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Original Article

Comparison of 25-hydroxyvitamin D and Calcium
Levels between Polycystic Ovarian Syndrome
and Normal Women
Ashraf Moini, M.D.1, 2, 3, Nooshin Shirzad, M.D.1, 4, Marzieh Ahmadzadeh, M.D.1, Reihaneh Hosseini, M.D.1*,
Ladan Hosseini, M.Sc.1, Shahideh Jahanian Sadatmahalleh, Ph.D.2, 5

1. Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
2. Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for
Reproductive Biomedicine, ACECR, Tehran, Iran
3. Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
4. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology
and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
5. Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares
University, Tehran, Iran

Abstract
Background: Given the relationship of vitamin D deficiency with insulin resistance syn-
drome as the component of polycystic ovary syndrome (PCOS), the main aim of this
study was to compare serum level of 25- hydroxyvitamin D [25(OH)D] between PCOS
patients and normal individuals.

Materials and Methods: A cross sectional study was conducted to compare 25(OH)D
level between117 normal and 125 untreated PCOS cases at our clinic in Arash Hospi-
tal, Tehran, Iran, during 2011-2012. The obtained levels of 25(OH)D were classified as
follows: lower than 25 nmol/ml as severe deficiency, between 25-49.9 nmol/ml as defi-
ciency, 50-74.9 nmol/ml as insufficiency, and above 75 nmol/ml asnormal. In addition,
endocrine and metabolic variables were evaluated.

Results: Among PCOS patients, our findings shows 3(2.4%) normal, 7(5.6%) with
insufficiency, 33(26.4%) with deficiency and 82(65.6%) with severe deficien-
cy, whereas in normal participants, 5(4.3%) normal, 4(3.4%) with insufficiency,
28(23.9%) with deficiency and 80(68.4%) with severe deficiency. Comparison of
25(OH)D level between two main groups showed no significant differences (p=
0.65). Also, the calcium and 25(OH)D levels had no significant differences in pa-
tients with overweight (p=0.22) and insulin resistance (p=0.64). But we also found
a relationship between 25(OH)D level and metabolic syndrome (p=0.01). Further-
more, there was a correlation between 25(OH)D and body mass index (BMI) in
control group (p=0.01), while the C-reactive protein (CRP) level was predominantly
higher in PCOS group (p<0.001).

Conclusion: Although the difference of 25(OH)D level between PCOS and healthy wom-
en is not significant, the high prevalence of 25(OH)D deficiency is a real alarm for public
health care system and may influence our results.

Keywords: Polycystic Ovary Syndrome, 25-Hydroxyvitamin D, Calcium

Citation: Moini A, Shirzad N, Ahmadzadeh M, Hosseini R, Hosseini L, Jahanian Sadatmahalleh Sh. Comparison of
25-hydroxyvitamin D and calcium levels between polycystic ovarian syndrome and normal women. Int J Fertil Steril.
2015; 9(1): 1-8.

Received: 15 Aug 2013, Accepted: 10 Feb 2014
* Corresponding Address: Department of Gynecology and Obstetrics,
Arash Women’s Hospital, Tehran University of Medical Sciences,
Tehran, Iran Royan Institute
Email: arash_hosp@tums.ac.ir International Journal of Fertility and Sterility
Vol 9, No 1, Apr-Jun 2015, Pages: 1-8
1

Introduction criteria: oligo and/or anovulation. women who D [25(OH)D] and PCOS. had male fertility problems. vitamin D. hyperparathyroidism. high density lipoprotein. Furthermore. while impaired glucose tolerance and had a history of chronic disease or endocrino- insulin secretion have been shown to be associated phaties. and hir- sutism are known as some of symptoms of PCOS A healthy woman was defined as woman in re- (1). >150 mg/dl. TG level cruited from our clinic in Arash Hospital.Moini et al. Apr-Jun 2015 2 . insulin resistance. The metabolic syndrome was defined Materials and Methods by the National Cholesterol Education Program This cross sectional study and was performed (NCEP) and the adult treatment panel III (ATP on 242 women. thy- In this study. hyperandro. A morning blood sample was taken after 12 There are suggestions that calcium has impor. and poly- Polycystic ovarian syndrome (PCOS) is known cystic ovaries in ultrasound. and who had a history of smoking or with vitamin D deficiency (3). fasting blood sugar (FBS). and infertility. metabolism may play an important role in patho. Iran. acanthosis nigricans. prolactin. tumors were excluded using specific laboratory tests to verify the concentrations of 17 OH pro- There are many evidence showing the relation. on the presence of two of following Rotterdam Also. hours fasting during the follicular phase (3-5 days tant role in activation and maturation of oocyte in of spontaneous or progesterone-induced menstrual animals (5). 12 or more follicles measuring 2-9 mm in diameter sand affects 5-10% of women that is characterized in each ovary and/or ovarian volume more than 10 by hyperandrogenism and chronic anovulation. Furthermore. consecutively. Additionally. therefore. fasting glucose Iran. cm3. The main problems of PCOS patients who at- PCOS as a multi-dimensional syndrome influenc. genesis of PCOS. (n=39) and non-metabolic syndrome group (n=86). and waist circumference >88 cm. Infertility. we aimed to find a correla- tion between body mass index (BMI). dehydroepiandrosterone sulfate (DHEAS). dehydroepiandestronsulfate (DHEA- ship between serum level of 25. All participants were data have suggested that both calcium and vitamin living in Tehran. Vol 9. the strong used medications suspicious to affect carbohy- association between PCOS and insulin resistance drate metabolism or calcium/vitamin D concen- indicates that insulin directly influences ovarian trations during 6 months prior to the study.cholesterol (HDL-C). All screening programs or supplement therapy in samples were obtained during fall and winter sea- sons. or their partners type II diabetes. recent drug abuse were excluded. gesterone. who function (2). Tehran. All women criteria: systolic blood pressure >130 mmHg and in 16-44 age group (reproductive age) were re. hyperprolactinemia. and they had no history of D supplements may improve insulin sensitivity in calcium or vitamin D supplementation. abnormalities in calcium cycle). and androgen secretory sonable treatment. we used the homeostatic model assessment Int J Fertil Steril. irregular menses. Therefore. Women with con- lemma for gynecologists and endocrinologists to genital adrenal hyperplasia. it has some long term consequences productive age with regular cycles. and prolactin. triglyceride (TG). Also. roid stimulating hormone (TSH). diastolic blood pressure >85 mmHg. They came to such as hypertension coronary artery diseases and our clinic for annual check-up. clinical and/or biochemical signs of hyperandrogenism. we tried to investigate the cor. The levels of calcium. PCOS patients. reveal its basic phathophysiology and offer a rea. PCOS seems a real di. testos- relation between vitamin D levels and PCOS in terone. Also. tended our clinic were abnormal uterine bleeding es various systems. our population in order to make a decision about and C-reactive protein (CRP) were measured. The PCOS patients were divided into two sub- genism and metabolic syndrome with serum level groups as follows: metabolic syndrome group of 25(OH)D in PCOS patients. PCOS was diagnosed based >100 mg/dl. No 1. 125 patients with PCOS and 117 III) after observing three of the four following healthy individuals. PCOS women (4). meaning presence of as one of the most common endocrine disorder. during 2011-2012. HDL <50 mg/dl. insulin.hydroxyvitamin S).

Vol 9. sidered as statistically significant.41 25-OH vitamin D (nmol/ml) 8.08 and 82.55 ± 9.001 Testosterone (ng/ml) 0.59 ± 0.14-0.7 47.3-10. Relationship between variables were (≤100 mg/dl). IL. Table 1: Comparison of different biological and biochemical values between two main groups PCOS Non-PCOS P value Mean ± SD Mean ± SD Age (Y) 28.30 ± 1. total between groups.18 Insulin (µIU/ml) 16.0 μIU/ml).49 0.8-29.3 15.47 0. Apr-Jun 2015 3 .08 <0. Body mass index.34 ± 11.92 ± 6.73 111. High density lipoprotein. IDS. acne or alopecia and/or Results elevated androgen levels.66 ± 17.99 ± 9.8 µg/ml) concentrations were measured us.33 ± 16 90. Thyroid stimulating hormone and DHEAS.9 ng/ml and/or DHEAS level above patients and 117 healthy women. respectively.46 TSH (mIU/ml) 2. The approval was obtained from the Ethic Com- sulin resistance based on the following formula: mittee of Endocrinology and Metabolism Re- fasting plasma glucose (mmol/L)×fasting plasma search Institute. TSH (0. No 1. C-reactive protein.92 ± 4. Tehran University of Medical Sci- insulin (µU/L) divided by 22.02 BMI (kg/m ) 2 25. TG (≤150 mg/dl).87 0. To analyze differences (2.0-25. Iran).97 1. UK) with normal range of 75-100 nmol/ ml with 5. HDL (>40 mg/ evaluated using Pearson’s correlation coefficient. Fasting blood sugar.34 ± 0.43 9.2 16.97.41 0. CRP. USA). TSH.77 HDL-C (mg/dl) 48. Int J Fertil Steril.47 ± 0.01 FBS (mg/dl) 90.72 0.4 coefficient of variation (CV).80 1.41 ± 3.1-4 mIU/ml).29 ± 7. calcium (8. the means of various factors in two main groups.2 μg/ml). and an informed consent was obtained from all participants.61 TG (mg/dl) 119.71 24. tration was done using serum assay and at least 1 Also.12 ± 49. and DHEAS (up mally distributed samples and nonparametric Mann- to 5.88 CRP (mg/ml) 1. Hyperandrogenism was de. All dl). The mean age was 5. Whitney U-test was appliedfor abnormally distrib- ing ELISA (Monobind. Next 25(OH)D was measured using enzyme- linked immunosorbent assay (ELISA.8 µg/ml. Student’s t test was used for nor- testosterone (0.41 ± 66.19 0.76 0.163 DHEAS (μg/ml) 1. 25(OH)D Concentration in PCOS Women of insulin resistance (HOMA-IR) to evaluate in. Statistical analysis Boldon.88 0. The measurement of 25(OH)D concen. the mean weight in PCOS and healthy women cc of patient’s serum was stored in freezer (-40˚C) were 83.02 2. Iran.12 0. Dehydroepiandrosterone sulfate.82 Ca (mg/dl) 9.82 in normal subjects.9 ng/ml).82 ± 0.37 0.82 ± 7.55 ± 2. FBS. all data were collected from 125 PCOS level above 0. We used Kolmogorov-Smirnov test (K-S test) for thermore.50 ± 2.43 ± 0. meaning as testosterone Totally..69 0. Triglyceride. Fasting glucose uted samples.92 9.85 in PCOS group and 30. insulin (2. fined as the clinical presence of hirsutism (Ferri- man-Gallway score ≥8). Tehran.96 Prolactin (ng/ml) 15. HDL.5 mg/dl) and CRP (≤8 mg/ml) analyses were performed by SPSS version 16 (SPSS concentrations were determined using photometry Inc. TG. Table 1 shows for maximum 30 days.2 ± 8.82 ± 0.45 0.96 ± 10. 27.4 30.7 ± 9.35 0.05 was con- (Parsazmoon.77 ± 1. ence. USA).5.41 BMI. Chicago. Fur. prolactin evaluating data distribution. A value of p<0.24 ± 13.

3%) were normal.36 0. 4 cant differences.11 0.18 0.94 -0.69 -0.34 mg/ with insufficiency.17 0.63 0.92 0.02 0.50 -0. We stratified level of 25(OH)D as follows: Totally.09 0. HDL.52 -0. P.08 -0. No 1.5%) had insufficiency.31 BMI. R. 33 (26. Table 2 shows the relation- (3. P value.11 0. group. None of them implied statistical signifi- as in normal participants. Triglyceride.06 0. Int J Fertil Steril. Odd ratio.4%) normal.55 -0. The mean of calcium was 9.10 0.04 -0.06 0. DHEAS.03 0.10 -0.99 0.24 0. High density lipoprotein.01 0.51 -0.25 -0.14 HDL-C -0.4%) within sufficiency. 50-74.01 Insulin -0.9 women (4. Dehydroepiandrosterone sulfate. 7 (5. Thyroid stimulating hormone.19 TSH 0. Among PCOS patients. Fasting blood sugar.9%) with de.Moini et al. Pearson correlation coefficient and OR. TSH.49 0. Comparison be- ml as normal (6). ships between 25(OH)D and other parameters ficiency and 80 (68.14 0.23 TG -0. CRP.52 0.3%) normal.08 0.08 0.90 0. Apr-Jun 2015 4 . be. our tween two main groups showed no statistically findings shows that 3 (2.04 0.9%) had severe defi- lower than 25 nmol/ml as severe deficiency.06 0. 28 (23. where.6%) differences.6%) with severe deficiency.00 0.08 -0. ciency.05 0. whereas only nmol/ml as insufficiency.03 0.24 0. 5 (4.13 FBS -0.95 0.25 -0.22 0.07 Prolactin 0.06 0.17 -0. and above 75 nmol/ 8 women (3. 162 women (66. Table 2: The correlation of vitamin D and other biochemical levels between two main groups 25-hydroxyvitamin D PCOS group Non-PCOS group R P OR R P OR BMI -0.00 0.19 CRP -0. 61women (25%) had deficiency and 11 tween 25-49.66 -0. C-reactive protein.07 DHEAS 0.00 Ca -0. Body mass index. in PCOS and non-PCOS groups. FBS.43 mg/dl in normal and 82 (65.23 -0.16 0.4%) with severe deficiency.55 -0.05 0.00 0.06 -0.05 Testosterone -0. TG. Vol 9.56 0.4%) with deficiency dl in PCOS subjects and 9.9 nmol/ml as deficiency.10 0.10 0.

87.95 ng/ml for 25(OH)D level and difference between two sub-groups (pvitD=0. 59 out of values of non-hyperandrogenism sub-group. p=0. pCa=0. In control group.59. in control group. showing there were pCa=0.39 mg/dl in obese women with pre- two main groups in final analysis. there was a relationship between the mean of their calcium and 25(OH)D concen- metabolic syndrome and the level of 25(OH)D trations did not differ significantly with the related (pvitD=0.17). Apr-Jun 2015 5 . 39 patients (31. pCa=0. But in total popula- A total of 30 patients had hyperandrogenism and tion of our study. as an inflammatory factor. PCOS was not correlated with level is lower in obese women. The mean of 25(OH)D and calcium con.97.1).29 the age and BMI values were different between nmol/ml and 9. 125 PCOS patients (47. According to BMI.32 mg/dl.respectively. groups (pvitD=0. 39 women be- correlation with BMI (p=0.2%) were overweight. 24. pCa=0. Fig.34 nmol/ml nificantly higher in PCOS patients. pCa=0. We used logis. Int J Fertil Steril. senting no significant differences between these tic regression to control confounding factors and sub-groups(pvitD=0. the level of 25(OH)D is significantly lower in Fig.74). obese women (pvitD=0.1: Distribution of 25(OH)D level in women. the level of 25(OH)D showed no significant Furthermore. it was sig- mg/dl in normal weight women.47). and 27 women were C-reactive protein. 63 women were non-insulin resistant with bolic syndrome group.35).5) group and the mean of centrations were 28. the levels of no significant differences between these two sub- Ca and 25(OH)D showed no statistically differ. In total popu- lation.18.1. PCOS (HOMA-IR >2.2%) were lean.57 nmol/ml and 9. The mean of calcium and vitamin was measured and showed no correlation with D concentrations were 25. Also. and 15. 25(OH)D level (OR: 1.6%). and and 9.57 nmol/ml and 9. longed to metabolic syndrome group.15 nmol/ml and 9.35). No 1.33 25-hydroxyvitamin D levels. while86 women belonged to non-metabolic syndrome We had 62 patients with insulin resistance in group. the in this analysis. 9.27 mg/dl in their 25(OH)D and calcium concentrations were the metabolic syndrome group in comparison with 25.08 ng/ml and 9.38 mg/ml for calcium level. obese (21.22).65. 25(OH)D Concentration in PCOS Women We chose consecutive patients in our clinic. Be- 22. pCa=0. ence (pvitD=0. sides. Vol 9. however.01. in PCOS group.34 mg/dl in overweight women.37. 95% CI=0.39 mg/dl in the non-meta. indicating no significant the mean of 23.01. Although.52).

PCOS. there was a significant and winter-related reduced sunlight exposure have negative correlation between 25(OH)D levels and been reported as probable causes (16). although the HOMA-IR (as insulin correlation between 25(OH)D and insulin resist. But man bodies. and may have a beneficial effect on insulin action Whereas obesity and insulin resistance aggra- by stimulating the expression of insulin receptors vate hyperandrogenism (7). Also. level which is in agreement with mentioned mech- Animal researches have demonstrated the role anisms of 25(OH)D. Manco et study. may be due to the common nutritional sources. be due to high percentage of severe vitamin D fluenced other aspects of our study. In our study. they (5) and hypothesized that disturbances in calcium found a strong association between low serum homeostasis may mediate the pathogenesis of levels of vitamin D and the metabolic syndrome.9% in Austria (8). 14). may be due to the small sample size or high per- vitamin D has some effects on beta-cell function centage of deficiency in all groups. in total. Yildizhan et al. pregnancy. resistance) was higher in severe deficient group. reliable. (7). receptors. Although the PCOS group had lower lev. the difference was this result has not been reported in other articles not considerable.7% in PCOS comes. According to study of Wehr of calcium in oocyte activation and maturation et al. In severely obese patients. In overall. in this study. 25(OH)D did not differ significantly between two vere 25(OH)D deficiency in over than 70% of our sub-groups (obese and non-obese). It may population. Also. ated 120 PCOS patients. Vol 9. we saw a positive correlation between TG of 25(OH)D deficiency in both PCOS and normal and 25(OH)D levels in PCOS group (p=0. (8) which included 205 PCOS women. In a study by Hahn et al. (12) studied consecu. It groups. like 26. 25(OH)D is believed to have found lower levels of 25(OH)D in morbidly obese some roles in insulin release. 20). It associations are not fully understood (13. Therefore. It seems that this high prevalence in. Low-calcium. In our study. there are no signifi- (8). 2. ated 100 patients with PCOS and found no correla. high-phytate diets. However. but els of calcium and 25(OH)D. Middle East have implied high prevalence of vi- relation was found only in control group. expression of insulin women. patients in Germany (7). Apr-Jun 2015 6 . and suppression of cytokines that are 25(OH)D deficiency has diverse effects in hu. Possible be due to confounding effects of other factors such explanation for high proportion of vitamin D defi- as higher rate of insulin resistance and metabolic ciency is different level of sun exposure as a result syndrome in PCOS group.9% of tion between 25(OH)D level and PCOS. It may tamin D deficiency in this area (16-19). No 1.002). many studies have reported nega- In addition. the most prominent point in our Despite these facts. Another study in Iran also shows that 64. and needs more precise studies. there was a high incidence Also. (7) who evalu. this negative cor. our result imply a negative corre- in Caucasian infertile women (9). and 64. but they women in Tehran have mild to moderate 25(OH) suggested a negative correlation between BMI and D deficiency (11). Perhaps this result can be due to the fact the mechanisms mediating these finding remain that we didnot measure the sex hormone binding Int J Fertil Steril. BMI. they showed that cant differences in testosterone and DHEAS lev- 25(OH)D was associated with higher BMI values els between PCOS and non-PCOS women in our and body fat.Moini et al. Furthermore. 11. take. There is evidence that demonstrate a in this study. 27% Furthermore. the level of study was the high percentage of moderate to se. deficiency in our subjects that influenced our out- tion is lower in other studies. Although the mechanisms underlying these the difference was not statistically significant. Discussion unclear. ance. (11) evalu. (15) has illustrated that the fat mass is the best D and testosterone levels in our PCOS group is not predictor for serum level of 25(OH)D. several studies from the 25(OH)D levels.9% for lation between metabolic syndrome and 25(OH)D female population in Iran (10). tive correlation between 25(OH)D level and HO- tively 76 PCOS women and 30 healthy ones and MA-IR (8. Asheim et al. but there was no difference in calcium level. possible mediators for insulin resistance (21). This propor. of urban life style or different levels of calcium in- In another study from Hahn et al. the correlation between 25(OH) al.

may influence these results and a clinical trial with 11. 260(3): several malignant tumors (31). high prevalence of vitamin D deficiency 8-15. Pal L. Eur J Endocrinol. Shu J. 333(13): 853-861. whereas the final result implicates to not only an ies in Iran have reported 20-40% hyperandrogen. The vitamin D receptor gene variant and tion (e. J Exp Zool. Metrikat J. we should try to change Roesler S. Serum 25-hydroxyvitamin D concen- vitamin D supplement therapy can be the next step trations in obese and non-obese women with polycystic of our study. study had some limitations such as relatively small 8. Schmidt M. Ortlepp JR. 2009. in this study. von Kroff A. No 1. D. Apr-Jun 2015 7 . ate SR. Vitamin D deficiency. 280(4): 559- Int J Fertil Steril. Yavos JG. of vitamin D deficiency as a risk factor for multiple 5. characterized by a prothrombotic state. ed by increased plasminogen activator inhibitor- 1(PAI-1) activity and fibrinogen concentration. 2007. 10. J Clin Endocrinol Metab. 1(1): our study. et al. PCOS group showed Acknowledgements higher levels of CRP level and BMI that have been known as risk factors for cardiovascular disease This study was financially supported by Endo- (CVD). Nabipour I. In a diazoxide reduces serum testosterone levels in obese study by Li et al. N Engl J Med. 27).g. and cellular free Ca2+ is essential for spontaneous meiotic re- sumption by mouse oocytes. 20(6): 451-454. as reflect. Int J Osteoporosis Metab Disorders. Holick MF. Low serum 25-hydroxyvitamin D concen- people’s life style and to design practical plans for trations are associated with insulin resistance and obesity food fortification and screening programs. So. Although need to reevaluate the androgen level of our PCOS a direct association between PCOS and vitamin D patients in another study with different methods of was not found. Pieber TR. 7. Steingold KA. health care system and implies an emergent need 357(3): 266-281. 3. Some PCOS stud. Consequently. It seems that there is an emergent need for sup. Suppression of serum insulin by this elevation has been also reported (26. Albercht M. 1995. 2009. Kolusari A. Zeitlian G. 2008. Wehr E. DeFelici M. An increase of intra- sclerosis (28). N Engl J Med. higher level of CRP in sever vitamin D physical activity predicts fasting glucose levels in healthy young men. A. In other studies. to interfere. Yildizhan B. Nestler JE. Vol 9. Hoffmann R. Kopera sample size and no information available with re. type 1 diabetes (29). with low heart rate explain high fibrinogen lev. 161(4): 575-582. The authors reported no conflict of interest. Iran. Giuliani A. in our study. Adali E. et al. ship between vitamin D deficiency and PCOS. Schweighofer N. Plym- els in women with PCOS (25). Normative values of vi- tamin D among Iranian population: a population based ference in 25(OH)D level between two groups in study. association between vitamin D and metabolic syn- ism in native population with PCOS (22. Pilz S. (20). deficiency group). 92(3): 1053-1058. Our in women with polycystic ovary syndrome. Although we did not find any dif. 20). cantly higher in PCOS groups. Matt DW. Hahn S. Women with PCOS are ran University of Medical Sciences. 1989. 23) and drome. ovary syndrom. Keshtkar AA. Arch Gynecol Obstet. 2003. 1991. it may need another study after the measurement. 2008. Kosta K. they reported that 25(OH)D women with polycystic ovary syndrome. et al. ic of 25(OH)D deficiency is an alarm for public 6. Tan S. Franks S. Hanrath However. this pandem. Teh- stroke in this population. Hickmon C. Fertil Steril. et al. concentration was negatively correlated with CRP. Yavropoulou MP. Kurdoglu M. 2006. 401. 4. Barlascini CO. but also a real peril of pandemic of severe some other studies from Middle East have found vitamin D deficiency which is considered as real lower androgen levels than expected (24). Polycystic ovary syndrome. 68(6): 1027-1032. Vitamin D insufficien- cy in reproductive years may be contributory to ovulatory plement therapy and screening programs among infertility and PCOS. P. 2. Siracusa G. Anastasiou O. et al. our women in reproductive age-PCOS and -non. 25(OH)D Concentration in PCOS Women globulin (SHBG) and free androgen index (FAI) in Conclusion this study. Hossein-Nezhad PCOS groups. correction of vitamin D level. Guler Sahin H. Role of vitamin D treatment in glucose metabolism in polycystic There are increasing evidence indicating the role ovary syndrome. Dolci S. CVD (30). Some data revealed a significant corre- lation between levels of 25(OH)D with SHBG and The first aim of the study was to find a relation- FAI (7. Quadbeck B. Fertil Steril. Diabetic Medicine. 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