Abstract
Background: Polycystic ovarian syndrome (PCOS) is a hormonal disorder common among women of the child-bearing age. Likewise, women with PCOS are more likely to be obese or overweight, which may be due to their higher Insulin resistance and TSH levels.
 Aim: The study's objectives were to assess the prevalence of subclinical hypothyroidism in infertile PCOS, distribution of insulin resistant in PCOS women with subclinical hypothyroidism, and the efficacy of Metformin treatment in these women.
 Methods: It was a single-center study which included all infertile patients who visited the Department of Obstetrics and Gynecology at a Karachi hospital between January 2019 and September 2019. The infertile PCOS patients were then divided into two groups: Group A (Insulin Resistant with Subclinical Hypothyroidism) and Group B. (Non-Insulin Resistant with Subclinical Hypothyroidism). Following the written consent, both the treatment groups received Metformin 500mg T.D. for three months.
 Results: The infertile PCOS patients showed a higher prevalence of subclinical hypothyroidism. Insulin resistance was found to be 63.3% among subclinical hypothyroid PCOS women. Finally, three months of Metformin treatment resulted in a significant reduction in TSH levels in Insulin resistant PCOS women.
 Conclusion: We identified a positive link between TSH levels and insulin resistance in PCOS women, both in terms of incidence and treatment.
Highlights
Polycystic ovary syndrome is the one of widely arising hormonal abnormality, affecting up to 10% women of childbearing year
Out of the 71 controls 21 (29%) women presented with Subclinical Hypothyroidism (SCH) and from the 63 infertile women with Polycystic ovarian syndrome (PCOS), 30 (47%) had Subclinical Hypothyroidism (SCH)
Out of 30 Subclinical Hypothyroidism with PCOS, 19 (63.3%) women presented with Insulin Resistance while 11 (36.6%) women were NonInsulin Resistant (Fig. 2)
Summary
Polycystic ovary syndrome is the one of widely arising hormonal abnormality, affecting up to 10% women of childbearing year. It is distinguished by menstrual abnormalities, an excess of the androgen hormones and enlarged ovaries containing multiple small follicles (polycystic ovaries) [1]. A large number of women with PCOS presents with signs of metabolic syndrome, comprising of insulin resistance, obesity, and dyslipidemia [24]. Women with PCOS are more likely to be obese or overweight, which may be due to their higher Insulin resistance and TSH levels. Aim: The study's objectives were to assess the prevalence of subclinical hypothyroidism in infertile PCOS, distribution of insulin resistant in PCOS women with subclinical hypothyroidism, and the efficacy of Metformin treatment in these women. Conclusion: We identified a positive link between TSH levels and insulin resistance in PCOS women, both in terms of incidence and treatment
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