Effect of Weight and Insulin Sensitivity on Reproductive Function in PCOS - Full Text View

Purpose

Polycystic ovary syndrome (PCOS) is the most common reproductive disorder in women of reproductive age and despite decades of research the etiology the disorder is not known. The characteristic hyperandrogenism and anovulation is associated with abnormal neuroendocrine function and insulin resistance. Obesity is a common correlated phenotype of Polycystic ovary syndrome and weight gain worsens the reproductive and metabolic complications. Currently there is no evidence-based treatment plan for infertility in Polycystic ovary syndrome; yet weight loss by dietary restriction and regular exercise are strongly advocated. Weight loss and increased insulin sensitivity appear to drive improvements in reproductive outcomes in women with Polycystic ovary syndrome; however, the mechanism connecting these changes with the reproductive axis is not fully understood.

Condition	Intervention	Phase
Polycystic Ovary Syndrome	Drug: Metformin Behavioral: Dietary Restriction Behavioral: Exercise Training	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Effect of Weight and Insulin Sensitivity on Reproductive Function in PCOS

Resource links provided by NLM:

MedlinePlus related topics: Allergy Body Weight Exercise and Physical Fitness Polycystic Ovary Syndrome

Drug Information available for: Metformin Metformin hydrochloride Insulin

U.S. FDA Resources

Further study details as provided by Pennington Biomedical Research Center:

Primary Outcome Measures:

Pulsatility profile of Luteinizing Hormone (LH) [ Time Frame: Baseline, Week 24 ] [ Designated as safety issue: No ]
Change in LH pulsatility measured over 12h (7pm - 7am)

Secondary Outcome Measures:

Insulin sensitivity [ Time Frame: Baseline and week 24 ] [ Designated as safety issue: No ]
Change in insulin sensitivity measured by the euglycemic hyperinsulinemic clamp


Enrollment:	32
Study Start Date:	May 2012
Estimated Study Completion Date:	December 2016
Primary Completion Date:	April 2016 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Metformin Subjects randomized to the metformin treatment group will receive 1000 mg extended release metformin hydrochloride tablets (Bristol Myers Squibb) twice per day with food approximately 8 hours apart.	Drug: Metformin Subjects randomized to the metformin treatment group will receive 1000 mg extended release metformin hydrochloride tablets (Bristol Myers Squibb) twice per day with food approximately 8 hours apart. Other Name: metformin hydrochloride tablets
Experimental: Dietary Restriction Subjects randomized to the dietary restriction group (DR) will reduce their energy intake by 25% from their weight maintenance energy intake determined at baseline by doubly labeled water.There will be no gradual ramping of dietary restriction. The 25% energy reduction goal will apply from the first day of the intervention for a period of 24 weeks. Subjects will be asked to not modify their normal level of physical activity.	Behavioral: Dietary Restriction Subjects randomized to the dietary restriction group will reduce their energy intake by 25% of their weight maintenance energy intake determined at baseline. Total energy expenditure as measured by a 14-day doubly labeled water (DLW) study will be used to determine the baseline energy intake of each subject. There will be no gradual ramping of dietary restriction. The 25% energy reduction goal will apply from the first day of the intervention for a period of 24 weeks. Subjects will be asked to not modify their normal level of physical activity. Other Names: 25% DR Calorie restriction
Experimental: Exercise Subjects randomized to the exercise training group will complete a structured program of aerobic training 3 to 4 times per week and resistance exercises 2 times per week.	Behavioral: Exercise Training For the aerobic training component, subjects are required to meet a weekly energy expenditure target of 10 kcal per kg of body weight per week (KKW). The resistance training program will be performed 2 days a week. The resistance program includes 9 exercises. The 9 primary exercises are seated chest press, seated row, shoulder press, lat pull down, double leg press, leg extension, leg curl, back extension and abdominal crunch. Other Name: Aerobic and resistance training
No Intervention: Control Subjects randomized to the no treatment control group will be asked to continue, as normal their usual dietary and exercise regimen. Subjects will be asked to not begin diet or exercise regimens through the 24-week study or to begin medical treatment for PCOS.

Detailed Description:

The goal of this study is to determine (using dietary restriction, exercise training, metformin or no treatment), the effects of weight loss and/or improved insulin sensitivity on reproductive function (neuroendocrine and ovarian) in obese women with Polycystic ovary syndrome.

Eligibility


Ages Eligible for Study:	20 Years to 40 Years (Adult)
Genders Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

20 - 40 years, inclusive
Body mass index ≥ 25 kg/m2
History of irregular menstrual cycles (fewer than 6 cycles in the past year)
Clinical and/or biochemical androgen excess (Free androgen index>3.85 and/or hirsuitism rating ≥8)
Anovulatory menstrual cycles (determined during screening)

Exclusion Criteria:

Ovulatory menstrual cycles (determined during screening by luteal phase serum progesterone >3ng/mL)
History or clinical appearance of cardiovascular disease, diabetes (Type 1 or Type 2) and any other significant reproductive, metabolic, hematologic, pulmonary, gastrointestinal, neurologic, immune, hepatic, renal, urologic disorders, or cancer.
Hemoglobin, hematocrit, red blood cell count, or iron level below the lower limit of normal at the screening visit confirmed by a test repeated within two weeks
Regular use of medications for weight control, glucose intolerance, thyroid disease
Use of hormonal contraception containing medroxyprogesterone acetate (A 3 month washout period will be permitted for oral, vaginal and transdermal contraceptives).

Psychiatric and Behavioral Exclusion Criteria

Smoking
History of drug or alcohol abuse (up to 14 drinks a week are allowed) within the past two years
History or presence of an eating disorder as determined by Interview for Diagnosis of Eating Disorders (IDED-IV)
Beck Depression Index (BDI) score of ≥15 at screening or baseline

Other Exclusion Criteria

Individuals who have lost more than 5kg (11lbs) in the past 6 months
Individuals who are pregnant or breast-feeding or whom become pregnant during the study
Individuals engaged in a regular program of physical fitness involving some heavy physical activity (e.g., jogging or riding fast on a bicycle for 30 minutes or more) at least five times per week over the past year
Individuals who have metallic objects in their body
Individuals who donated blood within 30 days prior to the date of randomization
Individuals unwilling to be assigned at random to either one of the intervention groups
Unwilling or unable to adhere to the rigors of the data collection (determined by food and activities diaries at screening, see below) and clinical evaluation schedule over the entire 24 week intervention period
Individuals who plan to move out of the area within the next 12 months or plan to be out of the study area for more than 4 weeks in the next 12 months
Individuals who reside too far from Pennington

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01482286

Locations


United States, Louisiana
Pennington Biomedical Research Center
Baton Rouge, Louisiana, United States, 70808

Sponsors and Collaborators

Pennington Biomedical Research Center

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Investigators


Principal Investigator:	Leanne M Redman, PhD	Pennington Biomedical Research Center

More Information

Additional Information:

Press Release: New Study at Pennington Biomedical Research Center Designed to Identify Factors Affecting Infertility in Women This link exits the ClinicalTrials.gov site

Study information and how to participate This link exits the ClinicalTrials.gov site


Responsible Party:	Leanne Redman, Principal Investigator, Pennington Biomedical Research Center
ClinicalTrials.gov Identifier:	NCT01482286 History of Changes
Other Study ID Numbers:	PBRC11016 R00HD060762
Study First Received:	November 28, 2011
Last Updated:	September 2, 2016
Health Authority:	United States: Institutional Review Board

Keywords provided by Pennington Biomedical Research Center:


Exercise Diet Insulin resistance Weight

Additional relevant MeSH terms:


Polycystic Ovary Syndrome Insulin Resistance Ovarian Cysts Cysts Neoplasms Ovarian Diseases Adnexal Diseases Genital Diseases, Female Gonadal Disorders	Endocrine System Diseases Hyperinsulinism Glucose Metabolism Disorders Metabolic Diseases Insulin Metformin Hypoglycemic Agents Physiological Effects of Drugs

ClinicalTrials.gov processed this record on September 23, 2016

Effect of Weight and Insulin Sensitivity on Reproductive Function in PCOS (PULSE)