In partial fulfilment of the requirements for the degree of Master in Medical Research.

Background: Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder characterized by metabolic and reproductive dysfunction. While insulin resistance (IR), dyslipidemia, and chronic inflammation are well-recognized features of PCOS, their relationship with body mass index (BMI) remains understudied in Nepalese women. This study aimed to compare metabolic and inflammatory profiles across BMI groups in infertile women with PCOS in Nepal.
Methods: We conducted a cross-sectional study of 72 infertile women diagnosed with PCOS according to Rotterdam criteria. Participants were stratified by BMI as per Asia-Pacific guidelines into Group 1 [obese (≥ 25 kg/m2) and overweight (23 to 24.9 kg/m2)] and Group 2 [normal (18.5 to 22.9 kg/m2) and underweight (< 18.5 kg/m2)]. Anthropometric measurements, fasting blood samples for HOMA-IR calculation, lipid profiles, and inflammatory markers {C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR)} were analyzed. Data analyses were done by independent t-tests, ANOVA, correlation, and multiple regression.
Results: Group 1 demonstrated significantly higher prevalence of insulin resistance (IR) (47.4% vs 6.7%, p < 0.001) and worse lipid profiles, including elevated triglycerides (140 ± 66 vs 97.5 ± 41 mg/dL, p = 0.02), LDL (119 ± 30.6 vs 98 ± 19 mg/dL, p = 0.011), and TG/HDL ratio (3.4 ± 2.2 vs 1.9 ± 0.9, p = 0.007) compared to Group 2. CRP levels showed strong positive correlation with HOMA-IR in obese women (r = 0.547, p < 0.001). Multiple regression identified fasting insulin (B = 0.630, p < 0.001) and BMI (B = 0.125, p < 0.05) as significant predictors of IR.
Conclusions
Our findings demonstrated that obesity exacerbates metabolic dysfunction in PCOS, particularly insulin resistance and dyslipidemia. The results highlighted the importance of BMI-stratified management approaches, with emphasis on weight reduction for obese patients and routine metabolic monitoring for all women with PCOS.
Keywords: Body mass index, Dyslipidemia, Inflammation, Insulin resistance, Polycystic ovarian syndrome