Infertility in Polycystic Ovary Syndrome Iraqi women Metabolic-Hormonal Profile and LH/FSH Ratio as predictors of infertility: A case Control study.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder characterized by inadequate secretion of gonadotropins, excess testosterone and oligo-anovulation. The main yet partially unanswered question is what hormonal markers are most applicable in the prediction of infertility among the victimized populations. Available evidence is scarce on the Middle Eastern cohorts, where there is a genetic working background and body composition, and lifestyle mismatch with the Western or Western reference groups.

Aim: To compare hormonal and metabolic variables in fertile controls, fertile PCOS women and infertile PCOS women visiting a tertiary centre in Iraq and determine independent predictors of hormones on reproductive failure.

Methods: The study was a case-control study, which enrolled 120 women, aged 18-40 years: healthy fertile controls (n=40), fertile women with Rotterdam-diagnosed PCOS (PCOS-NI, n=40), and infertile women with PCOS (PCOS-I, n=40). LH, FSH, total and free testosterone, AMH, SHBG, progesterone, and insulin in fasting serum were analysed. HOMA-IR was used to measure insulin resistance. Infertility predictors were found by binary logistic regression and ROC curve.

Findings: The LH/FSH ratio increased progressively: 0.81±0.21 (controls), 1.97±0.52 (PCOS-NI), and 2.94±0.74 (PCOS-I; p<0.001 in all the pair-wise comparisons). No significant difference in FSH was found (p=0.163). Testosterone total and AMH gradients were parallel. An analysis of ROC using a threshold of LH/FSH >2.15 was determined as the best threshold to predict infertility (sensitivity 82.5, specificity 77.5, AUC=0.856). On the multivariate logistic regression, BMI and testosterone were controlled to give HOMA-IR as a predictor of infertility (OR=2.89; 95% CI: 1.435.84).

Conclusions: The LH/FSH ratio is the only hormonal parameter with the strongest correlation with infertility in this local PCOS cohort, and the cut-off value of 2.15 can be used in practice in a discriminative manner. The risk of reproductive failure is increased by insulin resistance alone, and this fact calls to the combined metabolic assessment of such patients as a routine examination.