Reproductive consequences of polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women in their reproductive years. It is frequently associated with reproductive dysfunction, including anovulatory infertility and early pregnancy loss. The underlying pathophysiology of PCOS is not fully understood, although there is considerable evidence to suggest that an excess of ovarian androgen production, either genetically determined or due to hyperinsulinaemia or hypersecretion of luteinising hormone (LH), remains central in the pathogenesis of PCOS. Chronic anovulation seems to be the result of abnormal folliculogenesis characterised by follicular arrest at the small antral phase with escape from atresia. Hypersecretion of LH, hyperandrogenaemia and/or hyperinsulinaemia has been postulated as the possible underlying mechanism of early pregnancy loss in women with PCOS. Anovulatory infertility in PCOS women can be treated with insulin-sensitising measures (such as weight reduction and metformin), clomifene citrate, laparoscopic ovarian diathermy (LOD) and ovarian stimulation with follicle-stimulating hormone. LOD and metformin may help to reduce the risk of miscarriage in women with PCOS, although the effectiveness of these measures remains to be established.