Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan
DOI: https://doi.org/10.33533/jpm.v18i1.7546
Vol 18 No 1 (2024) ISSN 0216-3438 (print); ISSN 2621-1122 (online)

ARTICLE
HORMONAL PROFILE AND REPRODUCTIVE POTENTIAL OF POLYCYSTIC OVARYSYNDROME (PCOS) WOMEN IN INDONESIA
Ayu Mulia Sundari1, Tri Aprilliana Wulandari2, Nurul Muhammad Prakoso1, Astari Dwiranti1,
Abinawanto1 , Arief Boediono3, Hiroaki Funahashi4, Anom Bowolaksono1*
1Fakultas Matematika dan Ilmu Pengetahuan Alam, Universitas Indonesia, Jakarta, Indonesia
2IRSI Research and Training Centre, Jakarta, Indonesia

3 Departemen Anatomi Fisiologi dan Farmakologi, Institut Pertanian Bogor, Jawa Barat, Indonesia
4Faculty of Environmental and Life Science and Technology, Okayama University, Japan*Correspondence email : alaksono@sci.ui.ac.id.

ABSTRACT
Our study aims to scrutinize the hormonal and laboratory profile of women with polycystic ovary syndrome (PCOS)
in Indonesia. A computerized database of 120 diagnosed PCOS women and 120 controls was retrospectively
reviewed and analyzed. According to analysis, the concentration of anti-Müllerian hormone (AMH) and basal
luteinizing hormone (LH) were significantly more elevated in the PCOS group than in the control group (6.77 vs.
2.05, P<0.001; and 6.8 vs. 5.3, P<0.001, respectively). The level of basal follicle-stimulating hormone (FSH) was
significantly lower in the PCOS group (5.83 vs. 7.86; P<0.001). After an IVF cycle, PCOS women had a significantly
higher number of retrieved oocytes and the number of mature oocytes compared to controls (18 vs. 8, P<0.001; 12
vs. 6, P<0.001). The number of fertilizations, number of cleavages, and number of top-quality cleavages were also
higher in the PCOS group than in the control group (10 vs. 4, P<0.001; 10 vs. 4, P<0.001; 4 vs. 2, P<0.001). At theblastocyst stage, patients with PCOS had a higher number of blastocysts and top-quality blastocysts than control (9vs. 4, P<0.001); 4 vs. 1, P<0.01). However, the clinical pregnancy was significantly higher in the control group thanin the PCOS group (52.6% vs. 16.7%; P = 0.045).
Keywords: Hormonal profile; Laboratory profile; Polycystic ovary syndromeАБСТРАКТ
Цель нашего исследования - тщательно изучить гормональный и лабораторный профиль женщин ссиндромом поликистозных яичников (PCOS) в Индонезии. Была ретроспективно изучена ипроанализирована компьютеризированная база данных 120 женщин с диагностированным PCOS и 120
контрольных женщин. По данным анализа, концентрация антимюллерова гормона (АМГ) и базального
лютеинизирующего гормона (ЛГ) была значительно выше в группе PCOS, чем в контрольной группе (6,77против 2,05, P<0,001; и 6,8 против 5,3, P<0,001, соответственно). Уровень базального
фолликулостимулирующего гормона (ФСГ) был значительно ниже в группе ПКОС (5,83 против 7,86;
P<0,001). После проведения цикла ЭКО у женщин с PCOS было значительно выше количество извлеченных
ооцитов и количество зрелых ооцитов по сравнению с контрольной группой (18 против 8, P<0,001; 12против 6, P<0,001). Количество оплодотворений, количество расщеплений и количество расщеплений
высшего качества также было выше в группе PCOS, чем в контрольной группе (10 против 4, P<0,001; 10против 4, P<0,001; 4 против 2, P<0,001). На стадии бластоцисты у пациенток с ПКОС количество бластоцисти бластоцист высшего качества было выше, чем в контроле (9 против 4, P<0,001; 4 против 1, P<0,01). Однако
клиническая беременность была значительно выше в контрольной группе, чем в группе ПКОС (52,6 %против 16,7 %; P = 0,045).
Ключевые слова: Гормональный профиль; Лабораторный профиль; Синдром поликистозных яичников

Copyright © 2024 Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan
Submitted: 18 February 2024 ; Received in revised form:15 March 2024 ; Accepted: 26 March 2024 ; Available online 15 June 2024
Published regularly: June 2024

67

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

INTRODUCTION
Polycystic ovary syndrome (PCOS) is an
endocrine disorder that affects women ofchildbearing age. According to the Rotterdam
criteria, PCOS was diagnosed by the presenceof two out of three features of androgen excess,ovulatory dysfunction, and polycystic ovaries.1
Common symptoms of women with PCOS
include anovulatory menstrual cycles,
infertility, hirsutism, and obesity. The global
prevalence of PCOS is estimated between 4%
and 20%. In Indonesia, more than sevenmillion cases were reported in early 2000 andare projected to increase every year.2 The
exact pathogenesis of the disease remains
unknown. However, a large amount ofevidence signifies that PCOS might be amultigenic disorder with a complex genetic,
epigenetic, and environmental interaction.3
Dysregulation in the hypothalamic-pituitary
axis is recognized as a critical pathophysiology
underlying PCOS that plays a role in theevolution of the disease and is associated withthe development of the syndrome.4,5
The
gonadotropin-releasing
hormone(GnRH) is normally secreted in the pulse by the
hypothalamus and stimulates the anterior
pituitary to release luteinizing hormone (LH)and follicle-stimulating hormone (FSH). LH
acts on the theca cells to induce androgensynthesis while FSH promotes aromataseproduction in the granulosa cells for androgen
conversion into estradiol. In the PCOS state, theGnRH release is enhanced due to poor negative
feedback suppression of GnRH pulsatility by
estradiol and progesterone. Consequently, theLH pulse is raised, and ovarian androgenproduction is elevated. Due to thisneuroendocrine dysregulation, PCOS patients
have a significantly elevated level of LH anddecreased FSH compared to controls.6
Moreover, the anti-Müllerian hormone (AMH)level in PCOS women is significantly higher ascompared to the control group.7,8 The
deficiency of FSH subsequently disrupts
follicle selection and accumulates small andpre-antral follicles leading to an anovulatory
cycle. As a result, women with PCOS had alower natural pregnancy rate and therefore

68 |often underwent assisted reproductive
technology such as IVF to conceive.9
Although PCOS is highly related toreproductive morbidity, PCOS women are
known to have a higher risk of developing
insulinresistance,
diabetes
mellitus,
hypertension, lipid abnormalities, metabolic
syndrome, cancer, and cardiovasculardisease.3 It was also revealed that 75% of PCOS
women remain undiagnosed when visiting
their doctor.10 Moreover, women with PCOS
have a reduced IVF success rate than a normal
healthy woman.11 Therefore, early recognitionof PCOS and evaluation of IVF outcomes of
PCOS women are crucial to prevent those lifethreatening complications and to depict the
reproductive potential after the IVF cycle.
However, there is a lack of reports on that
information in Indonesia's population. As such,
this present study aims to evaluate thehormonal profile and laboratory outcomes ofwomen with PCOS in Indonesia.
The present study has several advantages
over previously published retrospective
studies of the same area which has a large
number of samples and involves subjects frommultiethnicity. This solid data set will make it
relatively representative of PCOS women inIndonesia thus envisioned to become a reliablebasis for improved diagnosis and treatment
strategy of PCOS.
MATERIAL AND METHODS
Study population

This retrospective cohort study was
conducted using a computerized database inMorula IVF Jakarta Clinic, Jakarta, Indonesia.
PCOS patients were selected based on the
Rotterdam criteria12, by which the disease wasdiagnosed by the presence of two out of threefollowing
criteria:
oligo-anovulation,
hyperandrogenism, and polycystic ovaries.
Individuals with a record of under medications
or with a condition that has a significant
impact on the endocrine system were excluded
from the study. 120 PCOS patients (n=120)
who underwent in vitro fertilization cycle
between 1 January 2020 and 30 June 2023
were randomly selected and their medical

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

records were reviewed. 120 healthy womencontrol group (n=120) was also selected. The
sample size was calculated using Cochran’s
formula as described previously.13
Blood sample collection, hormone measurement,
and ovarian stimulation

On the third day of the menstrual cycle, ablood sample was collected following standard
phlebotomy protocol to evaluate the baseline
hormone levels. Hormone concentration wasmeasured by the electrochemiluminescentimmunoassay. Following hormone level
determination, patients underwent mild,
agonist, or antagonist ovarian stimulation
protocol as described previously.14 In all
protocols, rhCG was given when the diameterof at least two leading follicles reached a size of≥18 mm.
Oocyte retrieval and maturation check
Oocytes were retrieved by transvaginalultrasound-guide at 36 hours after hCG trigger.
After aspiration, cumulus-oocyte complexes(COCs) were washed in G-MOPS Plus medium(Vitrolife, Sweden) and incubated in culture
medium for 3 hours under 6% CO2 at 37°C
covered with paraffin oil (Ovoil; Vitrolife).
Upon incubation, cumulus cells weremechanically removed by pipetting with 80 IU
hyaluronidase(Hyase™-10x,
Vitrolife,
Sweden). The denuded oocytes were thenanalyzed under an inverted microscope at
200x magnification to determine the nuclear
maturation stage. Mature oocytes wereidentified by the presence of the first polar
body in the perivitelline space.
Insemination
All mature oocytes were inseminated by
ICSI or IMSI as described previously.14 Briefly,
oocytes were placed in a 5 μL drop of G-MOPS
Plus medium (Vitrolife, Sweden) covered withmineral oil (Ovoil, Vitrolofe, Sweden) on a petri
dish (ICSI: Nunc IVF Dish, Thermo Scientific,
USA; IMSI: Fluorodish, WPI, USA). A single
motile spermatozoon was immobilised bycontacting its tail with an injection pipette(TPC;
CooperSurgical
Fertility).
The

69 |

irreversibly immobilised spermatozoon wasthen aspirated into the pipette and injected
into the oocyte with the 12 o'clock polar bodyorientation, starting from the 3 o'clock
position.
Fertilization assessment, embryo grading, andtransfer
After 17+2 hours after the insemination,
fertilization was assessed by the appearance of
two distinct pronuclei. Only oocytes thatshowed two pronuclei and the extrusion of thesecond polar body were considered normally
fertilized. Inseminated oocytes were thencultured in G1 medium (Vitrolife, Sweden) for
three days and transferred into G2 (Vitrolife,
Sweden) medium for another two or threedays in a humidified incubator at 37°C, 6%
CO2, and 5% O2. The quality of cleavage-stageembryos was determined by the degree offragmentation, the quantity of blastomeres,and the symmetry of the blastomeres. The
quality of blastocyst-stage embryos was
judged based on blastocyst cavity expansion,
trophectoderm, and inner cell mass.15 Goodquality embryos were then transferred to theuterus and the clinical pregnancy wasdetermined by 2 weeks after a positive
biochemical pregnancy test.
Statistical analysis
The statistical analysis was carried out with
a 95% confidence level using IBM Statistical
Package for Social Sciences (SPSS) software
version 20 (Chicago, USA). Descriptional
statistics were used to summarise the sample
population. The Chi-square test was used to
examine categorical data, which wererepresented by the number of individuals (n)and the percentage (%). The Mann-Whitney
test was employed to evaluate numericalvariables, which were presented as mean ± SD
or, if relevant, median and interquartile range(Q1 and Q3). To adjust for possible
confounders, we used multiple linear
regression.

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

RESULT
A total of 120 women diagnosed with PCOS
and 120 healthy women were enrolled in thisstudy. The clinical parameters of the subjects
are summarized in Table 1. The mean age ofparticipants was 33 (30,35) in the PCOS groupand 36 (33,40) in the control group (P<0.001).
The infertility duration and body mass index in
the PCOS and the control group were 5 years
and 6 years (P = 0.008) and 22.80 and 24.57(P=0.017), respectively. In terms of type of

infertility, 101 (84.20%) women had primaryinfertility, and 19 (15.80%) women had
secondary infertility in the PCOS group. In thecontrol group, 99 (82.50%) women werediagnosed with primary infertility, and 21(17.50%) women were secondary infertility
sufferers (P = 0.863). Women in the PCOS
group had significantly higher antral follicle
count (AFC) than in the control group (19(16,23) vs. 10 (6,12); P<0.001).

Table 1. Clinical characteristics of study participants
Characteristics

Study Group

Female age (years)
Infertility duration (years)

PCOS
33 (30,35)
5 (3,7)

Body Mass Index (kg/m2)

22.80 (20.57,25.63)

Type of Infertility[n (%)]
Primary
SecondaryAFC

101(84.20%)19(15.80%)19 (16,23)

Control
36 (33,40)
6 (3,9)24.57(21.45,27.78)
99(82.50%)21(17.50%)10 (6,12)

P-Value<0.001
0.008
0.017

0.863
<0.001

Data are presented as median (q1, q3), and Mann-Whitney test is used. Data are presented as the number of subjects
and percentage [n (%)], and Chi-square tests are used for the categorical variable.

As shown in Table 2, the findings of theinvestigation into the hormonal parameters
and the profile of ovarian stimulation arepresented. As can be seen in the table, thelevels of adrenocorticotropic hormone (AMH)
and basal luteinizing hormone (LH) werediscovered to be significantly higher in thegroup that was diagnosed with polycystic
ovarian syndrome (PCOS) in comparison to thegroup that served as the control. In particular,
the levels of AMH were 6.77 (5.85,8.52)
compared to 2.05 (1.03,3.11), and the p-value
was shown to be positive. Upon comparing thelevels of basal FSH in the PCOS group to thosein the control group, it was seen that the PCOS
group exhibited a significantly lower level(5.83 (5,6.81) against 7.86 (6.61,9.29); thestatistical significance of this finding wasdetermined to be less than 0.001). There was
not a significant difference in the levels of basal
estradiol and progesterone between the groupwith PCOS and the group that served as thecontrol (P = 0.098 and P = 0.661, respectively).
On the other hand, the PCOS group70 |experienced a significantly lower beginning
dose and total gonadotropin utilization during
ovarian stimulation in comparison to thecontrol group (225 (150,300) versus 300(300,300), with a p-value of less than 0.001;
1800 (1500,2400) versus 2438 (2400,2700),
with a p-value of less than 0.001 respectively).
The levels of progesterone and estradiol on thetrigger day were significantly higher in thegroup with polycystic ovary syndrome (PCOS)
compared to the control group (5900(3319,7825 vs. 2288 (1582,3113), P<0.001;
0.98 (0.72,1.4) vs. 0.53 (0.27,0.76), P<0.001
respectively). In contrast, the group that wasdiagnosed with polycystic ovary syndrome(PCOS)
hadasignificantly
higherconcentration of estradiol compared to thegroup that was used as a control. Stimulation
was given to both the group with PCOS and thecontrol group for a period of nine days, which
was comparable to the length of time that thetrial was conducted.

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)

A.M.Sundari, T. A .Wulandari, N.M.Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

Table 2. Comparison of hormonal and stimulation profile in PCOS and the control group
Study Group

Parameters

PCOS

Control

Basal LH (mIU/mL)
Basal FSH (mIU/mL)
AMH (ng/mL)

6.8 (5.00,9.33)
5.83 (5.00,6.81)
6.77 (5.85,8.52)

5.3 (4.2,6.8)
7.86 (6.61,9.29)
2.05 (1.03,3.11)

Basal Estradiol (pg/mL)

34.1 (26.8,42.53)

36.41 (28.12,48.72)

Basal Progesterone (ng/mL)

0.18 (0.07,0.28)

Starting dose (IU)

225 (150,300)

0.15 (0.07,0.26)300(300,300)
9 (8,9)2438 (2400,2700)
2288 (1582,3113)

P-Value<0.001<0.001<0.001
0.098
0.661<0.001

Stimulation duration (days)
9 (8,9)0.899
Total Gonadotropin used (IU)
1800 (1500,2400)<0.001
Estradiol on trigger day (pg/mL)
5900 (3319,7825)<0.001
Progesterone on trigger day
0.98 (0.72,1.40)
0.53 (0.27,0.76)<0.001(ng/mL)
Data are presented as median (q1,q3), and Mann-Whitney test is used. Data are presented as the number of subjects andpercentage [n (%)], and Chi-square tests are used for the categorical variable.

In terms of laboratory outcomes, we foundan interesting result in which the PCOS group
had a significantly higher number of retrieved
oocytes and number of mature oocytes ascompared to the control group (18 (13,24) vs.
8 (5,12), P<0.001; 12 (9,18) vs. 6 (4,9),
P<0.001). The number of fertilizations, thenumber of cleavages, the number of topquality cleavages were also higher in the PCOS
group than in the control group (10 (6,14) vs.
4 (2,7), P<0.001; 10 (6,14) vs. 4 (2,7), P<0.001;
4 (2,7) vs. 2 (1,3), P<0.001). At the blastocyst

stage, the number of blastocyst and thenumber of top-quality blastocysts weresignificantly higher in the PCOS groupcompared to the control group (9 (6,12) vs. 4(1,6), P<0.001); 4 (1,6) vs. 1 (0,3), P<0.01). The
number of embryo transfers was comparable
in both groups but the clinical pregnancy in thecontrol group was significantly higher than in
the PCOS group (20/18 (52.6%) vs. 2/10
(16.7%); P = 0.045).

Table 3. Comparison of laboratory outcome in PCOS and the control group
Laboratory
Outcomes
Number of retrieved oocytes
Number of mature oocytes
Number of fertilizations
Number of cleavages
Number of top-quality cleavages
Number of blastocysts
Number of top-quality blastocysts
Number of embryo transfer
Clinical Pregnancy (n=50)

Study GroupPCOS
18 (13,24)
12 (9,18)
10 (6,14)
10 (6,14)
4 (2,7)
9 (6,12)3 (2,6)
2 (1,2)
2/10 (16.7%)

Control
8 (5,12)6 (4,9)4 (2,7)
4 (2,7)
2 (1,3)4 (1,6)
1 (0,3)2 (1,2)
20/18 (52.6%)

P-Value<0.001<0.001<0.001<0.001<0.001<0.001<0.001
0.442
0.045

Data are presented as median (q1, q3), and Mann-Whitney test is used. Data are presented as the number of subjects andpercentage [n (%)], and Chi-square tests are used for the categorical variable

DISCUSSION
Our study demonstrated that the level ofbasal LH and AMH in PCOS subjects issignificantly higher than in the control group.
The level of basal FSH is significantly lower in

71 |the PCOS group whereas the level of basal
estradiol and progesterone is comparable in all
examined groups. In terms of laboratory
outcome, PCOS subjects had a higher numberof retrieved oocytes, mature oocytes,

DOI: https://doi.org/10.33533/jpm.v17i1.5653 Vol 18: No : 1 (2023)

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

fertilization, cleavage, number of top-quality
cleavages, number of blastocysts, and numberof top-quality blastocysts. The number ofembryo transfers was similar among the groupbut the control group had a significantly higher
clinical pregnancy rate than the PCOS group.
PCOS is a hormonal imbalance prevalent in
women of reproductive age.16 The mean age of
PCOS subjects in our study was 33 years old
with a BMI of 22.80. Our finding was in linewith the previous study in which the averageage of women with PCOS was reported
younger than healthy women which suggested
might be associated with normalized ovarian
ultrasound features with increasing age due tofollicular cohort physiological decline.13,17
In contrast to a previous study18, PCOS
women in our study were normoweight.
Although patients with PCOS are likely obese,some patients have a normal body mass index(BMI; ≤25 kg/m2).19 Several data suggested
that Asian PCOS patients had lower BMI
compared to other populations which might
attributed to differences in lifestyle.10,20 In
terms of hormonal profile, our finding agrees
previous report by which Wiweko et al.17
showed that the level of LH and AMH among
PCOS patients were higher than in the control
and the level of FSH was lower as compared tothe control. The exaggerated GnRH pulse dueto the neuroendocrine hallmark of PCOS
promotes LH hypersecretion which leads toelevated LH levels over FSH levels. The
insufficiency of FSH, whose role is to recruitand stimulate follicular growth, subsequently
disrupts follicular selection and accumulates
small and pre-antral follicles. AMH, which is
produced by antral follicles, is consequently
elevated9 and therefore describes the findingof our study. AMH has been proposed as adiagnostic marker for PCOS given its
circulating level in the blood is not affected by
the menstrual cycle and hormone drug use.21
During IVF, PCOS women usually have asuboptimal cycle outcome as previously
reported.22,23 However, our study found thatthe number of retrieved oocytes, mature
oocytes, and fertilization was higher in the
PCOS group. This finding was consistent with a72 |previous report as Ciepiela et al.24
demonstrated that the total number of
retrieved oocytes and mature oocytes was
significantly higher in women with PCOS
compared to the non-PCOS group and Su Liu etal.25 found a higher fertilization rate among
PCOS women than in control. PCOS women
typically had elevated LH/FSH ratio due toexcessive LH production. Wiser et al.26
reported that women with an LH/FSH ratio>1.5 had a significantly higher number of
retrieved oocytes and mature oocytes thanthose with a lower ratio. Moreover, Chung etal.27 suggested that a higher BMI was
associated with decreased insulin sensitivity
and a decline in the number of mature oocytes
from PCOS women was reported to be a part ofinsulin resistance.22 We assumed that thehigher number of recovered and mature
oocytes in the PCOS group of the present study
was probably attributed to the raised LH/FSH
ratio and normal BMI. Recovering more
oocytes and attaining higher mature oocytes
then leads to a higher subsequent fertilizationrate.
In terms of embryo development, it wassuggested that PCOS does not affect early
embryonic development.28–30 Nevertheless, we
depict that the number of cleavages,
blastocysts, and top-quality blastocysts was
significantly higher in the PCOS group. In
accordance,amorphokinetic
study
demonstrated that embryos from PCOS
women had faster growth until the 9-cell stage
with the highest at t7, t8, and t9.31 A time-lapse
data of 459 zygotes further suggested that theblastocyst rate, expansion rate, andimplantation rate of faster-cleaving embryos
are higher than slower-cleaving embryos.32 We
hypothesized that the higher cleavage rate in
the PCOS group of the present study might beassociated with its faster development which
in turn leads to a higher number of blastocysts
and top-quality blastocysts. The premise
seems to be consistent as a study done by
Lemmen et al.33 found that early cleavage wassignificantly correlated with remarkably
better embryo development and implantation.
However, a significant rise in LH level seems to

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

have a detrimental effect on subsequent
embryo development represented by thelowered clinical pregnancy rate of the PCOS
group in this study. Huirne et al.34
demonstrated that a significant rise or
decrease in LH levels will reduce the clinicalpregnancy rate.
CONCLUSION
Our study demonstrated that PCOS womenin the Indonesian population presented
elevated LH levels, increased AMH levels, anddecreased FSH levels. Following the IVF cycle,
the majority of the patients had a higher
number of retrieved oocytes, number ofmature oocytes, number of fertilizations,
number of cleavages, number of top-quality
cleavages, number of blastocysts, and numberof top-quality blastocysts but lower clinicalpregnancy rate.
ACKNOWLEDGMENT
This research was funded by the The
Directorate General of Higher Education,
Research, and Technology of Indonesia
through United Kingdom – Indonesia
Consortium for Interdisciplinary Sciences(UKICIS) Grant (No. 4345/E4/AL.04/2022).
DECLARATIONS
Author Contribution. AMS: conceptualization,
study design, manuscript preparation, andmanuscript final draft. TAW: data collection,
data analysis, statistical analysis. NMP:
laboratory work, data analysis. AD:supervision,
manuscript
review.
A:supervision,
manuscript
review.
AB:supervision, funding. HF: supervision,
manuscript review. AB: conceptualization,
supervision, funding.
Conflict of interest. The authors declare no
conflict of interest.
Additional information. No additional
information is available for this paper.
REFERENCES
1. Jabeen A, Yamini V, Amberina AR, Eshwar
MD, Vadakedath S, Begum GS, et al.
Polycystic Ovarian Syndrome: Prevalence,

73 |Predisposing Factors, and Awareness Among
Adolescent and Young Girls of South India.
Cureus. 2022 Aug 13 [cited 2023 Jul 5];14(8).
DOI: https://doi.org/10.7759/cureus.27943
2. 2. Muharam R, Purba JS, Hestiantoro A,
Elvira SD. Profile on personality types andcortisol in polycystic ovarian syndrome.
Middle East Fertil Soc J. 2018 Sep
1;23(3):189–94.
DOI:
https://doi.org/10.1016/j.mefs.2017.12.001
3. Escobar-Morreale HF. Polycystic ovary
syndrome: definition, aetiology, diagnosis andtreatment. Nat Rev Endocrinol. 2018 May 1[cited 2023 May 5];14(5):270–84. DOI:
https://doi.org/10.1038/nrendo.2018.24
4. Franks S, Berga SL. Does PCOS havedevelopmental
origins?
FertilSteril.
2012;97:2–6.
DOI:
https://doi.org/10.1016/j.fertnstert.2011.11.02
9
5. Liao B, Qiao J, Pang Y. Central Regulation of
PCOS: Abnormal Neuronal-ReproductiveMetabolic Circuits in PCOS Pathophysiology.
Front Endocrinol (Lausanne). 2021 May
28;12:667422.
DOI:
https://doi.org/10.3389/fendo.2021.667422
6. Atoum MF, Alajlouni MM, Alzoughool F. A
Case-Control Study of the Luteinizing
Hormone Level in Luteinizing Hormone
Receptor Gene (rs2293275) Polymorphism in
Polycystic Ovarian Syndrome Females. Public
Health Genomics. 2022 May 29 [cited 2024
Feb12];25(3):89–97.
DOI:
https://doi.org/10.1159/000521971
7. Roca FJ, Schutt AK, Mazur EC, Gibbons WE,
Kovanci E. Women with polycystic ovary
syndrome experience more rapid decline inanti-mullerian hormone levels. Fertil Steril.
2012 Sep 1 [cited 2024 Feb 12];98(3):S116.
DOI:
https://doi.org/10.1016/j.fertnstert.2012.07.42
9
8. Butt MS, Saleem J, Aiman S, Zakar R,
Sadique I, Fischer F. Serum anti-Müllerian
hormone as a predictor of polycystic ovarian
syndrome among women of reproductive age.
BMC Womens Health. 2022 Dec 1 [cited2024
Feb12];22(1).
DOI:
https://doi.org/10.1186/s12905-022-01782-2

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

9. Szeliga A, Rudnicka E, Maciejewska-Jeske
M, Kucharski M, Kostrzak A, Hajbos M, et al.
Neuroendocrine Determinants of Polycystic
Ovary Syndrome. Int J Environ Res Public
Health. 2022 Mar 1 [cited 2024 Feb 15];19(5).
DOI: https://doi.org/10.3390/ijerph19053089
10. Wolf WM, Wattick RA, Kinkade ON, Olfert
MD. Geographical Prevalence of Polycystic
Ovary Syndrome as Determined by Region
and Race/Ethnicity. Int J Environ Res Public
Health. 2018 Nov 20 [cited 2024 Feb
12];15(11).
DOI:
https://doi.org/10.3390/ijerph15112589
11. Tang K, Wu L, Luo Y, Gong B. In vitro
fertilization outcomes in women withpolycystic ovary syndrome: A meta-analysis.
Eur J Obstet Gynecol Reprod Biol. 2021 Apr
1 [cited 2024 Mar 12];259:146–52. DOI:
https://doi.org/10.1016/j.ejogrb.2021.02.023
12. Fauser BCJM, Tarlatzis, Fauser, Chang, Aziz,
Legro, et al. Revised 2003 consensus on
diagnostic criteria and long-term health risks
related to polycystic ovary syndrome (PCOS).
Hum Reprod. 2004 Jan [cited 2023 Jun9];19(1):41–7.
DOI:
https://doi.org/10.1093/humrep/deh098
13. Rajbanshi I, Sharma VK, Tuladhar ET,
Bhattarai A, Raut M, Dubey RK, et al.
Metabolic and biochemical profile in womenwith polycystic ovarian syndrome attending
tertiary care centre of central NEPAL. BMC
Womens Health. 2023 Dec 1 [cited 2024 Feb
9];23(1):1–7.
DOI:
https://doi.org/10.1186/s12905-023-02379-z
14. Handayani N, Sundari AM, Aprilliana T,
Boediono A, Polim AA, Sirait B, et al.
Clinical Pregnancy Is Not Associated with
Sperm Quality in POSEIDON Group 1 and 2
Patients. Andrologia. 2023 May 5;2023:1–8.
DOI: https://doi.org/10.1155/2023/4637822
15. Gardner DK, Lane M, Stevens J, Schlenker T,
Schoolcraft WB. Blastocyst score affects
implantation and pregnancy outcome: towards
a single blastocyst transfer. Fertil Steril. 2000
Jun [cited 2022 Apr 8];73(6):1155–8. DOI:
https://doi.org/10.1016/S00150282(00)00518-5
16. Lee TT, Rausch ME. Polycystic ovarian
syndrome: role of imaging in diagnosis.
Radiographics. 2012 Oct [cited 2023 Jul

74 |10];32(6):1643–57.
DOI:
https://doi.org/10.1148/rg.326125503
17. Wiweko B, Maidarti M, Priangga MD, Shafira
N, Fernando D, Sumapraja K, et al. Antimullerian hormone as a diagnostic andprognostic tool for PCOS patients. J Assist
Reprod Genet. 2014;31(10):1311–6. DOI:
https://doi.org/10.1007/s10815-014-0300-6
18. Sharma S, Majumdar A. Prevalence of
metabolic syndrome in relation to body massindex and polycystic ovarian syndrome inIndian women. J Hum Reprod Sci. 2015 Oct 1[cited 2024 Feb 13];8(4):202. DOI:
https://doi.org/10.4103/0974-1208.170394
19. Toosy S, Sodi R, Pappachan JM. Lean
polycystic ovary syndrome (PCOS): anevidence-based practical approach. J Diabetes
Metab Disord. 2018 Dec 31 [cited 2024 Feb
13];17(2):277.
DOI:
https://doi.org/10.1007/s40200-018-0371-5
20. Chen X, Ni R, Mo Y, Li L, Yang D.
Appropriate BMI levels for PCOS patients inSouthern China. Hum Reprod. 2010 May 1[cited 2024 Feb 13];25(5):1295–302. DOI:
https://doi.org/10.1093/humrep/deq028
21. Yue C-Y, Lu L-K-Y, Li M, Zhang Q-L, Ying
C-M. Threshold value of anti-Mullerian
hormone for the diagnosis of polycystic ovary
syndrome in Chinese women. 2018 [cited
2024
Feb
15];
DOI
:
https://doi.org/10.1371/journal.pone.0203129
22. Hassani F, Oryan S, Eftekhari-Yazdi P,
Bazrgar M, Moini A, Nasiri N, et al.
Association between The Number ofRetrieved Mature Oocytesand Insulin
Resistance or Sensitivity in Infertile
WomenPolycystic Ovary Syndrome. Int J
Fertil Steril. 2019 [cited 2024 Feb
15];12(4):310.
Availablefrom:https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC6186286/
23. Plachot M, Belaisch-Allart J, Mayenga JM,
Chouraqui A, Tesquier A, Serkine AM, et al.
Qualité des ovocytes et embryons dans lesyndrome des ovaires polykystiques. Gynecol
Obstet Fertil. 2003 Apr 1 [cited 2024 Feb
15];31(4):350–4.
DOI:
https://doi.org/10.1016/S12979589(03)00059-6

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)

A.M. Sundari, T.A. Wulandari, N.M. Prakoso, A. Dwiranti, Abinawanto, A. Boediono, H. Funahashi, A. Bowolaksono

24. Ciepiela P, Baczkowski T, Brelik P,
Antonowicz A, Safranow K, Kurzawa R.
Biotechnological and clinical outcome of invitro fertilization in non-obese patients withpolycystic ovarian syndrome. In: Folia
Histochemica et Cytobiologica. 2007 [cited
2024 Feb 15]. p. 65–71. Available from:https://pubmed.ncbi.nlm.nih.gov/18292838/
25. Liu S, Mo M, Xiao S, Li L, Hu X, Hong L, etal. Pregnancy Outcomes of Women With
Polycystic Ovary Syndrome for the First In
Vitro Fertilization Treatment: A Retrospective
Cohort Study With 7678 Patients. Front
Endocrinol (Lausanne). 2020 Sep 25 [cited2024
Feb15];11:575337.
DOI:
https://doi.org/10.3389/fendo.2020.575337
26. Wiser A, Shehata F, Holzer H, Hyman JH,
Shalom-Paz E, Son WY, et al. Effect of high
LH/FSH ratio on women with polycystic
ovary syndrome undergoing in vitro
maturation treatment. J Reprod Med. 2013
May 1 [cited 2024 Feb 15];58(5–6):219–23.
Availablefrom:https://europepmc.org/article/med/23763006
27. Chung JO, Cho DH, Chung DJ, Chung MY.
Associations among Body Mass Index, Insulin
Resistance, and Pancreatic β-Cell Function in
Korean Patients with New-Onset Type 2
Diabetes. Korean J Intern Med. 2012 Mar[cited 2024 Feb 15];27(1):66. DOI:
https://doi.org/10.3904/kjim.2012.27.1.66
28. Tam Le M, Van Nguyen T, Thanh Nguyen T,
Thanh Thi Nguyen T, An Thi Nguyen T, Huy
Vu Nguyen Q, et al. Does polycystic ovary
syndrome
affectmorphokinetics
orabnormalities
inearly
embryonic
development? Eur J Obstet Gynecol Reprod
Biol X. 2019 Jul 1 [cited 2024 Feb
16];3:100045.DOI:
https://doi.org/10.1016/j.eurox.2019.100045
29. Weghofer A, Munne S, Chen S, Barad D,
Gleicher N. Lack of association between
polycystic ovary syndrome and embryonic
aneuploidy. Fertil Steril. 2007 Oct 1 [cited2024
Feb16];88(4):900–5.
DOI:
https://doi.org/10.1016/j.fertnstert.2006.12.01
8
30. Sahu B, Ozturk O, Ranierri M, Serhal P.
Comparison of oocyte quality andintracytoplasmic sperm injection outcome in

75 |women with isolated polycystic ovaries or
polycystic ovarian syndrome. Arch Gynecol
Obstet. 2008 Mar [cited 2024 Feb
16];277(3):239–44.
DOI:
https://doi.org/10.1007/s00404-007-0462-x
31. Chappell NR, Barsky M, Shah J, Peavey M,
Yang L, Sangi-Haghpeykar H, et al. Embryosfrom polycystic ovary syndrome patients withhyperandrogenemia reach morula stage fasterthan controls. F&S Reports. 2020 Sep 1 [cited2024
Feb16];1(2):125.DOI:
https://doi.org/10.1016/j.xfre.2020.05.006
32. Meseguer M, Herrero J, Tejera A, Hilligsøe
KM, Ramsing NB, Remoh J. The use ofmorphokinetics as a predictor of embryo
implantation. Hum Reprod. 2011 [cited 2024
Feb16];26(10):2658–71.
DOI:
https://doi.org/10.1093/humrep/der256
33. Lemmen JG, Agerholm I, Ziebe S. Kinetic
markers of human embryo quality using timelapse recordings of IVF/ICSI-fertilized
oocytes. Reprod Biomed Online. 2008 [cited2024
Feb16];17(3):385–91.
DOI:
https://doi.org/10.1016/S14726483(10)60222-2
34. Huirne JAF, van Loenen ACD, Schats R
McDonnell J, Hompes PGA, Schoemaker J, etal. Dose-finding study of daily GnRH
antagonist for the prevention of premature LH
surges in IVF/ICSI patients: optimal changes
in LH and progesterone for clinical pregnancy.
Hum Reprod. 2005 [cited 2024 Feb
18];20(2):359–67.
DOI:
https://doi.org/10.1093/humrep/deh601

DOI: https://doi.org/10.33533/jpm.v18i1.7546 Vol 18 No 1 (2024)