Kathleen M Brennan1, Lindsay L Kroener1, Gregorio D Chazenbalk2, Daniel A Dumesic3. 1. Assistant Clinical Professor. 2. Adjunct Professor. 3. Professor, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA.
Abstract
IMPORTANCE: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. Women with PCOS are at increased risk of developing several metabolic and reproductive abnormalities, including metabolic syndrome. Underlying the combined metabolic and reproductive dysfunction is lipotoxicity, defined as the ectopic deposition of lipid in nonadipose tissue where it induces oxidative stress linked with insulin resistance and inflammation. OBJECTIVE: To examine what metabolic components underlie insulin resistance in PCOS, how lipotoxicity through insulin resistance impairs metabolism and reproduction in these women, and why evidence-based, individualized management is essential for their care. EVIDENCE ACQUISITION: PubMed search was performed using relevant terms to identify journal articles related to the subject. Relevant textbook chapters were also used. RESULTS: Polycystic ovary syndrome by Rotterdam criteria represents a complex syndrome of heterogeneous expression with variable adverse metabolic and reproductive implications. Women with classic PCOS are often insulin resistant and at greatest risk of developing metabolic syndrome with preferential fat accumulation and weight gain. Moreover, PCOS women may also have an altered capacity to properly store fat, causing ectopic lipid accumulation in nonadipose tissue, including the ovaries, where it can perpetuate insulin resistance and inflammation and harm the oocyte. CONCLUSIONS AND RELEVANCE: A personalized approach to managing PCOS is essential to improve the health of all PCOS women through cost-effective prevention and/or treatment, to minimize the risk of pregnancy complications in those individuals wishing to conceive, and to optimize the long-term health of PCOS women and their offspring.
IMPORTANCE: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. Women with PCOS are at increased risk of developing several metabolic and reproductive abnormalities, including metabolic syndrome. Underlying the combined metabolic and reproductive dysfunction is lipotoxicity, defined as the ectopic deposition of lipid in nonadipose tissue where it induces oxidative stress linked with insulin resistance and inflammation. OBJECTIVE: To examine what metabolic components underlie insulin resistance in PCOS, how lipotoxicity through insulin resistance impairs metabolism and reproduction in these women, and why evidence-based, individualized management is essential for their care. EVIDENCE ACQUISITION: PubMed search was performed using relevant terms to identify journal articles related to the subject. Relevant textbook chapters were also used. RESULTS: Polycystic ovary syndrome by Rotterdam criteria represents a complex syndrome of heterogeneous expression with variable adverse metabolic and reproductive implications. Women with classic PCOS are often insulin resistant and at greatest risk of developing metabolic syndrome with preferential fat accumulation and weight gain. Moreover, PCOS women may also have an altered capacity to properly store fat, causing ectopic lipid accumulation in nonadipose tissue, including the ovaries, where it can perpetuate insulin resistance and inflammation and harm the oocyte. CONCLUSIONS AND RELEVANCE: A personalized approach to managing PCOS is essential to improve the health of all PCOS women through cost-effective prevention and/or treatment, to minimize the risk of pregnancy complications in those individuals wishing to conceive, and to optimize the long-term health of PCOS women and their offspring.
Authors: Chandrika N Wijeyaratne; Ruwanthi de A Seneviratne; Shamalka Dahanayake; Vindya Kumarapeli; Ethusha Palipane; Nadeera Kuruppu; Chandrika Yapa; Rohini de A Seneviratne; Adam H Balen Journal: Hum Reprod Date: 2010-11-23 Impact factor: 6.918
Authors: Daniel A Dumesic; Sharon E Oberfield; Elisabet Stener-Victorin; John C Marshall; Joop S Laven; Richard S Legro Journal: Endocr Rev Date: 2015-10 Impact factor: 19.871
Authors: A J Goverde; A J B van Koert; M J Eijkemans; E A H Knauff; H E Westerveld; B C J M Fauser; F J Broekmans Journal: Hum Reprod Date: 2008-12-17 Impact factor: 6.918
Authors: Thomas M Barber; Stephen J Golding; Christopher Alvey; John A H Wass; Fredrik Karpe; Stephen Franks; Mark I McCarthy Journal: J Clin Endocrinol Metab Date: 2007-12-18 Impact factor: 5.958
Authors: Daniel A Dumesic; Ayli Tulberg; Karen L Leung; Samantha C Fisch; Tristan R Grogan; David H Abbott; Rajanigandha Naik; Gregorio D Chazenbalk Journal: Fertil Steril Date: 2020-12-17 Impact factor: 7.490
Authors: Daniel A Dumesic; Vasantha Padmanabhan; Gregorio D Chazenbalk; David H Abbott Journal: Reprod Biol Endocrinol Date: 2022-01-10 Impact factor: 4.982
Authors: Kehinde S Olaniyi; Al-Amin M Bashir; Stephanie E Areloegbe; Isaiah W Sabinari; Christopher O Akintayo; Adesola A Oniyide; Ayodeji Aturamu Journal: PLoS One Date: 2022-07-26 Impact factor: 3.752