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

Objective: To examine the null hypothesis that women with polycystic ovary syndrome (PCOS) produce similar levels of prorenin and other components 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 clinic in a university-based county hospital and a hospital-based private infertility practice. Patients: Twenty-eight infertile women aged 18 to 35 years. Thirteen patients were diagnosed with PCOS. Fifteen normal ovulatory patients who were matched for age and weight served as controls. Interventions: Twenty patients were stimulated with CC and eight 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 phase controls. Plasma prorenin correlated significantly with peripheral androgen levels. Prorenin, active renin, and Ang IT increased in response 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 hypothesis 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. Baseline active renin levels may be predictive of ovulation with CC.