Ayşen GÜÇLÜ, ÜMİT ARSLAN NAYKI, CENK NAYKI, Mehmet KÜLHAN, Salih SADIK

Polikistik over sendromunda klomifen sitrat ile ovulasyon indüksiyonunun serum leptin düzeylerine etkisi

Amaç: Bu çalışmada, polikistik over sendromu (PKOS) bulunan infertil kadınlarda, klomifen sitrat (KS) ile ovulasyon indüksiyonun serum leptin düzeylerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: PKOSli infertil 40 kadında KS tedavisi öncesi ve sonrası serum leptin düzeyleri değerlendirildi. Hastalar vücut kitle indeksine (VKİ) göre Grup1 (VKİ 0.05). Grup 2deki tedavi öncesi ve sonrası serum leptin düzeyleri Grup 1deki hastalara göre daha yüksekti. Bu fark istatistiksel olarak anlamlı bulundu (p

The effect of ovulation induction with clomiphene citrate on serum leptin levels in polycystic ovary syndrome

Aim: We aimed to assess the effect of ovulation induction with clomiphene citrate on serum leptin levels in infertile women with polycystic ovary syndrome (PCOS). Materials and Methods: Serum leptin levels were evaluated before and after clomiphene citrate (CC) therapy in 40 infertile women with PCOS. According to body mass index (BMI), the patients were divided into two groups as Group 1 (BMI <25kg/m2 ) and Group 2 (BMI ≥25 kg/m2 ) Results: The mean of basal leptin concentrations before CC therapy was 31.7±23.0 ng/mL while it was 35.6±23.0 ng/mL after CC therapy. There was not any significant differrence between basal leptin levels before and after CC therapy (p>0.05). However, before and after CC therapy, serum levels were higher in Group 2 than in Group 1; the difference was statistically significant (p<0.05). Conclusion: We did not observe any effect of CC on serum leptin concentrations in patients with PCOS after a three month CC therapy. However there is a strong relationship between serum leptin and BMI, we are of the opinion that leptin does not have a role in the evaluation of response to CC in PCOS.

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1. Chakrabarti J. Serum leptin level in women with polycystic ovary syndrome: Correlation with adiposity, insulin, and circulating testosterone. Ann Med Health Sci Res 2013;3(2):191-6. 2. Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Consensus on womens health aspects of polycysticovary syndrome (PCOS). Human Reproduction 2012;27(1):14-24. 3. Dunaif A, Wu X, Lee A, Diamanti-Kandarakis E. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab 2001;281(2):392-9 4. Clark AM, Ledger W, Galletly C, et al. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatuary obese women. Hum Reprod 1995;10(10):2705-12. 5. Lonnqvist F, Arner P, Nordfors L, Schalling M. Overexpression of the obese (ob) gene in adipose tissue of human obese subjects. Nat Med 1995;1(9):950-3. 6. Rogers J, Mitchell GW Jr. The relation of obesity to menstruel disturbances. N Engl J Med 1952;247(2):53-5. 7. Kaseki H, Maruyama S, Ishihara K, Araki T. Serum leptin concentration in young adult women with ovulatuary dysfunction. J Nippon Med Sch 2003;70(3):270-3. 8. Goumenou AG, Matalliotakis IM, Koumantakis GE, Panidis DK. The role of leptin in fertility. European J Obstet & Gynecol Reprod Biol 2003;106(10):118-24. 9. Hardie L, Trayhurn P, Abramovich D, Fowler P. Circulating leptin in women a longitudinal study in the menstruel cycle and during pregnancy. Clin Endocrinol 1997;47(1):101-6. 10. Finn PD, Cunningham MJ, Pau KY, Spies HG, Clifton DK, Steiner RA. The stimulatory effect of leptin on the neuroendocrine reproductive axis of the monkey. Endocrinology 1998;139(11):4652-62. 11. Clioffi JA, Van Blerkom J, Antczak M, Shafer A, Wittmer S, Snodgrass HR. The expression of leptin and its receptors in pre- ovulatory human follicles. Mol Hum Reprod 1997;3(6):467-72. 12. Brannian JD, Hansen KA. Leptin and ovarian folliculogenesis: Implications for ovulation induction and ART outcomrs. Semin Reprod Med 2002;20(2):103-12. 13. Micic D, Macut D, Popovic V, et al. Leptin levels and insulin sensitivity in obese and non-obese patients with polycystic ovary syndrome. Gynecol Endocrinol 1997;11(5):315-20. 14. Chow TK, Phoon MC. Measurement of serum leptin concentrations in university undergraduates by competitive elisa reveals correlations wiyh body mass index and sex. Adv PhysiolEduc 2003;27(1-4):70-7. 15. Campfield LA, Smith FJ, Guisez Y, Devas R, Burn P. Recombinant Mouse OB protein: Evidence for a peripheral signal linking adiposity and central neural Networks. Science 1995;269(5223):546-9. 16. Mantzoros CS, Dunaif A, Flier JS. Leptin concentrations in the polycystic ovary syndrome. J Clin Endocrinol Metab 1997;82(6):1687-91. 17. Barash IA, Cheung CC, Weigle DS, et al. Leptin is a metabolic signal to the reproductive system. Endocrinology 1996;137(7):3144-7. 18. Rouru J, Anttila L, Koskinen P, et al. Serum leptin concentrations in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 1997;82(6):1697-700. 19. Laughlin GA, Morales AJ, Yen SS. Serum leptin level in women with polycystic ovary syndrome: The role of insulin resistance/hyperinsulinemia. J Clin Endocrinol Metab 1997;82(6):1692-6. 20. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clinic Endocrinol 1961;21(11):1440-7. 21. Goodman N, Bledsoe M, Cobin R, et al. American Association of Clinical Endocrinologists medical guidelines for the clinical practice for the diagnosis and treatment of hyperandrogenic disorders. Endocr Pract 2001;7(2):120-34. 22. Hull MG, Savage PE, Bromham DR, Ismail AA, Morris AF. The value of a single serum progesterone measurement in the midluteal phase as a criterion of a potentially fertile cycle (ovulation) derived form treated and untreated conceptin cycles. Fertil Steril 1982;37(3):355-60. 23. Brzechffa PR, Jakimiuk AJ, Agarwal SK, Weitsman SR, Buyalos RP, Magoffln DA. Serum immunoreactive leptin concentrations in women wiyh polycystic ovary syndrome. Clin Endocrinol Metab 1996;81(11):4166-9. 24. Vicennati V, Gambineri A, Caizoni F, et al. Serum leptin in obese women with polycystic ovary syndrome is corelatedwith body weight and fat distribution but not with androgen and insulin levels. Metabolism 1998;47(8):988-92. 25. Lecke SB, Morsch DM, Spritzer PM. Association between adipose tissue expression and serum levels of leptin and adiponectin in women with polycystic ovary syndrome. Genetic and Molecular Research 2013;12(4):4292-4. 26. Moschos S, Chan JL. Leptin and reproduction: A review. Fertil Steril 2002;77(3):433-44. 27. Savastano S, Valentino R, Di Somma C, et al. Serum 25-Hydroxy vitamin D levels, phosphoprotein enriched in diabetes gene product (PED/PEA-15) and leptin-to-adiponectin ratio in women with PCOS. Nutr Metab 2011;23(8):84. 28. Lecke SB, Mattei F, Morsch DM, Spritzer PM. Abdominal subcutaneous fat gene expression and circulating levels of leptin and adiponectin in polycystic ovary syndrome. Fertil Steril 2011;95(6):2044-9. 29. Garutti G, de Paulo R, Rotelli MT, et al. Association between follicular fluid leptin and serum ınsulin levels in nonoverweight women with polycystic ovary syndrome. Biomed Res Int 2014;2014:980429. 30. Çimen S, Öztekin Ö, Gencer M, et al. Effects of female sex hormones and leptin levels on etiopathogenesis of polycystic ovary syndrome. Ege Tıp Dergisi; 2003;42(2):127-31. 31. Chapman IM, Wittert GA, Norman RJ. Circulating leptin concentrations in polycystic ovary syndrome: Relation to anthropometric and metabolic parameters. Clin Endocrinol 1997;46(2):175-81. 32. Spritzer PM, Poy M, Wiltgen D, Mylius LS, Capp E. Leptin concentrations in hirsute women with polycystic ovary syndrome or idiopathic hirsutism: Influence on LH and relationship with hormonal, metabolic, and anthropometric measurements. Hum Reprod 2001;16(7):1340-6. 33. Sahin I, Serter R, Karakurt F, et al. Leptin levels increase during flutamide therapy in women with polycystic ovary syndrome. Horm Res 2003;60(5):232-6. 34. Sağsöz N, Orbak Z, Noyan V, Yücel A, Uçar B, Yıldız L. The effcets of oral contaceptives including low-dose estrogen and drospirenone on the concentration of leptin and ghrelin in polycystic ovary syndrome. Fertil Steril 2009;92(2):660-6. 35. Imani B, Eijkemans MJ, de Jong FH, et al. Free androgen index and leptin are the most prominent endocrine predictors of ovarian response during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 2000;85(2):676-82.