Author(s): ZarkaaKhairi AL-Tahafi1 and Wahda Basheer Al-Youzbaki
Objective: To evaluate the effect of metformin on body mass index (BMI) and waist to hip (W/H) ratio and on insulin and ferritin serum level, and insulin resistance represented by Homeostasis Model Assessment (HOMA-IR).And to assess the relationship between serum ferritin and the above parameters in patients with polycystic ovary syndrome (PCOS), treated by metformin for more than three months. Methodology: This study is a case-control study, which was adopted in the Fertility and Invitro Fertilization (IVF) Center in AL. Batoll Teaching Hospital Mosul City/ Iraq, in the period between 1st of November 2013 and 1st April 2014. A group of 39 women with PCOS of reproductive age who used metformin for more than three months (metformin users) with another age-and BMI matched group of 47 women with PCOS who didn’t use metformin (metformin non-users), these groups were sub-divided into subgroups according to the BMI to (obese and non-obese). A 10 ml of fasting blood sample was taken from each PCOS woman of the two groups. The serum was used to measure serum insulin and ferritin level by using commercially available kits, whereas; BMI and insulin resistance represented by Homeostasis Model Assessment (HOMA) was calculated by using especial equations. Results: This study revealed that about half (53 %) of the studied PCOS patients (with and without metformin therapy) found to be obese. There were significant higher mean serum insulin and ferritin level and HOMA-IR value in the obese in comparison with non obese metformin non-users PCOS women. There were a significant lower mean serum level of insulin and ferritin in obese metformin users as compared with obese metformin non-users. Insulin level of obese metformin non-users of the studied PCOS patients found to be above the normal range (<20 μIU/ ml), but there were a non significant differences in the mean FSG between the same two groups. There are no significant differences between all these parameters of the non-obese metformin users and non-users, also insulin level of all non obese studied PCOS patients (metformin users and non-users) found to be within the normal range. There were a significant positive correlation between BMI and serum insulin level, BMI and serum ferritin level, serum insulin and HOMA-IR value, and insulin and ferritin level in metformin users and non-users PCOS patients. By using linear stepwise multiple regression, this study showed a significant effect of the nondepended variables W/H ratio and HOMA-IR on insulin level in obese metformin users. This study concluded that obesity is an important factor that affects insulin resistance and hyperinsulinemia lead to increase ferritin level as this study found a significant correlation between serum insulin and ferritin level in metformin users which was also very highly significant in non-metformin users PCOS patients.