Treatments in Patients with Polycystic Ovary Syndrome and Effects on Kisspeptin Serum Levels

Introduction: Polycystic ovarian syndrome (PCOS) is a common and multifactorial pathology among young women of reproductive age and one of the main causes for female infertility. Most patients are referred to a gynecologist due to specific symptoms such as menstrual irregularities, hirsutism, facial or body acne and inability to obtain a pregnancy. Lately, kisspeptin, a neuropeptide produced in the anterior region of the hypothalamus that seems to modulate the GnRH secretion and therefore the hypothalamic-hypophyseal-ovarian axis (HHO-axis), has been considered responsible for PCOS occurrence. Objectives:The aim of our study was to observe the changes in hormonal balances and kisspeptin serum levels in patients with PCOS after treatment with myo-inositol and vitex. Materials and methods:A prospective clinical study was conducted by us, between 4 January 2021 and 1 March 2022, in "Elena Doamna" Clinical Hospital of Obstetrics and Gynecology, Iasi, Romania. After obtaining the subjects' informed consent and agreement to participate, we identified 14 patients with PCOS and primary or secondary infertility, who underwent laboratory investigations during the follicular phase of their menstrual cycles, testing for kisspeptin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, testosterone, insulin, blood sugar levels and prolactin. An abdominal-pelvic scan and full body examination were also performed. Patients, in accordance with their gynecologists' recommendation, preferred a medical therapy consisting of myo-inositol 750 mg/day and vitex 400 mg/day. After three months of treatment, patients agreed to have a second check up to see if any changes occurred. Results:We found significant positive differences when considering kisspeptin, estradiol, FSH and prolactin serum values. There was no significant difference in testosterone and insulin serum levels; on the other hand, we observed an increase in LH serum levels. The mean ovarian volume before treatment was 14.0 for the right ovaries and 13.8 for the left ovaries. After treatment and the recommended lifestyle changes, we noticed a decrease in the mean ovarian volume (13.5 for the right ovaries and 13.4 for the left ovaries). Discussions and conclusions: The etiology of PCOS, which is considered a multifactorial pathology, remains unclear. Multiple studies have been conducted and are still exploring the role of kisspeptin as an etiologic factor for PCOS associated with infertility. Our study showed a decrease in kisspeptin values after the use of myo-inositol and vitex in patients with PCOS, therefore supporting the long-standing theory that kisspeptin might have an essential role in the development of PCOS.