evaluation of clinical, metabolic and ultrasonographic parameters of patients with polycystic ovary syndrome receiving vitamin D treatment

OBJECTİVE: There are a variety of treatment options for patients with polycystic ovary syndrome (PCOS). In recent years, the usage of pharmaceutics containing Vitamin D as nutritional supplements is consistently increasing. The aim of the study is the evaluation of clinical, metabolic and ultrasonographic parameters of patients with polycystic ovary syndrome, who are receiving treatment because of with vitamin D deficiency. MATERİALS & METHOD: This retrospective study was conducted after the permission was granted from the Ethics Committee for Clinical Studies of Dokuz Eylul University School of Medicine. 95 patients, who visited the reproductive endocrinology and infertility outpatient clinic of Dokuz Eylül University School of Medicine Department of Obstetrics and Gynaecology between December 1, 2013 and December 1, 2014 and were diagnosed with polycystic ovary syndrome according to Rotterdam Criteria. The clinical, metabolic and ultrasonographic parameters of the patients with polycystic ovary syndrome ,who received treatment due to vitamin D deficiency, were evaluated retrospectively. Anthropometric measurements, blood pressure measurements and calculations according to modified Ferriman-Gallwey scores were done for every case. The blood tests for the following parameters were done: serum fasting glucose, fasting insulin concentration, HOMA-IR, prolactin, thyroid stimulating hormone (TSH), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), total cholesterol, follicle stimulating hormone (FSH), lute¬inizing hormone (LH), estradiol, total testosterone, free testo¬sterone, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), 25-OH vitamin D, 17-OH progesterone, oral glucose tolerance test, androstenedione. Free androgen indexes, body mass indexes and LH/FSH ratios for all patients were calculated. The recorded ultrasonographic findings and clinical parameters of the patients were compared as before treatment and after treatment. The Statistical Program for Social Sciences (SPSS™ version 22, by IBM®) was used for the statistical analysis. p<0,05 was accepted as statistically significant. RESULTS: The results of 95 patients, whom received vitamin D3 treatment, were examined. Patients were between 18 and 34 years of age; the mean age was 23.26±4.22. The initial weights of patients were between 45 and 81 kgs; mean weight was 57.54±8.5. 81 of the 95 patients (%85.3), were complaining of irregular menses, 87 (%91,6) of hirsutism, 5 (%5.3) alopecia, 52 (%54.7) of acnes. After treatment, 69 (%72,6) of the patients had irregular menses, 84 (%88.4) has hirsutism, 5 (%5.3) had alopecia, 48 (%50.5) had acnes. Between the weight, waist circumference, waist to hip ratio, LH, FSH, estradiol, total testosterone, prolactin, thyroid stimulating hormone, oral glucose tolerance test, insulin, 17-OH progesterone, HDL, LDL, triglyceride, total cholesterol, fasting blood glucose level, mean arterial blood pressure, androstenedione, SHBG, VKİ, HOMA-IR, total ovarian volume values of the patients in the 0th and 3rd months, the difference was insignificant. The mean Ferriman-Gallwey score was 10.6±2.01 in the 0th month and 10.44±1.76 in the 3rd month. It was found statistically significant (p<0.001). Mean menstrual period was 41.65±5.7 in the 0th month, 40.16±5.31 in the 3rd month (p<0.001) and this value was found statistically significant. The mean 25-OH Vitamin D level was 12.20±6.11 ng/mL in the 0th month; 22.42±10.87ng/mL in the 3rd month(p<0.001) and this value was found statistically significant. Mean DHEAS level was 291.26±106.21 µg/dL in the 0th month, 281.60±95.33 µg/dL in the 3rd month and the difference was statistically significant (p<0.013). The mean free testosterone concentration was 1.92±0.70 pg/mL in the 0th month and 1.83±0.66 pg/mL in the 3rd month (p<0.001) and it was found statistically significant. The mean LH/FSH ratio was 1.22±0.75 in the 0th month, whereas it was 1.15±0.60 in the 3rd month (p<0.024) and the p value showed statistical significance. The mean of total number of antral follicles was 23.7±2.68 in the 0th month and 23.25±2.48 in the 3rd month (p<0.002) and the difference was found statistically significant. The mean free androgen index for all patients was 1.33±0.87 in the 0th month, while it was 1.15±0.70 in the third month (p<0.002) and it was found statistically significant The correlation among the increase in the concentration of 25 - OH Vitamin D, the level of LH to FSH ratio, total antral follicle count, level of free androgen index and the decrease in DHEAS levels was evaluated with Pearson Correlation Analysis and no statistically significant difference was detected [(p<0,05),(r: ±1)]. The increase in 25 - OH vitamin D level and the decrease Ferriman-Gallwey scores were evaluated with Pearson Correlation Analysis and the correlation was found statistically significant (p<0.024, r:-0,232). CONCLUSİON: After treatment with vitamin D3; no statistically significant difference was found between the lipid parameters and insulin resistance in patients with PCOS. The biochemical parameters of hyperandrogenism showed statistically significant difference after treatment. The clinical findings of the patients showed improvement after treatment; the difference in menstrual periods between before and after treatment was significant. The post-treatment ultrasonography of patients revealed significant decrease in total number of antral follicles when compared to the pre-treatment examination.