What is polycystic ovary syndrome?
Polycystic ovary syndrome is a syndrome of reproductive dysfunction and coexisting abnormal glucose metabolism, which is an endocrine disorder with hormonal disturbances. Infertility due to ovulatory dysfunction is the main clinical manifestation of polycystic ovary syndrome. Polycystic ovary syndrome is currently considered to be the result of excessive production of androgens by the ovaries, and the excess production of androgens is the result of the abnormal functioning of multiple endocrine systems in the body. Currently, out of 100 women, 6 to 10 have polycystic ovary syndrome (PCOS).
Most PCOS follicles cannot develop and mature, so they need stimulation to grow. Generally, starting ovulation induction immediately after stopping conventional hormone medications has excellent results. The first choice for ovulation induction is clomiphene. If high doses of clomiphene do not stimulate follicle growth, other medications like letrozole and gonadotropins can be considered. To date, no research has shown that commonly used ovulation induction medications cause fetal abnormalities, so relax and don’t worry too much.
Diagnostic criteria:
1. Infrequent ovulation or anovulation (menstrual or amenorrheic).
2. High hormone levels (clinical or biochemical manifestations).
Ultrasound findings show polycystic ovaries (PCO).
Typical symptoms include:
1. Obesity: Approximately half of the patients have this presentation, which is related to excess androgens, an increased ratio of unbound testosterone to androgens, and prolonged estrogen stimulation.
2. Menstrual irregularities: Menstrual irregularities, secondary amenorrhea, and anovulatory uterine bleeding occur after menarche.
3. Bilateral ovarian enlargement: Direct visualization of ovarian enlargement via laparoscopy; Confirmation of ovarian volume by direct visualization via laparoscopy or ultrasound imaging.
4. Hirsutism: Excessive body hair, male-pattern distribution of pubic hair, oily skin, acne, are due to androgen excess.
5. Infertility: Infertility after marriage is mainly due to menstrual irregularities and anovulation.
6 Pigmented skin lesions: Symmetrical gray-brown pigmentation appearing on the skin of the neck, back, armpits, under the breasts, and groin areas, with a velvety or patchy, excessive keratosis-like lesion.
Examination methods:
Physical examination: Measure blood pressure, determine BMI, waist circumference, hip circumference, check for hypertension and obesity to determine the type of obesity.
Pelvic examination and ultrasound: Assess ovarian morphology, capsule status, follicle development, and ovulation. Sometimes, pelvic examination may detect enlarged ovaries on one or both sides. Ultrasound findings may show enhanced capsule echoes, smooth contours, enhanced stromal echoes, 12 or more follicles with diameters of 2-9mm on one or both sides of the ovaries, and (or) ovarian volume above 10ml. The follicles are arranged around the edge of the ovary in a circular pattern, known as the “necklace sign.” Continuous monitoring does not show dominant follicle development and ovulation. Vaginal ultrasound is more accurate, and patients who have no history of sexual activity should undergo rectal ultrasound.
Endocrine testing:
1. Serum androgens: Testosterone levels usually do not exceed twice the upper limit of the normal range, with elevated androstenedione and normal or mildly elevated dehydroepiandrosterone sulfate.
2. Serum follicle-stimulating hormone and luteinizing hormone: Serum follicle-stimulating hormone is normal or low, luteinizing hormone is elevated, but there is no preovulatory peak of luteinizing hormone.
3. Serum estrogen: Elevated estradiol and mildly elevated estrone, stable at early follicular phase level.
4. Urinary 17-ketosteroids: Normal or mildly elevated; normal indicates ovarian source of androgens, elevated indicates adrenal hyperfunction.
5. Serum prolactin: Mildly elevated in 20% to 35% of patients.
6. Anti-Müllerian hormone: Often 2 to 4 times higher than in normal individuals.
