Journal
AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM
Volume 286, Issue 4, Pages E615-E620Publisher
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/ajpendo.00377.2003
Keywords
fertility; ovarian cycle; sex hormones; body fat distribution; gonadotropins
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Funding
- NCRR NIH HHS [RR M01 00585] Funding Source: Medline
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The present study tests the hypothesis that specific endocrine, metabolic, and anthropometric features distinguish obese women with polycystic ovary syndrome ( PCOS) who resume ovulation in response to calorie restriction and weight loss from those who do not. Fifteen obese ( body mass index 39 +/- 7 kg/m(2)) hyperandrogenemic oligoovulatory patients undertook a very low calorie diet (VLCD), wherein each lost greater than or equal to 10% of body weight over a mean of 6.25 mo. Body fat distribution was quantitated by magnetic resonance imaging. Hormones were measured in the morning at baseline, after 1 wk of VLCD, and after 10% weight loss. To monitor LH release, blood was sampled for 24 h at 10-min intervals before intervention and after 7 days of VLCD. Responders were defined a priori as individuals exhibiting two or more ovulatory cycles in the course of intervention, as corroborated by serum progesterone concentrations greater than or equal to 18 nmol/l followed by vaginal bleeding. At baseline, responders had a higher sex hormone-binding globulin ( SHBG) concentration but were otherwise indistinguishable from nonresponders. Body weight, the size of body fat depots, and plasma insulin levels declined to a similar extent in responders and nonresponders. Also, SHBG increased, and the free testosterone index decreased comparably. However, responders exhibited a significant decline of circulating estradiol concentrations ( from 191 +/- 82 to 158 +/- 77 pmol/l, means +/- SD, P = 0.037) and a concurrent increase in LH secretion ( from 104 +/- 42 to 140 +/- 5 U . l(-1) . day(-1), P = 0.006) in response to 7 days of VLCD, whereas neither parameter changed significantly in nonresponders. We infer that evidence of retention of estradiol-dependent negative feedback on LH secretion may forecast follicle maturation and ovulation in obese patients with PCOS under dietary restriction.
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