Trial Information

The Genetics of Polycystic Ovarian Syndrome

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women. Its
marked phenotypic variability, puzzling list of associated conditions, and hence potential
risk to a woman's health over her lifecycle clearly remain a clinical investigational,
genetic, and therapeutic challenge. To a great extent, this variability can be attributed to
the marked genetic and environmental heterogeneity of the populations studied. We plan to
address many of these long-term clinical research obstacles by delineating the genetic basis
of PCOS in a unique investigational venue, the Icelandic population. Studying the Icelandic
population has the following advantages: a) the population's relative genetic and
environmental homogeneity; b) the remarkably rich genealogic database; and c) the
centralized healthcare information. In this unusual venue, clustering of large numbers of
PCOS families with known relationships is possible. Their relative homogeneity and
genealogic characteristics can reduce genetic variance and hence be used to map the genetic
basis for PCOS more efficiently than in more heterogeneous populations. As the genes
responsible for PCOS emerge, this protocol will also determine phenotype/genotype
correlations in Iceland, contrasting them with US women, and assess their long-term medical
consequences.

Each female subject will be asked to arrive fasting in the morning. Women with PCOS will be
asked to arrive at least 10 days from their last menstrual period, while women with regular
menstrual cycles will be seen within the first 14 days after their menstrual period starts.
All subjects will be asked to fill out an extensive questionnaire. Subjects will then
undergo further history, physical exam and laboratory exams. Blood will be drawn at
baseline for DNA (the material in the cell that holds the genes), fasting blood glucose and
insulin, HbA1C, total and fractionated cholesterol, triglycerides, testosterone,
androstenedione, DHEAS, SHBG and 17-OH Progesterone. Additional blood will be drawn at 10
and 20 minutes for measurement of LH and FSH, which are pulsatile. An oral glucose
tolerance test will be optional. A standardized transvaginal ultrasound will be performed
to look at the ovaries in all female subjects. This can be done over the abdomen with a
full bladder if the patient prefers.

Male family members will also undergo a history, physical and laboratory exams in an
identical manner to that of their female family members with the addition that specific
notice of their hair distribution will be made. PCOS subjects who are on oral
contraceptives or other hormonal medication may have cholesterol, insulin, glucose,
triglycerides and HbA1C labs drawn, whereas subjects on insulin sensitizing agents will not
have any blood drawn for these tests. These subjects will undergo an ultrasound and DNA
sampling.

All hormone blood samples from Icelandic and Boston subjects will be examined in Boston.
All DNA testing will be performed in the Genotyping Core of deCODE, a company in Iceland.
Therefore, all DNA samples from Iceland and Boston will be analyzed in Iceland. The Boston
blood samples will be coded and sent to the DeCODE genotyping facility. The investigators
in Boston will retain the link between the code and the subject information in a locked area
in the office. The names of subjects will not be disclosed to deCODE.