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.