The Insulin resistance (IR), lipid profiles, body mass index and vitamin d levels in black women with polycystic ovary syndrome (PCOS) who are in vitro fertilization candidates at a tertiary hospital in western Kenya

Abstract

The primary cause of endocrine and reproductive abnormalities, with implications for metabolic syndrome and cardiovascular risk conditions, is Polycystic Ovary Syndrome. Since Achard and Thiers originally characterized "la diabetes des femmes a barbe" (diabetes of the bearded ladies) in 1921, insulin resistance and hyperinsulinemia in women with polycystic ovarian syndrome (PCOS) have remained two of the most prevalent metabolic issues. Seventy percent 70% of women with PCOS exhibit IR, with significant proportion at risk of type 2 diabetes mellitus. The underlying cause of insulin resistance is unclear, and conflicting research findings have hampered care strategies for both PCOS in general and insulin resistance specifically. Research suggests that 80% of women with PCOS had low vitamin D levels, which may be the missing component between Vitamin D and insulin resistance, since Vitamin D helps in reuptake of calcium and insulin release is calcium dependent.

Aim
To evaluate and compare the insulin resistance, lipid profiles, body mass index and Vitamin D levels in black women with PCOS who are IVF candidates.

Materials and Methods

A case control study conducted at the Mediheal Fertility Center in Eldoret, Western Kenya, between June 2023 and February 2024. A sample size of 40 was used in this study. Study population involved women of reproductive age who were divided into two groups. Twenty (20) cases were identified as per the Rotterdam criteria of PCOS diagnosis and assigned into group I while the 20 controls were drawn from the general population in the neighborhood community and assigned into group II.

The following measures were taken at the Mediheal Fertility Center and Moi Teaching & Referral hospital laboratories: body mass index, waist hip ratio, fasting blood glucose, insulin, lipid profiles; total cholesterol (TC), triglycerides, low density lipoprotein (LDL) and high-density lipoprotein (HDL), and vitamin D. Oxidase peroxidase, enzymatic colorimetric, and automated Chemiluminescence (ECLIA) method were used. The data were analyzed using Wilcoxon rank sum test and the statistical package for social science (SPSS) version 25, with significance set at  P <0.05.

Results

While lipid profiles and the waist-hip ratio were similar, there was a slight variation in the means of BMI, fasting blood glucose, insulin levels, and vitamin D levels between the PCOS group and the non-PCOS group. Homeostatic model assessment of insulin resistance (HOMA-IR) and BMI linked favorably in the PCOS group, whereas triglycerides and HOMA-IR correlated positively in group II. When comparing the metabolic parameters of the PCOS group, there were no statistically significant differences in HOMA-IR, BMI, waist-hip ratio, Vitamin D and lipid profiles cholesterol, triglycerides, HDL:LDL ratio, total cholesterol: triglyceride ratio and Castellis risk index between the PCOS and non PCOS group (all p> 0.05). Regression analysis showed that LDL, HDL, TRI, vitamin D, and total cholesterol were important predictors of HOMA-IR but WHR was not.

Conclusion

Although no statistically significant differences in HOMA-IR, BMI, Vitamin D, and lipid profiles were established between PCOS and non PCOS groups, these factors were still identified as significant predictors of insulin resistance within the PCOS population. Further research should explore additional factors influencing insulin resistance in PCOS, such as genetic predispositions or lifestyle interventions and assess the potential synergistic effects of Vitamin D supplementation and hypoglycemic agents on lipid metabolism and metabolic dysregulations