinde (%5.2) DM saptanmıştır.Lipid düzeyleri gruplar
arasında anlamlı farklılık göstermemiştir. Glikoz metabolizması bozuklukları
her iki grupta benzerdir.

Yaş
ortalaması 26.7, Ortalama BKİ 28.92 ± 5.95kg/m2 idi. Olguların% 25'i normal
kilolu,% 73'ü fazla kilolu olduğu belirlendi. Olguların 181'i (% 78.5) infertil,
49'u (% 21.5) fertil ve infertilite süresi 12 ile 196 ay arasındaydı (ortalama
33.92 ± 24.25 ay, median 24 ay). Hastaların 99'unda (% 43.1) insülin direnci,
77'sinde (% 33.5) bozulmuş glukoz toleransı ve 12'sinde (% 5.2) DM vardı.
Glikoz ve lipit metabolizması ve bozuklukları her iki grupta da benzerdir.

 

SONUÇ: PKOS
olgularında obezite ve metabolik bozukluklar daha sık görülmektedir. Ancak bu
durumun fertilite üzerine etkisi, saptanmamıştır.

Anahtar Kelimeler

Polikistik over sendromu, fertilite, metabolik durum

Evaluation of Obesity and Metabolic Status in Polycystic Ovary Syndrome in Fertile and Infertile Groups

Öz

OBJECTIVE: The aim of our study was to compare the BMI
and metabolic values ​​of fertile and infertile groups in patients with
polycystic ovary syndrome (PCOS) and to determine the effect of obesity and
metabolic status on fertility and infertile groups and the fertility effect of
obesity.

 

MATERIAL AND METHODS: The clinical and metabolic data of 230
patients who presented to the gynecology outpatient clinic of our hospital
between 2013 and 2018 and were diagnosed with PCOS according to the Rotterdam
Diagnosis Criteria were evaluated. Body mass index (BMI), waist ratio,
menstrual period, fertility status, fertility duration, parity status, presence
and degree of hirsutism were evaluated. 75 g oral glucose tolerance test (OGTT)
was performed following appropriate diet and fasting period. Fasting glucose
and insulin levels and insulin resistance cases were determined. Total
cholesterol, HDL and LDL cholesterol levels were determined. Patients with BMI;
The patients were divided into two groups as fertile and infertile, evaluated
for obesity and metabolic data, and data on the relationship with BMI were
calculated statistically. These metabolic disorders were compared to BMI and
fertility status.

 

RESULTS: The mean age of the patients was 26.7 years.
The mean BMI was 28.92 ± 5.95 kg / m2. Only 25% of the patients had normal
weight and 73% were overweight. 4 (1.7%) cases in the weak group with BMI less
than 18.5, 58 (25.2%) cases in normal weight group with BMI 19-24.9, 71 (30.9%)
in overweight group with BMI 25-29.9 There were 86 cases (37.4%) in obese group
with BMI 30-39.9 and 11 cases (4.8%) in morbidly obese group with BMI of 40 and
above. u (21.5%) is fertile. The duration of infertility ranged from 12 to 196
months, with a mean of 33.92 ± 24.25 months and a median of 24 months. The
waist circumference is between 62 and 135 cm and the average is 87.76 ± 13.48
cm. The waist / hip ratio ranged from 0.65 to 0.98 and the mean was 0.80 ±
0.06. The distribution of BMI was similar in the fertile and infertile groups.
99 (43.1%) of the patients had insulin resistance, 77 (33.5%) had impaired
glucose tolerance and 12 (5.2%) had DM. Mean blood lipid levels were not
significantly different between fertile and infertile groups. The distribution
of glucose metabolism disorders was similar in both groups.

 

CONCLUSION: Obesity and metabolic disorders are more
common in PCOS cases. There was no significant difference between fertile and
infertile groups according to BMI.

Anahtar Kelimeler

Policystic ovary syndrome, fertility, metabolic situations

Kaynakça

• Referans1.Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89:2745–9.
• Referans2. G. Garruti, R. Depalo, M. G. Vita et al., “Adipose tissue, metabolic syndrome and polycystic ovary syndrome: from pathophysiology to treatment,” Reproductive Biomedicine Online, vol. 19, no. 4, pp. 552–563, 2009.
• Referans3.Kudsy M, Alhalabi M, Al-Quobaili F. Follicular fluid Vascular Endothelial Growth Factor (VEGF) could be a predictor for pregnancy outcome in normo-responders and polycystic ovary syndrome women undergoing IVF/ICSI treatment cycles. Middle East Fertil Soc J. 2016; 21:52–56.
• Referans4. P. Fenichel, C. Rougier, S. Hieronimus, and N. Chevalier, “Which origin for polycystic ovaries syndrome: genetic, environmental or both?” Annales d'endocrinologie, vol. 78, no. 3, pp. 176–185, 2017.
• Referans5.Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41. 10.1186/1741-7015-8-41
• Referans6.Hallaizadeh J, Khoramdad M, Karamzad N,Alması-Hashiani A, Janati A, Ayubi E, Pakzad R. Metabolic syndrome and its components among women with polycystic ovary syndrome: a systematic review and meta-analysis J Cardiovasc Thorac Res. 2018;10(2):56-69. 10.15171/jcvtr.2018.10.
• Referans7. Alebic MS, Bulum T, Stojanovic N, Duvnjak L. Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria. Endocrine. 2014; 47:625–30.
• Referans8. Pelusi B, Gambineri A, Pasquali R. Type 2 diabetes and the polycystic ovary syndrome. Minerva Ginecol. 2004;56:41–51
• Referans9. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease study 2013. Lancet (2014) 384:766–81.10.1016/S0140-6736(14)60460-8
• Referans10. Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab (2008) 93:162–8.10.1210/jc.2007-1834
• Referans11. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, et al. Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab (2007) 92:2500–5.10.1210/jc.2006-2725
• Referans12. Panidis D, Macut D, Tziomalos K, Papadakis E, Mikhailidis K, Kandaraki EA, et al. Prevalence of metabolic syndrome in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) (2013) 78:586–92.10.1111/cen.12008
• Referans13. Alvarez-Blasco F, Botella-Carretero JI, San Millán JL, Escobar-Morreale HF. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Arch Intern Med (2006) 166:2081–6.10.1001/archinte.166.19.2081
• Referans14. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab (1999) 84:4006–11.10.1210/jcem.84.11.6148
• Referans15. Georgopoulos NA, Saltamavros AD, Vervita V, Karkoulias K, Adonakis G, Decavalas G, et al. Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertil Steril (2009) 92:250–5.10.1016/j.fertnstert.2008.04.067
• Referans16. Moran LJ, Noakes M, Clifton PM, Wittert GA, Tomlinson L, Galletly C, et al. Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. J Clin Endocrinol Metab (2004) 89:3337–44.10.1210/jc.2003-031583
• Referans17. Harrison CL, Lombard CB, Moran LJ, Teede HJ Exercise therapy in polycystic ovary syndrome: a systematic review. Hum Reprod Update. 2011 Mar;17(2):171-83.
• Referans18. Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, Balestra V, Melchionda N, Barbara L Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss.J Clin Endocrinol Metab. 1989;68(1):173.
• Referans19. Kiddy DS, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed MJ, Franks S Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992; 36(1):105.
• Referans20. Huber-Buchholz MM, Carey DG, Norman RJ Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone.J. Clin Endocrinol Metab. 1999;84(4):1470.
• Referans21. 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 2003;81:19-25
• Referans22. Hatun Ş. Çocukluk çağında obezite ve insülin rezistansı. Turkish Journal of Endocrinology and Metabolism. 2003; 7(2):23-6 Referans23. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89:2745–9.
• Referans24. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv. 2004;59:141–54.
• Referans25. Lewy VD, Danadian K, Witchel SF, Arslanian S. Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome. J Pediatr. 2001;138:38–44.
• Referans26. Metwally M, Li TC, Ledger WL. The impact of obesity on female reproductive function. Obes Rev. 2007;8:515-523.
• Referans27. Van der Steeg JW, Steures O, Eijkemans MJ, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23:324-328.
• Referans28. Dickey RP, Taylor SN, Curole DN, Rye PH, Lu PY, Pyrzak R. Relationship of clomiphene dose and patient weight to successful treatment. Hum Reprod. 1997;12:449-453.
• Referans29. Wittemer C, Ohl J, Bailly M, Bettahar-Lebugle K, Nisand I. Does body mass index of infertile women have an impact on IVF procedure and outcome? J. Assist Reprod Genet. 2000; 17:547-552.
• Referans30. Maheshwari A, Stofberg L, Bhattacharya S. Effect of overweight and obesity on assisted reproductive technology – systematic review. Hum Reprod Update. 2007;13: 433-444.
• Referans31. Moy V1, Jindal S1,2, Lieman H1,2, Buyuk E3,4. Obesity adversely affects serum anti-müllerian hormone (AMH) levels in Caucasian women. J. Assist Reprod Genet. 2015 Sep;32(9):1305-11.
• Referans32. Buyuk E, Seifer DB, Illions E, Grazi RV, Lieman H.Elevated body mass index is associated with lower serum anti-mullerian hormone levels in infertile women with diminished ovarian reserve but not with normal ovarian reserve. Fertil Steril. 2011 Jun;95(7):2364-8.
• Referans33 .Rosenfield RL, Ehrmann DA The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited.Endocr Rev. 2016;37(5):467.
• Referans34. Dumesic DA, Akopians AL, Madrigal VK, Ramirez E, Margolis DJ, Sarma MK, Thomas AM, Grogan TR, Haykal R, Schooler TA, Okeya BL, Abbott DH, Chazenbalk GD Hyperandrogenism Accompanies Increased Intra-Abdominal Fat Storage in Normal Weight Polycystic Ovary Syndrome Women. J Clin Endocrinol Metab. 2016;101(11):4178.
• Referans35. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol (2004);103: 219-24.
• Referans36. Linné Y. Effects of obesity on women's reproduction and complications during pregnancy. Obesity Rev (2004);5: 137-43.
• Referans37. Radon PA, McMahon MJ, Meyer WR. Impaired glucose tolerance in pregnant women with polycystic ovary syndrome. Obstet Gynecol (1999);94: 194-7.
• Referans38. Balen AH, Dresner M, Scott EM, Drife JO. Should obese women with polycystic ovary syndrome receive treatment for infertility? BMJ 2006;332: 434-5. (25 February.)