Ultrasonographic Evaluation of Anovulatory Disorders in Lean and Overweight Women
Ultrasonographic Evaluation of Anovulatory Disorders in Lean and Overweight Women
The investigators would like to determine whether ultrasound features of the ovaries can be
 used to reliably diagnose different types of anovulatory disorders in women across all body
 types. The study will also try to establish whether ultrasound features of the ovary can
 reflect the degree of reproductive and metabolic problems that a woman with irregular or
 absent periods might be experiencing.
This study is being conducted in order to determine if ultrasound features of the ovaries can
 be used to reliably diagnose different types of anovulatory disorders in women across all
 body types. The study will also try to establish whether ultrasound features of the ovary can
 reflect the degree of reproductive and metabolic problems that a woman with irregular or
 absent periods might be experiencing. In this way, the researchers can help to maximize the
 information that can be received when using ultrasound to evaluate patients with concerns
 over irregular menstrual cycles and/or infertility.

 The ovaries are the site of egg production and normally release one egg every month. The
 process of releasing an egg is called ovulation. The act of releasing an egg is the body's
 way of ensuring a woman's fertility each month during her reproductive years. There are a
 number of reasons why ovulation may not occur regularly in women. Some of these reasons are
 believed to relate to male hormone production (i.e. androgens), body composition, nutrition
 and overall metabolic health. However, the precise ways in which these factors affect
 ovulation are unknown.

 The researchers plan to evaluate how the ovaries look and function in a large group of women.
 Their goal is to recruit both lean and overweight women to this study and include both women
 that have regular, predictable menstrual cycles as well as those that have infrequent or
 absent menstrual cycles. The researchers will include women with irregular cycles due to
 increased androgen production, or hyperandrogenic anovulation - as well as those that have
 irregular cycles but normal androgen levels or normoandrogenic anovulation. The researchers
 will use ultrasound to collect information on how the ovaries look and function, and then
 relate the features of the ovaries to body composition, reproductive and metabolic hormones
 as well as nutritional factors. Because features of the ovaries are expected to be different
 in lean and overweight women, the researchers hope to develop ultrasound criteria that will
 help healthcare providers to diagnosis specific ovulation problems in women across all body
 sizes. Together, this research will help to better understand the complex relationship
 between nutrition, metabolism and reproductive health in women.

 To accomplish these objectives, the investigators plan to recruit 50 women with regular
 menstrual cycles, 50 women with normoandrogenic anovulation, and 50 women with
 hyperandrogenic anovulation. Their goal is to recruit an equal number of women in each group
 who are lean (BMI; Normal weight = 18.5 - 24.9 kg/m2) and overweight or obese (BMI;
 Overweight = 25 - 29.9 kg/m2; Obese >= 30kg/m2). Ultrasound scans of the ovaries will be
 assessed for the total number, size, and distribution of follicles using both two- and
 three-dimensional imaging techniques. Participants will have blood samples collected
 determine serum concentrations of luteinizing hormone (LH), follicle stimulating hormone
 (FSH), estradiol, progesterone. The following metabolic parameters will be assessed: (1)
 75-gram oral glucose tolerance test to characterize glucose and insulin dynamics at 0, 30,
 60, 90, and 120 minutes post-glucose ingestion; (2) dual X-ray absorptiometry (DXA) scan to
 quantify body fat and lean muscle distribution; (3) vitals and anthropometry assessment to
 measure waist and hip circumference, height, weight, blood pressure, and heart rate, and (4)
 fasting blood tests to detect serum concentrations of androgens (i.e., total testosterone,
 androstenedione, free androgen index) and serum markers of metabolic syndrome (i.e., lipids
 and hemoglobin A1C). Participants will complete a food frequency questionnaire and physical
 activity questionnaire. A researcher may also provide participants with an accelerometer to
 wear for a week.
Inclusion Criteria:

 -  Aged 18-45 years

 -  At least 2y post-menarche

 -  BMI >18.5kg/m2

 -  Good visibility of the ovaries on ultrasound

 Either:

 -  Regular menstrual cycles (21-35 days);

 -  Irregular menstrual cycles (>35 days); or

 -  Previous diagnosis of PCOS from a primary care provider

 Exclusion Criteria:

 -  Weight >300lbs

 -  Currently pregnant or breast feeding

 -  History of ovarian surgery

 -  Use of medications or supplements known or suspected to interfere with reproductive
 function and/or glucose and lipid metabolism in the past 3 months

 -  Evidence of reproductive aging as assessed by the principal criteria of STRAW+10
 stages