Prevalence of Polycystic Ovary Syndrome in Nigerian Women with Infertility: A Prospective Study of the Three Assessment Criteria

Background: Polycystic ovarian syndrome (PCOS) is a frequent diagnosis in oligomenorrheic and infertile Nigerian women. However, to date there is a paucity of data on the prevalence of PCOS in Nigerian women. The objective of this study was to investigate the prevalence of PCOS in a cross-section of women attending Infertility Clinics in Benin City, Nigeria using the three assessment criteria namely: the 1990 National Institutes of Health (NIH), the 2003 Rotterdam and 2006 Androgen Excess Society (AES) criteria. Method: Four hundred and twenty-one consecutive infertile premenopausal women aged 18 - 45 years were recruited and evaluated with a proforma that elicited information about their maternal and reproductive health history. Blood samples were analyzed for hormone levels using standard immunoassay procedures, while trans-vaginal ultrasound scan was carried out to determine the presence of ultrasonic features of PCOS. The control group comprised of eumenorrheics (n = 180). Results: An estimated prevalence of biochemical hyperandrogenism (BHA) was as high as 20.9% (88 women), while 3.6% (15 women) presented with clinical hyperandrogenism (CHA). Also the prevalence of polycystic ovaries (PCO) was 13.8%. The prevalence of PCOS based on NIH, Rotterdam and AES criteria was 16.9% (71 women), 27.6% (116 women) and 20.7% (87 women) respectively. However, women with PCOS were significantly younger and had higher total testosterone levels (p = 0.001) when compared to controls. Conclusion: The prevalence of PCOS is as high in the population under study as in other prevalence studies. The hormonal investigations were clinically useful in assessing the prevalence rates. However, the recruitment criteria, together with the regional and racial factors may have contributed to the estimates obtained, and the high incidence of biochemical hyperandrogenism in this region.

Insulin Resistance and Its Associated Risk Factors in Nigerian Women with Polycystic Ovary Syndrome

Background: The etiology of polycystic ovary syndrome (PCOS) is not completely understood;however one condition that correlates closely with the pathogenesis of PCOS is insulin resistance (IR). The objective of this study was to determine the prevalence of insulin resistance (IR) and the association of such abnormality with potential risk factors in women with PCOS. Method: 116 women with confirmed PCOS attending a reproductive clinic at the University of Benin Teaching Hospital in Benin City were studied. IR was determined by homeostatic model assessment (HOMA) ≥ 2 and pre-diabetes by fasting plasma glucose between 110 and 125 mg/dl and/or plasma glucose value between 140 and 200 mg/dl at 2 hours during an oral glucose tolerance test (OGTT) after ingestion of 75 g oral glucose load. Results: Forty-two women were insulin resistant among the 116 women with PCOS. The prevalence of IR was 36.2% (95% CI 26.6 - 46.2). The prevalence of impaired fasting glucose (IFG) showed 1.7% (95% CI 0.97 - 2.03), impaired glucose tolerance (IGT) was 2.6% (95% CI 1.97 - 3.03) and diabetes mellitus (DM) was 1.7% (95% CI 0.97 - 2.03) in the 116 PCOS women. Of these 42 insulin resistant PCOS women, 23.8% (n = 10) were obese and 40.5% (n = 17) were overweight. Multivariate analysis revealed that total cholesterol (OR, 1.07;95% CI, 1.04 - 1.10), triglycerides (OR, 1.08;95% CI, 1.04 - 1.13) and LDL-cholesterol (OR, 1.08;95% CI, 1.04 - 1.12) were statistically significant independent risk factors for IR. Conclusion: The prevalence of IR was high in women with PCOS, and there was a significant association between IR, obesity, and dyslipidemia. However, the prevalence rates of impaired glucose tolerance and DM were low in women with PCOS compared to other studies. Since women with PCOS are at risk of IR and dyslipidemia, early screening, detection, intervention, and lifestyle modification would ameliorate the financial burden of DM and cardiovascular disease (CVD).