The Polycystic Ovary Syndrome

About this book

Polycystic ovary syndrome (PCOS) is the single most common endocrinologic abnormality of women, affecting approximately 1 in 10-to 15 women of reproductive age. It is also the most frequent cause of oligo-ovulatory infertility. PCOS patients demonstrate androgenic symptoms including hirsutism, alopecia, and acne. Furthermore, patients with PCOS are at significant risk for developing diabetes, hypertension, dyslipidemia, and possibly cardiovascular disease. It is estimated that the healthcare cost exceeds four billion dollars annually in the United States alone, not even accounting for the significant negative effect this disorder has on quality of life.

Patients with PCOS are seen by a variety of specialists, depending on needs, including reproductive, medical, and pediatric endocrinologists; gynecologists; general internists; and dermatologists. This text reviews the latest concepts in the pathophysiology, diagnosis, and treatment of the this pervasive and significant disorder, a clear and focused manner.

In this concise volume, Dr. Azziz has integrated current clinical knowledge with principles of fundamental genetics and cell biology of polycystic ovary syndrome - a commonly encountered clinical entity.This book will assist clinicians treating this serious and often distressing disorder afflicting so many women in terms of quality of life,fertility and systemic wellbeing.The chapters also provide useful insights for researchers studying mechanisms for pathogenesis of the disorder,and those unraveling novel therapeutic approaches. Ultimately,women with this metabolic and reproductive disorder will benefit from the knowledge which this group of expert authors bring to publication in this text.

Shlomo Melmed, M.D.
Series Editor
Endocrine Updates

Written for:

Reproductive, adult medical, and pediatric endocrinologists, gynecologists, general internal medicine, general family practitioners, and dermatologists

Keywords:

• PCOS
• endocrinology
• epidemiology
• infertility

Table of contents

Chapter 1: Definition, Diagnosis, and Epidemiology of the Polycystic Ovary Syndrome - Ricardo Azziz (azzizr@cshs.org) 1
1. Defining PCOS: Basics 1
2. Specific Criteria for PCOS 2
3. Diagnosis of PCOS 6
4. Prevalence of PCOS 9
5. Conclusions 11

Chapter 2: Clinical Evaluation of PCOS - Richard S. Legro (RSL1@psu.edu) 17
1. Features of PCOS 17
2. Differential Diagnosis of PCOS 19
3. Evaluation for Insulin Resistance in PCOS 21
4. Summary 24

Chapter 3: Genetics of PCOS - Mark O. Goodarzi (Mark.Goodarzi@cshs.org) 29
1. The Inherited Basis of PCOS and Its Component Phenotypes 29
2. The Candidate Gene Approach as Applied to PCOS Genetics 30
3. Epigenetics: A New Avenue in PCOS Genetics 39
4. Conclusions 40

Chapter 4: Insulin Action in Polycystic Ovary Syndrome: In Vivo and In Vitro - Jean-Patrice Baillargeon (JP.Baillargeon@usherbrooke.ca) 43
1. Introduction 43
2. Insulin Action in PCOS 44
3. Androgenic Actions of Insulin in PCOS 46
4. Insulin Actions and Ovulatory Dysfunction in PCOS 54
5. Conclusions 59
6. Future Avenues of Investigation 61

Chapter 5: Ovarian Steroidogenic Abnormalities in PCOS - Jessica K. Wickenheisser and Jan M. McAllister
(jmcallister@psu.edu) 69
1. Ovarian Androgen and Estrogen Biosynthesis 70
2. Dysregulated Estrogen Biosynthesis in PCOS 72
3. Dysregulated Androgen Biosynthesis in PCOS 73
4. Increases in CYP17 and CYP11A1 Gene Transcription and mRNA Stability in PCOS 75
5. Insulin Sensitivity and the PCOS Ovary 77
6. Mitogen Activated Protein Kinase Signaling and Altered Steroid Biosynthesis in PCOS 77
7. Gene Expression Profiling and Candidate Gene Analysis in PCOS 78
8. Paracrine and Autocrine Regulators that May Impact Ovarian Steroid Abnormalities and Follicular Growth in the PCOS Ovary 80
9. Summary 82

Chapter 6: Role of Obesity and Adiposity in PCOS - Renato Pasquali, Laura Patton, Evanthia Diamanti-Kandarakis,
and Alessandra Gambineri (renato.pasquali@unibo.it) 85
1. Prevalence of Obesity in PCOS 86
2. Pattern and Implications of Body Fat Distribution in Women with PCOS 87
3. Pathophysiology of Obesity on the Hyperandrogenic, Ovulatory, and Metabolic Alterations of PCOS 88
4. Summary and Perspectives 96

Chapter 7: Strategies for Ovulation Induction in the Management of Anovulatory Polycystic Ovary Syndrome - Adam Balen (adam.balen@leedsth.nhs.uk) 99
1. PCOS and Anovulatory Infertility: The Basics 99
2. Lifestyle and Weight Loss in PCOS 101
3. CC Therapy 102
4. Aromatase Inhibitors 104
5. Gonadotropin Therapy 104
6. Surgical Ovulation Induction 105
7. The Role of Metformin and Other Insulin Sensitizers 107
8. IVF in Women with Polycystic Ovaries 110
9. IVM of Oocytes 112
10. Summary 112

Chapter 8: Long-Term Morbidity of PCOS - Ricardo Azziz (azzizr@cshs.org) 117
1. Introduction 117
2. Prevalence of Principal Morbidities Associated with PCOS 117
3. Estimating the Economic Burden of PCOS 124
4. Conclusions 124

Index 131