Certain reproductive problems are more common than others and PCOS is one of the most common fertility problems that we deal with in clinical practice. When lecturing the medical students and residents I spend a lot of time talking about PCOS because this is a problem that all Ob Gyn physicians should understand and manage. That being said, it sometimes seems to me that the patients understand a lot more about PCOS than their doctor.
Before I go any further let me set the record straight – polycystic ovaries are not like polycystic kidneys. In PCOS the cysts are just undeveloped follicles waiting for the signal to grow. The cysts in PCOS do not rupture leading to Emergency Room visits and they do not become cancerous.
So let’s start out with some basics about PCOS and then move to more specific questions. Of course, if you already have a copy of “100 Questions and Answers about Infertility” then turn to page 34 at the bottom and read along.
22. What is polycystic ovarian syndrome?
Polycystic ovarian syndrome (PCOS) is an exceedingly common reproductive disorder, affecting an estimated 10% to 15% of reproductive-age women. The diagnosis of PCOS is a clinical one. In 2003, the ESHRE/ASRM consensus conference redefined PCOS as the presence of at least two out of the three following clinical criteria:
Irregular menstrual cycles
Evidence of extra male hormones, as determined either by clinical examination or by blood tests
Ultrasound demonstrating ovaries with numerous small follicles (PCO-appearing ovaries)
Previously, only patients with irregular menstrual cycles were thought to have PCOS, so the expansion of this definition has led to some confusion among healthcare providers. Other features commonly associated with PCOS include obesity, insulin resistance, borderline diabetes, skin tags, and a velvety discoloration on the nape of the neck and inner thighs called acanthosis nigricans.