Can Sex‑hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome?

Abstract

Background: This study aims to evaluate the sex hormone binding globulin (SHBG) level as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome (PCOS).

Methods: This study was conducted in 2009-2012 in Isfahan, Iran. Anovulatory women with a diagnosis of PCOSwere studied. Metformin was started at 500 mg three times a day. If no ovulation occurred, Clomiphene citrate was added.

Results: The study comprised273 infertile women with PCOS completed the study, 75 (28%) of them became pregnant 6 months after treatment (7.36% with metformin and 20.14% with metformin and clomiphene citrate). Patients who responded to metformin treatment had significantly lower mean SHBG levels compared to those who did not (0.88+0.32vs. 0.2642+0.44 nmol/L, respectively, P<0.0001). The area under the ROC curve (AUC) for prediction the response to treatment was 0.85. The baseline level of 27was the most appropriate cut of point HSBG for the prediction of conception. HSBG had a sensitivity of 88%, and specificity of 73.6%. It had a false positive level of 26.4% and false negative level of 12%. Its positive predictive value was 56.4% and its negative predictive value was 94%. The chance of conception increased for reducing a unit of fpg (OR = 0.69; 95% CI = 0.54-0.86; P = .002), as well as reducing of every unit of HSBG (OR = 0.47; 95% CI = 0.39-0.56; P <0.001), and for reducing each unit of insulin in (OR = 0.082; 95% CI = 1.021-0.33; P <0.001).

Conclusion: HSBG test is suggested as an appropriate test for predicting pregnancy achievement of PCOs women after pharmacological treatment

Keywords: Binding globulin, metformin, polycystic ovary syndrome, sex‑hormone