Polycystic Ovarian Morphology is Associated with Hyperandrogenemia and Insulin Resistance in Women with Polycystic Ovary Syndrome (PCOS)

Objectives: The aim of the present study was to evaluate the impact of polycystic ovarian morphology in the hormonal and metabolic features of the "classical" phenotypes of PCOS. Design: The study included 1275 Caucasian women with PCOS with a mean age of 24.25 ± 5.79 years and a mean BMI of 26.80 ± 7.03 kg/m2. Diagnosis of PCOS was based on the 2003 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus criteria. Two phenotypes, matched for age and BMI were compared: Phenotype I (n=620) which included PCOS women with biochemical hyperandrogenemia and/or clinical hyperandrogenemia, chronic anovulation and polycystic ovarian morphology on ultrasound (PCO). Phenotype II (n=400) which included PCOS women with biochemical hyperandrogenemia and/or clinical hyperandrogenemia and chronic anovulation, without PCO. These phenotypes were further subdivided in normal weight and obese PCOS women. Results: PCOS women of Phenotype I had higher LH/FSH ratio (p<0.001), higher Testosterone (p<0.01), Δ4 Androstenedione (p<0.001) and 17-OH progesterone levels (p<0.001), and higher Free Androgen Index (FAI) values (p<0.01) compared to Phenotype II. With the exception of fasting glucose levels, all other indices of insulin resistance (fasting insulin, fasting glucose/insulin ratio, QUICKI and HOMA2IR) document an association between Phenotype I and greater insulin resistance in overweight/obese PCOS women. Conclusions: In conclusion, in "classical" phenotypes of polycystic ovary syndrome (PCOS), polycystic ovarian morphology is associated with more severe hyperandrogenemia and deranged LH/FSH ratio. In overweight/obese PCOS subjects, PCO is positively correlated with insulin resistance.