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      Síndrome de ovario poliquístico, endometrio y riesgo de aborto Translated title: Polycystic ovarian syndrome, endometrium and abortion risk

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          Abstract

          El síndrome de ovario poliquístico (SOP) es la endocrinopatía más frecuente en mujeres en edad reproductiva, se observa en el 5-7% de ellas. El diagnóstico se hace ante la presencia de por lo menos dos componentes de la triada: oligoovulación, hiperandrogenismo y ovarios poliquísticos. Estas mujeres tienen niveles elevados de lutropina (LH), hiperinsulinemia e hiperandrogenismo y se ha reportado un aumento en la incidencia de aborto en este grupo de pacientes. Este hecho podría estar relacionado con los cambios endometriales observados en estas mujeres y que se asocian a niveles elevados de andrógenos e insulina, provocando así, inadecuada implantación y probablemente mayor pérdida del embarazo en el primer trimestre. Medidas terapéuticas, como el uso de sensibilizantes a la acción de la insulina, que contribuyen a disminuir los niveles de insulina y por lo tanto de andrógenos, podrían tener un efecto favorable al disminuir la incidencia de aborto en pacientes con SOP.

          Translated abstract

          Polycystic ovarian syndrome is the most frequent endocrinopathy in reproductive age women (5-7%). The diagnosis is made when two out of three components are present, such as hyperandrogenism, polycystic ovaries and oligoovulation. These women have high levels of luteinizing hormone (LH), hyperisulinemia and hyperandrogenism and an increased rate of abortion has been reported in these patients. This fact could be related to changes found in the endometrium and the elevated serum levels of androgens and insulin. These changes can lead to an inadequate implantation and probably to an increase in first trimester pregnancy losses. Therapeutic approaches such as the use of insulin-sensitizing drugs to decrease insulin levels could be useful in decreasing abortion rates in these patients.

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          Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment.

          To determine the prevalence of insulin resistance (IR) in a large population of patients with the polycystic ovary syndrome (PCOS). Prospective, case-control. University medical center. Two hundred seventy-one PCOS patients and 260 eumenorrheic, non-hirsute, control women. History and physical examination and blood sampling. Total T, free T, DHEAS, sex hormone-binding globulin, and fasting glucose and insulin levels; homeostatic model assessment values for IR (HOMA-IR) and percent beta-cell function (HOMA-%beta-cell). Patients with PCOS and controls differed significantly in all parameters studied, except fasting glucose. Because the HOMA-IR and HOMA-%beta-cell values were variably associated with race, age, and body mass index, the HOMA-IR and HOMA-%beta-cell values were then adjusted for these cofounders. After adjustment, 64.4% of PCOS patients were noted to be insulin resistant, and 2.6% had beta-cell dysfunction. Compared with PCOS patients without IR (n = 96), patients with IR (n = 174) were more obese and had higher beta-cell function. In patients with PCOS, the prevalence of IR was 64% according to the HOMA-IR measurement, after adjustment. Patients with IR were more clinically affected. Although IR is a common abnormality in PCOS, it does not seem to be a universal feature.
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            Potential biochemical markers of uterine receptivity.

            Implantation in humans is a complex process that involves embryo apposition and attachment to the maternal endometrial epithelium, traversing adjacent cells of the epithelial lining, and invasion into the endometrial stroma. These processes involve a variety of molecules which are not unique in themselves, but play unique roles in the process of implantation. The molecular dialogue that occurs between the implanting conceptus and the endometrium involves cell-cell and cell-extracellular matrix interactions, mediated by lectins, integrins, matrix degrading enzymes and their inhibitors, prostaglandins, and a variety of growth factors, cytokines, and angiogenic peptides, their receptors and modulatory proteins. It is likely that each of these, when appropriately expressed or inhibited, contributes to endometrial receptivity or non-receptivity to an implanting conceptus. Currently, a working definition of a receptive versus a non-receptive endometrium is incomplete. While histological normality of the endometrium does not necessarily imply functional normality, temporal and spatial expression of particular biochemical principles in the endometrium are highly suggestive of functional roles of these principles in implantation and endometrial receptivity. These potential markers of endometrial receptivity are discussed herein. It is envisioned that as regulation of these markers is elucidated, their expression may be manipulated to improve implantation rates and fertility or to limit implantation for successful contraception.
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              Metformin administration modulates and restores luteinizing hormone spontaneous episodic secretion and ovarian function in nonobese patients with polycystic ovary syndrome

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                Author and article information

                Contributors
                Role: ND
                Journal
                rcog
                Revista Colombiana de Obstetricia y Ginecología
                Rev Colomb Obstet Ginecol
                Federación Colombiana de Obstetricia y Ginecología (Bogotá )
                0034-7434
                December 2005
                : 56
                : 4
                : 303-309
                Affiliations
                [1 ] Universidad del Tolima Colombia
                Article
                S0034-74342005000400006
                a71b53ae-9e66-43c3-b82a-3affdd17e76c

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0034-7434&lng=en
                Categories
                OBSTETRICS & GYNECOLOGY

                Obstetrics & Gynecology
                polycystic ovarian syndrome,endometrium,abortion,insulin,síndrome de ovario poliquístico,aborto,endometrio,insulina

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