Bakgrund: Polycystisk ovarialsyndrom (PCOS) är den vanligaste hormonella rubbningen hos fertila kvinnor, ändå är den okänd för många. Det finns ett flertal symtom där dessa varierar från kvinna till kvinna. Okunskap kring PCOSförekommer både i vården liksom i samhället och diagnosen kan därför vara svåratt upptäcka. Att leva med symtomen från PCOS kan påverka negativt både kroppsligt och psykiskt. Hur kvinnor med diagnosen upplever PCOS behöverlyftas fram och förståelsen för dem behöver ökas både inom vården liksom förkvinnorna med PCOS. Med ökad förståelse kan ett bättre bemötande och vård ges.Syfte: Syftet är att beskriva kvinnors upplevelser av att leva med Polycystiskovarialsyndrom. Metod: Kvalitativ metasyntes med metaetnografisk analysmetod.16 kvalitativa artiklar är inkluderade i resultatet och samtliga artiklar hargenomgått en kvalitetsgranskning. Tre databaser användes vid insamling av data; Cinahl, Medline och PubMed. Resultat: Resultatet lyfter fram att flertalet kvinnorfick diagnos efter en lång tid och där kvinnorna ibland behövde vara påstridiga,medan i andra fall diagnosticerades PCOS som bifynd. Vissa kvinnor kände inte till att deras symtom kunde vara något avvikande och sökte sig därför inte till vården. Information om PCOS från vården mötte inte alltid patienternas behov.Fertilitetsaspekten ansågs vara det som fokuserades mest på från vårdens sida ochatt de psykologiska aspekterna glömdes bort. Symtom som övervikt och hirsutism påverkade det sociala livet negativt och psykisk ohälsa är vanligt förekommande.Slutsats: PCOS behöver uppmärksammas mer och normaliseras. En mer holistiskvård där fokus inte enbart ligger på det medicinska aspekterna, utan även ser till individens behov av stöd och information hade gynnat bemötandet och vårdandet till kvinnor med PCOS. / Background: Polycystic ovary syndrome (PCOS) is the most common hormonal condition amongst fertile women, yet it is still unknown for many. There are several symptoms that may vary from woman to woman. Ignorance of polycystic ovary syndrome occurs in healthcare and in society and can be difficult to detect.Living with the symptoms of PCOS can have a negative effect both physically andmentally. How women with the diagnosis experience PCOS needs to be highlighted and the understanding of them needs to be increased, both inhealthcare and for the women with PCOS. With increased understanding, bettertreatment and care can be provided. Aim: The purpose was to describe women’sexperiences of living with Polycystic ovary syndrome. Method: Qualitative meta synthesis with meta ethnographic analysis method. A total of 16 articles wereincluded and all passed through a quality critique checklist. The articles werecollected from three databases: Cinahl, Medline and PubMed. Findings: It couldtake a long time for a diagnosis to be made and sometimes the women had to be persistent, while others could be diagnoses as an incidental finding. Some womendid not know that their symptoms were not normal and therefore did not seekmedical care. Information about PCOS from the health care did not always meetthe patient’s needs. The fertility aspect was thought to be the main focus from the health care providers and that the phycological aspects were forgotten. Symptoms like overweight and hirsutism affected the social life in a negative way and mental illness was common. Conclusion: Polycystic ovary syndrome needs to be brought more attention to and to be normalized. A more holistic care where not only the main focus is on the medical aspects of PCOS, but instead also sees that the individuals need for support and information can be met.

People who are diagnosed with or suspect endometriosis or polycystic ovary syndrome (PCOS) are rarely included in the design of reproductive health applications, leading to a lack of functions useful to this user group. Non-normative user groups in general, including those experiencing endometriosis or PCOS, are also rarely mentioned in research of reproductive health applications or Human-Computer Interaction. Based on user requests, the aim of this thesis was to design new functions within the application Read Your Body aimed at their users experiencing endometriosis or PCOS. The project consisted of an iterative design process including research for design, sketching, prototyping, and user tests. It was found that this user group mainly wanted to track their symptoms and cycle to gain health insight, and a large number of tracking options and easy customisation was requested. The design process resulted in a design prototype that includes the ability to track symptoms, triggers, self-care practices and treatments as well as visualising and exporting data for personal health insight or to communicate with others. Knowledge created on the non-normative user group, their goals for tracking, and how to design reproductive health tracking applications for non-normative users could be useful in future research and design projects. The functions designed could improve understanding of self and communication with healthcare professionals, and inform diagnosis, treatment plans and self-care practices.

Ziel der Untersuchungen war, zur Klärung der Ursachen einer während der letzten Jahrzehnte erhöhten Frequenz sowohl von PCOS als auch von IO beizutragen. Es war zu ermitteln, ob hormonelle Verschiebungen bei den Patienten nachweisbar und diese durch genetische und epigenetische Faktoren erklärbar sind. Ausgehend von dem Postulat, daß verminderte 21-OH- und 3beta-HSD-Aktivitäten als prädisponierende Faktoren von PCOS und IO angesehen werden, waren hormonanalytische Untersuchungen zur Ermittlung partieller 21-OH- bzw. 3beta-HSD-Defizienzen durchgeführt worden. Den eigenen Erfahrungen und Darstellungen der internationalen Literatur entsprechend befaßt sich ein Teil der Methodik mit der Entwicklung einer neuen, der üblichen 17alfa-OHP-Messung überlegenen Methode zur Ermittlung von 21-OH-Defizienzen durch 21-DOF-Bestimmung nach ACTH-Test im Blutplasma. Wir erhielten bei vier von 21 PCOS-Patientinnen und drei von acht Patienten mit IO erhöhte 21-DOF-, 21-DOF/F- bzw. 17alfa-OHP-Werte nach ACTH-Test, die auf partielle 21-OH-Defizienzen hinweisen. Zusätzlich wurden bei 12 PCOS-Patientinnen erhöhte basale DHEAS- oder DHEAS/F-Werte gefunden, die als Hinweise auf partielle 3beta-HSD-Defizienzen oder 17,20-Lyase-Hyperaktivität gedeutet wurden. In der Stichprobe der IO waren DHEAS oder DHEAS/F-Werte bei vier Patienten erhöht. Da bei vier der 12 Patientinnen mit PCOS und zwei von vier Patienten mit IO genetisch und endokrinologisch gleichzeitig eine partielle 21-OH-Defizienz nachgewiesen wurde, kann bei diesen Patienten eine partielle 3beta-HSD-Defizienz weitgehend ausgeschlossen werden. Es wurden molekulargenetische Untersuchungen für die 14 häufigsten Mutationen in CYP21 bei Cohorten mit AGS, PCOS und IO durchgeführt. Die Untersuchung der AGS-Patienten sollte dazu dienen, ein effizientes und schnelles System der Mutationssuche für diagnostische Zwecke zu etablieren. Es wurden die häufigsten, phänotypisch wirksamen Mutationen in CYP21 bei der Mehrzahl dieser Patientengruppe im homozygoten bzw. compound heterozygoten Zustand gefunden und eine deutliche Genotyp-Phänotyp-Korrelation festgestellt. Auch bei Patientinnen mit PCOS sowie bei IO, bei denen partielle 21-OH-Defizienzen nachweisbar waren, wurden Mutationen in CYP21 gefunden. Die hierbei heterozygot vorliegenden Mutationen waren dieselben, die homozygot oder compound heterozygot bei schweren Formen des AGS gefunden wurden. Es ergab sich eine Korrelation molekulargenetischer und hormonanalytischer Befunde bei AGS, PCOS sowie IO. Allerdings konnten bei der Mehrzahl der Fälle mit PCOS und mit IO weder Mutationen noch hormonelle Auffälligkeiten hinsichtlich partieller 21-OH-Defizienzen gefunden werden. Die jedoch bei vielen Patientinnen gefundenen erhöhten DHEAS- und DHEAS/F-Werte stimmen mit Untersuchungen überein, die parallel starke Zunahmen der Häufigkeit der Hemmung des Enzyms 3ß-HSD bzw. der Aktivierung der 17,20-Lyase bei PCOS-Patientinnen und der Prävalenz des PCOS selbst bei nach 1955 geborenen Frauen und von Spermatogenesestörungen bei nach 1960 geborenen Männern fanden. Die Ursache hierfür wird in der Beeinflussung der adrenalen und gonadalen Steroidhormonsynthese vor allem durch das Umweltteratogen DDT und seine Metaboliten gesehen. Weiterhin wurde der Umweltfaktor Streß diskutiert. Für die Ätiopathogenese der untersuchten Fertilitätsstörungen werden materno-fetale Mechanismen postuliert, worauf unsere sowohl molekulargenetischen als auch hormonanalytischen Befunde hinweisen. Insgesamt bestätigen die Ergebnisse unserer Arbeit die These, daß Leben auf der Interaktion von Genen und Umweltfaktoren beruht und daß Hormone dabei als Mediatoren wirken. In gen- oder umweltbedingten unphysiologischen Konzentrationen können sie während kritischer Entwicklungsphasen des neuroendokrinen Systems als Teratogene wirken und zu lebenslangen Reproduktionsstörungen führen. / This paper describes a mutational and hormonal screening in a cohort of 21 patients ultrasonically diagnosed with PCO. Our data show single heterozygous base pair CYP21 mutations in 4 patients. The four women with PCOS and CYP21 mutations also displayed clear signs of partial 21-hydroxylase deficiency through a significant rise in 21DOF or 17alfa-OHP plasma levels after ACTH stimulation. Azziz et al. have reported several heterozygous mutations in hyperandrogenic women with LO-CAH. Other studies report several heterozygous point mutations in hyperandrogenic woman who, however, were not examined for polycystic ovaries.The correlation between the hormone profiles and genetic screening results found with our patients underscores the latter s usefulness with PCOS patients. In contrast to the hormone profile, genetic screening is not influenced by external factors. The frequency of heterozygous CYP21 mutations is higher (19%) than in the normal population (5-8%), suggesting a link with PCOS in some cases. The ratio of LH/FSH was significantly raised in 43% of the cases. Most importantly, basal plasma DHEA-S levels and DHEA-S/F ratios were clearly increased, higher than the means +2SD in controls. This suggests a partial 3beta-hydroxysteroid dehydrogenase deficiency or 17,20 lyase hyperactivity. Other authors, however, were not able to find mutations in the corresponding genes. This could be explained by the fact that the DDT metabolite o,p DDD is a strong inhibitor of 3beta-HSD, and that DDT and its metabolites may be able to activate the 17,20 lyase, a cytochrome P450 enzyme. Furthermore, DDT has some oestrogen activity, and its perinatal administration can produce a PCOS-like syndrome in rats. Very significantly, there has not only been an approximately fourfold increased prevalence of PCO in women borne since 1955 in eastern Germany, following a massive prenatal exposure to DDT, but also a notable shift in the hormone profiles of those affected. A predominance of 3beta-HSD deficiencies and 17,20 lyase hyperactivity (70%) vs. 21-hydroxylase deficiency (23%) has emerged, in contrast with 21-hydroxylase deficiencies in 70% vs. 3beta-HSD deficiencies or 17,20 lyase hyperactivity in 14% for those born earlier than 1955. Similar results were obtained in this study for women with PCOS born since 1955, suggesting that the prenatal exposure of high amounts of DDT and its metabolites indeed appear to be responsible - at least in part - for the major increase in PCO and PCOS.

Σκοπός: η μελέτη της επίδρασης εξάμηνης θεραπείας με από του στόματος αντισυλληπτικό δισκίο περιέχον 35μg αιθινυλ-οιστραδιόλης και 2mg οξικής κυπροτερόνης στη γλοιότητα πλάσματος νέων γυναικών με σύνδρομο πολυκυστικών ωοθηκών. Σχεδίαση: Η γλοιότητα πλάσματος μετρήθηκε σε ασθενείς με σύνδρομο πολυκυστικών ωοθηκών πριν και 6 μήνες μετά από τη χορήγηση αντισυλληπτικού δισκίου περιέχοντος 35μg αιθινυλ-οιστραδιόλης και 2mg οξικής κυπροτερόνης. Η μέτρηση της γλοιότητας έγινε σε ιξωδόμετρο τύπου 53610/I SCHOTT-Instruments, Mainz στους 37ο C. Ασθενείς: Οι ασθενείς στρατολογήθηκαν από το τμήμα Αναπαραγωγικής Ενδοκρινολογίας της Μαιευτικής - Γυναικολογικής Κλινικής του Πανεπιστημιακού Νοσοκομείου Πατρών Ελλάδας. Στη μελέτη περιλήφθηκαν 66 νέες γυναίκες με σύνδρομο πολυκυστικών ωοθηκών. Βασικοί προσδιορισμοί: Γλοιότητα πλάσματος Αποτελέσματα: Στις ασθενείς ως σύνολο, η γλοιότητα πλάσματος ήταν 1.249±0.049 mm2/s (n=66). Μετά από 6 μήνες θεραπείας με από του στόματος αντισυλληπτικό δισκίο περιέχον 35μg αιθινυλ-οιστραδιόλης και 2mg οξικής κυπροτερόνης, η γλοιότητα πλάσματος αυξήθηκε σε 1.268±0.065 mm2/s (p=0.038). Η διαφορά στη γλοιότητα πλάσματος πριν και 6 μήνες μετά τη θεραπεία (Δ Γλοιότητας) ήταν 0,01864±,071452 mm2/s. Η Δ Γλοιότητας σχετιζόταν με τη Δ Ινωδογόνου (r=0.270, p=0.046), τη Δ Αιματοκρίτη (r=0.514, p=0.09) και τη Δ Τριγλυκεριδίων (r=0.292, p=0.021). Συμπέρασμα: Νέες γυναίκες με σύνδρομο πολυκυστικών ωοθηκών εμφάνισαν αυξημένη γλοιότητα πλάσματος μετά από θεραπεία με από του στόματος αντισυλληπτικό, το οποίο θα πρέπει για το λόγο αυτό να χρησιμοποιείται με προσοχή στον εν λόγω πληθυσμό. / Objectives: To investigate the influence of 6 months of treatment with an oral contraceptive (OC) containing 35μg ethinyl estradiol and 2mg cyproterone acetate on plasma viscosity in young women with PCOS. Design: PCOS patients were assessed for plasma viscosity before and after 6 months of treatment with an OC containing 35μg ethinyl estradiol and 2mg cyproterone acetate. Plasma viscosity was determined by a viscometer Type 53610/I SCHOTT-Instruments, Mainz at 37o C. Settings: Subjects were recruited from the Department of Obstetrics and Gynaecology, Division of Reproductive Endocrinology at the University Hospital of Patras, Greece. Patients: The study included 66 young PCOS women. Main Outcome measures: Plasma viscosity. Results: In PCOS women as a whole, plasma viscosity at baseline was 1.249±0.049 mm2/s (n=66). After 6 months of treatment with an oral contraceptive containing 35μg ethinyl estradiol and 2mg cyproterone acetate, plasma viscosity increased to 1.268±0.065 mm2/s (p=0.038). The difference between plasma viscosity before and after 6 months of treatment with an oral contraceptive containing 35μg ethinyl estradiol and 2mg cyproterone acetate (Δviscosity) was 0,01864±,071452 mm2/s. Δviscosity was related to Δfibrinogen (r=0.270, p=0.046), to Δhaematocrit (r=0.514, p=0.09) and to Δtriglycerides (r=0.292, p=0.021). Conclusion: Young PCOS women presented an increased plasma viscosity under OC treatment, which therefore should be used with caution.

Objetivo:Comparar a eficácia dos meios de cultivo HTF (Human Tubal Fluid) e TCM 199 (Tissue Culture Medium) na maturação in vitro. Métodos:Estudo experimental controlado e randomizado no qual foram avaliadas as taxas de maturação oocitária, fertilização, clivagem e produção de embriões de boa qualidade em 23 ciclos não estimulados de maturação oocitária, com 119 oócitos coletados, de 13 mulheres com Síndrome dos Ovários Policísticos. Os oócitos de cada paciente foram transferidos randomicamente para cada um dos meios de cultivo sendo que, 61 (51%) foram colocados no meio TCM 199 e 58 (49%) no meio HTF. Os dois meios de cultivo receberam suplementação hormonal. Resultados:Diferenças significativas foram encontradas entre os meios de cultivo TCM 199 e HTF em relação à taxa de maturação oocitária (82% vs. 56.9%, p = 0.005), taxa de fertilização (70% vs. 39.4%, p = 0.007) e taxade produção de embriões de boa qualidade (81.3% vs. 41.7%, p= 0.023). Conclusão:O meio de cultivo HTF embora seja utilizado para manutenção de embriões em técnicas de fertilização assistida e em procedimentos de maturação in vitrocom ciclos estimulados, não é o meio mais apropriado paramaturação de oócitos obtidos de mulheres com Síndrome dos Ovários policísticosem ciclos não estimulados. / Objective:Compare oocytes human culture in human tubal fluid (HTF) and Tissue Culture Medium (TCM 199) invitromaturation cycles. Methods:Randomized controlled trial which oocyte maturation, fertilization, cleavage rates and embryo quality in 23 in vitromaturation cycles no stimulation were evaluated, resulting in 119 oocytes retrieved from 13 patients withpolycystic ovarian syndrome. The oocytes from each patient were assigned randomly to the two culture media, 61 (51%) to the TCM 199 and 58 (49%) to the HTF using the same hormonal supplementation. Results:Significant differences were observed between TCM 199 and HTF regarding maturation rate (82% vs. 56.9%, p = 0.005), fertilization rate (70% vs. 39.4%, p = 0.007) rates and embryo quality (81.3% vs. 41.7%, p= 0.023). Conclusion:The HTF medium, although widely employed for oocyte fertilization and embryo maintenance in IVF techniques, is not an appropriated medium to maturation oocytes obtained from PCOS patients innon - stimulated cycles.

INTRODUÇÃO - A síndrome dos ovários policísticos (SOP) é uma das mais controversas entidades da endocrinologia ginecológica. Após o simpósio de Rotterdam, em 2003, ficou evidente a importância da morfologia ovariana para o diagnóstico e para a composição dos fenótipos. A ultra-sonografia transvaginal com dopplervelocimetria pode ajudar a analisar as variáveis implicadas na vascularização e a monitorar os ovários. OBJETIVO - Avaliar o volume, a espessura do estroma e a vascularização dos ovários de mulheres com SOP. MÉTODO - Estudo prospectivo com cinqüenta mulheres que foram divididas em dois grupos (grupo SOP: n=30 e grupo Normal: n=20) e submetidas à ultra-sonografia transvaginal com Dopplervelocimetria, entre o terceiro e sexto dias do ciclo menstrual, para a avaliação do volume e da espessura do estroma do ovário e dos índices de resistência (IR) e pulsatilidade (IP) nas artérias uterinas, artérias ovarianas e vasos do estroma. RESULTADOS - No grupo SOP, o volume ovariano e a espessura do estroma ovariano foram significativamente maiores. Também o IR e o IP das artérias uterinas e ovarianas foram significativamente maiores. Já o IR e o IP dos vasos do estroma foram significativamente menores no grupo SOP, em comparação com o grupo Normal. CONCLUSÃO - As mulheres com SOP, em relação às mulheres normais, têm aumento do volume e da espessura do estroma dos ovários. Também apresentam diminuição do fluxo ovariano; porém, com aumento da vascularização do estroma. / INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most controversial conditions in gynecological endocrinology. After the symposium in Rotterdam in 2003, the importance of ovary morphology has become evident for the diagnosis and the composition of phenotypes. Transvaginal ultrasound with Doppler velocimetry can help us analyze the variables implied in vascularization and monitor the ovaries of women with PCOS. METHOD: Prospective study with 50 women who were divided into 2 groups (PCOS group: n=30 and Normal group = 20), submitted to transvaginal ultrasound with doppler velocimetry between the third and sixth day of the monthly period to assess size and thickness of ovarian stroma and index of resistance (IR) and pulsatility (IP) of uterine arteries, ovarian arteries and stromal vessels. RESULTS: In the PCOS group, ovarian size and thickness of ovarian stroma were significantly greater. Uterine and ovarian arteries IR and IP were significantly higher. IR and IP of stromal vessels were significantly lower in the PCOS group relative to the Normal group. CONCLUSION: PCOS female patients compared to normal women have increase size and thickness of ovarian stroma. They also present reduced ovarian flow, but there is increased vascularization of the stroma.

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting reproductive aged women, with reproductive, metabolic and cardiovascular implications across the life span. The typical features of PCOS include irregular menstruation, androgen excess and polycystic ovaries in ultrasonography. The majority of women with PCOS are overweight or obese, and, at least partly, obesity-driven metabolic abnormalities often coexist with PCOS. Despite intensive research, it has remained unclear whether PCOS per se is a risk factor of metabolic abnormalities, and cardiovascular disease and events. The main aim of the current work was to investigate whether PCOS is an independent risk factor of metabolic abnormalities and cardiovascular diseases. The study population consisted of the prospective population-based Northern Finland Birth Cohort 1966, and we used data collected at ages 14, 31 and 46. The definition of PCOS was based on self-reported PCOS symptoms at age 31 and/or PCOS diagnosis by age 46. The results revealed that weight gain in early life was a risk factor for the development of PCOS. As for metabolic outcomes, at age 46, normal-weight women with PCOS did not display increased odds of abnormal glucose metabolism. However, weight gain during early adulthood was significantly associated with abnormal glucose metabolism in women with PCOS by age 46. Interestingly, PCOS per se was already associated with elevated blood pressure at age 31 and hypertension at age 46, independently of obesity. Women with PCOS also displayed reduced cardiac vagal activity, which was associated with metabolic abnormalities and hypertension. Furthermore, even though no major anatomical or functional impairments were observed in echocardiography, women with PCOS displayed a significantly greater prevalence of myocardial infarction and a two-fold higher prevalence of cardiovascular events than controls. In conclusion, our findings indicate that even though PCOS is an independent risk factor of metabolic derangements, related obesity is a major metabolic risk factor in these women. The role of PCOS in cardiovascular events per se remains controversial and requires follow-up of this cohort. Given all this, maintaining normal weight and preventing weight gain, especially during early adulthood, should be the main priority in the prevention of adverse metabolic changes in women with PCOS. / Tiivistelmä Munasarjojen monirakkulaoireyhtymä (polycystic ovary syndrome, PCOS) on lisääntymisikäisten naisten yleisin hormonaalinen häiriö aiheuttaen runsaasti sairastavuutta ja terveydenhuollon kustannuksia. PCOS:n diagnostisiin kriteereihin kuuluvat epäsäännöllinen kuukautiskierto, lisääntynyt miessukupuoli-hormonivaikutus sekä monirakkulaiset munasarjat. Merkittävä osa oireyhtymää sairastavista naisista on ylipainoisia tai lihavia ja oireyhtymän kanssa yhtä aikaa esiintyykin useita, ainakin osittain ylipainosta johtuvia, metabolisia häiriöitä. Lukuisista tutkimuksista huolimatta on kuitenkin epäselvää, altistaako PCOS itsessään metabolisille häiriöille sekä sydän- ja verisuonisairauksille. Väitöskirjatutkimuksen tavoitteena oli selvittää, onko PCOS itsenäinen metabolisten ja sydän- ja verisuonisairauksien riskiä lisäävä tekijä. Tutkimus pohjautui Pohjois-Suomen syntymäkohortti 1966 tutkimuksen 14-, 31- ja 46-vuotisseurantoihin. PCOS luokittelu perustui 31- ja 46-vuotiskyselyissä itse ilmoitettuihin tyypillisiin PCOS oireisiin ja/tai diagnoosiin. Tutkimuksessa havaittiin, että 14- ja 31-ikävuoden välillä tapahtuva painonnousu oli yhteydessä PCOS diagnoosiin myöhemmällä iällä. 46-vuotiaana normaalipainoisilla PCOS naisilla ei ollut suurentunut tyypin 2 diabetes riski, mutta painonnousu varhaisaikuisuudessa oli merkittävästi yhteydessä sokeriaineenvaihdunnan häiriöön PCOS naisilla. PCOS oli yhteydessä kohonneeseen verenpaineeseen 31-vuotiaana ja hypertensioon 46-vuotiaana ylipainosta riippumatta. Oireyhtymään liittyvät metaboliset häiriöt olivat tärkein sydämen autonomisen hermoston säätelyyn vaikuttava tekijää, kun taas PCOS itsessään ei vaikuttanut autonomisen hermoston toimintaan. PCOS:ään sairastavien naisten sydämen rakenne ja funktio eivät merkitsevästi poikenneet kontrolloiden vastaavista muuttujista. Kuitenkin suhteellisen nuoresta iästä huolimatta PCOS naisilla esiintyi enemmän sydäninfarkteja ja kaksi kertaa enemmän sydän- ja verisuonitapahtumia, kuin kontrolleilla. Tutkimuksen tulokset osoittavat, että vaikkakin PCOS on itsenäinen riskitekijä metabolisille häiriöille, oireyhtymään liittyvä ylipaino vaikuttaa merkittävästi metabolisten häiriöiden esiintymiseen. PCOS:n ja sydän- ja verisuonitautitapahtumien yhteyden tarkempi tutkiminen vaatii kohortin jatkoseurantaa. Painonhallinnan tukemisen tulisi olla PCOS:ää sairastavien naisten hoidon kulmakivi.

Objetivo:Comparar a eficácia dos meios de cultivo HTF (Human Tubal Fluid) e TCM 199 (Tissue Culture Medium) na maturação in vitro. Métodos:Estudo experimental controlado e randomizado no qual foram avaliadas as taxas de maturação oocitária, fertilização, clivagem e produção de embriões de boa qualidade em 23 ciclos não estimulados de maturação oocitária, com 119 oócitos coletados, de 13 mulheres com Síndrome dos Ovários Policísticos. Os oócitos de cada paciente foram transferidos randomicamente para cada um dos meios de cultivo sendo que, 61 (51%) foram colocados no meio TCM 199 e 58 (49%) no meio HTF. Os dois meios de cultivo receberam suplementação hormonal. Resultados:Diferenças significativas foram encontradas entre os meios de cultivo TCM 199 e HTF em relação à taxa de maturação oocitária (82% vs. 56.9%, p = 0.005), taxa de fertilização (70% vs. 39.4%, p = 0.007) e taxade produção de embriões de boa qualidade (81.3% vs. 41.7%, p= 0.023). Conclusão:O meio de cultivo HTF embora seja utilizado para manutenção de embriões em técnicas de fertilização assistida e em procedimentos de maturação in vitrocom ciclos estimulados, não é o meio mais apropriado paramaturação de oócitos obtidos de mulheres com Síndrome dos Ovários policísticosem ciclos não estimulados. / Objective:Compare oocytes human culture in human tubal fluid (HTF) and Tissue Culture Medium (TCM 199) invitromaturation cycles. Methods:Randomized controlled trial which oocyte maturation, fertilization, cleavage rates and embryo quality in 23 in vitromaturation cycles no stimulation were evaluated, resulting in 119 oocytes retrieved from 13 patients withpolycystic ovarian syndrome. The oocytes from each patient were assigned randomly to the two culture media, 61 (51%) to the TCM 199 and 58 (49%) to the HTF using the same hormonal supplementation. Results:Significant differences were observed between TCM 199 and HTF regarding maturation rate (82% vs. 56.9%, p = 0.005), fertilization rate (70% vs. 39.4%, p = 0.007) rates and embryo quality (81.3% vs. 41.7%, p= 0.023). Conclusion:The HTF medium, although widely employed for oocyte fertilization and embryo maintenance in IVF techniques, is not an appropriated medium to maturation oocytes obtained from PCOS patients innon - stimulated cycles.

<p>Uvod: Ftalati su vrsta endokrinih disruptora koji se &scaron;iroko koriste kao plastifikatori i rastvarači ali i kao aditivi brojim proizvodima koji se svakodnevno koriste. Prema dosada&scaron;njim studijama na eksperimentalnim životinjama, ali i u humanoj populaciji, diestri ftalne kiseline utiču na reproduktivni sistem, učestvuju u nastanku insulinske rezistencije i gojaznosti. Sindrom policističnih ovarijuma (PCOS) je najče&scaron;ći endokrinolo&scaron;ki poremećaj reproduktivnog sistema žena u generativnom periodu. Insulinska rezistencija i centralna gojaznost, kao faktori kardiometaboličkog sindroma imaju značajnu ulogu u etiologiji PCOS. Ciljevi: Utvrditi prisustvo metabolita ftalne kiseline kod žena u reproduktivnom periodu u na&scaron;oj sredini, kao i da li postoji povezanost ovih endokrinih disruptora sa antropometrijskim parametrima, parametrima glikoregulacije, lipidima i lipoproteinima seruma, gonadotropinima, polnim hormonima, leptinom i indeksima kardiometaboličkog rizika kod žena sa sindromom policističnih jajnika. Metode: Istraživanje je obuhvatalo 61 ženu sa sindromom policističnih jajnika koje su podeljene u dve podgrupe: 31 ispitanica sa PCOS i prisutnim ftalatnim metabolitima u urinu i 30 ispitanica sa PCOS bez ftalatnih metabolita u urinu. Kontrolnu grupu je činilo 30 zdravih žena. Kod svih ispitanica vr&scaron;ena su antropometrijska merenja (TV, TM, OS) i određivane vrednosti parametara glikoregulacije (glikemija i insulinemija, izačunat je HOMA index), lipidi i lipoproteini seruma (ukupan holesterol, trigliceridi, LDL i HDL holesterol), gonadotropini (LH i FSH), polni hormoni (estradiol i testosteron) i leptin. U proceni kardiometaboličkog rizika kori&scaron;ćena su dva indeksa LAP i VAI. Iz jutarnjeg uzorka urina određivano je prisustvo i koncentracija 10 ftalatnih metabolita: Mono-metil ftalat- MMP, Mono-etil ftalat - MEP, Mono-n-butil ftalat - MBP, Mono-n-propil ftalat- MPP, Mono-izo-amil ftalat - MiAP, Mono-n-amil ftalat - MnAP, Mono-cikloheksil ftalat - MCHP, Monobenzil ftalat- MBzP, Mono-(2-etilheksil) ftalat- MHEP, Mono-n-octil ftalat-MOP. Za statističku obradu podataka kori&scaron;ćeni su odgovarajući parametarski i neparametarski testovi. Rezultati: Kod 51 % ispitanica sa PCOS potvrđeno je prisustvo ftalatnih metabolita u urinu. Najzastupljeniji ftalatni metabolit je bio MEHP, zatim MEP, ali je potvrđeno i prisustvo MMP, MPP i MOP. Kod ispitanica sa PCOS su potvrđene statistički značajne korelacije između ukupnih ftalatnih metabolita i BMI, obima struka, glikemije, insulinemije, HOMA indeksa, ukupnog holesterola, triglicerida, LDL holesterola, leptina i testosterona. Analizom pojedinačnih ftalatnih metabolita utvrđene su pozitivne korelacije između MMP i obima struka, parametara glukoznog metabolizma, ukupnog holesterola, LDL holesterola, triglicerida, LAP i VAI indeksa. Zaključak: Kod žena sa PCOS u reproduktivnom periodu u na&scaron;oj sredini je potvrđeno prisustvo ftalanih metabolita. Najvi&scaron;e koncentracije su verifikovane za MEHP i MEP, ukazujući na visoku ekspoziciju di-etilheksil ftalatu (DEHP) i di-etil ftalatu (DEP). Ukupni ftalati značajno povećavaju vrednosti parametara koje učestvuju u razvoju metaboličkog sindroma kod PCOS, ali i povećavaju kardiovaskularni rizik ovih bolesnica. Direktna, značajna veza je potvrđena između MMP i testosterona, parametara i indeksa kardiometaboličkog sindroma.</p> / <p>Introduction: Phthalates are a type of endocrine disruptor widely used as plasticizers and solvents but also as additives to many products that are used daily. According to previous studies in experimental animals, but also in the human population, phthalic diesters affect the reproductive system, participate in the onset of insulin resistance and obesity. Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of the reproductive system of women in the generative period. Insulin resistance and central obesity, as factors of cardiometabolic syndrome, have a significant role in the etiology of PCOS. Objectives: To determine the presence of phthalic acid metabolites in women in the reproductive period in our environment, and whether there is a connection between these endocrine disruptors with anthropometric parameters, glycoregulation parameters, lipids and serum lipoproteins, gonadotrophins, sex hormones, leptin and indexes of cardiometabolic risk in women with polycystic ovarian syndrome. Methods: The study included 61 women with polycystic ovarian syndrome divided into two subgroups: 31 subjects with PCOS and present phthalate metabolites in urine and 30 subjects with PCOS without phthalate metabolites in urine. The control group consisted of 30 healthy women. In all subjects, anthropometric measurements were carried out (TV, TM, WC) and the values of glycoregulation parameters (glycemia and insulinemia, HOMA index), lipids and serum lipoproteins (total cholesterol, triglycerides, LDL I HDL cholesterol), gonadotropins FSH), sex hormones (estradiol and testosterone) and leptin. In the assessment of cardiometabolic risk LAP and VAI indexes were determined. From the morning urine sample, the presence and concentration of 10 phthalate metabolites were determined: Mono-methyl phthalate-MMP, Mono-ethyl phthalate-MEP, Mono-n-butyl phthalate-MBF, Mono-n- propyl phthalate- MPP, Mono-iso-amyl phthalate &ndash; MiAP, Mono-n-amyl phthalate &ndash; MnAP, Mono-cyclohexyl phthalate-MCHP, Monobenzyl phthalate-MBzP, Mono- (2-ethylhexyl) phthalate-MHEP, Mono-n-octyl phthalate-MOP. For statistical data processing, appropriate parametric and non-parametric tests were used. Results: 51% of subjects with PCOS confirmed the presence of phthalate metabolites in urine. The most common phthalate metabolite was MEHP, then MEP, but the presence of MMP, MPP and MOP also was confirmed. In subjects with PCOS, a statistically significant correlations between total phthalate metabolites and BMI, waist circumference, glycemia, insulinemia, HOMA index, total cholesterol, triglyceride, LDL cholesterol, leptin and testosterone were confirmed. By analyzing individual phthalate metabolites, a positive correlations between MMP and waist circumference, glycoregulation parameters, total cholesterol, LDL cholesterol, triglyceride, testosterone and LAP and VAI index were determined. Conclusion: In women with PCOS in the reproductive period, the presence of phthalic metabolites in our environment was confirmed. The highest concentrations were verified for MEHP and MEP, indicating a high exposure of DEHP and DEP. Total phthalates significantly increase the values of parameters involved in the development of metabolic syndrome in PCOS, but also increase the cardiovascular risk of these patients. A direct, significant association was confirmed between MMP and testosterone, parameters and index of cardiometabolic syndrome.</p>

INTRODUÇÃO - A síndrome dos ovários policísticos (SOP) é uma das mais controversas entidades da endocrinologia ginecológica. Após o simpósio de Rotterdam, em 2003, ficou evidente a importância da morfologia ovariana para o diagnóstico e para a composição dos fenótipos. A ultra-sonografia transvaginal com dopplervelocimetria pode ajudar a analisar as variáveis implicadas na vascularização e a monitorar os ovários. OBJETIVO - Avaliar o volume, a espessura do estroma e a vascularização dos ovários de mulheres com SOP. MÉTODO - Estudo prospectivo com cinqüenta mulheres que foram divididas em dois grupos (grupo SOP: n=30 e grupo Normal: n=20) e submetidas à ultra-sonografia transvaginal com Dopplervelocimetria, entre o terceiro e sexto dias do ciclo menstrual, para a avaliação do volume e da espessura do estroma do ovário e dos índices de resistência (IR) e pulsatilidade (IP) nas artérias uterinas, artérias ovarianas e vasos do estroma. RESULTADOS - No grupo SOP, o volume ovariano e a espessura do estroma ovariano foram significativamente maiores. Também o IR e o IP das artérias uterinas e ovarianas foram significativamente maiores. Já o IR e o IP dos vasos do estroma foram significativamente menores no grupo SOP, em comparação com o grupo Normal. CONCLUSÃO - As mulheres com SOP, em relação às mulheres normais, têm aumento do volume e da espessura do estroma dos ovários. Também apresentam diminuição do fluxo ovariano; porém, com aumento da vascularização do estroma. / INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most controversial conditions in gynecological endocrinology. After the symposium in Rotterdam in 2003, the importance of ovary morphology has become evident for the diagnosis and the composition of phenotypes. Transvaginal ultrasound with Doppler velocimetry can help us analyze the variables implied in vascularization and monitor the ovaries of women with PCOS. METHOD: Prospective study with 50 women who were divided into 2 groups (PCOS group: n=30 and Normal group = 20), submitted to transvaginal ultrasound with doppler velocimetry between the third and sixth day of the monthly period to assess size and thickness of ovarian stroma and index of resistance (IR) and pulsatility (IP) of uterine arteries, ovarian arteries and stromal vessels. RESULTS: In the PCOS group, ovarian size and thickness of ovarian stroma were significantly greater. Uterine and ovarian arteries IR and IP were significantly higher. IR and IP of stromal vessels were significantly lower in the PCOS group relative to the Normal group. CONCLUSION: PCOS female patients compared to normal women have increase size and thickness of ovarian stroma. They also present reduced ovarian flow, but there is increased vascularization of the stroma.