Metabolic Risk in Patients with a Diminished Ovarian Reserve and Premature Ovarian Insufficiency

Abstract

Objective: Diminished ovarian reserve (DOR) and premature ovarian insufficiency (POI) represent conditions of different severity, characterized by an earlier-than-expected decrease in ovarian activity. The present study aims to compare metabolic disturbances between women with DOR and patients with POI from a different origin. Materials and methods: A total of 226 women (28 healthy women; 77 individuals with DOR, and 121 patients with POI/36 with Turner syndrome [TS] and 85 with non-TS POI/) have been studied retrospectively. Data concerning anthropometric indices, and metabolic parameters were collected. Results: Patients with DOR, non-TS POI, and TS had increased blood pressure and liver enzymes, pronounced insulin resistance, and worse lipid profiles than controls (p < 0.008 for all). TS patients had significantly higher ASAT, GGT, and TSH levels compared to non-TS POI and DOR individuals. The prevalence of type 2 diabetes tended to be higher in TS women compared to other groups. The prevalence of previously diagnosed polycystic ovarian syndrome was lower in the non-TS POI patients than in the DOR patients (p = 0.005). Conclusions: patients with decreased ovarian function suffer from insulin resistance, abnormal lipid profile, and subtle hepatic disturbances, irrespective of the severity of the condition and the presence of chromosomal aberrations.

Keywords: Turner syndrome; diminished ovarian reserve; hepatic; insulin resistance; lipid; metabolic; premature ovarian insufficiency.

Figure 1

Etiology of diminished ovarian reserve (DOR) (A) and non-chromosomal premature ovarian failure (POI) (B). Patients with DOR showed slight differences in the etiology compared to non-chromosomal POI, with fewer autoimmune disorders and familial cases (p = 0.027). Iatrogenic causes included pelvic surgery, chemotherapy and/or radiotherapy for neoplastic disorders. Autoimmune origin was suspected in the case of at least one concomitant autoimmune condition.

Figure 2

Hepatic and metabolic parameters ((A)—ALAT; (B)—GGT; (C)—Triglycerides; (D)—Total cholesterol, (E)—HDL-cholesterol, (F)—HOMA-IR) in the investigated women who had not been treated with hormone-replacement therapy. DOR-diminished ovarian reserve; POI–premature ovarian insufficiency (non-chromosomal); TS—Turner syndrome; NS—non significant.