Abstract
Polycystic ovary syndrome (PCOS) is a common problem among Arab women and is the main cause of infertility due to anovulation. This study investigates insulin resistance (IR) and obesity in different PCOS phenotypes among infertile women (n = 213), of whom 159 had PCOS and 54 women without PCOS, recruited as a control group. Biometric, hormonal and clinical parameters were studied. IR was observed in 133 (83.6%) women with PCOS and in 25 (46.3%) women without PCOS (p < 0.001). IR was significantly associated with PCOS only among women with central obesity (χ2 = 35.0, p < 0.001) and not for the normal category (χ2 = 4.04, p < 0.058). The LH/FSH ratio was not significantly different among the PCOS group (n = 37, 23.3%) compared to the control group (n = 9, 16.7%) (p = 0.308). Among women with PCOS, the most common phenotype was type I (50.3%), with type III (29.6%), type II (14.5%) and type IV (5.7%). Type I had the highest values of fasting insulin (median = 12.98 mU/mL) and HOMA IR values (significant difference among the four phenotypes, p = 0.009 and 0.006, respectively) and is associated with severity of the disease. There was no difference in glucose levels.
Highlights
Polycystic ovary syndrome (PCOS) is a heterogeneous condition, the pathophysiology of which appears to be a multifactorial, polygenic and multisystem endocrine disorder affecting 5–10% of women of reproductive age, characterised by hyperandrogenism and chronic anovulation[1]
No difference was observed in body mass index (BMI) and waist circumference (WC) values or categories between PCOS phenotypes
Our study shows that the type I classical and full-blown severe PCOS phenotype is the most common; this accords with other studies
Summary
Polycystic ovary syndrome (PCOS) is a heterogeneous condition, the pathophysiology of which appears to be a multifactorial, polygenic and multisystem endocrine disorder affecting 5–10% of women of reproductive age, characterised by hyperandrogenism and chronic anovulation[1]. According to ESHRE guidelines[15], women with PCOS present with four phenotypes: type I: hyperandrogenism, chronic anovulation, and polycystic ovaries; type II: hyperandrogenism and chronic anovulation but with normal ovaries; type III: hyperandrogenism and polycystic ovaries but ovulatory cycles; and type IV: chronic anovulation and polycystic ovaries but no clinical or biochemical hyperandrogenism. More attention was focused on the degree of IR (insulin resistance) in women with PCOS. Recent evidence suggests that obesity appears to exert an additive synergistic impact on the manifestations of PCOS, including a modifying effect on insulin sensitivity and gonadotrophin secretion and independently and negatively affecting insulin sensitivity, risk of diabetes, and cardiovascular impact[18].
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