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{In no situation do we ever recommend that fertility diagnosis or treatment be undertaken without the oversight of a qualified medical practitioner. Please use the enclosed information as quick reference and for discussion aids with your practitioner.}

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.

Treatment:

Treat Hyperinsulinemia:
• Metformin
• Rosiglitazone
• Avandia
• Carbohydrate-controlled diet

Stimulate Ovulation:
• Clomiphene citrate
• injectable human menopausal gonadotropins (combination FSH/LH drugs)
  • Risk: Ovarian hyperstimulation
• laparoscopic ovarian drilling
• ovarian wedge resection
  • Risk: Fertility-hampering adhesion formation

Treat Hirsutism:
• Spironolactone
• Aldactone
• Vaniqa
• oral contraceptives

Treat Amenorrhea:
• Oral contraceptives
• Provera

Women with PCOS are at greater risk for:

• endometrial cancer
• breast cancer
• glucose intolerance
• cardiovascular disease

The following conditions can mimic PCOS clinically:

• eating disorders (anorexia or bulimia)
• disorders of enzyme function (congenital adrenal hyperplasia, etc)

Notes: PCOS is a collection of symptoms, not a single disease. It is best treated as such, with efforts being made to respond to the affected systems of the body, rather than just attending to the symptoms singularly.

As PCOS can be difficult to accurately diagnosis, it is recommended that women who think they may be affected seek the services of an endocrinologist or reproductive specialist.