PCOS (Polycystic Ovary Syndrome)

Polycystic ovary syndrome (PCOS) affects women's ovaries and ovulation. Polycystic ovaries contain a large number of small harmless cysts. These cysts are sacs that contain immature eggs that are prevented from developing further. Without further development the egg will not mature and ovulation will not occur.
PCOS affects 18% of women of reproductive age (March et al., 2010). It has a broad range of clinical implications which vary due to age, genotype, ethnicity, lifestyle and bodyweight. PCOS is present in 28% of obese women and 5% of lean women.

    Effects include:
  1. Reproduction - Infertility (anovulation, irregular menstruation, amenorrhea) Obstetrical complications, Hyperandrogenism, Hirsutism (excessive hair growth), Acne
  2. Metabolism - Insulin resistance, Impaired glucose tolerance, Type 2 diabetes mellitus, High cholesterol levels Cardiovascular disease
  3. Psychological features - Anxiety, Depression, Eating disorders

It's thought PCOS may be so prevalent in society due to evolutionary advantages of the syndrome in ancient times, including smaller family sizes, reduced exposure to childbirth-related mortality, increased muscle mass and greater capacity to store energy.

What causes PCOS?

There isn't any one cause of PCOS. The hormonal imbalance created by a combination of increased androgens and/or insulin are the basis of PCOS and these can be caused by genetic and environmental factors.
Androgens are the masculinizing (male) hormones and insulin is a hormone which controls sugar levels in the blood. Increased levels of insulin can also lead to increased levels of testosterone (an androgen).
Hormonal disturbances combine with other factors, including obesity, ovarian dysfunction and hypothalamic pituitary abnormalities to contribute to the aetiology of PCOS. Hyperandrogenism (i.e. excessive amounts of androgen/masculinizing hormones) is detected in around 60→80% of PCOS cases. Insulin resistance is present in around 50→80% of women with PCOS.

How is PCOS diagnosed?

There has been debate on how to diagnose PCOS because it's clinical symptoms vary so much between patients. However in 2003, fertility experts from ESHRE/ASRM, met in Rotterdam, and decided on the following 'Rotterdam' criteria.

    PCOS is present if any 2 of the following 3 criteria are present:
  1. Polycystic ovaries (determined by ultrasound)
  2. Irregular ovulation (oligoovulation / anovulation)
  3. Excess androgen activity (hyperandrogenism)

The Sims IVF PCOS blood test includes testing: Insulin, Testosterone, SHBG, FSH, E2, LH, P4. These hormones and their ratios, in addition to an ultrasound scan, enables the clinician to diagnose PCOS.

How is PCOS treated?

  • Weight loss is an important first step for overweight PCOS women. Reducing weight by 5→10% can have significant clinical benefits. Reducing calorie intake by 500-1000 kcal/day can lead to weight loss of 7→10% over a 6-12 month period, greatly improving PCOS symptoms.
  • Exercise involving 30 minutes physical activity each day has also been show to improve clinical outcomes in PCOS, more so than dietary changes alone.
  • Clinicians might recommend the OCP (Oral Contraceptive Pill) to manage hyperandrogenism.
  • Insulin sensitisers such as Metformin can also reduce insulin resistance in PCOS.
  • Laparoscopic ovarian drilling is procedure used when medications are ineffective. This involves damaging ovarian tissue responsible for excess androgen production, using either heat or laser. Approximately half of patients get pregnant in the year following ovarian drilling.

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