الفهرس 
Introduction and aim of workOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome is the commonest endocrine disorder among women in reproductive age with a worldwide prevalence of 5–20%. it is recognized by a group of criteria include hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding) with polycystic ovaries. Also, several metabolic disturbances are associated with PCOS such as insulin resistance, compensatory hyperinsulinemia, dyslipidemia, and obesity and these consequently increase the risk for type 2 diabetes mellitus, metabolic syndrome, and cardiovascular diseases.
Vitamin D has vital actions in the body such as bone metabolism management and calcium homeostasis maintenance in addition to its recently proved role in cell proliferation, differentiation, immune regulation, and neurogenesis. vitamin D receptors (VDRs) were identified in some female reproductive tract organs such as the ovary, uterus, and the placenta and some studies reported that females with null vitamin D receptors were infertile and had folliculogenesis impairment.
The present study aimed to evaluate vitamin D levels in women with PCOS compared to normal fertile women and to study the relation between vitamin D and fasting insulin hormone levels in women with PCOS.
The study is a prospective case-control study. The control and PCOS patients were enrolled for this study corresponding to inclusion and exclusion criteria mentioned before.
The study included a total of 80 subjects who were classified into two groups: group (I) cases which included 40 infertile women diagnosed with PCOS and group (II) control which included 40 normal fertile women. The diagnosis of PCOS in cases group was based on the presence of at least two of the Rotterdam criteria that includes the following: the presence of oligomenorrhea and/or amenorrhea, hyperandrogenism and/or hirsutism in addition to polycystic ovarian morphology. All included women were subjected to the following: thorough history taking including personal, present, menstrual, obstetric, past and family histories also, general examination in terms of weight, height, body mass index, blood pressure, the presence or absence of galactorrhea, chest, heart and abdominal examination. Gynaecological examination was done to evaluate the uterus and ovaries. Regarding sonographic evaluation, transvaginal ultrasonography was performed using Toshiba SAA 270 AUS machine with 7.5 MHZ vaginal transducer to evaluate the uterus and ovaries and to confirm the diagnosis of PCOS. Also, the ovarian volume, the stromal thickness and the number and arrangement of follicles were evaluated. In addition, some laboratory investigations were done including basal LH, FSH hormone levels.
Venous blood sample (4 ml) was taken from all included women after 12 hours overnight fasting and serum was separated by centrifugation and then stored at -40 Co. Serum insulin assay was done by the method of quantitative determination of insulin levels in human serum by a Microplate Enzyme Immunoassay, Colorimetric using AccuBind ELISA Microwells, supplied by Monobind Inc, Lake Forest, CA 92630, USA. Also, 25 OH Vitamin D assay was done by the method of quantitative determination of 25 OH Vitamin D concentration in human serum by a Microplate Enzyme Immunoassay, Colorimetric using AccuBind ELISA Microwells, supplied by Monobind Inc, Lake Forest, CA 92630, USA.
The present results showed that there were no significant differences between groups regarding age, body mass index, however, cases group had significantly lower gravidity. In cases group, there are 22 cases (55.0%) had a primary type of infertility while, 18 cases had a secondary type and the duration of infertility was 1-3 years in about two-thirds of cases (62.5%) and it was 4-9 years in the rest of cases. The majority of cases group (39 cases, 97.5%) had irregular menstrual pattern (80.0% had oligomenorrhea and 17.5% had amenorrhea) versus only 2 cases (5.0%) in the control group who had oligomenorrhea. The results of the ultrasound findings showed that PCOS group had significantly higher both right and left antral follicle count compared to control group. As regards the previous treatment of cases group, 37 cases (92.5%) were treated with Clomid, 18 cases (45.0%) had hormonal treatment, 12 cases (30.0%) had drilling and 5 cases (12.5%) had ICSI.
The results revealed that LH level was significantly higher in PCOS group compared to control one (11.37 vs. 4.04 IU/L,). While in contrary, FSH level was significantly lower in PCOS group compared to control (4.68 vs. 7.51 IU/L). The fasting insulin level was significantly elevated in PCOS group compared to control (12.64 ± 3.94 vs. 7.49 ± 2.41 IU/ml). Regarding the results of 25 (OH) D, PCOS group had a significantly lower 25 (OH) D level compared to control group (15.5 ± 5.16 vs. 23.5 ± 5.0 ng/ml). Cases group had 11 cases (27.5%) with vitamin D deficiency versus no cases in control group while, 32 cases (80.0%) had vitamin D sufficiency in control group versus only 4 cases (10.0%) in cases group.
The fasting insulin hormone level was negatively correlated with 25 (OH) D level in the PCOS group (r=0.48). Cases with vitamin D deficiency (<12 ng/ml) had higher fasting insulin hormone level (15.5 ± 3.79 IU/ml), cases with vitamin D insufficiency (12-20 ng/ml) had moderate fasting insulin hormone level (12.07 ± 3.36 IU/ml) while, cases with vitamin D sufficiency (20-50 ng/ml) had the lowest level of fasting insulin hormone (8.15 ± 1.55 IU/ml) with a significant difference among all. Also, the results showed a significant negative correlation between 25 (OH) D level and body mass index in PCOS patients (r=-0.50). However, no obvious correlation was noticed between 25 (OH) D level and all of LH, FSH and, age.
In conclusion, Women with PCOS had a significantly lower serum 25 (OH) D level compared to normal fertile women. Insulin resistance was prevalent in PCOS patients and there was a significant inverse correlation between vitamin D level and both fasting insulin hormone and BMI in these patients. These results suggest a possible role of vitamin D supplementations in the management of PCOS, Further large randomized controlled studies are needed to explore the causality of this linkage.