In Vitro Modelling Of The Impact Of Polycystic Ovary Syndrome And The Metabolic Syndrome On Conception

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In Vitro Modelling Of The Impact Of Polycystic Ovary Syndrome And The Metabolic Syndrome On Conception

Polycystic ovary syndrome (PCOS) is a heterogeneous, multifactorial, complex genetic and endocrine disorder, characterized by menstrual disturbances, clinical and biochemical manifestations of hyperandrogenism (1) and polycystic ovaries. The detrimental and widespread effects of PCOS on the physiology and metabolism of the body have led to its recognition as a metabolic syndrome with detectable abnormalities, such as insulin resistance, hyperinsulinemia, obesity, dyslipidemia [decreased high-density lipoprotein (HDL) cholesterol and hypertriglyceridemia] and hypertension that culminate in serious long-term consequences, such as increased risk of development of type 2 diabetes mellitus (2), endometrial hyperplasia and coronary artery disease (3). PCOS affects 5-10% of women of reproductive age (4), menstrual disorders and biochemical and clinical hyperandrogenism being reported in 60.6% of PCOS women (5). Familial aggregation of this syndrome is well established and there are ethnic and racial variations in the prevalence of the syndrome and its symptoms (6).

Initially recognized as an endocrine disorder of premenopausal women (2), the definition of PCOS has now been expanded from a disorder that presents at menarche and ends at menopause to a disorder that may be present from birth to senescence (7).

The Rotterdam ESHRE/ASRM criteria for confirming the diagnosis of PCOS following certain exclusion criteria are presented in Table 1. However, though the ultrasound morphological characteristics, detailed in Table 1, may be a typical appearance of PCOS ovaries, this finding is not specific, since it may occur in >20% of healthy girls (4). The spectrum of clinical signs and symptoms differs widely among women with PCOS and can also vary over time within the same individual woman in the presence of particular precipitating factors, the most significant of which is an alteration in body weight (8). There is evidence that a history of weight gain frequently precedes the onset of clinical manifestations of PCOS and obese PCOS women have more severe hyperandrogenism and a significantly higher incidence of anovulatory cycles, oligomenorrhea and/or hirsutism compared to normal-weight women (9).

The impact of PCOS on growth is reflected by its widespread detrimental effects on the physiology and metabolism of the body and their resulting long-term consequences. Environmental influences play an important role in the multi-system dysfunctions, with obesity, abnormal gonadotropin dynamics, excessive androgen production and insulin resistance presenting as the key features of the disorder. Though the multi-system dysfunctions in PCOS are strongly interlinked by the pathogenesis of these individual disorders, they ...