Association Between Serum Antinuclear Antibody and Polycystic Ovarian Syndrome in Reproductive Women Aged 18 to 35 Years: A Quest for an Autoimmune Marker

Introduction: Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrinal physiological disorder characterized by chronic oligo-ovulation or an-ovulation, hyperandrogenism, and polycystic morphology in ovaries on transvaginal or abdominal ultrasound. Hyperandrogenism and insulin resistance are already well-documented pathophysiological mechanisms in PCOS. Besides this, autoimmunity has been hypothesized in its pathogenesis. Studies regarding the association between PCOS and autoimmunity have yielded contradictory results. There is scarce data regarding the prevalence of autoimmune markers among PCOS women from India. Therefore, this study was done to find the relationship between antinuclear antibody (ANA) positivity and PCOS.

Objective: To determine the prevalence of ANA positivity in women with PCOS and to see the association of Serum antinuclear antibodies ANA with clinical, hormonal, and biochemical parameters of PCOS.

Methods: This cross-sectional study was done in the Obstetrics and Gynaecology department, All India Institute of Medical Sciences (AIIMS), Raipur, for a period of 18 months. The study population consisted of a total of 140 women aged 18-35 years and were equally divided into the 'PCOS 'and 'Control' groups. The 'PCOS' group consisted of 70 women with a diagnosis of PCOS as per revised 2003 Rotterdam criteria. The 'Control' group consisted of 70 healthy women with no PCOS. History-taking and clinical examinations were done on all women. History taking included medical, surgical, menstrual, and any other relevant history. Clinical examinations included general physical examination and anthropometry like height, weight, build, body mass index (BMI), waist-to-hip ratio (WHI), etc. We did Hirsutism scoring with a modified Ferriman-Gallaway scoring system. Blood samples were taken for ANA estimation and biochemical and hormonal essay.

Results: The prevalence of ANA positivity in PCOS and the control group was 10% and 4.3%, respectively (not statistically significant). There was no significant association found between ANA positivity and PCOS (p-value=-0.326). There was no significant association found between ANA positivity and modified Ferriman-Gallwey scores, serum testosterone levels and HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) levels.

Conclusion: There was no statistically significant association between ANA positivity and PCOS, but we found an increased prevalence of ANA in the PCOS group as compared to the non-PCOS group.Though our study did not find a significant association between ANA positivity and modified Ferriman Gallwey score, serum testosterone levels, and HOMA-IR levels, we found a significant increase in anti-TPO levels in ANA-positive PCOS women. We conclude that the increased prevalence of ANA positivity in PCOS could be an indicator of autoimmunity.