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Journal of Ovarian Research
Published in: Journal of Ovarian Research 1/2014

Open Access 01-12-2014 | Research

Brachial-to-ankle pulse wave velocity as an independent prognostic factor for ovulatory response to clomiphene citrate in women with polycystic ovary syndrome

Authors: Toshifumi Takahashi, Hideki Igarashi, Shuichiro Hara, Mitsuyoshi Amita, Koki Matsuo, Ayumi Hasegawa, Hirohisa Kurachi

Published in: Journal of Ovarian Research | Issue 1/2014

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Abstract

Background

Polycystic ovary syndrome (PCOS) has a risk for cardiovascular disease. Increased arterial stiffness has been observed in women with PCOS. The purpose of the present study was to investigate whether the brachial-to-ankle pulse wave velocity (baPWV) is a prognostic factor for ovulatory response to clomiphene citrate (CC) in women with PCOS.

Methods

This study was a retrospective cohort study of 62 women with PCOS conducted from January 2009 to December 2012 at the university hospital, Yamagata, Japan. We analyzed 62 infertile PCOS patients who received CC. Ovulation was induced by 100 mg CC for 5 days. CC non-responder was defined as failure to ovulate for at least 2 consecutive CC-treatment cycles. The endocrine, metabolic, and cardiovascular parameters between CC responder (38 patients) and non-responder (24 patients) groups were analyzed.

Results

In univariate analysis, waist-to-hip ratio, level of free testosterone, percentages of patients with dyslipidemia, impaired glucose tolerance, and diabetes mellitus, blood glucose and insulin levels at 60 min and 120 min, the area under the curve of glucose and insulin after 75-g oral glucose intolerance test, and baPWV were significantly higher in CC non-responders compared with responders. In multivariate logistic regression analysis, both waist-to-hip ratio (odds ratio, 1.77; 95% confidence interval, 2.2–14.1; P = 0.04) and baPWV (odds ratio, 1.71; 95% confidence interval, 1.1–2.8; P = 0.03) were independent predictors of ovulation induction by CC in PCOS patients. The predictive values of waist-to-hip ratio and baPWV for the CC resistance in PCOS patients were determined by the receiver operating characteristic curves. The area under the curves for waist-to-hip ratio and baPWV were 0.76 and 0.77, respectively. Setting the threshold at 0.83 for waist-to-hip ratio offered the best compromise between specificity (0.65) and sensitivity (0.84), while the setting the threshold at 1,182 cm/s for baPWV offered the best compromise between specificity (0.80) and sensitivity (0.71).

Conclusions

Both metabolic and cardiovascular parameters were predictive for CC resistance in PCOS patients. The measurement of baPWV may be a useful tool to predict ovulation in PCOS patients who receive CC.
Appendix
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Literature
1.
Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF: A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000, 85: 2434–2438.PubMed
2.
Kousta E, White DM, Franks S: Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update 1997, 3: 359–365.CrossRefPubMed
3.
Pritts EA: Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv 2002, 57: 587–597.CrossRefPubMed
4.
Eijkemans MJC, Imani B, Mulders AGMGJ, Habbema JDF, Fauser BCJM: High singleton live birth rate following classical ovulation induction in normogonadotrophic anovulatory infertility (WHO 2). Hum Reprod 2003, 18: 2357–2362.CrossRefPubMed
5.
Thessaloniki EA-SPCWG: Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 2008, 89: 505–522.CrossRef
6.
Fernandez H, Morin-Surruca M, Torre A, Faivre E, Deffieux X, Gervaise A: Ovarian drilling for surgical treatment of polycystic ovarian syndrome: a comprehensive review. Reprod Biomed Online 2011, 22: 556–568.CrossRefPubMed
7.
Dunaif A: Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997, 18: 774–800.PubMed
8.
Adashi EY, Resnick CE, D’Ercole AJ, Svoboda ME, Van Wyk JJ: Insulin-like growth factors as intraovarian regulators of granulosa cell growth and function. Endocr Rev 1985, 6: 400–420.CrossRefPubMed
9.
Nestler JE, Powers LP, Matt DW, Steingold KA, Plymate SR, Rittmaster RS, Clore JN, Blackard WG: A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1991, 72: 83–89.CrossRefPubMed
10.
Murakawa H, Hasegawa I, Kurabayashi T, Tanaka K: Polycystic ovary syndrome. Insulin resistance and ovulatory responses to clomiphene citrate. J Reprod Med 1999, 44: 23–27.PubMed
11.
Kurabayashi T, Suzuki M, Fujita K, Murakawa H, Hasegawa I, Tanaka K: Prognostic factors for ovulatory response with clomiphene citrate in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2006, 126: 201–205.CrossRefPubMed
12.
Legro RS, Kunselman AR, Dodson WC, Dunaif A: Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999, 84: 165–169.PubMed
13.
Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA: Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010, 95: 2038–2049.CrossRefPubMed
14.
Giallauria F, Orio F, Palomba S, Lombardi G, Colao A, Vigorito C: Cardiovascular risk in women with polycystic ovary syndrome. J Cardiovasc Med (Hagerstown) 2008, 9: 987–992.CrossRef
15.
Orio F, Vuolo L, Palomba S, Lombardi G, Colao A: Metabolic and cardiovascular consequences of polycystic ovary syndrome. Minerva Ginecol 2008, 60: 39–51.PubMed
16.
Giallauria F, Orio F, Lombardi G, Colao A, Vigorito C, Tafuri MG, Palomba S: Relationship between heart rate recovery and inflammatory markers in patients with polycystic ovary syndrome: a cross-sectional study. J Ovarian Res 2009, 2: 3.PubMedCentralCrossRefPubMed
17.
Kelly CJ, Speirs A, Gould GW, Petrie JR, Lyall H, Connell JM: Altered vascular function in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87: 742–746.CrossRefPubMed
18.
Sasaki A, Emi Y, Matsuda M, Sharula , Kamada Y, Chekir C, Hiramatsu Y, Nakatsuka M: Increased arterial stiffness in mildly-hypertensive women with polycystic ovary syndrome. J Obstet Gynaecol Res 2011, 37: 402–411.CrossRefPubMed
19.
Newman AB, Siscovick DS, Manolio TA, Polak J, Fried LP, Borhani NO, Wolfson SK: Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation 1993, 88: 837–845.CrossRefPubMed
20.
Hara S, Takahashi T, Amita M, Igarashi H, Kurachi H: Usefulness of bezafibrate for ovulation induction in clomiphene citrate-resistant polycystic ovary syndrome patients with dyslipidemia: a prospective pilot study of seven cases. Gynecol Obstet Invest 2010, 70: 166–172.CrossRefPubMed
21.
Mizunuma H, Irahara M: The Committee for Reproductive and Endocrine in Japan Society of Obstetrics and Gynecology. Annual report fro the determination of diagnostic criteria for polycystic ovary syndrome. Acta Obstet Gynaecol Jpn 2007, 59: 1142–1147.
22.
Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA: Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992, 167: 1807–1812.CrossRefPubMed
23.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop G: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004, 81: 19–25.
24.
Homburg R: Clomiphene citrate--end of an era? a mini-review. Hum Reprod 2005, 2043–2051.
25.
Padova G, Briguglia G, Tita P, Arpi ML, Munguira ME, Cafiso F, Cianci A, Ettore G, Pezzino V: Ovulation monitored by serum 17 beta-estradiol and ultrasound: differential ovarian response to human gonadotropins in various anovulatory states. Acta Eur Fertil 1988, 19: 283–286.PubMed
26.
Badawy A, Mosbah A, Tharwat A, Eid M: Extended letrozole therapy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a novel protocol. Fertil Steril 2009, 92: 236–239.CrossRefPubMed
27.
Teramoto T, Sasaki J, Ueshima H, Egusa G, Kinoshita M, Shimamoto K, Daida H, Biro S, Hirobe K, Funahashi T, Yokote K, Yokode M: Diagnostic criteria for dyslipidemia. Executive summary of Japan Atherosclerosis Society (JAS) guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese. J Atheroscler Thromb 2007, 14: 155–158.CrossRefPubMed
28.
Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, Ito C, Inagaki N, Iwamoto Y, Kasuga M, Hanafusa T, Haneda M, Ueki K: Report of the Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus. J Diabetes Invest 2010, 1: 212–228.CrossRef
29.
Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M, Imai Y, Imaizumi T, Ito S, Iwao H, Kario K, Kawano Y, Kim-Mitsuyama S, Kimura G, Matsubara H, Matsuura H, Naruse M, Saito I, Shimada K, Shimamoto K, Suzuki H, Takishita S, Tanahashi N, Tsuchihashi T, Uchiyama M, Ueda S, Ueshima H, Umemura S, Ishimitsu T, Rakugi H: The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res 2009, 32: 3–107.CrossRefPubMed
30.
Lord J, Thomas R, Fox B, Acharya U, Wilkin T: The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome. BJOG 2006, 113: 1203–1209.CrossRefPubMed
31.
Douchi T, Oki T, Yamasaki H, Nakae M, Imabayashi A, Nagata Y: Body fat patterning in polycystic ovary syndrome women as a predictor of the response to clomiphene. Acta Obstet Gynecol Scand 2004, 83: 838–841.CrossRefPubMed
32.
Matsuzawa Y: Adiponectin: a key player in obesity related disorders. Curr Pharm Des 2010, 16: 1896–1901.CrossRefPubMed
33.
de Koning L, Merchant AT, Pogue J, Anand SS: Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007, 28: 850–856.CrossRefPubMed
34.
Wang Z, Hoy W: Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people. Eur J Clin Nutr 2004, 58: 888–893.CrossRefPubMed
35.
Yokoyama H, Shoji T, Kimoto E, Shinohara K, Tanaka S, Koyama H, Emoto M, Nishizawa Y: Pulse wave velocity in lower-limb arteries among diabetic patients with peripheral arterial disease. J Atheroscler Thromb 2003, 10: 253–258.CrossRefPubMed
36.
Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001, 37: 1236–1241.CrossRefPubMed
37.
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM: Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999, 99: 2434–2439.CrossRefPubMed
38.
Lakhani K, Seifalian AM, Hardiman P: Impaired carotid viscoelastic properties in women with polycystic ovaries. Circulation 2002, 106: 81–85.CrossRefPubMed
39.
Meyer C, McGrath BP, Teede HJ: Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab 2005, 90: 5711–5716.CrossRefPubMed
40.
Soares GM, Vieira CS, Martins WP, Franceschini SA, dos Reis RM, de Sa MF S, Ferriani RA: Increased arterial stiffness in nonobese women with polycystic ovary syndrome (PCOS) without comorbidities: one more characteristic inherent to the syndrome? Clin Endocrinol (Oxf) 2009, 71: 406–411.CrossRef
41.
Hasegawa M, Nagao K, Kinoshita Y, Rodbard D, Asahina A: Increased pulse wave velocity and shortened pulse wave transmission time in hypertension and aging. Cardiology 1997, 88: 147–151.CrossRefPubMed
42.
Tsubakimoto A, Saito I, Mannami T, Naito Y, Nakamura S, Dohi Y, Yonemasu K: Impact of metabolic syndrome on brachial-ankle pulse wave velocity in Japanese. Hypertens Res 2006, 29: 29–37.CrossRefPubMed
43.
Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG: Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002, 106: 2085–2090.CrossRefPubMed
44.
Legro RS, Kunselman AR, Dunaif A: Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001, 111: 607–613.CrossRefPubMed
45.
Yokoyama H, Kawasaki M, Ito Y, Minatoguchi S, Fujiwara H: Effects of fluvastatin on the carotid arterial media as assessed by integrated backscatter ultrasound compared with pulse-wave velocity. J Am Coll Cardiol 2005, 46: 2031–2037.CrossRefPubMed
46.
Verit FF, Erel O, Kocyigit A: Association of increased total antioxidant capacity and anovulation in nonobese infertile patients with clomiphene citrate-resistant polycystic ovary syndrome. Fertil Steril 2007, 88: 418–424.CrossRefPubMed
47.
Imani B, Eijkemans MJC, te Velde ER, Habbema JDF, Fauser BCJM: Predictors of Patients Remaining Anovulatory during Clomiphene Citrate Induction of Ovulation in Normogonadotropic Oligoamenorrheic Infertility. J Clin Endocrinol Metab 1998, 83: 2361–2365.PubMed
48.
Calderon-Margalit R, Schwartz SM, Wellons MF, Lewis CE, Daviglus ML, Schreiner PJ, Williams OD, Sternfeld B, Carr JJ, O’Leary DH, Sidney S, Friedlander Y, Siscovick DS: Prospective association of serum androgens and sex hormone-binding globulin with subclinical cardiovascular disease in young adult women: the “Coronary Artery Risk Development in Young Adults” women’s study. J Clin Endocrinol Metab 2010, 95: 4424–4431.PubMedCentralCrossRefPubMed
49.
Creatsa M, Armeni E, Stamatelopoulos K, Rizos D, Georgiopoulos G, Kazani M, Alexandrou A, Dendrinos S, Augoulea A, Papamichael C, Lambrinoudaki I: Circulating androgen levels are associated with subclinical atherosclerosis and arterial stiffness in healthy recently menopausal women. Metabolism 2012, 61: 193–201.CrossRefPubMed
50.
Yarali H, Yildiz BO, Demirol A, Zeyneloglu HB, Yigit N, Bukulmez O, Koray Z: Co-administration of metformin during rFSH treatment in patients with clomiphene citrate-resistant polycystic ovarian syndrome: a prospective randomized trial. Hum Reprod 2002, 17: 289–294.CrossRefPubMed
51.
Ahmed MI, Duleba AJ, El Shahat O, Ibrahim ME, Salem A: Naltrexone treatment in clomiphene resistant women with polycystic ovary syndrome. Hum Reprod 2008, 23: 2564–2569.CrossRefPubMed
Metadata
Title
Brachial-to-ankle pulse wave velocity as an independent prognostic factor for ovulatory response to clomiphene citrate in women with polycystic ovary syndrome
Authors
Toshifumi Takahashi
Hideki Igarashi
Shuichiro Hara
Mitsuyoshi Amita
Koki Matsuo
Ayumi Hasegawa
Hirohisa Kurachi
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Ovarian Research / Issue 1/2014
Electronic ISSN: 1757-2215
DOI
https://doi.org/10.1186/1757-2215-7-74

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