Study of prevalence of insulin resistance and other metabolic abnormalities in various phenotypes of polycystic ovary syndrome in central India

Deepti Gupta, Rini Upadhyaya, Anjlina Bhati


Background: Till recent times, defining symptoms of PCOS remained a debatable topic. In 2012, National Institute of health consensus panel proposed diagnostic criteria based on phenotypes. Evidence showed higher incidence of diabetes mellitus, insulin resistance and compensatory hyperinsulinemia among women with PCOS. So, the present study was undertaken to compare the clinical, metabolic and hormonal profile among various phenotypes in women with PCOS and to find out the prevalence of insulin resistance among the PCOS phenotypes.

Methods: The prospective, observational study was done on 292 women with PCOS-related infertility. These women were divided into 4 phenotypes. Ferriman-Gallwey score, HOMA-IR, OGTT, lipid parameters, hormonal parameters, mean ovarian volume and mean antral follicle counts were compared among the 4 phenotypic groups. One-way ANOVA followed by post-hoc Tukey was applied.

Results: Mean weight, BMI, waist circumference, SBP, DBP and Ferriman-Gallwey score, fasting glucose, fasting insulin, OGTT (1 hour) and HOMA-IR was highest in phenotype A, while fasting glucose / insulin ratio was lowest in phenotype A. Total triglycerides, total cholesterol, LDL were higher and HDL was lowest, testosterone, mean ovarian volume and mean antral follicle count were highest and vitamin D was lowest in Phenotype A.

Conclusions: Phenotype A is the group with all features of PCOS syndrome, while phenotype D is associated with milder metabolic profile. Women with phenotype A and B are at a higher risk for metabolic syndrome. Identifying various phenotypes will assist in providing appropriate treatment and prognosticating the patients with PCOS-related infertility.


Infertility, Metabolic syndrome, Phenotypes, Polycystic ovary syndrome-related infertility, Rotterdam criteria

Full Text:



Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnoses criteria. Hum Reprod. 2012;27(10):3067-73.

Adams JM, Taylor AE, Crowley WF Jr, Hall JE. Polycystic ovarian morphology with regular ovulatory cycles: insights into the patho- physiology of polycystic ovarian syndrome. J Clin Endocrimol Metab. 2004;89:4343-50.

Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781-5.

Lujan ME, Chizen DR, Pierson RA. Diagnostic criteria for polycystic ovary syndrome: pitfalls and controversies. J Obstet Gynaecol Can. 2008;30(8):671‐9.

Kim MJ, Lim NK, Choi YM, Kim JJ, Hwang KR, Chae SJ, et al. Prevalence of metabolic syndrome is higher among non-obese PCOS women with hyperandrogenism and menstrual irregularity in Korea. PLoS One. 2014;9(6):e99252.

Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981-1030.

Gambineri A, Patton L, Altieri P, Pagotto U, Pizzi C, Manzoli L, et al. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes. 2012;61(9):2369-74.

Zawadzski JK. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic Ovary Syndrome. 1992:39-50.

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(1):19-25.

Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W. Task force on the phenotype of the polycystic ovary syndrome of the androgen E, Society P. The androgen excess and PCOS society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456-88.

Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6-15.

Norman RJ, Hague WM, Masters SC, Wang XJ. Subjects with polycystic ovaries without hyperandrogenemia exhibit similar disturbances in insulin and lipid profiles as those with polycystic ovary syndrome. Hum Reprod. 1995;10:2258-61.

Dokras A, Bochner M, Hollinrake E, Markham S, Vanvoorhis B, Jagasia DH. Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol. 2005;106(1):131-7.

Chang RJ, Nakamura RM, Judd HL, Kaplan SA. Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab. 1983;57(2):356-9.

Ciaraldi TP, el-Roeiy A, Madar Z, Reichart D, Olefsky JM, Yen SS. Cellular mechanisms of insulin resistance in polycystic ovarian syndrome. J Clin Endocrinol Metab. 1992;75(2):577-83.

Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989;38(9):1165-74.

Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes. 1992;41(10):1257-66.

Fritz MA, Sreroff L. Chronic anovulation and the polycystic ovary syndrome. In: Baltimore MD, ed. Clinical Gynecologic Endocrinology and Infertility. 8th Ed. Philadelphia: Lippincott Williams and Wilkins; 2011:495-532.

Hettihewa LM, Shalika P, Jayasinghe SS, Gunasekara SW, Weerarathna TP. Comparison of insulin resistance by indirect methods-HOMA, QUICKI and McAuley-with fasting insulin in patients with type 2 diabetes in Galle, Sri Lanka: A pilot study. Online J Health Allied Sci. 2006;1:2.

Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85(7):2402-10.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9.

McAuley KA, Williams SM, Mann JI, Walker RJ, Lewis-Barned NJ, Temple LA, et al. Diagnosing insulin resistance in the general population. Diabetes Care. 2001;24(3):460-4.

Nishida C, Ko GT, Kumanyika S. Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO expert consultation on waist circumference and waist-hip ratio. Eur J Clin Nutr. 2010;64(1):2-5.

Wild RA, Vesely S, Beebe L, Whitsett T, Owen W. Ferriman Gallwey self-scoring I: performance assessment in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(7):4112-4.

Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.

Franks S, McCarthy MI, Hardy K. Development of polycystic ovary syndrome: involvement of genetic and environmental factors. Int J Androl. 2006;29(1):278-85.

Urbanek M. The genetics of the polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab. 2007;3(2):103-11.

Głuszak O, Stopińska-Głuszak U, Glinicki P, Kapuscinska R, Snochowska H, Zgliczynski W, et al. Phenotype and metabolic disorders in polycystic ovary syndrome. ISRN Endocrinol. 2012;2012:569862.

Pehlivanov B, Orbetzova M. Characteristics of different phenotypes of polycystic ovary syndrome in a Bulgarian population. Gynecol Endocrinol. 2007;23(10):604-9.

Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab. 1980;50(1):113-6.

Dunaif A, Graf M, Mandeli J, Laumas V, Dobrjansky A. Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J Clin Endocrinol Metab. 1987;65(3):499-507.

Dunaif A, Finegood DT. Beta-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome. J Clin Endocrinol Metab. 1996;81(3):942-7.

Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774-800.

Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries-a common finding in normal women. Lancet. 1988;1(8590):870-2.

Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril. 2005;83(6):1717-23.