TABLE 1
Patient characteristics for controls and women with polycystic ovary syndrome.
Study Group
Variable Controls (n$45) Patients with PCOS (n$57)
Age (y) 29.3 # 6.8 (20–42) 29.2 # 6.1 (19–43)
Waist (cm) 74.8 # 7.8 (62–101) 102.4 # 17.6 (61–138)
Waist-to-hip ratio 0.753 # 0.038 (0.699–0.841) 0.841 # 0.068 (0.649–1.104)
BMI (kg/m2) 23.6 # 3.4 (19.2–37.5) 34.6 # 9.5 (20.6–64.7)
Glucose level (mmol/L) 4.9 # 0.3 (4.3–5.5) 5.4 # 0.9 (4.1–10.0)
Insulin level (pmol/L) 51.9 # 18.0 (22.1–113.6) 139.6 # 85.9 (31.1–356.5)
Glucose-to-insulin ratio (mmol/pmol) 0.104 # 0.036 (0.043–0.208) 0.056 # 0.037 (0.017–0.160)
Cholesterol level (mmol/L) 4.08 # 0.72 (3.19–5.88) 4.98 # 1.12 (2.46–8.25)
HDL level (mmol/L) 1.39 # 0.31 (0.84–1.97) 1.10 # 0.29 (0.55–1.86)
LDL level (mmol/L) 2.26 # 0.68 (1.20–4.10) 3.01 # 0.81 (1.42–4.96)
TG level (mmol/L) 0.94 # 0.42 (0.39–2.56) 1.91 # 1.18 (0.55–5.28)
SBP (mm Hg) 108.9 # 9.0 (88–132) 124.2 # 14.1 (100–158)
DBP (mm Hg) 66.9 # 6.4 (51–80) 76.6 # 10.9 (50–100)
Note: Values are mean # SD (range). Glucose, insulin, and lipid values are serum concentrations. BMI $ body mass index; DBP $ diastolic blood pressure;
HDL $ high-density lipoprotein cholesterol; LDL $ low-density lipoprotein cholesterol; SBP $ systolic blood pressure; TG $ triglyceride.
Mather. Hyperinsulinemia in PCOS. Fertil Steril 2000.
insulin resistance. We were able to show that the degree of circumference !96.5 cm (13), total cholesterol level !5.2
hyperinsulinemia correlates significantly with CV risk in mmol/L, high-density lipoprotein level "0.90 mmol/L, sys-
women with PCOS, independent of body mass index (BMI). tolic blood pressure !140 or diastolic blood pressure !90
(14), and the presence of diabetes mellitus (fasting glucose
MATERIALS AND METHODS level !7.0 mmol/L) (15). For the presence of each of these,
a score of 1 was given (maximum score, 5). All our patients
Patients were younger than 45 years of age, so categorical designa-
A cross-sectional study was undertaken in women re-
tions for age were not included (14). Smoking was excluded
ferred for evaluation of possible PCOS. Fifty-seven patients
from the risk factor score, as it does not reflect metabolic
with a clinical diagnosis of PCOS (clinical evidence of
alterations related to the presence of PCOS.
chronic estrogenized anovulation, as well as clinical or lab-
oratory evidence of hyperandrogenism), without hyperpro-
lactinemia or elevated 8-A.M. 17-hydroxyprogesterone levels
Insulin Sensitivity
In designing the study, we set out to compare groups on
and with normal follicle-stimulating hormone levels were
the basis of their fasting insulin levels. There is ongoing
included. Forty-five healthy age-matched women with reg-
debate regarding the best marker of insulin sensitivity in
ular menstrual cycles were recruited as unselected controls
various populations. Some authorities recommend the fast-
through posted advertisements in the local hospital and med-
ing insulin level itself (16), whereas others find that mathe-
ical school. All study subjects were required to be between
matical combinations of the fasting glucose and insulin lev-
the ages of 18 and 45 years; consume fewer than two glasses
of wine per day; and not have received any medications els correlate best with formal measures of insulin sensitivity.
known to alter hormone, lipid, or insulin metabolism within In particular, the glucose-to-insulin ratio (GIR) has recently
the 3 months before the study. been reported to correlate well with dynamic testing of
insulin dynamics in women with PCOS (17). Therefore, we
This project was approved by our university’s ethical undertook comparisons using both the GIR and the insulin
review board and was designed and carried out in accordance level itself. For markers of insulin sensitivity, there is cur-
with the Declaration of Helsinki. After full and informed rently no consensus on the definition of a normal range.
written consent was obtained, subjects completed a question- Therefore, we defined the normal range as mean # 2 SDs
naire documenting lifestyle factors, smoking, alcohol use, from the control group data. Using these definitions, com-
and general health. Anthropomorphic measurements were parisons were made among the controls, the PCOS women
recorded, and a fasting blood sample for determination of without insulin resistance (“normoinsulinemic” [insulin
serum lipids, insulin, and glucose levels was taken. level " 88 pmol/L] or “insulin sensitive” [GIR ! 0.032]),
Risk Factors and the PCOS women with insulin resistance (“hyperinsu-
A composite score for CV risk was calculated for each linemic” [insulin level ! 88 pmol/L] or “insulin resistant”
subject using the following risk factor classifications: waist [GIR " 0.032]).
FERTILITY & STERILITY! 151