Impaired Glucose Tolerance in Vietnamese Infertile PCOS Women
Impaired Glucose Tolerance in Vietnamese Infertile PCOS Women
Polycystic ovary syndrome (PCOS) is a common endocrine and reproductive disorder in which
 insulin resistance (IR) is proposed as a key pathophysiological feature of the disease's
 symptoms and consequences. Impaired glucose tolerance (IGT) which is a significant
 consequence of IR, is related to a higher risk of diabetes mellitus, future cardiovascular
 events, and adverse pregnancy outcomes.
All Vietnamese, infertile women, with PCOS according to the Rotterdam criteria present at
 IVFMD Tan Binh and IVFMD Phu Nhuan will be enrolled to the study. Phenotypes of PCOS are
 classified into A, B, C and D due to hyperandrogegism (HA), ovulatory dysfunction (OD) and
 polycystic ovarian morphology (PCOM)

 -  A: HA + OD + PCOM

 -  B: HA + OD

 -  C: HA + PCOM

 -  D: OD + PCOM

 All patients enrolled in this study will have:

 -  Standard anthropometric data will be done by professional and experience physicians
 according to standard study protocol: Weight, height, waist and hip circumference, waist
 to hip ratio, BMI calculated, followed by World Health Organization guidelines for Asian
 women.

 -  Blood pressure

 -  Fat mass measure by specific caliper which are available at the clinic. Fat mass index
 (FMI) are classified as: deficit < 5, normal 5-9, excess female >9-13, obese >13

 -  Gynecologic ultrasound scan

 -  Blood tests:

 -  Hormonal profile evaluation: Luteinizing hormone (LH) (Roche Cobas e411, S: 25.816
 mIU/mL, CV: 5.8%), Follicle-stimulating hormone (FSH) (Roche Cobas e411, S: 25.045
 mIU/mL, CV: 5.8%), Estradiol (Roche Cobas e411, S: 210.390 ng/L, CV: 6.6%), Total
 testosterone, SHBG, androstenedione, TSH (Beckman Access - S: 2,712 ng/dL, CV:
 5.6%), Total triiodothyronine (total T3) (Beckman Access - S: 7.284 pg/mL, CV:
 6.1%), Free thyroxine (free T4) (Beckman Access - S: 2.712 ng/dL, CV: 5.6%),
 Prolactin (Roche Cobas e411 - S: 37.993 mcg/L, CV: 5.5%), Progesterone (Roche Cobas
 e411, S:10.553 ng/mL and CV: 5.4%),17(OH)-progesterone (Elisa, DRG International,
 S: 0.03 ng/ml and CV: 5.8-9.2%), Free androgen index (FAI) = Serum testosterone
 (nmol/L)/serum SHBG (nmol/L) × 100, HDL, LDL, Fasting serum insulin (Roche Cobas
 e411 - S: 1.39 pmol/L, CV: 1.4%), Insulin sensitivity is estimated by homeostasis
 model assessment of insulin resistance (1/HOMA-IR) index. HOMA-IR is calculated by
 the following formula: HOMA-IR = fasting plasma glucose (mmol/L) × fasting insulin
 (uIU/mL)/22.5

 -  Glucose tests:

 -  Fasting plasma glucose: will be measured by Humastar 600 System (Humastar
 Systems,), sensitivity (S): 6.421 mmol/L and coefficient of variation (CV):
 2.5% and performed when patients have already had fasting for at least 8
 hours. A volume of 2 ml of blood will be withdrawn and contained in a
 vacutainer with additive of natri oxalate and EDTA. Diagnosis of diabetes
 mellitus will be made when fasting glucose ≥126 mg/dL (7 nmol/L) or HbA1C
 ≥6.5% (48 mmol/mol) (American Diabetes Association, 2018). When glucose ≥126
 mg/dL (7 nmol/L) or HbA1C ≥6.5% (48 mmol/mol) (American Diabetes Association,
 2018).

 -  Oral glucose tolerance test with 75 g glucose (75 g OGTT) will be performed to
 those with normal fasting glucose and HbA1C levels. Women will be recommended
 to have normal diet for 3 days and overnight fasting for at least 8 hours. The
 blood withdrawal will be performed twice: (i) fasting and (2i) 2 hours after
 solution administration. The volume of blood for each test is 2 ml. Impaired
 glucose tolerance will be diagnosed when two-hour glucose levels of 140 to 199
 mg/dL (7.8 to 11.0 mmol/l) (American Diabetes Association, 2018).

 -  Hyperandrogenism:

 -  Clinical hyperandrogenism: Hirsutism using the modified Ferriman Gallwey score
 (mFG) and severe acnes

 -  Biochemical hyperandrogenism: free testosterone (normal range below
 2,53nmol/ml), free testosterone index, SHBG
Inclusion Criteria:

 -  Vietnamese women with polycystic ovarian syndrome diagnosed followed by Rotterdam
 criteria (2003) having indications for infertility treatments

 Exclusion Criteria:

 -  Endocrinal abnormalities including thyroid-stimulating hormone (TSH) >5mIU/mL, serum
 prolactin (PRL) >30ng/mL and any other concomitant endocrinopathy such as a history of
 hypothyroidism, Cushing's syndrome, premature ovarian insufficiency and late-onset or
 non-classic congenital adrenal hyperplasia will be excluded.

 -  Women who were already diagnosed as diabetes by endocrinologists