Vitamin D deficiency, insulin resistance, and antimüllerian hormone level: a tale of trio in the expression of polycystic ovary syndrome

Abstract

To study the association between altered vitamin D profiles and different indices and clinical features of polycystic ovary syndrome (PCOS), including anti-mullerian hormone (AMH) levels, phenotypes [A {hyperandrogenism (HA)+ ovulatory dysfunction (OD)+ polycystic ovarian morphology (PCOM)}], B (HA+OD), C (HA+PCOM), and D (OD+PCOM)], insulin resistance (IR), oligomenorrhea, hyperandrogenism, obesity indices, and stress biomarkers in the ethnic population of West Bengal. Case-control observational study. Outpatient department of gynaecology and obstetrics, Medical College, Kolkata-700073, and environing Kolkata, West Bengal, India. (Patients and Control): Sample size: case group (PCOS, n=160), age: 16-38 years, and their gender, age, and ethnicity-matched healthy control (n=160). In this observational study, a structured questionnaire for menstrual status and to determine the scores of cutaneous manifestations, a bioelectrical impedance analyser for measurement of anthropometric indices, relevant biochemical assessments (vitamin D, AMH, insulin, glucose and other associated hormonal profiles), statistical software for the social sciences, and Microsoft Office Excel were used to evaluate and analyze different indices (significant at P<0.01 and P<0.05). Study of the association of vitamin D deficiency with differential manifestations of PCOS such as phenotypes of the syndrome, altered AMH levels, and risk of insulin resistance. An attempt has been made to determine the cut-off value of AMH of the PCOS patients belonging to the ethnic population of West Bengal using receiver operating characteristic (ROC). Vitamin D deficiency was found to be directly correlated (P=0.000) with AMH in PCOS phenotype A (67%), oligomenorrhea, and PCOM, along with a substantial (P<0.01) agonistic relationship with insulin resistance in the PCOS population under study. In the PCOS phenotype B, the AMH level was highest, with a cut-off value of 5.27 ng/ml (asymptotic sig.=0.000, 95% CI: 8.37-9.95, derived by receiver operating characteristic-ROC analysis, with area under the ROC curve-AUC=0.949, sensitivity=0.882, and specificity=0.880). Oligomenorrhic PCOS women possess significantly (P=0.000) higher values of AMH (8.70±3.66>3.09±1.86) than the regular menstrual rhythm within the same group. PCOS patients had significantly (P<0.01 and 0.05) less skeletal muscle mass and greater subcutaneous fat content than the control group. 25-hydroxy-vitamin D might be intermeshed with the underlying pathophysiology and severity of PCOS, and associated metabolic disorders like IR. The AMH level is finely tuned by most of the plausible effectors of PCOS and contends to be a promising biomarker for the diagnosis and prognosis of PCOS.