PRORENIN IS ELEVATED IN POLYCYSTIC-OVARY-SYNDROME AND MAY REFLECT HYPERANDROGENISM

Objective: To examine the null hypothesis that women with polycystic o vary syndrome (PCOS) produce similar levels of prorenin and other comp onents of the ovarian-derived prorenin to angiotensin cascade (ODPAC) at baseline and after stimulation with clomiphene citrate (CC) or hMG when compared with normal age- and weight-matched ovulatory controls. Design: Prospective controlled clinical trial. Setting: Infertility cl inic in a university-based county hospital and a hospital-based privat e infertility practice. Patients: Twenty-eight infertile women aged 18 to 35 years. Thirteen patients were diagnosed with PCOS. Fifteen norm al ovulatory patients who were matched for age and weight served as co ntrols. Interventions: Twenty patients were stimulated with CC and eig ht were stimulated with hMG. Main Outcome Measures: Serum E(2), P, T, androstenedione (A), DHEAS, LH, FSH, and plasma prorenin, active renin , and angiotensin II (Ang IT) were measured at baseline and during the preovulatory and midluteal phases of the stimulation cycles. Results: Baseline plasma prorenin in PCOS was higher than that of follicular p hase controls. Plasma prorenin correlated significantly with periphera l androgen levels. Prorenin, active renin, and Ang IT increased in res ponse to gonadotropins with the largest increases occurring in control patients receiving CC. An association was seen between ovulation with CC and lower baseline levels of active renin. Conclusions: The null h ypothesis was rejected. Infertile women with PCOS have higher baseline prorenin levels when compared with age- and weight-matched ovulatory controls. There is a significant correlation between prorenin and the peripheral levels of androgens produced during ovarian stimulation. Ba seline active renin levels may be predictive of ovulation with CC.