Vol 91, No 4 (2020)
Research paper
Published online: 2020-04-29

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Smoking reduces ovarian stromal blood flow in polycystic ovary syndrome patients

Özlen Emekçi Özay1, Ali Cenk Özay1
Pubmed: 32374020
Ginekol Pol 2020;91(4):201-206.


Objectives: The objective of the current research is to compare hormonal, metabolic and ovarian stromal blood flow
outcomes in smoking versus non-smoking polycystic ovary syndrome (PCOS) patients.
Material and methods: 79 PCOS women (Group 1) and 79 healthy subjects (Group 2) were recruited. Both groups were
subdivided according to their smoking habits. Ovarian stromal blood flow was assessed with pulsatility and resistance
index for both ovaries and compared among smoking women.
Results: The smokers in the PCOS group had statistically significant higher levels of pulsatility and resistance index in both
ovaries compared to nonsmoker PCOS patients (p < 0.001). Comparison of ovarian stromal blood flow indexes shows that
pulsatility and resistance index for both ovaries is statistically significantly high in smoking healthy patients compared to
the nonsmoking group (p < 0.001). There is a positive correlation between smoking and free androgen index (r = 0.866,
p < 0.001) for PCOS patients and healthy women.
Conclusions: Smoking reduces ovarian blood flow in PCOS patients and healthy subjects. Smoke components effect the
vascular structure and form endothelial injuries that may reduce ovarian tissue perfusion. In this study, the positive correlation
between smoking and free androgen index shows that the main effect of smoking on ovarian blood flow may be
through androgen metabolism.

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  1. Stein I, Leventhal M. Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935; 29: 181–185.
  2. Asunción M, Calvo RM, San Millán JL, et al. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000; 85(7): 2434–2438.
  3. Azziz R, Carmina E, Dewailly D, et al. Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006; 91(11): 4237–4245.
  4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19(1): 41–47.
  5. Glintborg D, Andersen M. An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecol Endocrinol. 2010; 26(4): 281–296.
  6. Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010; 95(5): 2038–2049.
  7. Battaglia C, Artini PG, D'Ambrogio G, et al. The role of color Doppler imaging in the diagnosis of polycystic ovary syndrome. Am J Obstet Gynecol. 1995; 172(1 Pt 1): 108–113.
  8. Zaidi J, Campbell S, Pittrof R, et al. Ovarian stromal blood flow in women with polycystic ovaries--a possible new marker for diagnosis? Hum Reprod. 1995; 10(8): 1992–1996.
  9. Aleem FA, Predanic M. Transvaginal color Doppler determination of the ovarian and uterine blood flow characteristics in polycystic ovary disease. Fertil Steril. 1996; 65(3): 510–516.
  10. Bostanci MS, Sagsoz N, Noyan V. Comprasion of ovarian stromal and uterine artery blood flow measured by color Doppler ultrasonography in polycystic ovary syndrome patients and patients with ultrasonographic evidence of polycystic. J Clin Gynecol Obstet. 2013; 2: 20–26.
  11. Pan HA, Wu MH, Cheng YC, et al. Quantification of Doppler signal in polycystic ovary syndrome using three-dimensional power Doppler ultrasonography: a possible new marker for diagnosis. Hum Reprod. 2002; 17(1): 201–206.
  12. Rahman MM, Laher I. Structural and functional alteration of blood vessels caused by cigarette smoking: an overview of molecular mechanisms. Curr Vasc Pharmacol. 2007; 5(4): 276–292.
  13. Li J, Wu Q, Wu XK, et al. Effect of exposure to second-hand smoke from husbands on biochemical hyperandrogenism, metabolic syndrome and conception rates in women with polycystic ovary syndrome undergoing ovulation induction. Human Reproduction. 2018; 33(4): 617–625.
  14. Price JF, Mowbray PI, Lee AJ, et al. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study. Eur Heart J. 1999; 20(5): 344–353.
  15. Kalfaoglu ME, Hızal M, Kiyan A, et al. The effects of chronic smoking on total cerebral blood volume measured by carotid and vertebral artery doppler ultrasonography. J Clin Ultrasound. 2017; 45(9): 561–565.
  16. Dechanet C, Brunet C, Anahory T, et al. Effects of cigarette smoking on reproduction. Hum Reprod Update. 2011; 17(1): 76–95.
  17. Battaglia C, Battaglia B, Mancini F, et al. Cigarette smoking decreases the genital vascularization in young healthy, eumenorrheic women. J Sex Med. 2011; 8(6): 1717–1725.
  18. Nordenvall M, Ullberg U, Laurin J, et al. Placental morphology in relation to umbilical artery blood velocity waveforms. Eur J Obstet Gynecol Reprod Biol. 1991; 40(3): 179–190.
  19. Albuquerque CA, Smith KR, Johnson C, et al. Influence of maternal tobacco smoking during pregnancy on uterine, umbilical and fetal cerebral artery blood flows. Early Hum Dev. 2004; 80(1): 31–42.
  20. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004; 43(10): 1731–1737.
  21. Morotti E, Battaglia B, Fabbri R, et al. Cigarette smoking and cardiovascular risk in young women with polycystic ovary syndrome. Int J Fertil Steril. 2014; 7(4): 301–312.
  22. Battaglia C, Mancini F, Fabbri R, et al. Vascular risk in young women with polycystic ovary and polycystic ovary syndrome. Obstet Gynecol. 2008; 111(2 Pt 1): 385–395.
  23. Elmashad AI. Impact of laparoscopic ovarian drilling on anti-Müllerian hormone levels and ovarian stromal blood flow using three-dimensional power Doppler in women with anovulatory polycystic ovary syndrome. Fertil Steril. 2011; 95(7): 2342–6, 2346.e1.
  24. Ozdemir O, Sari ME, Kalkan D, et al. Comprasion of ovarian stromal blood flow measured by color Doppler ultrasonography in polycystic ovary syndrome patients and healthy women with ultrasonographic evidence of polycystic. Gynecol Endocrinol. 2015; 31(4): 322–326.
  25. Loverro G, Vicino M, Lorusso F, et al. Polycystic ovary syndrome: relationship between insulin sensitivity, sex hormone levels and ovarian stromal blood flow. Gynecol Endocrinol. 2001; 15(2): 142–149.
  26. Agrawal R, Conway G, Sladkevicius P, et al. Serum vascular endothelial growth factor and Doppler blood flow velocities in in vitro fertilization: relevance to ovarian hyperstimulation syndrome and polycystic ovaries. Fertil Steril. 1998; 70(4): 651–658.
  27. Lam PoM, Johnson IR, Raine-Fenning NJ. Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters. Hum Reprod. 2007; 22(12): 3116–3123.
  28. Morotti E, Giovanni Artini P, Persico N, et al. Metformin metabolic and vascular effects in overweight/moderately obese hyperinsulinemic PCOS patients treated with contraceptive vaginal ring: a pilot study. Gynecol Endocrinol. 2019 [Epub ahead of print]: 1–8.
  29. Rahman MM, Laher I. Structural and functional alteration of blood vessels caused by cigarette smoking: an overview of molecular mechanisms. Curr Vasc Pharmacol. 2007; 5(4): 276–292.
  30. Ciftçi O, Günday M, Calişkan M, et al. Light cigarette smoking and vascular function. Acta Cardiol. 2013; 68(3): 255–261.
  31. Cupisti S, Häberle L, Dittrich R, et al. Smoking is associated with increased free testosterone and fasting insulin levels in women with polycystic ovary syndrome, resulting in aggravated insulin resistance. Fertil Steril. 2010; 94(2): 673–677.
  32. Funabashi T, Sano A, Mitsushima D, et al. Nicotine inhibits pulsatile luteinizing hormone secretion in human males but not in human females, and tolerance to this nicotine effect is lost within one week of quitting smoking. J Clin Endocrinol Metab. 2005; 90(7): 3908–3913.
  33. Enea C, Boisseau N, Diaz V, et al. Biological factors and the determination of androgens in female subjects. Steroids. 2008; 73(12): 1203–1216.