Polycystic Ovarian disease/syndrome(PCOD/PCO's)

{(functional ovarian hyperandrogenism, Stein-Leventhal syndrome (original name, not used in modern literature), ovarian hyperthecosis and sclerocystic ovary syndrome)}

The leading cause of female infertility (both primary and secondary) and still on rise.

What is it ?

In each menstrual cycle, Ovarian Cells(follicles )grow on the ovaries. Eggs develop within those follicles, one of which will reach maturity faster than the others and

be released into the fallopian tubes. This is "ovulation". The remaining follicles will degenerate(get destroyed/die)

In the case of polycystic ovaries, however, the ovaries are larger than normal, and there are a series of undeveloped ovarian cells(follicles)that appear as cyst(fluid filled cells) in  clumps, somewhat like a bunch of grapes. Polycystic ovaries are not especially troublesome and may not even affect your fertility.

Difference Between PCOD and PCO's:

A female may have PCOD but not PCO's and vice versa

PCOD: it is basically that your ovary is having multiple cyst while there is most probably no other symptom manifested(female has no menstrual problems , no weight gain and no increased hair growth but she has problem in fertility)

PCO'S: it is when female has symptoms while she  may or may not have multiple cyst in ovaries though its rare that ovaries are healthy looking and female has symptoms.

Symptoms:

Polycystic ovarian syndrome presents as following symptoms, consisting of some combination of the following symptoms that vary with each individual:

1)Multiple ovarian cysts

2)Irregular or absent menses

3)Infertility

4)Acne

5)Obesity or inability to lose weight

6)Excessive body or facial hair (hirsutism){male pattern hair growth—under chin and on chest and legs} …. While hair loss on head (alopecia) its due to increased male hormones

7)Insulin resistance and possibly diabetes

8)Thinning of scalp hair

9)Velvety, hyperpigmented skin folds  especially axilla (Under Arms)(acanthosis nigricans)

10)High blood pressure

11)Multiple hormone imbalances,

Incidence:

Mostly it is said 7-10% in females but that is totally an American women incidence . in UK it is 30%... but what is important for us is the Indo-pak area incidence and unfortunately very rarely our statistics are collected…. But a recent study has shown that indo pak area has an incidence of 60% in females of reproductive group(15yr-45yr) and its alarming!!

What causes PCOD/PCO's:

There have been so many theories and they keep on changing.initially stress was on that disturbance occur on hormonal release from brain(hypothalamic-pituitary –gonadal axis) and that effect ovaries….

Then came the theory about that overweight females have it as obesity causes hormonal disturbance and increased male type hormone is produced..while now it is seen that it's a viscous circle(close circle) that weight may cuse it or it may itself cause weight gain and then both of these complement each other

Then the root cause was considered as food adulteration(like boiler chicken with steroids in it) that food has steroids and when we take it hormonal imbalance occurs..

Then came that insulin resistance(insulin not able to function in body) is the cause that diabetes occur but it is now clear that PCO itself causes insulin resistence.

The new theory states its genetic…. {Well in my personal view when no cause is found clearly everything gets genetically transmitted}and state that a gene has been found …

What happens in PCO That May Cause Infertility

It has a great scientific detail but in short it is that there is hormonal imbalance going on that is superadded by weight gain leading to more hormonal imbalance and male type hormones increase and a female is supposed to have less male type hormones and female hormones balance themselves is disturbed this all is basically leading to not only decreased egg production but also thick capsule of the egg formed and sperm is inable to enter it and mix with it..

Diagnosis:

If as we follow UK criteria it just says a female with menstrual problems , features of male hormones increasing(increased hair ,deep voice etc) and infertility issues without anyother cause is diagnostic of PCO

Ultrasound: it has however quite a diagnostic value… done on 10^th day of cycle if ovary volume greater than 10ml and more than 8cells of ovary are large its considered PCOD..

Polycystic ovaries that are 2-5 times larger than healthy ovaries

Hormones: level of female hormones and male type are done same as for infertility testing , only additional insulin and blood glucose level are done if required.

Treatment:

Basically five things are treated:

1)obesity --- decrease weight first by food control and exercise and then if required medication is given

2) hormonal imbalance—birth control pills are given(COCPs)

3)contol of male type hormones—anti androgen drugs given(cypoterone acetate)

4) insulin resistance—anti diabetic one particular group is recommended(biguanide/metformin) it control sugar plus decreases weight

5) infertility itself—by inducing egg production(causing ovulation)clomid/clomiphene acetate.

6)surgery: a chunk/piece of ovary is removed via surgery (wedge shaped) and even mostly done by camera surgery(laproscopy)