A group of oligomenorrhoeic women without obesity or hirsuties was investigated with high-resolution ultrasound, laparoscopy and biochemical parameters. In this series, polycystic ovaries (PCO), as defined by ultrasound and laparoscopy, are a common cause of oligomenorrhoea in women without the classic symptoms, and were strongly associated with an elevated free androgen index (FAI). Despite an elevated FAI, these women were not hirsute, It would seem reasonable to include a FAI in the investigation of the oligomenorrhoeic woman, along with the more 'standard' tests, such as thyroid function and a prolactin level.
Thirty-two ovulatory women had serial ultrasound measurements of uterine volume, endometrial thickness and leading follicular diameter compared with serum oestradiol, testosterone and sex-hormone binding globulin. Follicular diameter, endometrial thickness and uterine volume were significantly correlated with serum oestradiol. The day before ovulation was characterized by maximal values for oestradiol, testosterone, luteinizing hormone, endometrial thickness, uterine volume and leading follicular diameter. Leading follicular diameter and endometrial thickness in particular, appear to be useful parameters to indicate impending ovulation.
Summary. Laparoscopy was used to identify the polycystic ovary (PCO) in a group of subfertile women. A third were found to have PCO. These patients had higher levels of luteinizing hormone (LH), testosterone (T) and a higher free androgen index (FAI) than those with normal ovaries. Only 15% of patients with laparoscopic evidence of PCO were obese, hirsute and oligomenorrhoeic. Within the PCO group, hirsutism was strongly associated with obesity and a high FAI. A group of subfertile women with PCO and regular cycles was found who had no other identifiable cause for their infertility. These women had higher follicular phase concentrations of LH and higher FAI than ovulatory women with normal ovaries.
Ovulatory women with polycystic ovaries (PCO) were compared with ovulatory women with normal ovaries, using high-resolution ultrasound and biochemical parameters to compare precise points in the menstrual cycle taking the day of ovulation as day 0. The PCO group had higher median follicular phase LH (days 'menses', -5, -3), FSH (days -5, -3) testosterone (days -3, -2) and free androgen index (days -5, -3, -1) than the controls. Women with PCO had a longer follicular phase and larger follicles. These results suggest that abnormal secretion of LH and free testosterone may contribute to the subfertility of women with PCO, possibly by premature activation of the oocyte or by interfering with folliculogenesis.
Polycystic ovaries (PCO), identified by ultrasonography, may be present in as many as 23% of otherwise normal women not manifesting any of the clinical signs of obesity, hirsutism and oligomenorrhoea.' Furthermore, a third of women being investigated for infertility in a recent study were shown to have PCO by laparocopy.^ Thus this condition would appear to be far more common than hitherto suspected, and could account for a large proportion of infertility cases. The condition is usually associated with elevated concentrations of LH and androgens, including testosterone,' but some indices such as free androgen index may be influenced by factors such as age and obesity4 and LH concentrations are not always raised.The ovaries and the adrenal glands are the main sources of androgens in women. Increased stimulation of the ovaries by LH during the follicular phase could account for raised androgen concentrations, in which case precursor progestogens should also be increased. Late onset congenital adrenal hyperplasia due to mild (subclinical) 2 1 a-hydroxylase deficiency might also result in increased concentrations of progesterone and I7a-hydroxyprogesterone, some of which would be converted to androgens. Since low dose progestogen pills can be used t o reduce fertility in normal women, it is possible that raised endogenous progestogen concentrations in women with PCO during the follicular phase could contribute to their infertility.We have compared serum progesterone, 17a-hydroxyprogesterone and various androgen indices during the early part of the follicular phase in women with PCO and in women with normal ovaries, since during this part of the cycle the concentrations of these steroids are normally low. METHODSSeventeen young female medical students initially volunteered to take part in the study which had Medical Ethical Committee approval. All the women underwent abdominal ultrasonography, and were subsequently classified as negative (n = 10) or positive (n = 7) for the presence of polycystic ovaries using the criteria of Adams et u I .~ A blood sample was taken between days 1-5 of the cycle from each subject and the steroid concentrations subsequently determined using standard radioimmunoassay techniques.The hormones measured were progesterone, 1 7a-hydroxyprogesterone, androstenedione, dehydroepiandrosterone sulphate and testosterone. In addition, sex hormone binding globulin (SHBG) concentrations were determined, and the ratio of testosterone to SHBG expressed as a percentage to give a value for the free androgen index (FAI). All samples for progesterone and 17a-hydroxyprogesterone were measured in the same batch. The within-assay coefficient of variation for progesterone at 1.039nmol/L was 12% while that for 17a-hydroxyprogesterone at 1.003 nmol/L was 24%.One woman, classified as having normal ovaries was subsequently found to have concentrations of hormones all well above those measured for the rest of the group. She was diagnosed as a probable late onset congenital adrenal hyperplasia and was not included i...
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