Is the Polycystic Ovary a Cause of Infertility in the Ovulatory Woman?

Abstract

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.

The significance of a single serum LH measurement in women with cycle disturbances: discrepancies between immunoreactive and bioactive hormone estimates*

“…It has become 0 (18.3-38.5) 22.3 (19.0-32.8) 26.1 (18.148.7 6 (0.3-15'9) 4.9 (24-19.9) 10.4 (1.3-35.5) <0.001 /1) 2.8 (1.0-4.7) 6.9 (5'1-9.8) 23.8 (10'2-67.1 0.5 (0.2-2.3) 1.3 (0.3-3.1) 2.4 (0.9-25.9) < 0.001 0.8 (0.2-3.1) 1.3 (0'5-7.3 AD (nmol/l) 11.7 (6.1-20.1) 11.5 (7'3-19.6) 15.0 (2.6-37.0) 0.002 DHEAS (pmol/l) 6. 2 (1.2-14.3) 5.7 (2.1-15.6) 8.1 (0.3-15.8 evident, however, that a wide overlap with normal ovarian appearance exists (Pache et al, 1990(Pache et al, , 1992, and that a proportion of patients with polycystic ovaries may not suffer from the clinical syndrome PCOS (Conway et al, 1989;Eden et a!., 1989;Obhrai et al, 1990). Because of the controversy surrounding many features involved in PCOS diagnosis, for clinical practice elevated serum LH concentration is still considered an important diagnostic feature by many authors.…”

Polycystic ovary syndrome--from gynaecological curiosity to multisystem endocrinopathy

“…In a series of apparently normal, eumenorrhoeic women, Poison et al (1988) found that >90% of the group with PCO had a clinical or biochemical feature consistent with the ultrasound diagnosis. In similar groups of women, all ovulatory, those with PCO were more likely to be troubled by subfertility (Eden et al, 1989) and recurrent miscarriage (Sagle et al, 1988). In a very large series, Conway et al (1989) demonstrated overall, the typical endocrinological and classical clinical findings of PCOS in women in whom the diagnosis was made solely on the basis of the ultrasound findings.…”

Polycystic ovary syndrome

“…These patients have been characterised as having "mild PCOS" with only marginal increases in LH, some markers for cardiovascular disease and marginal elevations in insulin. [34][35][36][37] Long-term studies are required to determine the reproductive and metabolic consequences of this group. It should be noted that the task force did not exclude the possibility that a subset of women with PCOM and anovulation and no androgen excess may exist but decided to defer expanding the definition until long-term outcomes in this subgroup become available.…”