Vitamin D, Hormonal profiles and Homa-IR in Polycystic Ovary Syndrome (PCOS) Women who are candidates for In Vitro Fertilization at a Tertiary Hospital in Western Kenya
Keywords:
Mabonga Cyprian School of Health Sciences,, Kaimosi Friends University,, Vihiga,, KenyaAbstract
Polycystic Ovary Syndrome (PCOS) is a condition that presents with high androgens levels, disturbances in menstrual cycles and polycystic ovaries in shape. Studies report of 30% to 80 % of PCOS gets insulin resistance, hyperinsulinemia and type II diabetes mellitus. It is one of the most common cause of infertility and thus lowering their quality of life. Research is emerging that 70 % of PCOS patients do have Vitamin D deficiency, whether there is a connection between Vitamin D and insulin resistance in PCOS, studies have remained inconsistent and inconclusive. To compare the insulin resistance, hormonal profiles and Vitamin D levels in PCOS women who are candidates for IVF at a tertiary hospital. A case control study carried out between June 2023 and April 2024 at Mediheal Fertility Centre and MTRH in Eldoret. A sample of 60 women. Group 1 of 20 participants with infertile PCOS diagnosed according to Rotterdam criteria and group II of 20 women who are fertile without PCOS and group III of 20 infertile non PCOS who are also candidates for IVF served as controls. Luteinizing hormone, Testosterone, Ant Mullerian hormone, Insulin, fasting blood sugar and Vitamin D levels were carried out using automated Chemiluminescence (ECLIA) methods at MTRH. Data was analyzed using STATA version 15 and Wilcoxon rank-sum test. P values set at <0.05.AMH, Testosterone, LH and Insulin hormone levels were significantly higher as compared to fertile non PCOS and infertile non PCOS p<0.05. However, Vitamin D was significantly lower in infertile PCOS as compared to fertile non PCOS and infertile non PCOS p< 0.05. Vitamin D correlated negatively with LH and Testosterone but positively with AMH and Insulin suggesting that higher levels of LH and Testosterone are linked to lower levels of Vitamin D unlike AMH and Insulin though the correlation was not statistically significant p> 0.05. HOMA-IR, HbA1C and fasting blood sugar were significantly higher in infertile PCOS as compared to fertile non PCOS and infertile non PCOS p< 0.05. Vitamin D correlated negatively with HbA1C but positively with HOMA-IR though not statistically significant p> 0.05. Further research may be warranted to explore additional factors influencing IR and randomized clinical trials to test impact of Vitamin D on metabolic dysregualtions. Healthcare professionals should ensure adequate Vitamin D levels in patients to potentially mitigate insulin resistance.
References
Ameri P., A. Giusti, M. Boschetti, G. Murialdo, F. Minuto, and D. Ferone, “Interactions between vitamin D and IGF-I: from physiology to clinical practice,” Clinical Endocrinology 79(4), (2013), 457–463
Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, Lizneva D, Natterson-Horowtiz B, Teede HJ, Yildiz BO. Polycystic ovary syndrome. Nature reviews Disease primers 2(1), (2016),1-8.
Bakeer, E.; Radwan, R.; El Mandoury, A.; El Rahman, A.A.; Gad, M.; El Maksoud, S.A. Anti-müllerian hormone as a diagnostic marker in Egyptian Infertile polycystic ovary syndrome females: Correlations with vitamin D, total testosterone, dyslipidemia and anthropometric parameters. J. Med. Biochem. 2018, 37,448–455.
Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., Yildiz, B.O., 2016. The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-Analysis. Hum. Reprod. 31, 2841–2855. https://doi.org/10.1093/humrep/dew218
Brassard M, AinMelk Y, Baillargeon JP (2008) Basic infertility including polycystic ovary syndrome. Med Clin North Am 92:1163–1192
Chang, E.M.; Kim, Y.S.;Won, H.J.; Yoon, T.K.; Lee,W.S. Association between sex steroids, ovarian reserve,and vitamin D levels in healthy nonobese women. J. Clin. Endocrinol. Metab. 2014, 99, 2526–2532
Çiçek, N. M., Bala, A., Çelik, Ç., & Akyürek, C. (2003). The comparison of clinical and hormonal parameters in PCOS patients treated with metformin and GnRH analogue. Archives of gynecology and obstetrics, 268, 107-112.
Dunaif, A., Green, G., Futterweit, W., Dobrjansky, A., 1990. Suppression of Hyperandrogenism Does not Improve Peripheral or Hepatic IR in the Polycystic Ovary Syndrome. J. Clin. Endocrinol. Metab. 70, 699–704. https://doi.org/10.1210/jcem-70-3-699
Farquhar, C. (2007). Introduction and history of polycystic ovary syndrome. In, Kovacs, G. T. and Norman, R. (eds). Polycystic Ovary Syndrome. Cambridge, UK: Cambridge University Press.
Glintborg, D. (2016). Endocrine and metabolic characteristics in polycystic ovary syndrome. Danish medical journal, 63(4), B5232.
Gupta T, Rawat M, Gupta N, Arora S. Study of effect of vitamin D supplementation on the clinical, hormonal and metabolic profile of the PCOS women. J ObstetGynaecol India. 2017;67:349–55
Hahn S, Haselhorst U, Tan S, Quadbeck B, Schmidt M, Roesler S et al (2006) Low serum 25-hy-droxyvitamin D concentrations are associated with IR and obesity in women with polycystic ovary syndrome. ExpClinEndocrinol Diabetes 114(10):577–583
Legro, R. S. (2011). Effects of metformin in adolescents with polycystic ovary syndrome undertakinglifestyle therapy: a pilot randomized double-blind study. Fertility and Sterility, 95(8), 2595-2598
Mishra, S. (2016). Diabetic and cardio-damaging aspects of the polycystic ovary syndrome among Indian women.
Moghetti, P., & Tosi, F. (2021). Insulin resistance and PCOS: chicken or egg?. Journal of endocrinological investigation, 44(2), 233-244.
Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I: The relationships between AMH, androgens,IR and basal ovarian follicular status in non-obese subfertile women with and withoutpolycystic ovary syndrome. Hum Reprod 2009, 24:2917-2923.
Neagu M, Cristescu C: Anti-Mullerian hormone--a prognostic marker for metformin therapy efficiency in the treatment of women with infertility and polycystic ovary syndrome. J Med Life 2012, 5:462-464
Neven, A. C. H., Laven, J., Teede, H. J., & Boyle, J. A. (2018, January). A summary on polycystic ovary syndrome: diagnostic criteria, prevalence, clinical manifestations, and management according to the latest international guidelines. In Seminars in reproductive medicine (Vol. 36, No. 01, pp. 005-012). Thieme Medical Publishers.
Odera F; Prevalence by criterion basis for polycystic ovary syndrome among women presenting with amenorrhea and oligomenorrhea at the Kenyatta national hospital in 2018. Journal of Obstetrics and gynecology of Eastern and Central Africa. JOGECA, 2020, 32(S1)
Pembe, A. B., & Abeid, M. S. (2009). Polycystic ovaries and associated clinical and biochemical features among women with infertility in a tertiary hospital in Tanzania. Tanzania journal of health research, 11(4).
Seyyed Abootorabi M, Ayremlou P, Behroozi-Lak T, Nourisaeidlou S. The effect of vitamin D supplementation on IR, visceral fat and adiponectin in vitamin D deficient women with polycystic ovary syndrome: a randomized placebo-controlled trial. GynecolEndocrinol. 2018;34:489–94.
Sharma, S., & Ghosh, S. (2023). PCOS and Osteoporosis: The Correlation Between Hormonal Alterations and Vitamin D Levels. Obstetrics and Gynecology Advances, 139.
Sova H, Unkila-Kallio L, Tiitinen A, et al.: Hormone profiling, including anti-Müllerian hormone (AMH), for the diagnosis of polycystic ovary syndrome (PCOS) and characterization of PCOS phenotypes. GynecolEndocrinol. 2019, 35:595-600. 10.1080/09513590.2018.1559807
Ugwu GO, Iyoke CA, Onah HE, Mba SG. Prevalence, presentation and management of polycystic ovary syndrome in Enugu, South East Nigeria Niger J Med. 2013;22:313–6
Wehr E, Pilz S, Schweighofer N, et al. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol. 2009;161(4):575–82.
Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and metanalysis. Fertil Steril 2011 Mar 1;95(3):1073-1079.e1-e11.
Wong, H.Y.Q.; Li, H.W.R.; Lam, K.S.L.; Tam, S.; Shek, C.C.; Lee, C.Y.V.; Yeung, W.S.B.; Ho, P.C.; Ng, E.H.Y. Independent association of serum vitamin D with anti-Mullerian hormone levels in women with polycystic ovary syndrome. Clin. Endocrinol. 2018, 89, 634–641
Zella JB, Mccary LC, Deluca HF. Oral administration of 1,25-dihydroxyvitamin D 3 completely protects NOD mice from insulin-dependent diabetes mellitus. 2003; 417:77–80
