Frontiers in Gynecological Endocrinology by Andrea R. Genazzani & Basil C. Tarlatzis

Author:Andrea R. Genazzani & Basil C. Tarlatzis
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Recently, three different studies evaluated the efficacy of a treatment based on the physiological plasma ratio between MI and DCI of 40:1 in PCOS women. The idea behind this therapy is that an INS dysregulation plays a central role in nurturing PCOS. Indeed, epimerase dysregulation changes the MI:DCI ratio, which in turn could impair hormone signaling, namely, of both insulin and FSH.

Various evidences supported a deficiency concerning the availability and/or utilization of MI and/or DCI in tissues of PCOS women, and this impairment likely contributes to the insulin resistance typical of that syndrome [6, 10]. Unlike other tissues, such as muscles and liver, the ovaries are not insulin resistant. Because the epimerase activity, regulating the MI:DCI ratio, is insulin dependent, PCOS patients are affected by a boosted MI to DCI epimerization into the ovary, leading to overproduction of DCI and MI deficiency [11], as shown by two independent laboratories [6, 10]. Thus, a specific MI depletion and a DCI overload characterize the ovary of PCOS women. The poor oocyte quality observed in PCOS patients can be explained by this imbalance, responsible also for the impaired FSH signaling [12, 13].

Literature evidences have already shown that MI supplementation is able to correct PCOS metabolic aspects. Two trials demonstrated that the same effect was obtained even in a more effective way by administering MI and DCI in a physiological ratio (40:1). Indeed, the improved parameters were diastolic blood pressure, fasting glucose, fasting insulin, and both insulin and glucose AUCs [14, 15]. Additional improved parameters were those linked to the CVD, namely, HOMA index, triglycerides, and both HDL and LDL cholesterol. Noteworthy, ovulation was restored in the majority of the women.

Furthermore, by moving from the metabolic aspects of the syndrome to the reproductive ones, a trial has shown that the treatment of PCOS women undergoing ICSI, with a MI:DCI 40:1 based therapy, retains the beneficial effects of MI treatment alone, outperforming the DCI treatment [12].

In particular, the treatment is able to improve ovarian response and oocyte and embryo quality. Recently, the interest of the scientific world on MI and DCI has pushed the PRESIS to organize an international consensus conference in order to clarify this issue and lay the foundations of future researches.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.