BRITISH BIOMEDICAL BULLETIN

Background: Polycystic ovary syndrome (PCOS), which is considered as one of the important gynaecological endocrine disorders, usually affects 6-10% of the women population. The present work described the effect of obese and non-obese on fertility treatment practices in polycystic ovary syndrome affected women populations. Materials and Method: About 105 PCOS affected women patients (18-41 years old) along with control who had regularly visited the hospital for fertility treatment were selected for the present study and clinical experiment was performed. The PCOS affected population was classified into two groups based on their Body Mass Index (BMI) as obese and non-obese PCOS affected groups and the clinical and biochemical aspects were studied. Results: There was a significantly higher rate of BMI was noticed in obese PCOS patients (29.32±0.40) than non-obese PCOS (21.75±0.36) and control group (21.95±0.97). The level of Luteinizing Hormone (LH) was found to be high in the non-obese PCOS group than the obese PCOS while a decreased rate of FSH noticed was more in obese PCOS group than non-obese group. The frequency of positive pregnancy was significantly high in obese groups (66.7%) than non-obese group with IVF treatment. Conclusion: It is concluded that higher level of BMI and LH was noticed in PCOS groups compared to non-obese and a decreased rate of FSH was recorded in PCOS patients. The results of the present investigation confirm that the impact of obesity and non-obesity on PCOS women fertility treatment showed higher pregnancy rates in women compared with normal BMI. Of the two groups tested, a significantly higher per cent of pregnancy was recorded with obese PCOS than non-obese PCOS patients. Venkatachalam et al ____________________________________________ ISSN-2347-5447 BBB[3][4][2015] 476-484 Introduction Polycystic ovary syndrome (PCOS) or Stein-Leventhal syndrome is considered to be the most important endocrine disorder in the reproductive age of women. The incidence of PCOS affects teens metabolism that are having serious implications with health care. The clinical manifestations of PCOS include menstrual irregularities, hyperandrogenism with hirsutism, acne, alopecia, truncal obesity and multiple ovarian follicular cysts. The significant endocrine abnormalities caused by PCOS includes Leutinizing Hormone (LH) hyper secretion, decreased follicle stimulating hormone, alterations of the GonadotropinReleasing Hormone (GnRH) pulse generator and ovarian stromal-thecal hyperactivity that leads to major biochemical, reproductive and metabolic dysfunction. It has been reported that about 4050% PCOS affected women are overweight or obese, presented with high insulin levels and reduced glucose-induced insulin metabolism. Also both thin and obese women with PCOS, were found to be insulin resistant reflected by fasting glucose/insulin ratio.The major consequences of obesity on health include infertility, menstrual problem and maternal defects in pregnancy. It has been noticed that nearly 65% of PCOS patients are obese and pregnancy is severely affected by obesity, overweight or elevated body mass index among women population. Obese women are also associated with high chance of miscarriage after fertility treatment due to less number of oocytes release. Therefore, a new worldwide threat to adolescence is obesity and its serious concern is onset of PCOS. Many adolescent women with PCOS do not ovulate regularly and takes longer time for the women to conceive. The PCOS event has been increased recently and the age of onset of PCOS is getting early. Regardless of PCOS incidence, earlier results indicated that pregnancy achievements are affected much by obesity. Most of the earlier studies suggested that obesity is the major cause for onset of PCOS in women population. However, few reports have demonstrated the relationship between PCOS and BMI. Wang and Zhu reported that obesity is not the only criteria for onset of PCOS in Asian race. In addition there are few published reports that showed contradictory findings for PCOS in recent past. Earlier study suggested that modest weight loss of 5% (non-obese) has proved to result in increased percent of hyperandrogenism and ovulatory function in PCOS women patients. Further, it is suggested that adiposity is also playing an important role not only for the onset but also for the maintenance of PCOS in women population. It is hypothesized that adolescent women population with PCOS may partly depending on ever increasing prevalence of obesity worldwide. It is pointed out that though the obesity has prominent effects on regulation of reproductive cycles in women with PCOS, the exact mechanisms for onset of PCOS are not fully identified. The most recent study showed that metabolic and sex hormones levels were found to be high in obese PCOS women compared with non-obese PCOS women. Although, there are reports on development and maintenance of PCOS, there is still a shortage of studies pertaining to obesity and non-obesity impacts on fertility treatments in PCOS women patients especially in our region. In view of the above, the present investigation was focused to find out the impacts of obese and nonobese on fertility treatment and to determine the rate of pregnancy apart from biochemical assessments in women patients with PCOS. Venkatachalam et al ____________________________________________ ISSN-2347-5447 BBB[3][4][2015] 476-484 Material and Method This study was performed on adolescence women with PCOS who had visited the gynecological outpatient department of J. S. hospital, Salem. The study methodology was approved by the institutional review board of the hospital. About 105 adolescent women patients were tested for identification of PCOS incidence by ultrasonography. They were classified into two groups depending on their Body Mass Index (BMI): 62 obese (ward A) and 43 non-obese (ward B) women patients. Further, 30 healthy non-obese, normal women were included as control (ward C). The adolescence women patient for the diagnosis of PCOS was followed the revised Rotterdam criteria. The patients must have at least 2 out of the following 3 criteria: 1) hyperandrogenism, 2) oligomennorhea /or amennorhea, and 3) presence of polycystic ovary found in ultrasound. Any kinds of medications that will affect sex hormone levels or carbohydrate and lipid metabolism were terminated a month before the experiment. All women patients selected for the present PCOS diagnosis were in good health conditions. The clinical parameters namely height and body weight were measured on the morning of testing. Blood pressure was also measured. The Body Mass Index (BMI) was calculated using the formula: Weight in Kilograms/Height in m. Body mass index with body fat as Standard Consensus Statement for Indian population was considered, for obese : >25kg/m and <25kg/m for non-obese PCOS patients as cut off for BMI. The biochemical parameters for the study groups were performed in the hospital laboratory. Two PCOS groups (ward A and ward B) as well as the control women (ward C) were examined for the basal gonadotropic hormone levels such as Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and Prolactin (PRL). The blood samples were collected on the day 2 or 3 of their menstrual cycles by venipuncture and stored in plain vacutainers. The clotted blood was centrifuged and the separated serum was analyzed using autoanalyser by the Immunofluorescent assay technique (Johnson & Johnson S.P. A-Ortho Clinical Inc.). Both obese and non-obese PCOS women patients were placed on metformin tablets 500mg b.d. before the commencement of pituitary down regulation. Both IVF and IUI treatments were proceeded by down regulation from the mid-luteal phase of the previous menstrual cycle. Ovulation stimulation was performed by FSH using the standard protocol. When at least one or two follicle had reached a minimum diameter of >18mm, ovulation was achieved with HCG (10,000 IU). Oocytes were aspirated within 36-38 hour after induction of ovulation by guidance of transvaginal ultrasound. Patient weight and height data were taken in attention at the time of oocyte retrieval and BMI was calculated. The collected oocytes were fertilized in vitro by IVF. Gamete handling, fertilization and embryo culture were carried out according to the Standard IVF protocol. The collected fast moving sperms were then injected into the mother’s womb by IUI method using standard procedure. An ultrasound scan was conducted 4-6 weeks later to test the viability of pregnancy. The pregnancy percent was compared between the two PCOS groups with IVF/ and IUI treatments. Main outcome measures that reflect IVF/IUI treatments were defined as positive pregnancy, negative pregnancy and miscarriage. The result obtained for clinical as well as biochemical parameters and fertility treatments were used for statistical analysis. The mean, percentage and standard error of Venkatachalam et al ____________________________________________ ISSN-2347-5447 BBB[3][4][2015] 476-484 the clinical and biochemical measurements were calculated for all the data obtained from both the PCOS affected patients (obese and non-obese) and the control group selected for the present study. The rate of pregnancy obtained in the fertility treatment among the obese PCOS and non-obese PCOS groups along with their percentage of miscarriage was expressed as percentage. Data were presented as mean ± SE and Student ‘t’ test was applied to identify the differences between two wards.