Polycystic Ovary Syndrome

The polycystic ovary syndrome (PCOS) is an important cause of both menstrual irregularity and androgen excess in women. When fully expressed (hirsutism, irregular menstrual cycles, obesity, and a classic ovarian morphology), PCOS can be readily diagnosed. However, there has been considerable controversy about specific diagnostic criteria when not all of these classic features are evident.

Diagnostic Criteria

  • Menstrual irregularity due to oligo- or anovulation
  • Evidence of hyperandrogenism, whether clinical (hirsutism, acne, or male pattern balding)or biochemical (high serum androgen concentrations)
  • Exclusion of other causes of hyperandrogenism and menstrual irregularity, such as congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia Polycystic ovary syndrome (PCOS) is characterized by menstrual irregularity and evidence of hyperandrogenism, whether clinical (hirsutism, acne, or male pattern balding) or biochemical (elevated serum androgen level).

The majority of women who have infertility associated with chronic anovulation in this disorder ovulate in response to clomiphene citrate . However, up to 30 percent remain anovulatory. Furthermore, of the roughly 70 percent who do ovulate in response to clomiphene citrate, only one-half will conceive . Although some women who are resistant to clomiphene alone are able to ovulate with metformin (alone or combined with clomiphene), there are still women who are unresponsive. In women resistant to clomiphene citrate, or metformin combined with clomiphene, the next step has been gonadotrophin therapy. While this treatment causes ovulation in most women, it has several potential problems:

  • It can be very difficult to titrate the dose of gonadotrophins to achieve monofollicular ovulation.
  • The high frequency of multifollicular ovulation results in multiple gestations in 30 percent or more of women.
  • The risk of ovarian hyperstimulation syndrome (OHSS) during gonadotrophin administration is substantial, necessitating careful monitoring during treatment.
  • The costs of therapy are high, especially considering that only one ovulatory event will occur with each course of treatment.
  • For those women who do become pregnant, the frequency of spontaneous abortion appears to be higher than when conception occurs after spontaneous ovulation .