Ultrasonographic Evaluation of Anovulatory Disorders in Lean and Overweight Women

February 8, 2024 updated by: Cornell University
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.

Study Overview

Status

Completed

Detailed Description

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.

Study Type

Observational

Enrollment (Actual)

59

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • New York
      • New York, New York, United States, 10065
        • Clinical and Translational Science Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 45 years (Adult)

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Women must be able to transport to Weill Cornell University. Eligible participants are between 18-45 years with a BMI of 18.5 kg/m2 or higher. Women are screened and enrolled following consent based on their response to our advertisements. Women are recruited from the general population. Enrollment is restricted to the geographical area.

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Case-Control
  • Time Perspectives: Cross-Sectional

Cohorts and Interventions

Group / Cohort
Regular menstrual cycles
Women will be assigned to this category if they report a history of regular menstrual cycles (every 21 to 35 days). Recruitment will be targeted such that equal numbers of lean (BMI <25kg/m2) and overweight or obese (BMI >24.9kg/m2) participate.
Normoandrogenic anovulation
Women will be assigned to this category if they do not have clinical or biochemical androgen excess and report a history of irregular menstrual cycles (<21 days or >35 days), including women with a pre-existing diagnosis of PCOS. Recruitment will be targeted such that equal numbers of lean (BMI <25kg/m2) and overweight or obese (BMI >24.9kg/m2) participate.
Hyperandrogenic anovulation
Women will be assigned to this category if they have clinical or biochemical androgen excess and report a history of irregular menstrual cycles (<21 days or >35 days), including women with a pre-existing diagnosis of PCOS. Recruitment will be targeted such that equal numbers of lean (BMI <25kg/m2) and overweight or obese (BMI >24.9kg/m2) participate.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Follicle number per ovary
Time Frame: 1 day
The number and size of all follicles in each ovary will be assessed by ultrasonography
1 day

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Insulin sensitivity
Time Frame: 1 day
Insulin sensitivity will be determined by administration of an oral glucose tolerance test and compared across groups.
1 day
Androgen concentrations
Time Frame: 1 day
Total testosterone, androstenedione and free androgen index concentrations in serum will be determined and compared across groups.
1 day
Serum markers of metabolic syndrome
Time Frame: 1 day
Lipids, glucose and HbA1C concentrations will be determined and compared across groups.
1 day
Body mass index
Time Frame: 1 day
The ratio of weight to height will be determined and compared across groups.
1 day
Body fat distribution
Time Frame: 1 day
Percentage and distribution of fat and lean mass as assessed using DXA technology will be compared across groups.
1 day
Follicle number per cross section
Time Frame: 1 day
The number all follicles in a single cross sectional plane of each ovary will be assessed by ultrasonography
1 day
Ovarian volume
Time Frame: 1 day
The size of each ovary will be determined by ultrasonography for each participant and compared across groups.
1 day
Stromal echogenicity on ultrasound
Time Frame: 1 day
The brightness of the ovarian stroma in a single cross section will be determined by ultrasonography for each participant and compared across groups.
1 day
Ovarian area-stromal area ratio
Time Frame: 1 day
The ratio of the stromal area to the total ovarian area of the ovary in a single cross section will be determined by ultrasonography for each participant and compared across groups.
1 day
LH-FSH ratio
Time Frame: 1 day
The ratio of circulating LH to FSH concentrations in the serum will be determined for each participant and compared across groups
1 day
Hirsutism Score
Time Frame: 1 day
Degree of hirsutism as judged by the Ferriman-Gallwey scale will be determined and compared across groups
1 day
Menstrual Cycle Length
Time Frame: 1 day
Average menstrual cycle length as determined by self-reported history will be determined and compared across groups
1 day
Blood Pressure
Time Frame: 1 day
Blood pressure will be determined and compared across groups. [Time Frame: 1 day]
1 day
Waist-to-hip ratio
Time Frame: 1 day
The ratio of waist circumference to hip circumference will be determined and compared across groups
1 day
Differences in diet composition assessed via food frequency questionnaire
Time Frame: 1 day
A food frequency questionnaire will be administered to assess diet composition for the last three months and will be compared across groups
1 day
Differences in energy expenditure assessed via a waist-worn accelerometer
Time Frame: 1 week
Participants will be asked to wear a small accelerometer device to assess physical activity
1 week

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Marla E Lujan, PhD, Cornell University
  • Principal Investigator: Steven Spandorfer, MD, Weill Medical College of Cornell University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 1, 2015

Primary Completion (Actual)

April 1, 2023

Study Completion (Actual)

April 1, 2023

Study Registration Dates

First Submitted

October 6, 2017

First Submitted That Met QC Criteria

October 6, 2017

First Posted (Actual)

October 11, 2017

Study Record Updates

Last Update Posted (Estimated)

February 9, 2024

Last Update Submitted That Met QC Criteria

February 8, 2024

Last Verified

February 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 1410015577

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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