Investigating the Roles of Follistatin and Sex Hormone- Binding Globulin in Polycystic Ovary Syndrome Pathogenesis: Implications for HOMA-IR and Hyperandrogenism

Ayat Salim Khaleel; Abeer Cheaid Yousif Al-Fatlawi; Wasan Ghazi Abood

doi:10.31557/APJCC.2026.11.4.501

Authors

Ayat Salim Khaleel College of Applied Medical Science, Department of Pathological Analysis, University of Karbala, Karbala, Iraq.
Abeer Cheaid Yousif Al-Fatlawi College of Applied Medical Science, Department of Pathological Analysis, University of Karbala, Karbala, Iraq.
Wasan Ghazi Abood College of Medicine, Department of Obstetrics and Gynecology, University of Kerbala, Karbala, Iraq.

DOI:

https://doi.org/10.31557/APJCC.2026.11.4.501

Keywords:

Polycystic ovarian syndrome, follistatin, sex hormone binding globulin, HOMA-IR.

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by an imbalance of reproductive hormones that leads to anovulation and irregular menstruation. We aimed to evaluate serum levels of SHBG, follistatin and HSP-70, alongside HOMA-IR and hyperandrogenism markers, in PCOS vs. controls.

Materials and Methods: Ninety women aged 15 to 45 years participated in this case-control study, with 45 diagnosed with polycystic ovary syndrome and 45 serving as controls. Blood samples were collected during the early follicular phase and analyzed using enzyme-linked immunosorbent assay (ELISA) to measure levels of SHBG, follistatin, HSP-70, anti-Müllerian hormone (AMH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), insulin, prolactin, and testosterone.

Results: Results showed that women with polycystic ovary syndrome had significantly higher levels of follistatin (5.37 ± 0.45 ng/ml), HSP-70 (16.49±2.79), AMH (2386.14 ± 530.09 pg/dL), LH (3.33 ± 0.75 ng/dL), testosterone (2.73 ± 0.51 ng/ml), prolactin (64.21 ± 11.66 ng/ml), and free androgen index (773.23 ± 152.41), fasting insulin (15.21 ± 5.41 μIU/ml), glycated hemoglobin (HbA1c) (6.01 ± 0.24%), and HOMA-IR (3.72 ± 1.44), with reduced SHBG (0.35 ± 0.03 ng/dL) and FSH (2.61 ± 0.61 ng/ml) (p≤0.01 for all).

Conclusion: These findings suggest that decreased SHBG and increased follistatin and HSP-70 contribute to the hormonal and metabolic disturbances observed in polycystic ovary syndrome. Therefore, SHBG, follistatin and HSP-70 serve as useful biomarkers for the early diagnosis and prognosis of this condition.