The pathogenesis of infertility and early pregnancy loss in polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) frequently present with reproductive dysfunction. Ovarian function might be disturbed, with resultant abnormal folliculogenesis and steroidogenesis and, although it is difficult to define the exact pathogenesis of anovulation, many possible mechanisms have...

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Published inBest practice & research. Clinical obstetrics & gynaecology Vol. 18; no. 5; pp. 755 - 771
Main Authors van der Spuy, Zephne M., Dyer, Silke J.
Format Journal Article
LanguageEnglish
Published Elsevier Ltd 01.10.2004
Subjects
anovulation
apoptosis
early pregnancy loss
hyperandrogenaemia
hyperinsulinaemia
luteinizing hormone
polycystic ovary syndrome
anovulation
hyperandrogenaemia
apoptosis
early pregnancy loss
hyperinsulinaemia
luteinizing hormone
polycystic ovary syndrome
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Summary:Women with polycystic ovary syndrome (PCOS) frequently present with reproductive dysfunction. Ovarian function might be disturbed, with resultant abnormal folliculogenesis and steroidogenesis and, although it is difficult to define the exact pathogenesis of anovulation, many possible mechanisms have been postulated. Folliculogenesis in anovulatory women with PCOS is characterized by failure of dominance and the ovary has multiple small follicles, which are arrested but capable of steroidogenesis. Abnormalities in gonadotrophin and insulin secretion and disordered paracrine function have been identified. Women with PCOS have an increased prevalence of miscarriage, both after spontaneous and induced ovulation. Hypersecretion of LH, hyperandrogenaemia and hyperinsulinaemia have all been investigated as possible causes of PCOS. It is likely that these factors are interlinked and together might result in disordered ovarian and endometrial function. Multiple other possible abnormalities have been postulated as contributory factors in the reproductive failure. These include decreased plasminogen activator inhibitor activity, endothelial dysfunction and obesity. Ideally, therapy should target the underlying disorders but at present data are inadequate and further investigations are essential before therapeutic recommendations are truly based on an understanding of the pathophysiology.
ISSN:1521-6934
1532-1932
DOI:10.1016/j.bpobgyn.2004.06.001