Polycystic ovary syndrome

Polycystic ovary syndrome is the most common endocrine pathology in women of reproductive age, affecting 6-10% of the female population. In fact, it is considered to be the most common cause of anovulatory problems in women with infertility.

It is a very heterogeneous picture, with very variable clinical manifestations in those affected. In 2003, a group of experts met in Rotterdam to establish the necessary criteria for the diagnosis of the disease, known as the Rotterdam criteria. According to this consensus, diagnosis of the disease requires the presence of two of the following three clinical signs:

oligoovulation/anovulation

hyperandrogenism

ultrasound image of polycystic ovary

(The Rotterdam ESHRE/ASRM‐sponsored PCOS consensus workshop group, 2004)

However, the disease is also associated with metabolic problems that may include obesity, insulin resistance, hyperinsulinemia, and type 2 diabetes mellitus.

PCOS has also been associated with cardiovascular and neurological problems, anxiety, depression, and even breast and endometrial cancer.

To this day, the aetiology of the disease is still unknown, but genetic and environmental factors seem to influence its development. Based on different studies of family aggregation, it has been argued that the disease presents a genetic susceptibility, with an autosomal dominant inheritance pattern. It is likely that the genetic background of this disease is very complex, with multiple genes involved in the origin of polycystic ovary syndrome.

Many patients with infertility present PCOS, although not all people with PCOS have sterility issues, which is due to several concomitant factors involved in this syndrome. What is evident is that when a patient with PCOS presents sterility, certain characteristics may be associated that are not always present in other patients with sterility.In women with PCOS, what does not hinder ovulation is the reversal of the balance between the FSH and LH hormones, which regulate the menstrual cycle.

The increase of FSH favours follicular growth and the peak elevation of LH causes the expulsion of the egg. In women with PCOS, difficulties are encountered in the growth and maturation of the eggs, which can often prevent them from being released. Because of this, when ovulation is induced pharmacologically, to correct this problem, there is a greater propensity towards ovarian hyperstimulation syndrome and sometimes poorer oocyte quality, a higher rate of miscarriage (possibly because of obesity, when there is hyperinsulinemia due to insulin resistance, and / or greater number of embryos with alterations in the number of chromosomes) although this association is not fully demonstrated.

Therefore, IVF/ICSI is usually recommended as the best technique, avoiding the use of hCG to trigger ovulation, performing a segmented cycle with deferred transfer and with very controlled ovarian stimulation through personalised protocols to minimise the risk of hyperstimulation.

Sometimes, when a large number of embryos is obtained, it is advisable to use an embryo selection technique (Time-Labs, PGT-A or non-invasive genetic study) that helps us to select embryos with real chances of pregnancy (since there is usually a higher percentage of non-viable embryos), avoiding the vitrification of non-viable embryos that will decrease the changes of pregnancy per attempt.

Treatment using artificial insemination does not usually offer good results in patients with PCOS and in many cases must be cancelled due to the risk of multiple ovulation.

YOU’RE TRYING FOR A BABY

YOU WANT TO HAVE A CHILD IN THE FUTURE

Testing

Assisted reproduction

Polycystic ovary syndrome

oligoovulation/anovulation

hyperandrogenism

ultrasound image of polycystic ovary

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941 275 062

We are here to support you.

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YOU’RE TRYING FOR A BABY

YOU WANT TO HAVE A CHILD IN THE FUTURE

Testing

Assisted reproduction

Polycystic ovary syndrome

oligoovulation/anovulation

hyperandrogenism

ultrasound image of polycystic ovary

¿Te acompañamos?

941 275 062

We are here to support you.

954 032 022

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