Stein and Leventhal were the first to recognize an association between the presence of polycystic ovaries and signs of hirsutism, amenorrhea, oligomenorrhea and obesity. Subsequently, it was reported that after successful wedge resection of the ovaries in women diagnosed with Stein-Leventhal syndrome, menstrual cycles became regular and these patients were able to conceive.
Stein and Leventhal were the first to recognize an association between the presence of polycystic ovaries and signs of hirsutism, amenorrhea, oligomenorrhea and obesity. Subsequently, it was reported that after successful wedge resection of the ovaries in women diagnosed with Stein-Leventhal syndrome, menstrual cycles became regular and these patients were able to conceive. Consequently, it was thought that a primary ovarian defect was the main culprit, and the disorder came to be known as polycystic ovarian disease (PCOD). Further biochemical, clinical, and endocrinological studies have shown an array of underlying abnormalities, though it may occur in women without ovarian cysts. Since the era of Stein and Leventhal, many treatment protocols have been implemented for the treatment of PCOD. The aim of any treatment is to get a live birth of a singleton from a healthy mother. To achieve such result, treatment by Clomiphene Citrate, Gonadotropin and Gonadotropin analogs (GnRh-a) have been reviewed. Most of the work done are on the favor of Rec-FSH as a treatment without the addition of GnRh-a. It should be stressed on the importance of adding Metphormin for Hyperinsulinemic patients as it improves the treatment results as far as ovulation rate, pregnancy rate, abortion rate and ovarian hyperstimulation are concerned.
We should stress that that before addressing failure for any treatment protocol, the treatment cycle should be properly evaluated and monitored. For failed treatment with Gonadotropin, there is a question to be addressed, do we embark on ovarian drilling (the replacement of the obsolete wedge resection) or do we start In vitro fertilization?
In 1935 the pathology of polycystic ovarian disease (PCOD) was described by Stein and Leventhal. It is a clinical syndrome consisting of menstrual irregularities featuring amenorrhea, oligomenorrhea, infertility, masculine type hirsutism and obesity. Since that time many theories have been postulated for the pathology causing the disorder. In the meanwhile and because of the uncertainty of the underlying etiology, many treatment protocols, surgical and medical have been recommended to control that disorder.
The diagnosis of PCOD does not require the presence of polycystic ovaries. However, it is believed that 80-100% of women with PCOD have polycystic ovaries, which are defined as the presence of 8 or more small (2-8 mm) follicles in each ovary. Polycystic ovaries also can be present in other causes of androgen excess and in approximately 20% of normal women.
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Originally presented: Lotfi, G (2002): Polycystic ovary syndrome: Treatment protocol. Obstetrics and gynecology annual meeting, Suez Canal university, Ismaila. Egypt. April 25-26, 2002
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