Polycystic Ovarian Syndrome (PCOS)

Classification in relation to fertility:

Complex endocrinologic disorder resulting in chronic anovulation

Also called

PCOS, PCO, Stein Leventhal syndrome, hyperandrogenic chronic anovulation

Female/Male:

Female only

Most Common Clinical symptoms:

  • obesity
  • amenorrhea
  • anovulation
  • hirsutism
  • enlarged ovaries
  • inadequately developing follicular cysts

Other symptoms

  • mild elevation of insulin and associated insulin resistance
  • abnormal uterine bleeding
  • dark discoloration of skin in folds or creases (HAIR-AN syndrome)
  • male-pattern hair loss
  • male fat storage patterns (more in the abdomen than in thigh & waist)
  • adult acne

How does PCOS make a woman infertile?

In many cases, hyperinsulinemia leads to overproduction by the ovaries of testosterone and adrenal overproduction of DHEAS and androstenedione, which in turn leads to abnormal production of LH & FSH. This results in ovarian underproduction of estrogen, abnormal production of progesterone, overproduction of testosterone, amenorrhea and infertility.

Suggested Diagnostic Evaluations

Labwork

  • LH:FSH ratio + equal or greater than 3:1 ratio = PCOS
  • free & total testosterone + elevations = PCOS
  • prolactin
  • TSH
  • DHEAS

Ultrasound

appearance of many small cysts on ovaries, commonly called "string of pearls"
Note: appearance of such cysts alone is not enough for definitive diagnosis.