REPRODUCTIVE AND METABOLIC FEATURES OF THE POLYCYSTIC OVARY SYNDROME IN WOMEN CONSULTING FOR INFERTILITY.

Betsy Efu-dem BATE (betcieville@yahoo.com)
Gynaecology/Obstetrics, The University of Yaounde I
June, 2013
 

Abstract

Background: Polycystic ovary syndrome (PCOS) is universally recognized as the commonest endocrinopathy in women of reproductive age. This syndrome is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovary (PCO) morphology. Metabolic disorders, such as insulin resistance and obesity, are often associated with PCOS. Accordingly, insulin resistance seems to be the mechanism linking the reproductive and metabolic feature of the syndrome.

Methods: The aim of our study was to assess insulin sensitivity (IS) in women consulting for infertility with or without PCOS. We carried out a cross sectional and analytical study. Patients were recruited in the outpatient department of Obstetrics and Gynaecology, at the Gyneco-obstetric and Pediatrics hospital, Yaounde. All paraclinical investigations were carried out at the National Obesity Centre (NOC), of the Central hospital Yaounde. The patients were evaluated with detailed anthropometric measurements, body composition analysis and biochemical assays (fasting blood sugar and lipid profile). For the assessment of insulin sensitivity (KITT), the rate of decline of blood glucose levels was calculated by plotting the disappearance of glucose per unit time (K value) during the short insulin tolerance test. After obtaining an informed consent in each case, a total 36 women consulting for infertility were enrolled in our study. They included 15 diagnosed cases of PCOS according to Rotterdam consensus meeting of 2003 and 21 non PCOS subjects as controls.

Results; Our results show that the majority of PCOS women were in the younger age group (28.8± 5.5) than in the older women (35.0± 4.2). The majority of the women in the PCOS group had spaniomenorhea (13/15), and ultrasound findings were typical of PCOS. Hirsutism score was higher in the PCOS group with a median of 9(7-13)
Insulin sensitivity was impaired in our study population, with KITT values at 1.72±0.1 in the PCOS group versus 1.71±0.1 in the non PCOS group. Biological assays showed fasting blood glycemia of 99.7 ± 13.7mg/dl in PCOS women compared to 96.5 ± 12.9mg/dl in the non PCOS group. The lipid profiles were not significant between PCOS and non PCOS women with mean values at 2.07 ± 0.4g/l (PCOS) versus 1.95 ± 0.4g/l (non PCOS group) for total cholesterol, 0.66 ± 0.2g/l (PCOS) versus 0.58 ± 0.2g/l (non PCOS group) for the HDL and 1.45 ± 0.3g/l (PCOS) versus 1.43 ± 0.2g/l (non PCOS) for triglycerides. Anthropometric values in our study population were not statistically significant between the two groups. Mean values in our study population were BMI 27.3 ± 4.6kg/m2, waist circumference at 89.7 ± 11.6cm, %body fat at 33.9 ± 6.6%, lean mass at 46.9 ± 3.9kg. Metabolic syndrome defined using the IDF found a higher prevalence among PCOS women than non PCOS women, though no significant difference was observed between metabolic syndrome and insulin sensitivity (p=0.413). Spearman’s correlation identified fasting plasma glucose (p< 0.0001) and total cholesterol (0.01) as predictors of insulin sensitivity in women with PCOS.

Conclusion: In our study, women with PCOS seek infertility treatment at a younger age. Despite normal fasting plasma glucose levels and more favorable lipid profile in women with PCOS, a good proportion of these women have impaired insulin sensitivity. Though there was no statistically significant difference in insulin resistance between the two groups (p=0.76), the metabolic syndrome was higher in the PCOS group than non PCOS group. As such we conclude that it is no longer possible to consider PCOS as a purely gynecological disorder but also a systemic metabolic disease.

Recommendations; Women with PCOS should be screened for impaired fasting glucose and metabolic syndrome. More research is required to assess the hormonal profile and the level of risk for cardiovascular disease in these women and determine the, timing and efficacy of interventional measures.


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