Role of Nesfatin-1 and Nicotinamide in Infertile Women With Polycystic Ovary Syndrome
Role of Nesfatin-1 and Nicotinamide in Infertile Women With Polycystic Ovary Syndrome
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.
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 <18 or > 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.