Polycystic ovary syndrome (PCOS) is a common cause of ovarian dysfunction in women of reproductive age, characterized by symptoms like hirsutism, acne, obesity, and infertility, alongside bilateral polycystic ovaries. According to the 2003 Rotterdam criteria, PCOS is diagnosed when two of the following three criteria are met: oligo/anovulation, clinical or biochemical evidence of hyperandrogenism, and polycystic ovaries on ultrasound¹.The highest reported prevalence of PCOS, at 52%, has been observed among South Asian immigrants in Britain, with 49.1% experiencing menstrual irregularities. South Asian women with PCOS show higher insulin resistance and more severe symptoms compared to Caucasians, with a greater familial predisposition to type 2 diabetes, influenced by both genetic and environmental factors, including nutrition².The prevalence of PCOS ranges from 9 to 18%, with 30–40% of affected women exhibiting insulin resistance (IR) and compensatory hyperinsulinaemia, 10% of whom develop type 2 diabetes³.

Additionally, dyslipidaemia, including higher triglycerides, low-density lipoprotein (LDL-C), and lower high-density lipoprotein (HDL-C), is more common in PCOS patients, with the phenotypic manifestations linked to both genetic and environmental factors⁴.Polycystic ovary syndrome (PCOS) affects 6-10% of women of reproductive age and presents with a spectrum of clinical and laboratory manifestations⁵. Despite being one of the most common endocrinopathies, the underlying mechanisms of PCOS are not fully understood, and it is associated with several hypotheses, including neuroendocrine, ovarian, adrenal, and metabolic dysfunctions⁶. One factor that has been studied in relation to PCOS is Vitamin D3, which is linked to insulin metabolism and metabolic abnormalities, though it remains unclear whether serum Vitamin D3 levels differ between women with and without PCOS⁷.Obesity, insulin resistance, and metabolic abnormalities, common in PCOS, increase the risk of ischaemic heart disease (IHD) by elevating cardiovascular risk factors like glucose intolerance, hypertension, and dyslipidaemia. Insulin resistance in PCOS women leads to higher insulin levels to maintain normal glucose, contributing to metabolic disturbances⁸. Vitamin D, a steroid hormone synthesized in the skin, plays a role in both reproduction and glucose homeostasis by affecting ovarian function and insulin sensitivity through its receptors in key tissues. It influences glucose metabolism by activating enzymes that regulate vitamin D conversion and impacting insulin gene expression⁹.Some studies have shown that PCOS women have Vitamin D3 deficiency unlike age matched healthy women^7,8. However, other studies show different results⁹. However there is paucity of correlation studies of vit. D and PCOS in India thus we have planed this study to compare level of 25 hydroxyVitamin D3 in women with and without PCOS.  

AIM

The study aimed to evaluate the levels of 25-hydroxyvitamin D3 in women with PCOS, assess the levels in healthy women, and compare the vitamin D3 levels between women with and without PCOS.

The study was a hospital-based observational investigation conducted in the Department of Obstetrics and Gynaecology at PBM Hospital, Bikaner, Rajasthan, located in the North-Western part of India. The study was carried out over a period of one year. The study population included women diagnosed with Polycystic Ovary Syndrome (PCOS) and age-matched healthy women of reproductive age attending the outpatient department of Obstetrics and Gynaecology at the hospital.The inclusion criteria for the study were women aged 18 years or older, who were willing to participate, and had a confirmed diagnosis of PCOS according to the modified Rotterdam criteria. For the control group, healthy women within the same age range as the PCOS patients were included.Women were excluded from the study if they refused to give consent, had any major surgical or medical illness, or were diagnosed with hypothyroidism or hyperprolactinemia. Additionally, women who had been taking multivitamin or mineral supplements for the past two months, or who had been using hormonal drugs or oral contraceptive pills (OCPs) in the last six weeks, were excluded. Pregnant and lactating women were also excluded from the study to minimize confounding factors related to hormonal fluctuations during pregnancy and breastfeeding.

TABLE 1: Age Distribution of subjects

Majority of the subjects were of 21-25 years age in cases 56.00% and controls   56% whereas minimum were of 31- 35years age in cases (2.4%) and controls (3.2%). The mean age in cases was 24.56 ± 5.56 yrs and in controls, it was 24.12 ± 4.51 years. In the present study, the two groups were comparable with regard to age distribution. (p=0.869)

Graph : Distribution of subjects according to their indication for Marital history and family history

76% subjects in cases were unmarried and 24% were married whereas in controls 75.2% were unmarried and 24.8% were married. The difference between the two groups was found statistically insignificant. (p=1.000) 88% subjects in cases had family h/o PCOS whereas in controls 9.6% had family h/o PCOS. The difference between the two groups was found statistically insignificant. (p=0.684)

TABLE 2: Clinical profile

82.4% subjects in cases had Irregular menstruation, 56% Weight gain, 24% Infertility, 12% acne and 8% hirsutism whereas in controls all had no abnormality. The difference between the two groups was found statistically significant. (p=0.001)

TABLE 3: Random blood sugar

87.2% subjects in cases had random blood sugar between 90 – 110 mg/dl whereas in controls 92.8%. Mean blood sugar was 103.5 ± 5.9 in cases and 98.5 ± 6.6 mg/dl in controls. The difference between the two groups was found statistically significant. (p=0.0001)

TABLE 4: According to their LH/FSH ratio

Mean LH / FSH ratio was 3.47 ± 0.65 in cases and 3.47 ± 0.65 in controls. The difference between the two groups was found statistically significant. (p=0.0001)

TABLE 5: According to USG findings

73.26% subjects in cases had volume on USG was >10cc and 26.4% had <10cc whereas in controls 96.8% had <10cc and 3.2% had >10cc. The difference between the two groups was found statistically significant. (p=0.0001)

TABLE 6: Correlation of Vit D3 with both groups

76% subjects in cases had vit D3 level <10, 23.2% had 10-30 and >30 in only 0.8%  whereas in controls 68.8% had >30, 28% had 10-30 and 3.2% had <10.  Mean vit D3 level in cases was 12.15 ± 6.8 and 35.6 ± 5.5 in controls. The difference between the two groups was found statistically significant. (p=0.0001)

In our study, majority of the subjects were of 21-25 years age in cases (56%) and controls (56%) whereas minimum were of 31- 35years age in cases (2.4%) and controls (3.2%). The mean age in cases was 24.56 ± 5.56 yrs and in controls, it was 24.12 ± 4.51 years. In the present study, the two groups were comparable with regard to age distribution. (p=0.869) Similarly Saru Arora et al. (2022)¹⁰ the mean age of patients in both the groups was found to be comparable (study group: 26.45±5.95 years versus control group: 28.40±6.65 years; p=0.221). Also Khedr AHM, et al. (2022)¹¹ Age of the patients ranged from 25-37 years, mean value 31.86 ±3.5 years.

In our study, 76% subjects in cases were unmarried and 24% were married whereas in controls, 75.2% were unmarried and 24.8% were married. 88% subjects in cases had family h/o pcos whereas in controls 9.6% had family h/o pcos. The difference between the two groups was found statistically insignificant. (p=0.684) Similarly Omran et al. (2020)¹² found that most of our study cases had primary infertility (n = 74; 92.5%). Also Khedr AHM, et al. (2022)¹¹ found that there were 26 (26%) patients with family history of PCOS and 20 (20%) patients with early menarche.

In our study, 88% subjects in cases had menarche age between 13 – 14 yr whereas in controls 90.4%. Mean age of menarche was 13.4 ± 2.56 yr in cases and 13.2 ± 2.3 yr in controls. 82.4% subjects in cases had irregular menstruation, 56% weight gain, 24% infertility, 12% acne and 8% hirsutism whereas in controls all had no abnormality. (p=0.001) Similarly Omran et al. (2020)¹² found that most of our study cases had irregular menstruation (n = 48, 60%). Also Saru Arora et al. (2022)¹⁰ In the study group, 46 patients (76.66%) had irregular menstrual cycle (i.e., oligomenorrhea, amenorrhea, or heavy menstrual bleeding) while in the control group, three patients (15%) had irregular menstrual cycle (p<0.0001 (HS).

In the study group, 46 patients (76.66%) had irregular menstrual cycle (i.e., oligomenorrhea, amenorrhea, or heavy menstrual bleeding) while in the control group, three patients (15%) had irregular menstrual cycle (p<0.0001 (HS).

In our study, 87.2% subjects in cases had random blood sugar between 90 – 110 mg/dl whereas in controls 92.8%. Mean blood sugar was 103.5 ± 5.9 in cases and 98.5 ± 6.6 mg/dl in controls. (p=0.0001) Similarly Taru Gupta et al. (2017)¹³ there was significant difference seen in serum fasting insulin (10.34 ± 20.00–5.00 ± 3.25, p = 0.021). Also SARU ARORA et al. (2022)32 found that fasting blood sugar (103.41±33.40 mg/dl vs. 87±19.91 mg/dl; p<0.041).

In our study, mean LH / FSH ratio was 3.47 ± 0.65 in cases and 3.47 ± 0.65 in controls. The difference between the two groups was found statistically significant. (p=0.0001) similarly Feyzi Gokosmanoglu et al. (2020)¹⁴ found that two hundred sixty-seven patients with PCOS were divided into two groups, Group 1 with 25(OH)D3 deficiency, and Group 2 with normal 25(OH)D3. Statistically significantly higher concentrations of serum testosterone, dehydroepiandrosterone-sulfate and LH were determined in Group1 (p<0.05).

In our study, 73.26% subjects in cases had volume on usg was >10cc and 26.4% had <10cc whereas in controls 96.8% had <10cc and 3.2% had >10cc. The difference between the two groups was found statistically significant. (p=0.0001)

In our study, 76% subjects in cases had vit D3 level <10, 23.2% had 1030 and >30 in only 0.8% whereas in controls 68.8% had >30, 28% had 10-30 and 3.2% had <10.  Mean vit D3 level in cases was 12.15 ± 6.8 and 35.6 ± 5.5 in controls. The difference between the two groups was found statistically significant. (p=0.0001) Similarly  SARU ARORA et al. (2022)¹⁰ found that in the study group, 48 (80%) belonged to the deficient category, 9 (15%) belonged to the insufficient category, and 3 (5%) belonged to the sufficient category. In the control group, 6 (30%) belonged to the deficient category, 11 (55%) belonged to the insufficient category, and 3 (15%) belonged to the sufficient category. The mean 25-Hydroxy Vitamin D3 level in the study group was 14.71 (±9.12) ng/mL. The mean 25-Hydroxy Vitamin D3 level in the control group was 22.47 (±6.71) ng/mL. The difference was found to be statistically highly significant (p=0.0008). Also Saswati Mukhopadhyay et al. (2022)¹⁵ Vitamin D3 level was significantly lower in cases than in controls (P < 0.05). On the other hand, Li et al.¹⁶ reported lower vitamin D levels, although not significant, in women with PCOS compared with women without PCOS (11 ng/ml in PCOS group vs 17 ng/ml in control group).

This study demonstrates that women with PCOS have a significantly lower serum 25-hydroxyvitamin D3 levels as compared to controls. Low vitamin D3 levels in PCOS women were found to be associated with metabolic and hormonal disturbance. The accumulating data shows negative correlation between vitamin  D3 levels with PCOS; hence, it is speculated that improvement of  vitamin D3 and at a younger age can contribute to prevention of PCOS. There is need for routine vitamin D3 screening in all patients of  PCOS for better insight into its role in the syndrome. Screening and correction of vitamin D3 deficiency may prevent PCOS and its manifestations.

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