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Title: Oligo/amenorrhoea : endocrine profiles, ovarian ultrasound, insulin resistance and anthropometric factors : relationships between insulin resistance and ovarian function
Author: Al-Zekri, Huda
ISNI:       0000 0001 3407 6298
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1997
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There is a lack of longitudinal studies of infertile patients with oligo/amenorrhoea examining changes in hormone concentrations and ovarian morphology. In this prospective longitudinal study, women with oligo/amenorrhoea (n = 42) were studied in detail and compared with a weight-matched group of regularly menstruating females (n = 20). Women with oligo/amenorrhoea exhibited an insignificant increase in body weight (BMI) but truncal-abdominal fat (WHR) was significantly higher than that of the control group. The mean basal FSH concentrations were similar in both the groups; E2 and SHBG concentrations were lower, and LH, T and FAI were significantly higher in patients than in controls. The comparison of the mean follicular phase endocrine profile during the 5-week window of observations, showed that the ovary was in a dynamic state, even in the absence of follicular growth and ovulation, and that E2, LH, T and consequently FAI were variable, both between and within patients. The mean follicular phase SHBG concentration was the most stable endocrine variable, and SHBG was also the only endocrine parameter able to distinguish between ovulatory and anovulatory cycles. Significantly higher concentrations of SHBG were found in spontaneously occurring ovulatory cycles of patients in comparison to those in patients who were anovulatory during the period of observation; the former group SHBG levels were compatible with the levels of controls measured in the follicular phase. The dynamic test for measurement of insulin resistance (IR), the SITT, was carried out twice in patients with oligo/amenorrhoea (n = 34) and in controls (n = 20). The SITT yielded similar KITT-values in patients and controls, there was considerable within patient variation and no relationship with anthropometric variables. Fasting I, GLU/INS ratio and FIRI (log10 FIRI) appeared to be better markers of IR than the KITT-value in patients with oligo/amenorrhoea, as they showed the significant expected relationships with anthropometric variables, especially WHR. The differences in IR between the groups appeared to be related to body mass differences as they disappeared after controlling for anthropometric variables. These studies showed that women with oligo/amenorrhoea, showed dynamic changes in ovarian and biochemical / endocrine parameters when examined serially. These changes were independent of ovulation and did not appear to be directly related to any of the metabolic parameters. The only parameter which was significantly linked to ovulation was SHBG. The results of these studies improve our insight into oligo/amenorrhoea and the associated PCOD and mean that in future any investigations performed on such patients should involve serial rather than single observations.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: Infertility; Heart disease; Menstruation