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31 - Surgical Management of Polycystic Ovary Syndrome

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

By
Hakan Yarali ,
Gurkan Bozdag  and
Ibrahim Esinler
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

Polycystic ovarian syndrome (PCOS) is a common and illunderstood endocrine disorder with multisystem sequelae. Clinical presentation is variable. It is characterized clinically by oligoamenorrhoea, signs of androgen excess such as hirsutism, acne, alopecia, obesity, and infertility, biochemically by elevation of serum androgens, luteinizing hormone (LH), and LH/follicular-stimulating hormone (FSH) ratio and not infrequently by insulin resistance (1). Morphologically, the ovaries are enlarged and have thick shiny capsules with peripherally placed multiple intermediate sized (2–8 mm in diameter) follicles. However, not all patients with clinically or endocrinologically defined PCOS demonstrate polycystic ovaries, nor do all women with polycystic ovaries have PCOS. Among 257 “normal volunteers,” 23 percent were found to have polycystic ovaries, and of the patients with polycystic ovaries, only about 50 percent had PCOS (2). Alternatively, of those women with PCOS, approximately, 70 percent have polycystic ovaries on ultrasonographic examination (3).

The diagnostic criteria of PCOS have been recently revised after a joint meeting of the European Society for Human Reproduction (ESHRE) and American Society for Reproductive Medicine (ASRM) in Rotterdam in May 2003 (4). It was agreed that the diagnosis of PCOS required the presence of at least two of the following three criteria: 1) oligo- and/or anovulation, 2) hyperandrogenism (clinical and/or biochemical), and 3) ultrasonographic appearance of polycystic ovaries, after the exclusion of other etiological factors (4).

Keywords

clomiphene citrategonadotrophin treatmenthyperandrogenismlaparoscopic ovarian drillingpolycystic ovary syndromemetformin
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 294 - 301
Publisher: Cambridge University Press
Print publication year: 2008

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References

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