Effect of Omega-3 on Subendometrial, Endometrial and Ovarian Stromal Blood Flow in Patients with Polycystic Ovarian Disease

Abstract

T his is a placebo-controlled double randomized clinical trial was carried out at outpatient infertility clinic at Maternity Hospital Ain Shams University during the period from November 2013 to June 2014. It included 100 women diagnosed with PCOS according to the criteria of ASRM/ESHRE consensus meeting on PCOS held in Rotterdam (2003) (The Rotterdam/ESHRE/ASRM-sponsered PCOS consensus Workshop Group, 2004). PCOS was diagnosed according to criteria stated by European Society of Human Reproductive and Embryology (ESHRE) and American Society of Reproductive Medicine (ASRM) by at least 2 out of 3 of the following: menstrual disturbance (amenorrhea or oligomenorrhea), clinical and/or biochemical sign of hyperandrogenism and/or typical ultrasonographic finding of PCO (with 1 ovary being sufficient for diagnosis), defined as the presence of 12 or more follicle measuring 2 to 9 mm in diameter or ovarian volume over 10 ml (The Rotterdam/ ESHRE/ASRM-sponsered PCOS consensus Workshop Group, 2004). Women with chronic disease (diabetes mellitus, chronoic liver disease, cushing syndrome…..etc), women with abnormal prolactin level, women with abnormal TSH level, women using or previously used fish oil and/or other dietary supplement within 3 monthes before starting this study were excluded. 100 women were randomized into 2 group each include 50 cases according to computer generated randomization. Group 1: 50 patients took 4 gm omega-3 fatty acids 4 capsules each capsule 1 gm 2 at morning and 2 at night (omega-3 plus ®,) (Sedico company, Egypt) for 12 weeks. Group 2: 50 controls took the placebo in the form of capsule with the same colour, shape and taste daily 4 capsules 2 at night and 2 at morning for 12 weeks The first aim of the current study was to evaluate the effect of omega-3 fatty acid administration on endometrial, subendometrial and ovarian stromal blood flow in PCOS patients by using 3D- power Doppler (GE Medical system volouson E6,5-7 MHz). The second aim of the current study was to evaluate the effect of omega-3 fatty acids on insulin resistance after usage of omega-3 fatty acids for 12 weeks in PCOS patients. The effect of omega-3 fatty acids on endometrial, subendometrial and ovarian stromal blood flow was assessed by using 3D-power Doppler (GE Medical system volouson E6,5-7 MHz) at Ain Shams University Maternity Hospital before and after 12 weeks of treatment by measured Gray:Mean Gray Value Color angio: Flow index, Vascularization index and Vascularization Flow index The effect of omega-3 fatty acids on insulin resistance was measured before and after 12 weeks of treatment Homeostasis Model Assessment (HOMA) index formula: HOMA-Insulin resistance=

Our results confirm that there was a statistically difference between both group concerning post treatment: fasting glucose (Mean= 84.7,SD=3.2 and P-value <0.001), fasting insulin (Mean=1.4, SD=1.4 and P-value <0.001) and HOMA (Mean=3.6, SD = 0.3 and p-value <0.001) in study group but in control group fasting glucose (Mean=94.8, SD=3.1), fasting insulin (Mean=2.2, SD=1.4) and HOMA (Mean= 5.2, SD=0.4). Improvement in insulin sensitivity by omega-3 fatty acids in PCOS patients might be resulted from elevated adiponectin level which has anti-diabetic, anti-atherosclerotic and anti-inflammatory effects. Adiponectin increase glucose utilization by activiation of AMPK (AMP-activated protein kinase) (Higuchi et al., 2008). We observed that omega-3 FA had no significant effect on any of the Doppler indices in study group after 12 weeks of treatment with omega-3 1-Endometrial: (MG, VI, FI and VFI with p-value >0.005). 2-Subendometrial: (MG, VI, FI and VFI with P-value >0.005). 3-mean ovarian stroma: (MG, FI, VI and VFI with P-value >0.005). In conclusion we are able to suggest that non-significant effect of omega-3 FAs on endometrial, subendometrial, ovarian stromal blood flow in our studies might be due to short duration of administration of omega-3 FAs.