Analysis of expression differences between endometria of women with PCOS and normal cycling women, collection of normal endometrial tissue

PCOS (Polycystic Ovary Syndrome) is a common endocrine and metabolic disorder
in women in the reproductive age. It is the most common cause of anovulatory
infertility, and its prevalence is estimated to be 5-10%.
The currently accepted definition of PCOS involves the combination of at least
two of the following features: chronic anovulation, clinical or
endocrinological signs of hyperandrogonism and polycystic ovaries (PCO)
assessed by ultrasound.
Women with PCOS have a lower fecundity rate. Infertility associated with PCOS
derives from chronic anovulation, but there are increasing data suggesting that
poor oöcyt quality, implantation failure, and higher rates of miscarriage
further complicate achieving and maintaining a pregnancy in women with PCOS.
Miscarriage rates have been reported to be between 30 and 50%, and 30% of women
with recurrent miscarriages are reported to have PCOS. Moreover, PCOS women
have a significantly higher risk of endometrial hyperplasia and endometrial
cancer. If these women develop endometrial cancer it is at an earlier age as
compared to non PCOS women (mean age 40 compared to 64 years of age).
The endometrium is the inner layer of the uterus, and undergoes a rapid cycling
process of proliferation, differentiation and cell death due to do the
production of the ovarian hormones, estrogen and progesterone. In women with
PCOS who are anovulatory, the regulatory roles of progesterone and progesterone
withdrawal in the endometrium is absent or suboptimal. As a result, the tissue
is continuously exposed to estrogens, and does not undergo the sequential
changes in gene expression and associated biochemical processes resulting in
normal endometrial cellular proliferation, differentiation, and tissue
desquamation. There is increasing evidence of dysregulated expression of
biomarkers in the epithelium of the endometrium of women with PCOS, for example
αvβ3 integrin, ERα and a dysregulation in the IGF (insulin-like growth factor)
system.
The aim of this study is to understand dysregulated signalling pathways in the
endometrium of PCOS women by analyzing expression profiles using a
pathway-oriented method.

1. Evaluation of gene-expression profiles of endometria of PCOS women compared
to normal ovulatory women
2. Identify genes and pathways which contribute to a high rate of miscarriages
of PCOS women
3. Identify genes and pathways related to the high incidence of endometrial
cancer in PCOS women

The study is an analysis of endometrial gene-expression profiles of PCOS
patients and normal ovulatory control women.

Risk and burden are linked to protocol procedures, such as blood withdrawal,
ultrasound and biopsy sampling. Although these are routine procedures, carried
out by medical qualified personnel, they may cause side effects or discomfort
to the subject. However, it is expected that these procedures will generally be
well tolerated.
The patient is asked to come once to the hospital and a questionnaire is send
to her. At the study visit the blood and endometrium samples are collected, and
the ultrasound is performed.