January Journal Club: A Simple and Improved Predictor of Insulin Resistance Extracted From the OGTT

This Journal club presented by Dr. Mary Davenport, looks at the article by Contreras P. et. al , “Simple and Improved Predictor of Insulin Resistance Extracted From the Oral Glucose Tolerance Test: The I0*G60”. Dr. Davenport is a FertilityCare Medical Consultant and a Fellow of the RHRI, with a master’s degree in nutrition and metabolism, which informs her integrative approach to women’s health care, and is a private practice OBGYN in the San Francisco, USA area.

Journal Nook

Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood
This study created a fair bit of buzz in the news and across social media in May suggesting hormone exposure in the womb may be a cause of PCOS, and a gonadotrophin-blocking treatment, cetrorelix, could be used to treat and prevent PCOS . New research from France suggests PCOS may develop in women who were exposed to elevated levels of AMH in-utero. They found pregnant women with PCOS had higher levels of AMH than normal. The elevated AMH seems to trigger a maternal neuroendocrine driven testosterone excess and decreases the placental metabolism of testosterone to estradiol, leading to masculinization of the exposed female fetus. Given PCOS tends to run in families, this explanation could make sense. In this study, pregnant mice were injected with the antimüllerian hormone (AMH), to mimic the hormonal imbalance they observed in the women with PCOS. Sure enough, after injection of the mothers, the next generation of female mice developed symptoms that are very similar to PCOS – such as elevated testosterone levels and disrupted ovulation. The team noted it is planning on looking at how hormones such as testosterone, regulated during pregnancy, affect their offspring.

Of course this study was done on mice, so we don’t yet know the same thing happens in women, and although we know gonadotrophin hormones are often raised in women with PCOS, blocking these hormones can help manage some symptoms but may not necessarily mean a cure. The drug suggested, which is commonly used in IVF, would prevent ovulation altogether so we don’t know the affect this would have on fertility.