Polycystic ovary syndrome
Polycystic Ovary Syndrome (PCOS)
It is believed that the syndrome of polycystic ovaries
(polycystic ovary syndrome,
PCOS), now better known as polycystic ovarian disease (polycystic
ovary disease, PCOD), is the most common cause of ovarian
dysfunction in women of reproductive age. As such, it is clearly a major
cause of infertility and must be described in some detail.
PCOS is a condition in which the ovaries are enlarged, with a smooth
outer layer, but thicker than normal. Many small cysts cover this
surface, which are themselves harmless, but may cause amenorrhea,
resulting in infertility.
Clinical
The diagnostic criteria for PCOD is
confirmation of the existence of polycystic ovaries on ultrasound. This
may be accompanied by a broad spectrum of other signs and symptoms, the
main feature of hyper androgenism. On investigation, it appears that the
LH (luteinizing hormone,
Luteinizing hormone) levels usually rises above 10 IU / l and
testosterone levels may be elevated.
Signs and symptoms of PCOD:
- High levels of LH (LH
level> 10 IU / l).
- FSH levels low or normal
(if normal, are still probably below the threshold level required
for normal follicle development).
- Index LH / FSH elevated
(> 2:1 or 3:1).
- Androgen / testosterone
levels.
- Enlarged ovaries, multi
cysts.
- Multiple immature
follicles (usually 2 mm to 8 mm).
- 10 follicles / ovary.
- Irregular menses and
anovulation.
- Hirsutism and acne (due
to an excess of androgens).
- Obesity.
Although PCOD is associated with androgenic symptoms
such as hirsutism and obesity, these are not necessary for diagnosis.
Seborrhoea is also a common situation.
PCOD and fertility
In forms lighter of PCOD, the woman concerned
may not have menstrual abnormalities and may ovulate normally, but often
takes longer than normal to get pregnant and has a greater likelihood of
miscarriage.
In PCOS moderate. There is menstrual irregularity, such as
oligomenorrhea or secondary amenorrhea and failure of ovulation.
The most serious of PCOS is characterized by obesity, hirsutism,
amenorrhea and subsequent infertility.
Conduct towards
the PCOS
The conduct in this PCOD depends on whether the woman
wishes to become pregnant or not. Sometimes, the return of ovulatory
cycles is determined by simple measures such as weight loss.
In women who do not wish to become pregnant, treatment may be
symptomatic. A contraceptive pill for oral use can be given to restore
menstrual regularity and estrogens or anti-androgens such as cyproterone
acetate, can be used in those with hirsutism or acne.
In women who wish to become pregnant, treatment is usually initiated
with clomiphene citrate (see Treatment of female subjects) at doses of
50-110 mg / day for 5 days every month. This is effective in restoring
menstruation with ovulation in 70% of women and 30% will become pregnant
within three months of treatment. However, pregnancy rates are low and
there is a high incidence of abortion.
If conception has not occurred after an unsuccessful six months of
clomiphene, an attempt to gonadotropin therapy can be started, sometimes
in combination with a GnRH analogue in order to block LH secretion and
thus reduce the risk of abortion. This must be used with great caution
in patients with PCOD, since these patients are very susceptible to the
development of ovarian hyper stimulation syndrome, and also because the
same dose of gonadotropin can induce a very different answer in
different cycles.
In order to reduce this dose-response as much as possible, pure FSH
preparations are preferred for the impure extracts, such as hMG (see
Module 2). In order to restore a single ovulation without causing
ovarian hyper stimulation, it is important that the dose of gonadotropin
can be titrated as precisely as possible and therefore only preparations
of the highest purity should be used.
Last updated: 10/02/2012
