Comparison Between Testosterone Index and LH /FSH Ratio as Diagnostic Markers in Polycystic Ovary Syndrome (PCOS)

Abstract

Polycystic Ovary Syndrome (PCOS), also known clinically as Stein-Leventhal syndrome, was described in 1935 by Stein and Leventhal as one of the most common endocrine disorders that affects women in the reproductive age group being a leading cause of female infertility. Several factors have been implicated in the etiology of the disease such as Insulin resistance, elevated basal LH with high LH/FSH ratio, obesity and hereditary factors. The clinical diagnosis depends mainly on increased LH/FSH ratio that required measurement during ovulation phase only. Unfortunately this is not the case in Sudan, since in most cases the measurement of LH/FSH ratio is not done during ovulation period. In the present study we attempt to assess the relation between the testosterone level following the 2nd day of cycle and PCOS, and also the possibility of using it as diagnostic indicator for PCOS in females. Materials A total of 80 female Patients attending Khartoum infertility Center were enrolled in the present study during January 2009 and 2010. All patients were diagnosed as PCOS and signed a written informed consent based on the ethical approve obtained from Al Neelain Ethical Committee. Demographic and clinical data were collected from each patient according to pre-designed questionnaire. A total of 5ml venous blood has been collected from each patient under complete aseptic conditions and placed instantly in a sterile container and used for measurement of lipid profile, LH, FSH, and total testosterone. Methods Medical history and physical examination were performed in all patients by senior gynecologist. Body Mass Index (BMI) was calculated for each patient based on the following formula: Mass (kg ) (Height(m))2

Individual with BMI between 25-29 kg/m2 has been considered as overweight, and 30 kg/m2 as obese. The Lipid profile measurements including triglycerides, total cholesterol (TC), Low density lipoprotein cholesterol (LDLC), and High density lipoprotein cholesterol (HDLC) were performed according to standard protocol using Selectra E\vital Auto analyzer. Hormonal measurement of LH, FSH, and free testosterone were performed during the next day of the cycle using ELISA Technique. Results A total of 80 women with PCOS were enrolled in the present study. Their age ranged between 17-46 yrs (mean 37). Based on the tribal origin analysis Jaaliyin tribe was the most common affected tribe accounting for 26%, followed by Shaygia accounting for 15%, Khawahla accounting for 6.3% and Meseria accounting for 5%. Of the 80 PCOS patients 56.3% were considered obese with BMI greater than 30kg/m 2, and 37.5% were considered overweight with BMI equal or greater than 25kg/m2. According to the transvaginal ultrasound, all the 80 women diagnosed as PCOS turned to have ultrasound evidence of polycystic ovaries. The results of hormonal analysis showed that women with PCOS had significantly high testosterone (median = 3) compared with the control group (median = 1). The analysis of Serum FSH showed significantly high result in the control group (median=7.8), compared to PCOS women (median = 5), while LH showed non-significant difference between sample and control. The LH median in the control group was equal to 4.9, while in women with PCOS it was equal to 4.4. Of the 80 women with PCOS, 64 (80%) of them had a ratio of LH/FSH less than 2, and 16 (20%) had a ratio of LH/FSH greater than 2, in contrast to non- PCOS women, where 19 (95%) had LH/FSH ratio less than 2, and only 1 lady (5%) had a ratio of LH/FSH greater than 2. Within the 80 women with PCOS, total cholesterol, LDL and triglycerides were significantly high (P-value= 0.000) compared to control group. Total cholesterol, (n=66, 82%) was found to have a median equal to 191mg/dl, whereas triglycerides (n=56, 76%) had a median equal to 120.45mg/dl, and (n=75, 93%) had a median of LDLC equal to 118.20mg/dl. HDLC was found to be significantly decreased in 81%of the women with PCOS that showed a median level equal to 50mg/dl, compared with the control group that showed a median level of 68mg/dl, and P- value was 0.000. This elevation in the level of lipids could be due to the obesity of women with PCOS, which is a condition that has been found to increase fatty acids concentration.