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

Study Description

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Brief Summary:

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 or disease	Intervention/treatment	Phase
Polycystic Ovary Syndrome	Drug: Metformin; Behavioral: Dietary Restriction; Behavioral: Exercise Training	Phase 3

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.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	32 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Double (Investigator, Outcomes Assessor)
Primary Purpose:	Treatment
Official Title:	Effect of Weight and Insulin Sensitivity on Reproductive Function in PCOS
Study Start Date :	May 2012
Actual Primary Completion Date :	April 2016
Actual Study Completion Date :	December 2016

Arms and Interventions

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Arm	Intervention/treatment
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.

Outcome Measures

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Primary Outcome Measures :

1. Pulsatility profile of Luteinizing Hormone (LH) [ Time Frame: Baseline, Week 24 ]
   Change in LH pulsatility measured over 12h (7pm - 7am)

Secondary Outcome Measures :

1. Insulin sensitivity [ Time Frame: Baseline and week 24 ]
   Change in insulin sensitivity measured by the euglycemic hyperinsulinemic clamp

Eligibility Criteria

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Ages Eligible for Study:	20 Years to 40 Years (Adult)
Sexes 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

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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

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Additional Information:

Press Release: New Study at Pennington Biomedical Research Center Designed to Identify Factors Affecting Infertility in Women 

Study information and how to participate 

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Broskey NT, Klempel MC, Gilmore LA, Sutton EF, Altazan AD, Burton JH, Ravussin E, Redman LM. Assessing Energy Requirements in Women With Polycystic Ovary Syndrome: A Comparison Against Doubly Labeled Water. J Clin Endocrinol Metab. 2017 Jun 1;102(6):1951-1959. doi: 10.1210/jc.2017-00459.

Responsible Party:	Leanne Redman, Principal Investigator, Pennington Biomedical Research Center
ClinicalTrials.gov Identifier:	NCT01482286 History of Changes
Other Study ID Numbers:	PBRC11016; R00HD060762 ( U.S. NIH Grant/Contract )
First Posted:	November 30, 2011
Last Update Posted:	January 30, 2017
Last Verified:	January 2017

Keywords provided by Leanne Redman, Pennington Biomedical Research Center:

Exercise; Diet; Insulin resistance; Weight

Additional relevant MeSH terms:

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