PCOS and Infertility

What is Polycystic Ovarian Syndrome?
Polycystic Ovarian Syndrome (also known as Stein-Leventhal Syndrome, but most commonly referred to as simply PCOS) is a condition that affects up to 15% of the reproductive age women in today’s society. Originally this condition was considered to be an anatomical anomaly that prevented ovulation by way of a thickened coating about the ovaries. Today, it's known to be attributed to a hormonal imbalance. The woman with PCOS normally does not have a regular menstrual cycle, and she does not ovulate the way that someone with a “normal” reproductive system would. I place normal in quotation marks because for many women this does not represent normal, rather it represents an ideal.

Define a “Normal” Cycle
The normal cycle would involve ovulation, two weeks before the endometrial lining is shed (assuming that there is no successful pregnancy). Every woman has follicles in her uterus that contain eggs for the reproductive process. The pituitary gland orders follicle-stimulating hormone (FSH) to be delivered to the ovaries every month. Follicles in the ovaries grow in response to this signal, and by day five of the cycle the body has selected a dominant follicle from one of the ovaries. This follicle will produce estrogen, thickening the endometrium. Mid-cycle, the pituitary gland will order a release of luteinizing hormone (LH) to trigger the ovulation process.

The follicle will release the egg approximately 36 hours after receiving the signal, and the fallopian tube will catch the egg. If the egg is not caught by the fallopian tube, a pregnancy will not be possible. The egg is held inside of the fallopian tube, and if intercourse is had during ovulation period, the sperm will ideally travel from the vagina, through the cervix, and from the uterus through the fallopian tubes to meet the egg within. The fertilized egg will then travel for five more days through the fallopian tube. The egg will then be deposited in the uterus where it will attempt to attach to the endometrium, aided by the follicle, which began producing progesterone to change the properties of the endometrium, after the egg left the ovaries. Should the fertilized egg not become attached, the levels of both estrogen and progesterone will drop after two weeks, causing the endometrial lining to be shed. This is the menstrual flow, and it will usually last from anywhere between 3-5 days.

Who has PCOS?
A clinical diagnosis of PCOS normally requires two out of the three following criteria, as defined by the 2003 ESHRE/ASRM consensus conference

Male hormone presence, which would be determined by examination or blood testing

Abnormal menstrual cycles

Ovarian ultrasounds that display many small follicles (a PCOS appearance)

There are other signs that may appear in the patient that is effected PCOS, such as obesity, skin tags and acanthosis nigricans (dark, velvety patches that can be found on the inner thighs or neck). Often success can be found simply by working out an exercise routine and reduced carbohydrate diet with a doctor. This addresses both imbalanced blood glucose levels and obesity (which increases insulin resistance, and  encourages more weight gain).

Blood glucose levels are important, as PCOS is rooted in insulin resistance (which can also lead to diabetes). Insulin helps your body store the sugars that are in your bloodstream, but it also communicates with your pituitary gland and reproductive system about the release of certain hormones. These hormones are responsible for the regularity of your ovulation cycle. If your body does not produce insulin, you would need a routine of insulin therapy, in order to keep your blood sugar levels stable. This is known as type I diabetes. In type II diabetes, the body is not as sensitive to the effects of insulin itself, so the injections of insulin increase over time to help the body keep the blood sugar levels stable. Insulin dependent diabetes (type I diabetes) is more likely to occur in patients with impaired glucose metabolism, than the non-insulin-dependent variety (type II diabetes or adult-onset diabetes).      Page 1 2