41 - Polycystic Ovary Syndrome and IVF

Summary

INTRODUCTION

Polycystic ovary syndrome (PCOS), characterized by ovulatory dysfunction and hyperandrogenism, is the most common cause of infertility in women. Although prevalence data are limited, PCOS is thought to be one of the most common endocrinopathies in women (1). The prevalence of PCOS in women of reproductive age is changed in between 4.7 and 6.8 percent (2–4).

The classic syndrome originally was described by Stein and Leventhal as the association of amenorrhea with polycystic ovaries and, variably, hirsutism and obesity (5). It is now recognized that PCOS represents a spectrum of disease characterized primarily by the following features: hyperandrogenism, menstrual irregularity, polycystic ovaries (PCO), and central adiposity.

Two diagnostic criteria have been developed to identify and diagnose all patients with PCOS (6). In 1990, the National Institutes of Health Conference on PCOS defined PCOS as chronic, unexplained hyperandrogenism and menstrual dysfunction. Hyperandrogenism could be defined by either clinical or biochemical findings. In 2003, the European Society of Human Reproduction and Embryology/American Society of Reproductive Medicine consensus workshop group added polycystic ovaries as an alternative finding (7). The Rotterdam criteria define PCOS when two of the three primary features are present: PCO, oligoanovulation, and/or clinical or biochemical signs of unexplained hyperandrogenism.

The woman with PCOS usually presents to the gynecologist with menstrual dysfunction and complaints secondary to hyperandrogenism or unsuccessful reproduction. The reproductive problems relate both to subfertility, secondary to anovulation, and to early pregnancy loss.