COMPARISON OF FREE ANDROGEN INDEX IN POLYCYSTIC OVARY SYNDROME AND NON-POLYCYSTIC OVARY SYNDROME INFERTILE PATIENTS

Authors

  • Madiha Khattak Department of Physiology,Khyber Medical College, Khyber Medical University, Peshawar.
  • Robina Usman  Department of Physiology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan.
  • Nuzhat Sultana Department of Pathology, Northwest School of Medicine,Khyber Medical University, Peshawar, Pakistan.
  • Almas Khattak Department of Community Medicine, Northwest School of MedicineKhyber Medical University, Peshawar, Pakistan

Abstract

Background: One of the leading causes of infertility in child bearing age females is polycystic ovary syndrome. It is characterized by altered hormonal profile causing androgen excess and insulin resistance which eventually leads to decreased ovulation rate. Methods: This was a cross-sectional study that included 40 Polycystic ovary syndrome (PCOS) patients and 40 infertility patients that did not have polycystic ovary syndrome determined by sonography and clinical features through quota sampling technique. Serum Total Testosterone and Sex Hormone Binding Globulin Levels were assayed.  Using these two parameters, Free Androgen Index was calculated. Body Mass Index and central obesity was also determined. Results: Total Testosterone, Free Androgen Index and Body Mass Index were raised in PCOS group as indicated by p-value <0.05. Hirsutism was present in PCOS group (p-value <0.05). Sex Hormone Binding Globulin Levels were decreased in PCOS patients (p-value <0.05) but were within the lower half of normal range. Conclusion: Levels of Sex Hormone Binding Globulin were decreased in PCOS cases and Free Androgen Index can help in better determining hyperandrogenaemia than total testosterone alone.

Author Biographies

Madiha Khattak, Department of Physiology,Khyber Medical College, Khyber Medical University, Peshawar.

 MBBS, MPhil Physiology.  Assistant Professor  

Robina Usman,  Department of Physiology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan.

MBBS, DGO, MPhil Physiology, MHPE,  Associate Professor

Nuzhat Sultana, Department of Pathology, Northwest School of Medicine,Khyber Medical University, Peshawar, Pakistan.

MBBS, FCPS Pathology, Professor (Histopathology) ,  

Almas Khattak, Department of Community Medicine, Northwest School of MedicineKhyber Medical University, Peshawar, Pakistan

MBBS, MPH, Assistant Professor

References

Kauffman RP, Baker TE, Baker VM, DiMarino P, Castracane VD. Endocrine and metabolic differences among phenotypic expressions of polycystic ovary syndrome according to the 2003 Rotterdam consensus criteria. Am J Obstet Gynecol 2008;198(6):670–7.

Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, et al. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Hum Reprod Open 2019;2019:hoy021.

Baptiste CG, Battista MC, Trottier A, Baillargeon JP. Insulin and hyperandrogenism in women with polycystic ovary syndrome. J Steroid Biochem Mol Biol 2010;122(1-3):42–52.

Blank SK, McCartney CR, Chhabra S, Helm KD, Eagleson CA, Chang RJ, et al. Modulation of gonadotropin-releasing hormone pulse generator sensitivity to progesterone inhibition in hyperandrogenic adolescent girls--implications for regulation of pubertal maturation. J Clin Endocrinol Metab 2009;94(7):2360–6.

Rosenfield RL, Wroblewski K, Padmanabhan V, Littlejohn E, Mortensen M, Ehrmann DA. Antimüllerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil Steril 2012;98(1):242–9.

Toprak S, Yonem A, Cakir B, Guler S, Azal O, Ozata M, et al. Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm. Res 2001;55(2):65–70.

Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2014;6:1–13.

Martínez-García MÁ, Gambineri A, Alpañés M, Sanchón R, Pasquali R, Escobar-Morreale HF. Common variants in the sex hormone-binding globulin gene (SHBG) and polycystic ovary syndrome (PCOS) in Mediterranean women. Hum Reprod 2012;27(12):3569–76.

Hogeveen KN, Cousin P, Pugeat M, Dewailly D, Soudan B, Hammond GL. Human sex hormone–binding globulin variants associated with hyperandrogenism and ovarian dysfunction. J Clin Invest 2002;109(7):973–81.

Polak K, Czyzyk A, Simoncini T, Meczekalski B. New markers of insulin resistance in polycystic ovary syndrome. J Endocrinol Invest 2017;40(1):1–8.

Orio F Jr, Palomba S, Spinelli L, Cascella T, Tauchmanovà L, Zullo F, et al. The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study. J Clin Endocrinol Metab 2004;89(8):3696–701.

Al Kindi MK, Al Essry FS, Al Essry FS, Mula-Abed WA. Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism. Oman Med J 2012;27(6):471–4.

Yildiz BO, Bolour S, Woods K, Moore A, Azziz R. Visually scoring hirsutism. Hum Reprod Update 2010;16(1):51–64.

Sui X, LaMonte MJ, Laditka JN, Hardin JW, Chase N, Hooker SP, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007;298(21):2507–16.

Ahmad N, Adam SIM, Nawi AM, Hassan MR, Ghazi HF. Abdominal obesity indicators: Waist circumference or waist-to-hip ratio in Malaysian adults population. Int J Prev Med 2016;7:82.

Sathyapalan T, Al-Qaissi A, Kilpatrick ES, Dargham SR, Keevil B, Atkin SL. Salivary and serum androgens with anti-Müllerian hormone measurement for the diagnosis of polycystic ovary syndrome. Sci Rep 2018;8(1):3795.

Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004;18(5):671–83.

Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta‐analysis. Obes Rev 2013;14(2):95–109.

Selva DM, Hogeveen KN, Innis SM, Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone–binding globulin gene. J Clin Invest 2007;117(12):3979–87.

Kim C, Pi-Sunyer X, Barrett-Connor E, Stentz FB, Murphy MB, Kong S, et al. Sex hormone binding globulin and sex steroids among premenopausal women in the diabetes prevention program. J Clin Endocrinol Metab 2013;98(7):3049–57.

Barad D, Brill H, Gleicher N. Update on the use of dehydroepiandrosterone supplementation among women with diminished ovarian function. J Assist Reprod Genet 2007;24(12):629–34.

Qiao J, Feng HL. Extra-and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence. Hum Reprod Update 2011;17(1):17–33.

Proietto J. Mechanisms of insulin resistance caused by nutrient toxicity. Hepatol Res 2005;33(2):87–91.

Poretsky L, Cataldo NA, Rosenwaks Z, Guidice LC. The insulin-related ovarian regulatory system in health and disease. Endocr Rev 1999;20(4):535–82.

Hollmann M, Runnebaum B, Gerhard I. Impact of waist-hip-ratio and body-mass-index on hormonal and metabolic parameters in young, obese women. Int J Obes Relat Metab Disord 1997;21(6):476–83

Published

2021-10-06

Issue

Vol. 33 No. 4 (2021): Journal of Ayub Medical College Abbottabad

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.