The Prevalence of Insulin Resistance and Its Association With Thyroid-Stimulating Hormone and Obesity in Infertile Women With Different Polycystic Ovary Syndrome Phenotypes
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Abstract
The aim of this study was to investigate the prevalence of insulin resistance (IR) according to the phenotypic subgroups of polycystic ovary syndrome (PCOS) and to determine the associations of TSH levels and body mass index (BMI) with IR in infertile women with PCOS. In this cross-sectional study, we included 400 infertile women with a diagnosis of PCOS according to Rotterdam criteria who were referred to the infertility clinic of amir-al-Momenin University Hospital from April 2018- to January 2020. They were classified into four different phenotypic subgroups according to ESHRE guidelines. The homeostasis model (HOMA-IR) was used to measure IR. The prevalence of insulin resistance was 39.3% in infertile women with PCOS. Among women with PCOS, the commonest phenotype was type I (68%), with type II (18.2%), type III (8.8%), and type IV (5%), respectively. Furthermore, there was no significant difference in the prevalence of IR among different phenotypes of PCOS. Logistic regression analysis showed that the chance of insulin resistance was higher in overweight (OR: 1.76, 95% CI: 1.07, 2.88, P=0.024) and obese PCOS women (OR: 3.25, 95% CI: 1.86, 5.67, P<0.001) compared with those who were normal or underweight. Moreover, the chance of IR was higher in PCOS women with TSH ≥2.5 μIU/ml as compared with those who had TSH <2.5 μIU/ml (OR: 2.00, 95% CI: 1.18, 3.40, P<0.001). Insulin resistance is a prevalent disorder among infertile Iranian women with PCOS BMI, and serum levels of TSH ≥2.5 μIU/ml are independent predictors of IR.
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2. Dunaif A, Book CB. Insulin resistance in the polycystic ovary syndrome. Clin Res Diabetes Obes 1997;18:249-74.
3. Lim S, Norman RJ, Davies M, Moran L. The effect of obesity on polycystic ovary syndrome: a systematic review and meta‐analysis. Obes Rev 2013;14:95-109.
4. Mehrabian F, Khani B, Kelishadi R, Kermani N. The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females. J Res Med Sci 2011;16:763-9.
5. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril 2005;83:1454-60.
6. Le MT, Nguyen VQH, Truong QV, Le DD, Le VNS, Cao NT. Metabolic syndrome and insulin resistance syndrome among infertile women with polycystic ovary syndrome: a cross-sectional study from Central Vietnam. Endocrinol Metab (Seoul) 2018;33:447-58.
7. Reyes-Muñoz E, Ortega-González C, Martínez-Cruz N, Arce-Sánchez L, Estrada-Gutierrez G, Moran C, et al. Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical–biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: a cross-sectional study. BMJ Open 2016;6:e012107.
8. Möhlig M, Jürgens A, Spranger J, Hoffmann K, Weickert MO, Schlösser HW, et al. The androgen receptor CAG repeat modifies the impact of testosterone on insulin resistance in women with polycystic ovary syndrome. Eur J Endocrinol 2006;155:127-30.
9. Brenta G. Why can insulin resistance be a natural consequence of thyroid dysfunction? J Thyroid Res 2011;2011:152850.
10. Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 2006;91:4930-7.
11. Brenta G, Berg G, Arias P, Zago V, Schnitman M, Muzzio ML, et al. Lipoprotein alterations,hepatic lipase activity, and insulin sensitivity in subclinicalhypothyroidism: response to L-T4 treatment. Thyroid 2007;17:453-60.
12. Vyakaranam S, Vanaparthy S, Nori S, Palarapu S, Bhongir AV. Study of insulin resistance in subclinical hypothyroidism. Int J Health Sci Res 2014;4:147-53.
13. Ding X, Yang L, Wang J, Tang R, Chen Q, Pan J, et al. Subclinical hypothyroidism in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2018;9:700.
14. Dittrich R, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS. Reprod Biomed Online 2009;19:319-25.
15. Ganie MA, Laway BA, Wani TA, Zargar MA, Nisar S, Ahamed F, et al. Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome. Fertil Steril 2011;95:2039-43.
16. Mueller A, Schöfl C, Dittrich R, Cupisti S, Oppelt P, Schild R, et al. Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome. Hum Reprod 2009;24:2924-30.
17. Salama ASA, Matta RAE, Elhini SH, Hamdi L, Adel L, Hassan H. High-normal thyroid stimulating hormone is a predictor of metabolic syndrome among young polycystic ovary syndrome women. Egypt J Obes Diabetes Endocrinol 2016;2:146-55.
18. Benetti-Pinto CL, Piccolo VB, Yela DA, Garmes H. Thyroid-stimulating hormone and insulin resistance: their association with polycystic ovary syndrome without overt hypothyroidism. Rev Bras Ginecol Obstet 2017;39:224-8.
19. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicinepractice guidelines. Laboratory support for the diagnosis andmonitoring of thyroid disease. Thyroid 2003;13:3-126.
20. Oh JY, Sung YA, Lee HJ. Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in euthyroid young women. Korean J Intern Med 2013;28:180-6.
21. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Increased pregnancy loss rate in thyroid antibody negative women with TSHlevels between 2.5 and 5.0 in thefirst trimester of pregnancy. J Clin Endocrinol Metab 2010;95:E44-8.
22. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
23. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981;140:815-30.
24. Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
25. Hosseinpanah F, Barzin M, Tehrani FR, Azizi F. The lack of association between polycystic ovary syndrome and metabolic syndrome: Iranian PCOS prevalence study. Clin Endocrinol (Oxf) 2011;75:692-7.
26. Tavares A, Barros RCR. The prevalence of metabolic syndrome in the different phenotypes of polycystic ovarian syndrome. Rev Bras Ginecol Obstet 2019;41:37-43.
27. Zhang HY, Guo CX, Zhu FF, Qu PP, Lin WJ, Xiong J. Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case–control study. Arch Gynecol Obstet 2013;287:525-31.
28. Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A. Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril 2007;88:1389-95.
2. Dunaif A, Book CB. Insulin resistance in the polycystic ovary syndrome. Clin Res Diabetes Obes 1997;18:249-74.
3. Lim S, Norman RJ, Davies M, Moran L. The effect of obesity on polycystic ovary syndrome: a systematic review and meta‐analysis. Obes Rev 2013;14:95-109.
4. Mehrabian F, Khani B, Kelishadi R, Kermani N. The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females. J Res Med Sci 2011;16:763-9.
5. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril 2005;83:1454-60.
6. Le MT, Nguyen VQH, Truong QV, Le DD, Le VNS, Cao NT. Metabolic syndrome and insulin resistance syndrome among infertile women with polycystic ovary syndrome: a cross-sectional study from Central Vietnam. Endocrinol Metab (Seoul) 2018;33:447-58.
7. Reyes-Muñoz E, Ortega-González C, Martínez-Cruz N, Arce-Sánchez L, Estrada-Gutierrez G, Moran C, et al. Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical–biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: a cross-sectional study. BMJ Open 2016;6:e012107.
8. Möhlig M, Jürgens A, Spranger J, Hoffmann K, Weickert MO, Schlösser HW, et al. The androgen receptor CAG repeat modifies the impact of testosterone on insulin resistance in women with polycystic ovary syndrome. Eur J Endocrinol 2006;155:127-30.
9. Brenta G. Why can insulin resistance be a natural consequence of thyroid dysfunction? J Thyroid Res 2011;2011:152850.
10. Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 2006;91:4930-7.
11. Brenta G, Berg G, Arias P, Zago V, Schnitman M, Muzzio ML, et al. Lipoprotein alterations,hepatic lipase activity, and insulin sensitivity in subclinicalhypothyroidism: response to L-T4 treatment. Thyroid 2007;17:453-60.
12. Vyakaranam S, Vanaparthy S, Nori S, Palarapu S, Bhongir AV. Study of insulin resistance in subclinical hypothyroidism. Int J Health Sci Res 2014;4:147-53.
13. Ding X, Yang L, Wang J, Tang R, Chen Q, Pan J, et al. Subclinical hypothyroidism in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2018;9:700.
14. Dittrich R, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS. Reprod Biomed Online 2009;19:319-25.
15. Ganie MA, Laway BA, Wani TA, Zargar MA, Nisar S, Ahamed F, et al. Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome. Fertil Steril 2011;95:2039-43.
16. Mueller A, Schöfl C, Dittrich R, Cupisti S, Oppelt P, Schild R, et al. Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome. Hum Reprod 2009;24:2924-30.
17. Salama ASA, Matta RAE, Elhini SH, Hamdi L, Adel L, Hassan H. High-normal thyroid stimulating hormone is a predictor of metabolic syndrome among young polycystic ovary syndrome women. Egypt J Obes Diabetes Endocrinol 2016;2:146-55.
18. Benetti-Pinto CL, Piccolo VB, Yela DA, Garmes H. Thyroid-stimulating hormone and insulin resistance: their association with polycystic ovary syndrome without overt hypothyroidism. Rev Bras Ginecol Obstet 2017;39:224-8.
19. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicinepractice guidelines. Laboratory support for the diagnosis andmonitoring of thyroid disease. Thyroid 2003;13:3-126.
20. Oh JY, Sung YA, Lee HJ. Elevated thyroid stimulating hormone levels are associated with metabolic syndrome in euthyroid young women. Korean J Intern Med 2013;28:180-6.
21. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Increased pregnancy loss rate in thyroid antibody negative women with TSHlevels between 2.5 and 5.0 in thefirst trimester of pregnancy. J Clin Endocrinol Metab 2010;95:E44-8.
22. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
23. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981;140:815-30.
24. Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
25. Hosseinpanah F, Barzin M, Tehrani FR, Azizi F. The lack of association between polycystic ovary syndrome and metabolic syndrome: Iranian PCOS prevalence study. Clin Endocrinol (Oxf) 2011;75:692-7.
26. Tavares A, Barros RCR. The prevalence of metabolic syndrome in the different phenotypes of polycystic ovarian syndrome. Rev Bras Ginecol Obstet 2019;41:37-43.
27. Zhang HY, Guo CX, Zhu FF, Qu PP, Lin WJ, Xiong J. Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case–control study. Arch Gynecol Obstet 2013;287:525-31.
28. Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A. Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril 2007;88:1389-95.
| Files | ||
| Issue | Vol 59, No 8 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v59i8.7251 | |
| Keywords | ||
| Insulin resistance Infertility Obesity Prevalence Polycystic ovary syndrome Thyroid-stimulating hormone | ||
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How to Cite
1.
Azargoon A, Sadeghi N, Mirmohammadkhani M. The Prevalence of Insulin Resistance and Its Association With Thyroid-Stimulating Hormone and Obesity in Infertile Women With Different Polycystic Ovary Syndrome Phenotypes. Acta Med Iran. 2021;59(8):477-483.
