Investigating the Role of Hormonal Imbalances in Polycystic Ovary Syndrome (PCOS) and Fertility Outcomes

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is a multifactorial endocrine disorder causing ovulatory dysfunction and infertility, strongly linked to hormonal imbalance and metabolic disturbances in reproductive-aged women. Objective: This study aims to investigate hormonal imbalances in PCOS patients and analyze their impact on ovulatory function, oocyte quality, and fertility outcomes using clinical, biochemical, and statistical parameters. Methods: A cross-sectional observational study was conducted at the Department of Gynae and Obstetrics, Rajshahi Medical College, Bangladesh, from January to December 2023. One hundred PCOS-diagnosed patients (Rotterdam criteria) aged 18–35 years were enrolled. Hormonal assays (LH, FSH, LH/FSH ratio, total testosterone, fasting insulin) and metabolic profiles (BMI, HOMA-IR) were measured. Ovarian morphology was assessed by transvaginal ultrasound. Fertility outcomes, including ovulation rate, oocyte quality, and conception rates, were recorded. Data were analyzed using SPSS v.26 with t-tests and chi-square; significance was set at p<0.05. Results: Mean LH/FSH ratio was 2.8 ± 0.9, with elevated LH levels in 68% of patients. Hyperandrogenism was observed in 72%, while insulin resistance (HOMA-IR>2.5) was detected in 64%. Anovulation occurred in 61%, with 39% achieving ovulation. Oocyte maturation rates were 58% in PCOS patients versus reference 82% in controls (p=0.004). Fertility outcomes showed 32% conception within one year. Higher BMI (>27 kg/m²) was significantly associated with reduced ovulation (p=0.03) and lower conception (p=0.02). Standard deviation analysis demonstrated greater variability in LH (±7.2 IU/L) compared to FSH (±3.4 IU/L). Correlation revealed strong negative association between insulin resistance and oocyte quality (r=-0.63, p=0.001). Conclusion: Hormonal imbalance, particularly elevated LH/FSH ratio and insulin resistance, significantly impairs ovulation and fertility in PCOS, highlighting the necessity of integrated endocrine-metabolic management.