role of nesfatin-1 and nicotinamide in infertile women with polycystic ovary syndrome

Conditions: PCOS

Summary: evaluation of the potential role of circulating nesfatin-1 and nicotinamide in patients with polycystic ovary syndrome. and detection the correlation between nesfatin-1 and body mass index (bmi), waist hip ratio (whr), blood glucose, insulin, insulin resistance, lipid profiles, prolactin, lh, fsh, estrogen, progesterone, testosterone and dopamine.

* nesfatin-1 is an 82-amino acid polypeptide derived from the nucleobindin 2 (nucb2) precursor proteins. * it is a newly identified peptide. it is released from several tissues including forebrain, hindbrain, brainstem, spinal cord and adipose tissues. * it plays an important role in hypothalamic pathways such as feeding inhibition, locomotion, stress modulation, thermogenesis, and reproduction. * several studies had demonstrated that nesfatin-1 associated with body mass index (bmi), insulin resistance and inflammatory response disorders. * polycystic ovary syndrome (pcos) is one of the most common causes of infertility in women. it is characterized by hyperandrogenism, multiple ovarian cysts, oligomenorrhea/amenorrhea. many mechanisms had been reported to be responsible for the pathophysiology of pcos. the condition is thought to be interactions between hypothalamic-pituitary-ovarian, hypothalamic-pituitary-adrenal axis and metabolic disorders. * the circulating level of nesfatin-1 in pcos patients is controversial. some studies reveal lower nesfatin-1 serum levels while others reveal higher level. * women with pcos may have reduced dopamine production from the hypothalamus and elevated prolactin concentrations and this mechanism may be responsible for reproductive disorder. * in pcos, stimulation of reactive oxygen species (ros) generation from mononuclear cells (mncs) by hyperglycemia . the superoxide radical in particular is a ros that is generated by the activity of membrane-bound nicotinamide adenine dinucleotide phosphate (nadph) oxidase. * dopaminergic (da) neurons are highly susceptible to ros. da is relatively unstable molecule and undergoes auto-oxidative metabolism in nigro striatal tract system, leading to ros production. nicotinamide can reduce hypothalamic dopamine in postnatal brains results in dopamine-deficient phenotypes. nicotinamide prevents da release induced by long-term perinatal asphyxia.

Eligibility criteria:
inclusion criteria: * pcos patients in the age range 18 - 40 years old. * diagnosis of pcos is based on the 2003 eshre/asrm diagnostic criteria, according to which patients who had at least two of the following conditions are accepted as having pcos: 1. oligo or anovulation, defined by the presence of oligomenorrhea or amenorrhea, confirmed by luteal progesterone and normal serum follicle stimulating hormone (fsh) levels (1.0-10.0 iu/l). 2. clinical hyperandrogenism signs which was defined as the presence of at least one of the following three features: hirsutism, acne, and androgenic alopecia. biochemical hyperandrogenism was defined as a serum testosterone (t) level \>60 ng/dl (\>2.08 nmol/l). 3. pcos manifestation was defined as the presence of \>12 unilateral follicles 2-9 mm in size on the ovary or having the least unilateral ovary volume of 10 cm3 by ultrasonography (the measurement was performed when there was no follicle \>10 mm). ovarian volume was calculated by the formula \[0.5× ovarian length × thickness × width\]. in the case of transabdominal ultrasonography, the presence of at least 10 unilateral antral follicles was required. exclusion criteria: * patients (age \ 40years), * other endocrinology diseases as diabetes mellitus or thyroid disorders, brain disorders as pituitary adenoma or tumour or brain tumours or masses, * chronic diseases such as cardiovascular, hepatic, hematologic, chronic renal failure, hypertension, and cancer, * use of oral contraceptives, antiandrogenics, glucocorticoids, antihypertensives, antidiabetics and anti-obesity drugs as well as the cigarettes, alcohol, and patients unwilling to participate in the study.