Background: Polycystic ovary syndrome (PCOS) is a complex reproductive, endocrine-metabolic
disorder with insulin resistance (IR) as a common feature. Objective: To clarify whether
IR and associated hyperinsulinemia play a key role in the pathophysiological changes
in PCOS especially, reproductive and metabolic changes, and the efficacy of metformin
therapy in these cases. Patients and Methods: Twenty five PCOS patients received metformin
850 mg twice daily for four months and fifteen healthy controls were included in this
study. Body mass index (BMI) evaluation followed by ultrasound examination for measurement
of antral follicle count (AFC) in both ovaries, oral glucose tolerance test (OGTT),
fasting blood glucose, insulin and glucose / insulin ratio (G/I) were measured in
addition to serum total testosterone (T), luteinizing hormone (LH) and insulin like
growth factor-1 (IGF-1) estimation for all subjects. These parameters were re-evaluated
again 4 months after metformin treatment was initiated in PCOS patients. Results:
PCOS patients had significantly increased fasting blood glucose levels (P < 0.05),
BMI, T, IGF-1 (P < 0.01), LH, insulin levels and AFC (P < 0.001) but G/I ratio was
significantly (P < 0.001) lower in comparison to controls. Significant negative correlations
between fasting G/I ratio and each of BMI, T, and AFC respectively were evident. Impaired
OGTT at baseline was observed in PCOS patients with significant improvement noted
after initiation of metformin therapy. Metformin significantly decreased BMI, serum
T, LH, IGF-1 levels and AFC and increased the G/I ratio versus pretreatment values.
Conclusion: IR plays a vital pathophysiological role in PCOS patients as manifested
by causal relationship between insulin resistance and the reproductive and metabolic
changes of PCOS. Metformin potentially improves these changes.
Key-words:
Polycystic ovary syndrome - Insulin - Reproductive - Metabolic changes.
