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Infertility in polycystic ovary syndrome
Polycystic ovary disease (PCOS) is a hormonal imbalance in women that is thought to be one of the leading causes of female infertility.〔Palacio JR et,''al.''The presence of antibodies to oxidative modified proteins in serum from polycystic ovary syndrome patients Clin Exp Immunol. 2006 May;144(2):217-22.PMID 16634794〕〔Azziz R. et.''al.''The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004 Jun;89(6):2745-9. PMID 15181052〕 Polycystic ovary syndrome causes more than 75% of cases of anovulatory infertility.
==Pathophysiology==
Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation is a common cause. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which, in turn, may be caused by abnormal interaction of insulin and luteinizing hormone (LH) on granulosa cells.〔
Endocrine disruption may also directly decrease fertility, such as changed levels of gonadotropin-releasing hormone,〔 gonadotropins (especially an increase in luteinizing hormone), hyperandrogenemia,〔 and hyperinsulinemia. Gonadotropins are released by gonadotroph cells in pituary gland, and these cells appear to harbor insulin receptors, which are affected by elevated insulin levels.〔 A reason that insulin sensitizers work in increasing fertility is that they lower total insulin levels in body as metabolic tissues regain sensitivity to the hormone. This reduces the overstimulation of gonadotroph cells in pituitary.〔
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