OR WAIT null SECS
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.
Click here to find a doctor or for more symptoms and treatment options for endometriosis.
Originally presented: Lotfi, G (2002): Polycystic ovary syndrome: Treatment protocol. Obstetrics and gynecology annual meeting, Suez Canal university, Ismaila. Egypt. April 25-26, 2002
Adams J, Polson DW, Franks S: Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed) 1986 Aug 9; 293(6543): 355-9.
Conway GS, Agrawal R, Betteridge DJ: Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992 Aug; 37(2): 119-25.
Coulam CB, Annegers JF, Kranz JS: Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol 1983 Apr; 61(4): 403-7.
Cumming DC, Yang JC, Rebar RW: Treatment of hirsutism with spironolactone. JAMA 1982 Mar 5; 247(9): 1295-8.
Donesky BW, Adashi EY: Surgically induced ovulation in the polycystic ovary syndrome: wedge resection revisited in the age of laparoscopy. Fertil Steril 1995 Mar; 63(3): 439-63.
Ehrmann DA, Barnes RB, Rosenfield RL: Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999 Jan; 22(1): 141-6.
Johnson JE Jr, Cohen MR, Goldfarb AF et al, The efficacy of clomiphene citrare for induction of ovulation. A controlled study. Int J Fertil 1966. 11, 265-270
Kiddy DS, Hamilton-Fairley D, Bush A: Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992 Jan; 36(1): 105-11.
Lotfi,G: Polycystic ovary: Normal variation. Post Graduate Doctor. 1991. 16.
Nestler JE, Jakubowicz DJ, Evans WS: Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 1998 Jun 25; 338(26): 1876-80.
Polson DW, Adams J, Wadsworth J: Polycystic ovaries--a common finding in normal women. Lancet 1988 Apr 16; 1(8590): 870-2.
Rittmaster RS: Hirsutism. Lancet 1997 Jan 18; 349(9046): 191-5.
Stein I, Leventhal M.: Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935; 29: 181.
Stein IF: Duration of infertility following ovarian wedge resection. West J Surg 1964; 72: 237.
Stumvoll M, Nurjhan N, Perriello G: Metabolic effects of metformin in non-insulin-dependent diabetes mellitus. N Engl J Med 1995 Aug 31; 333(9): 550-4.
Velazquez EM, Mendoza S, Hamer T: Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994 May; 43(5): 647-54.
Zawadzki JK,, Dunaif A: Diagnostic criteria for polycystic ovary syndrome: Towards a rational approach. In Dunaif A, Givens JR, Haseltine FP, et al, ed. Current issues in Endocrinolgy and Metabolism. Oxford: Blackwell Scientific Publications; 1992: 377.