Behradmanesh et al. Discussion In this study, we found that three months intake of metformin in PCOS patients, irrespective to BMI groups, caused a reduction in serum ferritin. In a comparison between two groups of obese PCOS, re- duction of serum ferritin during treatment with met- formin and diane was investigated by Luque-Ramírez et al. 18 They showed that taking metformin for three months and also six months resulted in a reduction in serum ferritin among these patients. After data analy- sis based on BMI, they found that intake of metfor- min for three months reduced ferritin just in over- weight and lean groups but this reduction was not significant in the obese group. They concluded that the reason for this difference in obese group can pos- sibly be due to the comparison of metformin with di- ane.18 To investigate the reduction of CRP in PCOS during metformin treatment, Morin-Papunen et al. showed that CRP significantly decreased after three months and 6 months post treatment respectively com- pared to the beginning of the study. These finding was not in accordance with our findings. In the present study, there was not significant reduction in any of the subgroups possibly due to the sample size compared to our findings.12 Previous studies showed that obese PCOS had higher insulin resistance compared to normal weight PCOS.26,27 Insulin resistance and hyperinsulinemia resulted into an increase in iron storage through bow- el absorption, as indicated in metabolic syndrome and T2D.17,28,29 It was thought that metformin with respect to its effect on central obesity and facilitating insulin function30 reduces insulin sensitivity index together with a decrease in serum ferritin that does not affect CRP in comparison to the obese PCOS taking diane.17 In the present study, there was not any association between BMI, WHR, HOMA-IR and serum ferritin not only before but also after treatment possibly due to lack of control group or sample size difference in these two studies (19 vs 45). While in the present study, there was not any association between CRP and ferritin either before or after the treatment, former studies showed that the increase in ferritin is inde- pendent to the increase in CRP.15,18 Previous studies showed an increase in CRP serum level in obese peo- ple31 and an association between abdominal obesity, insulin resistance and CRP.32 It is was found that an- thropometric parameters especially waist and WHR are modified with metformin in PCOS resulting in a decrease in CRP.12 Although, there was not a signifi- cant decrease in CRP with metformin among all sub- jects and in subgroups in the present study, there was a direct significant association between CRP with BMI (before and after treatment). There was not a significant decrease in HOMA-IR in all subjects while a significant decrease was noticed among sub- groups. Among other anthropometric indexes and meta- bolic parameters of our study, hip circumference showed a significant reduction, although among oth- ers a decrease was seen but was not significant. In an another study in obese PCOS patients conducted by Morin-Papunen et al., intake of metformin for three straight months showed no significant decrease for BMI, WHR and insulin sensitivity index whereas a significant decrease was observed for WHR after six months. In addition, FPG and fasting insulin showed a significant reduction after three months.33 The effect of metformin on non-obese PCOS was also investi- gated in an another study by Morin-Papunen et al. They found a significant reduction in BMI, WHR, FPG and fasting insulin after three months of therapy with metformin, while the reduction in insulin sensi- tivity index was significant. The different results of two above studies compared to our findings was the existence of a control group and low sample size.33 There was not a significant difference between our findings and those two above regarding the HOMA- IR and the reduction of anthropometric indexes espe- cially in non-obese subjects. To investigate the basic CRP, ferritin and HOMA-IR in the related subgroups, there was a significant difference in CRP and HOMA-IR, in obese patients compared to normal weights (p=0.03), something consistent with former studies.12 The level of ferritin was not different in three groups. In a comparative research serum ferritin in PCOS group (compared to healthy group according to identical weight) serum ferritin was found not to be different in those with normal weight, while, mean serum ferritin level in overweight and obese PCOS subjects was significantly higher compared to the control group with identical weight, apparently not consistent with the present study possibly due to lack of a control group.12 In this study, we can concluded that intake of metformin for three months causes a reduction in serum ferritin in all PCOS subjects. This reduction was independent of subjects' weight group, CRP and HOAM-IR. Although hyperinsulinemia was investigated as an iron loading agent in PCOS obese subjects in former studies,18 regarding the results of the present study, the reason for iron overload still 490 WWW.ircmj.com Vol 13 July 2011