A brief review relating it to INFERTILITY:

PCOS is a collection of signs and symptoms in a woman of reproductive age group. It is the most common hormonal disorder relating to INFERTILITY -a multifactorial disease where an excess of male sex hormones (androgens) are produced.

Incidence – 1 in every 5 women. Prevalent worldwide.

1. •Polycystic Ovaries
2. •Irregular Periods
3. •Obesity with Hirsutism, Acne and Alopecia
4. •Irregular Periods with Reduced Fertility.

1. •Menstrual history in detail is important. eg. A menstrual cycle of more than 45days interval or scanty flow is suggestive.
2. •USG Scan TVS
3. •Pelvic Laparoscopy
4. •Hormonal Tests.

1. •Free Testosterone
2. •17 ketosteroids
3. •Insulin ( to r/o Insulin Resistance )
4. •Estrogen, Progesterone LH, and FSH

High LH to FSH ratio and Low levels of Female Hormones suggest PCO.

Sonographic Criteria For diagnosing PCO ( by TVS)

1. •presence of 12 or more follicles in each ovary measuring 2 to 9 mm in diameter and/ or
2. •Increased Ovarian volume (>1 Oml )
3. •only one ovary fitting this description can define PCO
4. •Does not apply to women it's on OCPills.

1. •weight reduction
2. •Fertility drugs if desiring Pregnancy If not then she is put on OC Pills.
3. •Progesterone Treatment
4. •Metformin
5. •Ovulation Inducing drugs
   1. •Clomiphene Citrate is the drug of choice
      OR
   2. •Letrozole

Finally, the other Assisted Reproductive Techniques come in where IVF is the final option.

PCOS -Conclusion

After excluding other endocrinopathies eg. Virilizing tumors Hyperprolactinemia Cushings Syndrome & Nonclassical adrenal Hyperplasia, there has been established a direct link between Obesity and PCOD. Obesity influences the PCO phenotype by unmasking the symptoms of hyper - Androgenism in susceptible individuals. Hence the first step of treatment is a Lifestyle modification with a Low Carbohydrate Diet and Exercise.