CORRELATION BETWEEN LEVELS OF HOMOCYSTEINE, ANTI-MÜLLERIAN HORMONE AND INSULIN RESISTANCE IN PCOS PATIENTS WITH RECURRENT MISCARRIAGE.

There are controversial opinions regarding the impact of hyperhomocysteinemia (HHcy) and insulin resistance in PCOS patients who experience Recurrent Pregnancy Loss (RPL). Nowadays the correlation between levels of anti-müllerian hormone (AMH), homocysteine and insulin resistance (IR) have become the main subject of interest in PCOS patients for predicting RPL. Objective - investigate the relationship between level of homocysteine, anti-müllerian hormone and insulin resistance in PCOS patients with Recurrent Pregnancy Loss. 80 Georgian young women (<30 years) with PCOS were involved in the prospective study. The diagnosis of PCOS was based on the criteria of Rotterdam Consensus 2003. Patients were divided into two groups: group I-50 patients, who experienced RPL, and group II-30 patients with live births in anamnesis (control group). Patients with RPL were divided into two subgroups: subgroup A-with insulin resistance (n=28), and subgroup B-without insulin resistance (n=22). All patients underwent hormonal investigation from day 2 to 3 of menstrual cycle. Plasma levels of anti-müllerian hormone, homocysteine, follicle-stimulating hormone, luteinizing hormone (LH), total testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG) were determined. Between 2-3 days of the menstrual cycle all participants underwent an ultrasound examination using Voluson E10. This was done to determine ovarian volume and antral follicle count. Average homocysteine (Hcy) level in PCOS patients with RPL (11.5±2.24μmol/l) was significantly higher than in controls (7.55±2.45 μmol/l, p<0.001). Incidence of (HHcy) and IR in patients with RPL was 70% and 56% respectively, which was significantly higher than in controls (HHcy-54.3%; IR- 9.4%; p<0.0001). HOMA-IR in patients with RPL was significantly higher compared with controls (p<0.001). Average AMH level in patients with RPL and live births did not differ significantly. In the group of PCOS with RPL significant positive correlation between Hcy and HOMA-IR, BMI, AMH and FT levels was found (p<0.001). Serum homocysteine level is elevated in PCOS patients with RPL. This elevation is correlated with the degree of obesity, BMI, Insulin Resistance status, AMH and androgen levels. The treatment of hyperhomocysteinemia and insulin resistance in women with PCOS might become the bases for prevention of pregnancy losses and improving reproductive outcomes.