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Abstract
PCOS represents a major health issue affecting young women today (Haslam and James, 2005). It is now recognized to be a metabolic syndrome which may include hyperinsulinaemia, hyperlipidaemia, diabetes mellitus, and possibly cardiac disease, as well as the more conventionally recognised increase in androgen levels, cosmetic problems, anovulation, infertility, obesity and endometrial cancer (Norman et al., 2004b).
It is characterized by chronic anovulation with oligo-amenorrhea, obesity, enlarged cystic ovaries, elevated lutinizing hormone (LH), hyperandrogenism and infertility.
Insulin-sensitizing agents have been shown to improve both reproductive and metabolic aspects of PCOS (Tan et al., 2007). Several insulin sensitizing agents have been tested in the management of PCOS. In particular, metformin is the only drug currently in widespread clinical use for treatment of PCOS (De Leo et al., 2003). Metformin treatment in patients with PCOS resulted in a significant weight loss. It proved to be safe, simple and non coasty.
Cytokines, soluble polypeptides of immunological origin, are local regulators of ovarian function. They are involved in regulation of gonadal steroid secretion and corpus luteum function as well as in the modulation of the ovulatory process. Tumor necrosis factor–α and interleukin-6 have been shown to exert a pleiotropic effect on ovary function. Both cytokines have been shown to be in the follicular fluid, suggesting their production by the granulosa cells (Amato et al., 2003). In patients with PCOS, circulating levels of IL-6 has been found to be elevated.