Androgen Responses to hCG and Ovarian Morphology in PCOS

NCT ID: NCT03489668

Last Updated: 2018-08-09

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-01-20
• Study Completion Date: 2020-03-31

Brief Summary

Rationale and Hypothesis We have previously reported that theca cells (TC) responses to hCG in women with PCOS represent a spectrum where some exhibit exaggerated increases of 17OHP while in others 17OHP responses resemble those of normal women (Maas KH et al, JCEM, 2015). The basis for this differential responsiveness is not clear. Earlier studies reported that 17OHP responses to gonadotropin stimulation were heterogeneous among PCOS women, which was attributed to the degree of hyperinsulinemia (Pasquali R et al, JCEM, 2007). However, assessment of the ovary was omitted in the analysis. In preliminary studies, we have found that in women with PCOS, insulin sensitivity was strongly correlated with insulin sensitivity index as assessed by the method of Matsuda and DeFronzo (Diabetes Care, 1999). However, the study lacked sufficient numbers. Further analysis of insulin sensitivity with respect to hCG stimulated theca cell responses is warranted.

We have also examined 17OHP responses to hCG in relationship to antral follicle count and anti-Müllerian hormone (AMH) in PCOS and normal women. In PCOS women, as expected, serum AMH correlated with antral follicle count. However, TC responses in PCOS were inversely related to AMH (Maas KH et al, JCEM, 2015). These novel observations suggested that in PCOS AMH production may reflect redistribution of the follicle population. In human ovaries maximal immunodetection of AMH is observed in small (< 4 mm) antral follicles followed by a rapid and progressive decline until an absence of the protein by 8 mm (Weenen C et al, Mol Hum Reprod, 2004). This consideration raises the issue of whether normal AMH levels represent more advanced follicle growth in some PCOS women compared with that of others with elevated AMH levels. An increased stage of follicle development would be accompanied by increased TC hyperplasia and may account for greater 17OHP responses to hCG stimulation. A comparison of TC responses to hCG with ovarian morphology has not be done in women with PCOS.

Based on these findings, we hypothesize that in PCOS, heterogeneous TC responses to hCG reflect differences in morphometric development of the follicle population. In addition, the positive correlation between insulin sensitivity and TC responses to hCG suggest an effect of hyperinsulinemia. We propose to investigate the relationship between theca cell responses to hCG, follicle morphology, and insulin sensitivity before and following treatment with an insulin lowering drug, metformin.

Detailed Description

50-100 PCOS and 50-100 normal women matched for age (<37 yr) and BMI (<35) will be studied. PCOS and normal women in the mid-follicular phase (day 5-7) of the menstrual cycle will receive an iv injection of hCG as previously described (see Experimental Design). Basal and stimulated blood samples will be assessed for 17OHP, androgens, gonadotropins and AMH. Detailed 3-D ultrasound imaging will be done prior to hCG stimulation (see Experimental Design). Ovarian morphology will include volume, antral follicle number, and the size of each follicle visualized.

Screening 100 women with PCOS and 100 normal women will be studied.

PCOS will be defined according to NIH criteria:

• <8 spontaneous menses per year
• hyperandrogenism clinically (Ferriman-Gallway score≥8 or total testosterone>0.5ng/ml).
• Absence of CAH, hyperprolactinemia, thyroid disorder, Cushings syndrome, hypothalamic anovulation.

Subjects will have a screening visit to establish eligibility and to sign the informed consent. They will have a history and physical examination performed which will include a urine pregnancy test, a transvaginal ultrasound, thyroid studies, a fasting chemistry panel, and a hemoglobin.

Experimental Design Phase 1 (Pretreatment)

1. In all subjects images of the both ovaries will be obtained using 3D technology and the number, size, and spatial arrangement of ovarian follicles will be noted for both ovaries in each subject.

2. Normal subjects will be studied during the mid-follicular phase of the cycle (Days 5-9) while PCOS women will be anovulatory and will not have a cycle day parameter.

3. On study day one, recombinant-hCG (r-hCG) will be administered intravenously at a dose of 25 micrograms.

4. Blood samples will be obtained at 1 hour before (T = -1), immediately prior (T = 0), and 24 hours after (T = +24) iv hCG injection.

5. Sera will be assayed at all time points for steroid and peptide hormones including 17OHP, androstenedione, testosterone, estradiol, progesterone, LH, FSH, and AMH.

6. All subjects will undergo an oral glucose tolerance test. Each will be placed on a 300-gram carbohydrate diet for three days before the study. On the day of testing each subject will ingest 75 gm of a glucose solution and blood samples for glucose and insulin will be obtained at 0, 15, 30, 60, 120 and 180 minutes after the glucose load.

Phase 2 (Posttreatment)

1. Each PCOS subject will be administered metformin, 1500 mg/day for 3 months. All subjects will be encouraged to maintain same dietary and exercise activity throughout the course of study.

2. After 3 months of treatment, all tests as described in Phase 1 will be repeated.

Conditions

PCOS

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

PCOS

Metformin administration 1500mg/day

Group Type: ACTIVE_COMPARATOR

MetFORMIN 500 Mg Oral Tablet

Intervention Type: DRUG

metformin administration 1500mg per day

Control

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

MetFORMIN 500 Mg Oral Tablet

metformin administration 1500mg per day

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• <8 spontaneous menses per year • hyperandrogenism clinically (Ferriman-Gallway score≥8 or total testosterone>0.5ng/ml).

Exclusion Criteria

• CAH, hyperprolactinemia, thyroid disorder, Cushings syndrome, hypothalamic anovulation

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 37 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

University of California, San Diego

OTHER

Sponsor Role: collaborator

Poznan University of Medical Sciences

OTHER

Sponsor Role: lead

Responsible Party

Beata Banaszewska

MD PhD Asssociate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Division of Infertility and Reproductive Endocrinology, Department of Gynecology and Obsterics

Poznan, , Poland

Site Status: RECRUITING

Countries

Poland

Central Contacts

Beata E Banaszewska, MD PhD

Role: CONTACT

bbeata48@gmail.com

+48501303173

Antoni Duleba, Prof

Role: CONTACT

antoni.duleba@yale.edu

Facility Contacts

Beata Banaszewska, MD PhD

Role: primary

bbeata48@gmail.com

Mateusz Trzciński, MD

Role: backup

mtrzcinski13@gmail.com

Other Identifiers

PoznanUMS6

Identifier Type: -

Identifier Source: org_study_id