The Smart Guide to Infertility by Robert Harrison

Author:Robert Harrison [Robert F Harrison]
Language: eng
Format: epub
ISBN: 9781781610114
Publisher: Hammersmith Books Limited
Published: 2012-01-15T00:00:00+00:00

Clinical suspicions

Fifty to sixty per cent of women with PCOs are overweight, although some 5% are lean. Periods are infrequent (‘oligomenorrhic’ – a cycle of three to six months in length) or amenorrhoic (no periods for over six months). Oligomenorrhoea occurs in 76% and many are hyperandrogenic-looking, with acne, hirsutism (excessive hairiness) or alopecia (loss of head hair).

Hormone, ultrasound and ovarian structural changes

In the basic hormone profile, the ratio of LH to FSH will more often than not be abnormal (more than 3:1 compared with the normal ratio of approximately 1:1). Levels of free testosterone (the male hormone) may be raised mildly but not always. Hyperinsulinism due to excessive insulin resistance may be detected (30-40%). On vaginal examination or at laparoscopy, the doctor may find the ovaries appear enlarged and hard. On ultrasound scan or seen directly at operation, the PCO ovary is typically enlarged (10 cm3) with a rosette of small follicles (12+ in number, like rosary beads, less than 10 mm in diameter) around the periphery. However, while this can be linked to PCOs and anovulation, such appearances may also be seen in up to 25% of normal women.

Ovarian biopsy (taking a tiny piece of the ovary for viewing under a microscope) shows a thickened ovarian capsule (skin). This was first described in the 1930s by Stein and Leventhal who gave the syndrome its alternative name, still sometimes used for severe cases.

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