Reproductive System Outcome Among Patients with Polycystic Ovarian Syndrome

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Key points

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    Polycystic ovarian syndrome (PCOS) is a heterogeneous disorder and the anovulatory phenotype, although the most common in patients who are referred to specialized clinics, may not be the most common in general population.

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    The association of a derangement of early follicle development and increased insulin level seems to be the main mechanism determining anovulation.

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    Because of the role of increased insulin levels in anovulation of women with PCOS, lifestyle represents the first step in any

Reproductive outcome in polycystic ovary syndrome: anovulatory and ovulatory patients

For many years it was believed that polycystic ovary syndrome (PCOS) is characterized by irregular menses and infertility. In the early 1990s the National Institutes of Health definition of PCOS included chronic anovulation as a cardinal symptom of the disorder.1 However, in the following years several studies indicated that many patients could present a very similar disorder but normal ovulatory cycles.2, 3, 4 Finally, Rotterdam and Androgen Excess definitions of the syndrome acknowledged that

Mechanisms of anovulation in polycystic ovary syndrome

Most available data suggest that anovulation in PCOS is not the consequence of increased androgen ovarian secretion. Although patients with the classic National Institutes of Health anovulatory phenotype tend to have higher androgen levels than patients with the hyperandrogenic ovulatory phenotype,21, 22 high androgen levels may be found in patients with no PCOS without determining anovulation.22, 23

It has been suggested that the arrest of antral follicle growth and anovulation are

Improvement of fertility during late reproductive age in polycystic ovary syndrome

For many years it was assumed that anovulatory patients with PCOS remain infertile for all their reproductive age. In fact, it was perceived that the disorder could worsen with age.

However, several studies have shown that many anovulatory patients with PCOS may become ovulatory in their later reproductive years.39, 40, 41, 42 In their initial study, evaluating 205 patients with PCOS, Elting and coworkers39 found a highly significant linear trend (P<.001) for a shorter menstrual cycle length

Menopausal age in women with polycystic ovary syndrome

Preliminary data seem to show that menopause may occur later in women with PCOS. Although no longitudinal studies until menopausal age exist, some cross-sectional data suggest that menopause may occur about 2 years later in women with PCOS.53 In addition, AMH values in women with PCOS tend to be higher in premenopausal age, probably because AMH is higher in these women and the decline to menopausal values takes more time.54 It suggests that the fertility potential may be more prolonged in women

A rationale approach to infertility treatment in polycystic ovary syndrome

Most women with PCOS, particularly those with a mild phenotype or only slightly increased AMH values, cannot wait for a future fertility but wish to have and should have children during their young adult age. Fertility treatment is needed and should be conducted in a way that is as rapid and effective as possible.

All reviews on therapy for infertility in PCOS suggest using diet and lifestyle measures as the first step of the treatment protocol.56, 57 In fact, several studies have shown that

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      Even during the premenopausal period, women with PCOS have an increased antral follicle count and a lower serum FSH level than do women without PCOS [10]. Furthermore, women with PCOS can achieve normal menstruation, reflecting appropriately balanced hormones, at late reproductive ages [11,12]. In the past, it was thought that patients with PCOS and women without ovulation abnormalities have similar rates of pregnancy and live birth per IVF cycle [13].

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    The author has nothing to disclose.

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