Semin Reprod Med 2008; 26(2): 196-203
DOI: 10.1055/s-2008-1042958
© Thieme Medical Publishers

Oocyte Quality in Adult Polycystic Ovary Syndrome

Satin S. Patel1 , Bruce R. Carr1
  • 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
Further Information

Publication History

Publication Date:
27 February 2008 (online)

ABSTRACT

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women. Folliculogenesis in the PCOS ovary is often disrupted, leading to suboptimal oocyte competence for fertilization. This alteration in oocyte development is likely due to intrinsic molecular defects in the oocyte along with the state of androgen excess in PCOS patients. Many therapeutic options are available to infertile couples with PCOS, including controlled ovarian hyperstimulation and in vitro fertilization. However, because of immature oocytes, many patients are not able to conceive using standard infertility treatments. The advent of in vitro maturation may allow patients an alternative option by which to achieve conception. This review is intended to describe the mechanisms of aberrant folliculogenesis and their impact on fertility in the PCOS patient.

REFERENCES

  • 1 Azziz R, Woods K S, Reyna R et al.. The prevalence and features of the polycystic ovary syndrome in an unselected population.  J Clin Endocrinol Metab. 2004;  89 2745-2749
  • 2 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.  Fertil Steril. 2004;  81 19-25
  • 3 Talbott E, Clerici A, Berga S L et al.. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study.  J Clin Epidemiol. 1998;  51 415-422
  • 4 Legro R S, Kunselman A R, Dodson W C, 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
  • 5 Hull M G. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies.  Gynecol Endocrinol. 1987;  1 235-245
  • 6 Knochenhauer E S, Key T J, Kahsar-Miller M et al.. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study.  J Clin Endocrinol Metab. 1998;  83 3078-3082
  • 7 Homburg R. The management of infertility associated with polycystic ovary syndrome.  Reprod Biol Endocrinol. 2003;  1 109
  • 8 Jakubowicz D J, Iuorno M J, Jakubowicz S, Roberts K A, Nestler J E. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome.  J Clin Endocrinol Metab. 2002;  87 524-529
  • 9 Daneshmand S, Weitsman S R, Navab A, Jakimiuk A J, Magoffin D A. Overexpression of theca-cell messenger RNA in polycystic ovary syndrome does not correlate with polymorphisms in the cholesterol side-chain cleavage and 17alpha-hydroxylase/C(17-20) lyase promoters.  Fertil Steril. 2002;  77 274-280
  • 10 Nelson V L, Legro R S, Strauss III J F, McAllister J M. Augmented androgen production is a stable steroidogenic phenotype of propagated theca cells from polycystic ovaries.  Mol Endocrinol. 1999;  13 946-957
  • 11 Wood J R, Dumesic D A, Abbott D H, Strauss III J F. Molecular abnormalities in oocytes from women with polycystic ovary syndrome revealed by microarray analysis.  J Clin Endocrinol Metab. 2007;  92 705-713
  • 12 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis.  Endocr Rev. 1997;  18 774-800
  • 13 Lutz L B, Cole L M, Gupta M K et al.. Evidence that androgens are the primary steroids produced by Xenopus laevis ovaries and may signal through the classical androgen receptor to promote oocyte maturation.  Proc Natl Acad Sci USA. 2001;  98 13728-13733
  • 14 Uilenbroek J T, Woutersen P J, van der Schoot P. Atresia of preovulatory follicles: gonadotropin binding and steroidogenic activity.  Biol Reprod. 1980;  23 219-229
  • 15 Mahesh V B, Mills T M, Bagnell C A, Conway B A. Animal models for study of polycystic ovaries and ovarian atresia.  Adv Exp Med Biol. 1987;  219 237-257
  • 16 Dhanasekaran N, Moudgal N R. Studies on follicular atresia: role of gonadotropins and gonadal steroids in regulating cathepsin-D activity of preovulatory follicles in the rat.  Mol Cell Endocrinol. 1989;  63 133-142
  • 17 De Leo V, Lanzetta D, D'Antona D, la Marca A, Morgante G. Hormonal effects of flutamide in young women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 1998;  83 99-102
  • 18 Wood J R, Nelson V L, Ho C et al.. The molecular phenotype of polycystic ovary syndrome (PCOS) theca cells and new candidate PCOS genes defined by microarray analysis.  J Biol Chem. 2003;  278 26380-26390
  • 19 Wood J R, Ho C K, Nelson-Degrave V L, McAllister J M, Strauss III J F. The molecular signature of polycystic ovary syndrome (PCOS) theca cells defined by gene expression profiling.  J Reprod Immunol. 2004;  63 51-60
  • 20 Jansen E, Laven J S, Dommerholt H B et al.. Abnormal gene expression profiles in human ovaries from polycystic ovary syndrome patients.  Mol Endocrinol. 2004;  18 3050-3063
  • 21 Hammes S R. Steroids and oocyte maturation-a new look at an old story.  Mol Endocrinol. 2004;  18 769-775
  • 22 Gill A, Jamnongjit M, Hammes S R. Androgens promote maturation and signaling in mouse oocytes independent of transcription: a release of inhibition model for mammalian oocyte meiosis.  Mol Endocrinol. 2004;  18 97-104
  • 23 Gelerstein S, Shapira H, Dascal N, Yekuel R, Oron Y. Is a decrease in cyclic AMP a necessary and sufficient signal for maturation of amphibian oocytes?.  Dev Biol. 1988;  127 25-32
  • 24 Brown R L, Ord T, Moss S B, Williams C J. A-kinase anchor proteins as potential regulators of protein kinase A function in oocytes.  Biol Reprod. 2002;  67 981-987
  • 25 Gotoh Y, Masuyama N, Dell K, Shirakabe K, Nishida E. Initiation of Xenopus oocyte maturation by activation of the mitogen-activated protein kinase cascade.  J Biol Chem. 1995;  270 25898-25904
  • 26 Diao F Y, Xu M, Hu Y et al.. The molecular characteristics of polycystic ovary syndrome (PCOS) ovary defined by human ovary cDNA microarray.  J Mol Endocrinol. 2004;  33 59-72
  • 27 Oksjoki S, Soderstrom M, Inki P, Vuorio E, Anttila L. Molecular profiling of polycystic ovaries for markers of cell invasion and matrix turnover.  Fertil Steril. 2005;  83 937-944
  • 28 Legro R S, Spielman R, Urbanek M et al.. Phenotype and genotype in polycystic ovary syndrome.  Recent Prog Horm Res. 1998;  53 217-256
  • 29 Jonard S, Dewailly D. Polycystic ovary syndrome: recent genetic contributions.  Gynecol Obstet Fertil. 2002;  30 603-609
  • 30 Alizadeh Z, Kageyama S, Aoki F. Degradation of maternal mRNA in mouse embryos: selective degradation of specific mRNAs after fertilization.  Mol Reprod Dev. 2005;  72 281-290
  • 31 Schultz R M. The molecular foundations of the maternal to zygotic transition in the preimplantation embryo.  Hum Reprod Update. 2002;  8 323-331
  • 32 Book C B, Dunaif A. Selective insulin resistance in the polycystic ovary syndrome.  J Clin Endocrinol Metab. 1999;  84 3110-3116
  • 33 Rosa G, Di Rocco P, Manco M et al.. Reduced PDK4 expression associates with increased insulin sensitivity in postobese patients.  Obes Res. 2003;  11 176-182
  • 34 Sugden M C. PDK4: a factor in fatness?.  Obes Res. 2003;  11 167-169
  • 35 Frick W, Bauer A, Bauer J, Wied S, Muller G. Structure-activity relationship of synthetic phosphoinositolglycans mimicking metabolic insulin action.  Biochemistry. 1998;  37 13421-13436
  • 36 Pouwels M J, Span P N, Tack C J et al.. Muscle uridine diphosphate-hexosamines do not decrease despite correction of hyperglycemia-induced insulin resistance in type 2 diabetes.  J Clin Endocrinol Metab. 2002;  87 5179-5184
  • 37 Arkenbout E K, de Waard V, van Bragt M et al.. Protective function of transcription factor TR3 orphan receptor in atherogenesis: decreased lesion formation in carotid artery ligation model in TR3 transgenic mice.  Circulation. 2002;  106 1530-1535
  • 38 Wang X, Li W, Williams M et al.. Regulation of elongation factor 2 kinase by p90(RSK1) and p70 S6 kinase.  EMBO J. 2001;  20 4370-4379
  • 39 Patel S M, Nestler J E. Fertility in polycystic ovary syndrome.  Endocrinol Metab Clin North Am. 2006;  35 137-155 , vii
  • 40 Legro R S, Barnhart H X, Schlaff W D et al.. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome.  N Engl J Med. 2007;  356 551-566
  • 41 Child T J, Abdul-Jalil A K, Gulekli B, Tan S L. In vitro maturation and fertilization of oocytes from unstimulated normal ovaries, polycystic ovaries, and women with polycystic ovary syndrome.  Fertil Steril. 2001;  76 936-942
  • 42 Chian R C, Buckett W M, Tulandi T, Tan S L. Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome.  Hum Reprod. 2000;  15 165-170
  • 43 Parazzini F, Pelucchi C, Negri E et al.. Use of fertility drugs and risk of ovarian cancer.  Hum Reprod. 2001;  16 1372-1375
  • 44 Child T J, Phillips S J, Abdul-Jalil A K, Gulekli B, Tan S L. A comparison of in vitro maturation and in vitro fertilization for women with polycystic ovaries.  Obstet Gynecol. 2002;  100 665-670
  • 45 Cha K Y, Han S Y, Chung H M et al.. Pregnancies and deliveries after in vitro maturation culture followed by in vitro fertilization and embryo transfer without stimulation in women with polycystic ovary syndrome.  Fertil Steril. 2000;  73 978-983
  • 46 Chian R C, Gulekli B, Buckett W M, Tan S L. Priming with human chorionic gonadotropin before retrieval of immature oocytes in women with infertility due to the polycystic ovary syndrome.  N Engl J Med. 1999;  341 1624-1626

Bruce R CarrM.D. 

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Texas Medical Center at Dallas

5323 Harry Hines Blvd., J6-114, Dallas, TX 75390-9032

Email: Bruce.Carr@utsouthwestern.edu

    >