*Corresponding Author: A. Sagaya Sowmya, Assistant Professor, Holy Cross College,
Tiruchirappalli, Tamil Nadu, India. Email: [email protected]. 17
International Journal of Zoology and Applied Biosciences ISSN: 2455-9571
Volume 10, Issue 5, pp: 17-25, 2025 http://www.ijzab.com
https://doi.org/10.55126/ijzab.2025.v10.i05.003
Research Article
ASSESSMENT OF POLYCYSTIC OVARY SYNDROME (PCOS)
OCCURRENCES AMONG ADOLESCENT AND YOUNG REPRODUCTIVE
AGE GROUP WOMEN IN TIRUCHIRAPPALLI DISTRICT
* 1A. Sagaya Sowmya, 2S. Sathyamoorthy and 3B. Deivasigamani
1Holy Cross College, Tiruchirappalli, Tamil Nadu, India,
2Guru Ghasidas Vishwavidyalaya Bilaspur, Chhattisgarh, India
3Centre for Advanced Studies in Marine Biology, Faculty of Marine Sciences, Parangipettai, Tamil Nadu, India
Article History: Received 22nd July 2025; Accepted 29th August 2025; Published 30th September 2025
ABSTRACT
In this study, the healthy patients of three different age groups - biochemical and hormonal profiles were compared with
PCOS patients. The results concluded that BS (Blood Sugar), FSH (Follicle Stimulating Hormone), LH (Luteinizing
Hormone), PRL (Prolactin), TSH (Thyroid Stimulating Hormones), T(Testosterone), SHBG (Sex Hormone Binding
Globulin), I (Insulin), BS(F) (Blood Sugar Fasting), DHEA-S (Dehydroepiandrosterone- sulphate), Creatinine, Cholesterol,
Triglycerides, LDL and were significantly varied in PCOS women than compared to the normal due to the altered
metabolism influenced by either GnRH or GnIH from hypothalamus. Among the three age categories, 21-26yrs age group
showed significantly varied result. Our study concluded that 21-26yrs women showed increased incidence of PCOS than
other reproductive age women. The aim is to reflect the assumed relation based on studies in different stages of life in
Women with PCOS.
Keywords: Patients, PCOS, Triglycerides, Hypothalamus, Blood Sugar.
INTRODUCTION
Chereau one who first described sclerostin changes in the
human ovary in1844, occasional reports on this condition
continued to appear over the years. Steain and Leventhal
(1935) described a case of polycystic ovaries as consisting
of menstrual irregularity. The Condition was called the
Stein-Leventhal Syndrome (Stein and Leventhal, 1935). In
1960s and 1970s, it became possible to measure the
hormonal change and some biochemical changes in urine
and blood. In the1980s, high- resolution ultrasound was
used to study a typical polycystic ovary containing over 10
follicles of diameter between 2 and 10mm.
Polycystic ovarian syndrome is a complex and
heterogeneous clinical condition characterized by hyper
androgenism and chronic oligo anovulation (Zawadski and
Dunaif,1992). In comparison to the normal ovary, the
polycystic ovary has multiple small cysts. These cysts
appear when frequent disruptions in menstrual cycles
occur. The ovary is enlarged and produces excessive
amounts of androgen and estrogenic hormones (Richard,
2011). Imbalance of hormones prevents the ovaries from
releasing an egg each month. So ovulation does not occur
and the ovaries produce more immature eggs. These eggs
turn into cysts and the ovaries become large and studded
with numerous cysts is called polycystic syndrome (Metab,
1998). Other metabolic disorders like obesity, type2
diabetes and cardiovascular problems can also be included
as its features (Xita et al., 2002). About 50% of the women
are obese particularly abdominal obesity in common,
suggesting that elevated androgen levels.
Diagnosis of Polycystic Ovarian Disorder. PCOS is the
most common disorder in women of reproductive age
group as well as premenopausal women (Janssen et
al.,2004; Zarger et al.,2005). PCOS increased serum
concentration of luteinizing hormone (LH), LH/FSH ratio
and increase in the amplitude and frequency of LH
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 18
secretion (Mobeen et al., 2016).Generally PCOS was
Diagnosed by the basis of clinical features of the menstrual
dysfunction, obesity, infertility and the direct visualization
of the ovaries at the laparotomy but in the NIH conference
agreed that biochemical markers like the LH/FSH ratio,
increased testosterone hormone levels in the blood is also a
diagnostic criteria for PCOS (Zawadzki and Dunaif,
1992).Other metabolic disorders like obesity, type2
diabetes and cardiovascular problems can also be included
as its features (Xitaet al., 2002). About 50% of the women
are obese particularly abdominal obesity in common,
suggesting that elevated androgen levels. The PCOS is not
only based on reproductive health issue but the metabolic
and the cardio vascular issue are also raised (King., 2006).
Risk Factors of PCOS
Cardiovascular Disease, Obesity, Infertility, Endometrial
Cancer, Complications in Pregnancy, Sleep Apnoea,
Depression.
MATERIALS AND METHODS
Patient details
The 357 female patients who visited the Reproductive
Medical Centre at Ramakrishna Hospital, Woraiyur,
Tiruchirappalli-620 003. Between May 2018 to September
2020 the data was collected and their sample size were
shown in the Table 1. The patients were categorized
according to their Age group. Group1 is age between 15 to
20, Group 2 is age between 21to 25, Group 3 is age
between 26 to 30 and Group 4 is age between 31 to 35.
Table 1. Age and Year Cross tabulation of No. of patients with PCOS.
Age Year Total
2018 2019 2020
15-20 yrs. 20 35 10 65
21-25 yrs. 70 57 29 156
26-30 yrs. 33 39 26 98
31-35 yrs. 9 20 9 38
Total 132 151 74 357
Clinical Detection
Clinical feature were recorded and variables such as age,
*BS (Blood Sugar),* FSH (Follicle Stimulating Hormone),
*LH (Luteinizing Hormone), *PRL (Prolactin), *TSH
(Thyroid Stimulating Hormones), *T(Testosterone),
*SHBG (Sex Hormone Binding Globulin), I
(Insulin),*BS(F) (Blood Sugar Fasting), *DHEA-S
(Dehydroepiandrosterone- sulphate),*E2(Estradiol), *BU
(Blood Urea), *Creatinine, * Cholesterol, * Triglycerides, *
HDL(High Density Lipoprotein), * LDL and VLDL (Very
Low Density Cholesterol). These parameters were
analysed to each patient by standard procedures in the
hospital and results were procured and compared with
normal age range values to find out the abnormal patients.
Statistical Analysis
The statistical analysis was performed using the Microsoft
excel version 2013. The base work has been stated as
grouping patients according to their age wise and plotted
graph with various parameters to find which age group
patients are more affected by PCOS. In addition to that
using Statistical Package for the Social Sciences for
Window version 20.0 (SPSS), I have been calculated Mean,
Median, Standard Error of Mean, Minimum, Maximum and
Standard Deviation.
RESULTS AND DISCUSSION
Three consecutive years patient blood glucose levels
between normal and diabetes results based on different age
groups. In all the three years, high number of diabetic
patients are under the 21-25 yrs., Table 2. Polycystic ovary
syndrome (PCOS) is an endocrine disorder characterized
by anovulation, menstrual disorder. It is also known as
stein levinthal syndrome1-3. Women with PCOS have
impaired metabolism of androgen, estrogen and also in the
control of androgen production. PCOS is the most common
disorder in women of reproductive age group as well as
premenopausal women (Janssen et al., 2004 and Zargeret
al., 2005). Biochemical features of PCOS include elevated
androgens, particularly testosterone, luteinizing hormone
(LH), Estrogen, insulin levels and decreased sex-hormone
binding globulin (SHBG) levels (Tsilchorozidu, 2004).
www.ijzab.com 18
secretion (Mobeen et al., 2016).Generally PCOS was
Diagnosed by the basis of clinical features of the menstrual
dysfunction, obesity, infertility and the direct visualization
of the ovaries at the laparotomy but in the NIH conference
agreed that biochemical markers like the LH/FSH ratio,
increased testosterone hormone levels in the blood is also a
diagnostic criteria for PCOS (Zawadzki and Dunaif,
1992).Other metabolic disorders like obesity, type2
diabetes and cardiovascular problems can also be included
as its features (Xitaet al., 2002). About 50% of the women
are obese particularly abdominal obesity in common,
suggesting that elevated androgen levels. The PCOS is not
only based on reproductive health issue but the metabolic
and the cardio vascular issue are also raised (King., 2006).
Risk Factors of PCOS
Cardiovascular Disease, Obesity, Infertility, Endometrial
Cancer, Complications in Pregnancy, Sleep Apnoea,
Depression.
MATERIALS AND METHODS
Patient details
The 357 female patients who visited the Reproductive
Medical Centre at Ramakrishna Hospital, Woraiyur,
Tiruchirappalli-620 003. Between May 2018 to September
2020 the data was collected and their sample size were
shown in the Table 1. The patients were categorized
according to their Age group. Group1 is age between 15 to
20, Group 2 is age between 21to 25, Group 3 is age
between 26 to 30 and Group 4 is age between 31 to 35.
Table 1. Age and Year Cross tabulation of No. of patients with PCOS.
Age Year Total
2018 2019 2020
15-20 yrs. 20 35 10 65
21-25 yrs. 70 57 29 156
26-30 yrs. 33 39 26 98
31-35 yrs. 9 20 9 38
Total 132 151 74 357
Clinical Detection
Clinical feature were recorded and variables such as age,
*BS (Blood Sugar),* FSH (Follicle Stimulating Hormone),
*LH (Luteinizing Hormone), *PRL (Prolactin), *TSH
(Thyroid Stimulating Hormones), *T(Testosterone),
*SHBG (Sex Hormone Binding Globulin), I
(Insulin),*BS(F) (Blood Sugar Fasting), *DHEA-S
(Dehydroepiandrosterone- sulphate),*E2(Estradiol), *BU
(Blood Urea), *Creatinine, * Cholesterol, * Triglycerides, *
HDL(High Density Lipoprotein), * LDL and VLDL (Very
Low Density Cholesterol). These parameters were
analysed to each patient by standard procedures in the
hospital and results were procured and compared with
normal age range values to find out the abnormal patients.
Statistical Analysis
The statistical analysis was performed using the Microsoft
excel version 2013. The base work has been stated as
grouping patients according to their age wise and plotted
graph with various parameters to find which age group
patients are more affected by PCOS. In addition to that
using Statistical Package for the Social Sciences for
Window version 20.0 (SPSS), I have been calculated Mean,
Median, Standard Error of Mean, Minimum, Maximum and
Standard Deviation.
RESULTS AND DISCUSSION
Three consecutive years patient blood glucose levels
between normal and diabetes results based on different age
groups. In all the three years, high number of diabetic
patients are under the 21-25 yrs., Table 2. Polycystic ovary
syndrome (PCOS) is an endocrine disorder characterized
by anovulation, menstrual disorder. It is also known as
stein levinthal syndrome1-3. Women with PCOS have
impaired metabolism of androgen, estrogen and also in the
control of androgen production. PCOS is the most common
disorder in women of reproductive age group as well as
premenopausal women (Janssen et al., 2004 and Zargeret
al., 2005). Biochemical features of PCOS include elevated
androgens, particularly testosterone, luteinizing hormone
(LH), Estrogen, insulin levels and decreased sex-hormone
binding globulin (SHBG) levels (Tsilchorozidu, 2004).
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 19
Table 2. Age wise variation in the mean level of blood glucose in the PCOS patients from 2018-2020.
Figure 1. Mean and SE of blood glucose level in patients with PCOS from 2018-2020.
www.ijzab.com 19
Table 2. Age wise variation in the mean level of blood glucose in the PCOS patients from 2018-2020.
Figure 1. Mean and SE of blood glucose level in patients with PCOS from 2018-2020.
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 20
Table 3. Age wise variation in the mean level of BSF in the PCOS patients from 2018-2020.
Figure 2. Mean and SE of Fasting Glucose levels in PCOS patients from 2018-2020.
www.ijzab.com 20
Table 3. Age wise variation in the mean level of BSF in the PCOS patients from 2018-2020.
Figure 2. Mean and SE of Fasting Glucose levels in PCOS patients from 2018-2020.
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 21
Table 4. Mean and SE of blood glucose level in patients with PCOS from 2018-2020.
Figure 3. Mean and SE of FSH level in patients with PCOS from 2018-2020.
www.ijzab.com 21
Table 4. Mean and SE of blood glucose level in patients with PCOS from 2018-2020.
Figure 3. Mean and SE of FSH level in patients with PCOS from 2018-2020.
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 22
Table 5. Mean and SE of LH level in patients with PCOS from 2018-2020.
Figure 4. Mean and SE of LH level in patients with PCOS from 2018-2020.
www.ijzab.com 22
Table 5. Mean and SE of LH level in patients with PCOS from 2018-2020.
Figure 4. Mean and SE of LH level in patients with PCOS from 2018-2020.
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 23
Table 6. Mean and SE of PRL level in patients with PCOS from 2018-2020.
Figure 5. Mean and SE of LH level in patients with PCOS from 2018-2020.
www.ijzab.com 23
Table 6. Mean and SE of PRL level in patients with PCOS from 2018-2020.
Figure 5. Mean and SE of LH level in patients with PCOS from 2018-2020.
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 24
These biochemical levels are extremely important because
SHBG normally binds to testosterone to transport it
throughout the body, and while some testosterone is needed
in women, too much free or unbound testosterone leads to
many problems such as the male-patterned hair loss seen in
many PCOS patients. Insulin directly stimulates the cells to
produce androgens, and elevated levels of androgens are
related to many of the problems or symptoms seen in
PCOS. Insulin also causes a decrease in the production of
hepatic Sex Hormone Binding Globulin (SHBG) (Moran et
al., 2003). Meals should be balanced in order for your body
to carry out the optimum insulin secretion and metabolism
by eating foods that will cause a slower rise in blood sugar
level, and prevent large peaks and valleys in insulin and
glucose levels. These results point to the conclusion that
energy restriction is what really matters in relations to diets
for PCOS patients.
CONCLUSION
Hence, I conclude that there are still many questions about
PCOS that remain unanswered. However, certain studies
are looking into many questions about PCOS. Some
researchers are proposing possible causes; others are trying
to determine which diet and exercise regimen is best; while
others are exploring the avenues of education, prevention,
and associated disorders. Regardless of the current state of
information, it can be said that there will be a brighter
future for patient with PCOS.
ACKNOWLEDGMENT
The authors thank the authorities of the Holy Cross
College, Tamil Nadu India, Guru Ghasidas
Vishwavidyalaya Bilaspur, Chhattisgarh and CAS in
Marine Biology, Annamalai university for permitting them
to carry out their work successfully
CONFLICT OF INTERESTS
The authors declare no conflict of interest
ETHICS APPROVAL
Not applicable
FUNDING
This study received no specific funding from public,
commercial, or not-for-profit funding agencies.
AI TOOL DECLARATION
The authors declares that no AI and related tools are used to
write the scientific content of this manuscript.
DATA AVAILABILITY
Data will be available on request
REFERENCES
Allahbadia, G. N., & Merchant, R. (2008). Polycystic ovary
syndrome in the Indian subcontinent. Seminars in
Reproductive Medicine, 26(1), 22-34.
Duleba, A. J., & Ahamed, I. M. (2010). Predictors of
urinary albumin excretion in women with polycystic
ovary syndrome. Fertility and Sterility, 93(7), 2285-2290.
Asunción, M., Calvo, R. M., San Millán, J. L., et al. (2000).
A prospective study of the prevalence of the polycystic
ovary syndrome in unselected Caucasian women from
Spain. Journal of Clinical Endocrinology & Metabolism,
85(7), 2434-2438.
Azziz, R., Marin, C., Hoq, L., Badamgarav, E., & Song, P.
(2005). Health care–related economic burden of the
polycystic ovary syndrome during the reproductive life
span. Journal of Clinical Endocrinology & Metabolism,
90(8), 4650-4658.
Balen, A. (2004). The pathophysiology of polycystic ovary
syndrome: Trying to understand PCOS and its
endocrinology. Best Practice & Research Clinical
Obstetrics & Gynaecology, 18(5), 685-706.
Boomsma, C. M., Eijkemans, M. J., Hughes, E. G., Visser,
G. H., Fauser, B. C., & Macklon, N. S. (2006). A meta-
analysis of pregnancy outcomes in women with
polycystic ovary syndrome. Human Reproduction
Update, 12(6), 673-683.
Broekmans, F. J., Knauff, E. A., Valkenburg, O., Laven, J.
S., Eijkemans, M. J., & Fauser, B. C. (2006). PCOS
according to the Rotterdam consensus criteria: Change in
prevalence among WHO-II anovulation and association
with metabolic factors. BJOG: An International Journal
of Obstetrics & Gynaecology, 113(10), 1210-1217.
Chen, X., Yang, D., Mo, Y., et al. (2008). Prevalence of
polycystic ovary syndrome in unselected women from
southern China. European Journal of Obstetrics &
Gynecology and Reproductive Biology, 139(1), 59-65.
Connolly, F., Rae, M. T., Spath, K., Boswell, L., McNeilly,
A. S., & Duncan, W. C. (2015). In an ovine model of
polycystic ovary syndrome (PCOS), prenatal androgens
suppress female renal gluconeogenesis. PLOS ONE,
10(7), e0132113.
Garad, R., Teede, H. J., & Moran, L. (2011). An evidence-
based guideline for polycystic ovary syndrome.
Australian Nursing Journal, 19(4), 30-34.
Goverde, A. J., van Koert, A. J., Eijkemans, M. J., et al.
(2009). Indicators for metabolic disturbances in
consensus criteria. Human Reproduction, 24(3), 710-717.
Hassa, H., Tanir, M., & Yildiz, B. (2006). Comparison of
clinical and laboratory characteristics of cases with
polycystic ovary syndrome based on Rotterdam’s criteria
and women whose only clinical signs are
oligo/anovulation or hirsutism. Archives of Gynecology
and Obstetrics, 274(4), 227-232.
www.ijzab.com 24
These biochemical levels are extremely important because
SHBG normally binds to testosterone to transport it
throughout the body, and while some testosterone is needed
in women, too much free or unbound testosterone leads to
many problems such as the male-patterned hair loss seen in
many PCOS patients. Insulin directly stimulates the cells to
produce androgens, and elevated levels of androgens are
related to many of the problems or symptoms seen in
PCOS. Insulin also causes a decrease in the production of
hepatic Sex Hormone Binding Globulin (SHBG) (Moran et
al., 2003). Meals should be balanced in order for your body
to carry out the optimum insulin secretion and metabolism
by eating foods that will cause a slower rise in blood sugar
level, and prevent large peaks and valleys in insulin and
glucose levels. These results point to the conclusion that
energy restriction is what really matters in relations to diets
for PCOS patients.
CONCLUSION
Hence, I conclude that there are still many questions about
PCOS that remain unanswered. However, certain studies
are looking into many questions about PCOS. Some
researchers are proposing possible causes; others are trying
to determine which diet and exercise regimen is best; while
others are exploring the avenues of education, prevention,
and associated disorders. Regardless of the current state of
information, it can be said that there will be a brighter
future for patient with PCOS.
ACKNOWLEDGMENT
The authors thank the authorities of the Holy Cross
College, Tamil Nadu India, Guru Ghasidas
Vishwavidyalaya Bilaspur, Chhattisgarh and CAS in
Marine Biology, Annamalai university for permitting them
to carry out their work successfully
CONFLICT OF INTERESTS
The authors declare no conflict of interest
ETHICS APPROVAL
Not applicable
FUNDING
This study received no specific funding from public,
commercial, or not-for-profit funding agencies.
AI TOOL DECLARATION
The authors declares that no AI and related tools are used to
write the scientific content of this manuscript.
DATA AVAILABILITY
Data will be available on request
REFERENCES
Allahbadia, G. N., & Merchant, R. (2008). Polycystic ovary
syndrome in the Indian subcontinent. Seminars in
Reproductive Medicine, 26(1), 22-34.
Duleba, A. J., & Ahamed, I. M. (2010). Predictors of
urinary albumin excretion in women with polycystic
ovary syndrome. Fertility and Sterility, 93(7), 2285-2290.
Asunción, M., Calvo, R. M., San Millán, J. L., et al. (2000).
A prospective study of the prevalence of the polycystic
ovary syndrome in unselected Caucasian women from
Spain. Journal of Clinical Endocrinology & Metabolism,
85(7), 2434-2438.
Azziz, R., Marin, C., Hoq, L., Badamgarav, E., & Song, P.
(2005). Health care–related economic burden of the
polycystic ovary syndrome during the reproductive life
span. Journal of Clinical Endocrinology & Metabolism,
90(8), 4650-4658.
Balen, A. (2004). The pathophysiology of polycystic ovary
syndrome: Trying to understand PCOS and its
endocrinology. Best Practice & Research Clinical
Obstetrics & Gynaecology, 18(5), 685-706.
Boomsma, C. M., Eijkemans, M. J., Hughes, E. G., Visser,
G. H., Fauser, B. C., & Macklon, N. S. (2006). A meta-
analysis of pregnancy outcomes in women with
polycystic ovary syndrome. Human Reproduction
Update, 12(6), 673-683.
Broekmans, F. J., Knauff, E. A., Valkenburg, O., Laven, J.
S., Eijkemans, M. J., & Fauser, B. C. (2006). PCOS
according to the Rotterdam consensus criteria: Change in
prevalence among WHO-II anovulation and association
with metabolic factors. BJOG: An International Journal
of Obstetrics & Gynaecology, 113(10), 1210-1217.
Chen, X., Yang, D., Mo, Y., et al. (2008). Prevalence of
polycystic ovary syndrome in unselected women from
southern China. European Journal of Obstetrics &
Gynecology and Reproductive Biology, 139(1), 59-65.
Connolly, F., Rae, M. T., Spath, K., Boswell, L., McNeilly,
A. S., & Duncan, W. C. (2015). In an ovine model of
polycystic ovary syndrome (PCOS), prenatal androgens
suppress female renal gluconeogenesis. PLOS ONE,
10(7), e0132113.
Garad, R., Teede, H. J., & Moran, L. (2011). An evidence-
based guideline for polycystic ovary syndrome.
Australian Nursing Journal, 19(4), 30-34.
Goverde, A. J., van Koert, A. J., Eijkemans, M. J., et al.
(2009). Indicators for metabolic disturbances in
consensus criteria. Human Reproduction, 24(3), 710-717.
Hassa, H., Tanir, M., & Yildiz, B. (2006). Comparison of
clinical and laboratory characteristics of cases with
polycystic ovary syndrome based on Rotterdam’s criteria
and women whose only clinical signs are
oligo/anovulation or hirsutism. Archives of Gynecology
and Obstetrics, 274(4), 227-232.
A. Sagaya Sowmya et al. Int. J. Zool. Appl. Biosci., 10(5), 17-25, 2025
www.ijzab.com 25
Hart, R., & Norman, R. (2006). Polycystic ovarian
syndrome: Progenesis and outcomes. Best Practice &
Research Clinical Obstetrics & Gynaecology, 20(5), 751-
778.
Kashar-Miller, M. D., Nixon, C., Boots, L. R., Go, R. C., &
Azziz, R. (2001). Prevalence of polycystic ovary
syndrome (PCOS) in first-degree relatives of patients
with PCOS. Fertility and Sterility, 75(1), 53-58.
King, J. (2006). Polycystic ovary syndrome. Journal of
Midwifery & Women’s Health, 51(6), 415-422.
Katulski, K., Czyzyk, A., Podkowa, N., Podfigurna, A.,
Ignaszak, N., Paczkowska, K., Slawek, S., Spzurek, D., &
Meczekalski, B. (2017). Clinical and hormonal features
of women with polycystic ovary syndrome living in rural
and urban areas. Annals of Agricultural and
Environmental Medicine, 24(3), 522-526.
Legro, R. S., Castracane, V. D., & Kauffman, R. P. (2004).
Detecting insulin resistance in polycystic ovary
syndrome: Purposes and pitfalls. Obstetrical &
Gynecological Survey, 59(2), 141-154.
www.ijzab.com 25
Hart, R., & Norman, R. (2006). Polycystic ovarian
syndrome: Progenesis and outcomes. Best Practice &
Research Clinical Obstetrics & Gynaecology, 20(5), 751-
778.
Kashar-Miller, M. D., Nixon, C., Boots, L. R., Go, R. C., &
Azziz, R. (2001). Prevalence of polycystic ovary
syndrome (PCOS) in first-degree relatives of patients
with PCOS. Fertility and Sterility, 75(1), 53-58.
King, J. (2006). Polycystic ovary syndrome. Journal of
Midwifery & Women’s Health, 51(6), 415-422.
Katulski, K., Czyzyk, A., Podkowa, N., Podfigurna, A.,
Ignaszak, N., Paczkowska, K., Slawek, S., Spzurek, D., &
Meczekalski, B. (2017). Clinical and hormonal features
of women with polycystic ovary syndrome living in rural
and urban areas. Annals of Agricultural and
Environmental Medicine, 24(3), 522-526.
Legro, R. S., Castracane, V. D., & Kauffman, R. P. (2004).
Detecting insulin resistance in polycystic ovary
syndrome: Purposes and pitfalls. Obstetrical &
Gynecological Survey, 59(2), 141-154.