Where does PCOS come from?

Years ago the field of Gynecology was actually a subspecialty within Surgery and many surgeons were trained in Gynecology since it was not a separate medical specialty. My father was one such surgeon and he still loves to tell me how he was better at hysterectomies than any Gyn physician. Since I never do hysterectomies as a fertility physician, I never took this comment as an insult. In any case, one day we were discussing fertility problems and I mentioned PCOS. I was surprised to hear from my Dad that he was quite familiar with PCOS and had performed many ovarian wedge resections to treat PCOS. Although this approach has been more or less abandoned with better ovulation induction medications, it may still have a place in some patients.

So what is our current understanding of where PCOS comes from? Well read the following excerpt from "100 Questions and Answers About Infertility" and find out. And while you are at Barnes and Noble at Midnight tonight be sure to order a copy of this book while you wait for Harry Potter!


23. Where does PCOS come from?

The topic of PCOS can fill an entire book. In fact, several books have been devoted to this subject. Although this condition was originally described by Drs. Stein and Leventhal in 1935, our understanding of PCOS has advanced significantly in the last decade. Originally, PCOS was thought to be an anatomical problem in which a thickened coating around the ovary prevented ovulation. It is now agreed that PCOS represents a hormonal imbalance. At the heart of this disorder is insulin resistance.

Insulin is a hormone secreted by the pancreas that induces your body to store the sugar circulating in the bloodstream. Individuals who fail to produce insulin as a result of an autoimmune disorder require insulin therapy to maintain normal blood sugar levels. These patients are referred to as having insulin-dependent diabetes (also known as type 1 diabetes). The majority of patients with impaired glucose metabolism actually suffer from insulin resistance rather than insulin deficiency. That is, the cells of their bodies are not sensitive to the effects of insulin, so they require ever-increasing amounts of insulin to be released from the pancreas until appropriate blood levels of glucose are obtained. These patients are commonly referred to as having non-insulin-dependent diabetes (also known as type 2 diabetes or adult-onset diabetes). Despite the name of the disease, persons with type 2 diabetes may require insulin injections to maintain normal glucose levels depending on their degree of insulin resistance.

Insulin resistance is often a genetic disorder. This explains why adult-onset type 2 diabetes is so prevalent in certain families and in certain ethnic groups. In patients who are insulin resistant, the excessive levels of insulin affect not only their metabolism, but also their reproductive system.

Insulin directly affects the release of reproductive hormones from the pituitary gland and directly stimulates ovarian production of male hormones. Thus the presence of excess insulin results in a local environment that is not conducive to follicle growth. When multiple follicles fail to grow, they release excessive male hormones, resulting in the acne and abnormal hair growth commonly encountered in women with PCOS.

Obesity itself also increases insulin resistance, so patients can find themselves trapped in a vicious cycle of irregular cycles and worsening weight gain. Women who have always had regular periods during their entire life but suddenly gain significant weight can find themselves resembling patients with PCOS. In these cases weight loss by itself may restore normal cycles and improve fertility