Article

Age-related differences in features associated with polycystic ovary syndrome in normogonadotrophic oligo-amenorrhoeic infertile women of reproductive years

Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
European Journal of Endocrinology (Impact Factor: 3.69). 01/2002; 145(6):749-55. DOI: 10.1530/eje.0.1450749
Source: PubMed

ABSTRACT To assess the effect of age on clinical, endocrine and sonographic features associated with polycystic ovary syndrome (PCOS) in normogonadotrophic anovulatory infertile women of reproductive years.
Cross-sectional study.
Four hundred and seventy-two oligo-amenorrhoeic infertile patients, presenting with normal FSH and oestradiol concentrations, aged 17-42 years underwent a standardised initial evaluation including: cycle history, body mass index, waist-to-hip ratio and transvaginal ultrasound scanning of ovaries. Fasting blood samples were obtained for extensive endocrine evaluation. Cycle duration, serum levels of gonadotrophins, androgens, oestradiol, insulin, glucose, inhibin B as well as mean number of follicles, ovarian volume and ovarian stroma echogenicity were assessed.
Older women had significantly lower LH and androgen and inhibin B serum levels. Similarly, older women presented with a reduced number of ovarian follicles. Age was inversely correlated with cycle duration (r=-0.112, P=0.02), LH (r=-0.154, P=0.001), testosterone (r=-0.194, P=0.001), androstenedione (r=-0.170, P=0.001), dehydroepiandrosterone (r=-0.157, P=0.001), insulin (r=-0.126, P=0.02), inhibin B (r=-0.118, P=0.03) serum levels and mean follicle number (r=-0.100, P=0.03). A positive correlation was observed between age and glucose to insulin ratio (r=0.138, P=0.009).
Advanced age in normogonadotrophic anovulatory infertile women is associated with lower LH and androgen levels and with a decreased number of ovarian follicles. Although during reproductive years observed differences are relatively small, these age-related changes may affect the observed incidence of PCOS.

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    • "Inhibin B is a marker of ovarian antral follicle cohort in PCOS (Bili et al., 2001) and eumenorrheic women (Danforth et al., 1998). Bili et al. (2001) found an age-related reduction in the number of antral follicles and a decrease in inhibin B in 472 PCOS patients and Elting, in 27 women found an age-related reduction in inhibin B increment during FSH-stimulated ovarian reserve testing (Elting et al., 2001). However, Piltonen et al. (2004) found unchanged age-related inhibin B levels in 42 women with PCOS. "
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    • "Furthermore, it has been reported previously that cycle irregularities improve with increasing age (Dahlgren et al., 1992; Elting et al., 2000; Bili et al., 2001), possibly associated with a decrease in the follicle cohort size (Elting et al., 2003). Although no information is available regarding the age of menopause in women with WHO 2 anovulation, it has been shown in a cross-sectional study that advanced age is associated with lower LH and androgen levels in this group (Bili et al., 2001), as could be confirmed for the androgens in the current longitudinal study. Both oocyte quantity and quality dictate the subsequent reproductive events including decrease of fertility, increased abortion rate, the end of fertility, the beginning of cycle irregularity and, when almost no follicles are left, the occurrence of menopause (te Velde et al., 1998). "
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