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  • Polycystic Ovarian Syndrome Part 4
    An infertile couple may feel that they are losing control of their lives if they seek help and receive treatment and this may

    lead to feelings of anguish and helplessness. Ensuring that couples have accurate and relevant information to enable them to

    make informed and appropriate choices about their treatment will help alleviate these feelings.
  • Polycystic Ovarian Syndrome Part 2
    Blood samples from women with PCOS show that gonadotrophin secretion is disordered resulting in increased plasma LH relative

    to FSH levels. FSH peaks, which characterise ovulatory cycles, are absent and therefore pro-ovulatory follicular development

    ceases. Thus the granulosa cells do not acquire a fully activated aromatase system and remain unresponsive to LH. Because

    of this, healthy follicles in polycystic ovaries rarely develop beyond 5mm. Oestrogens are normally converted from androgens

    in the presence of aromatase which is decreased when high levels of: H exists. In women with PCOS therefore, oestrogen

    synthesis and production of oestradiol from granulosa cells is decreased and atresia of the follicle occurs. This atresia

    causes a build up of secondary interstitial tissue and ovarian stroma. This disorder of gonadotrophin secretion causes

    anovulation.
  • Polycystic Ovarian Syndrome Part 3
    A more aggressive regime to stimulate ovarian function is to administer exogenous human gonadotrophin combined with the use of human chorionic gonadotrophin (HCG) to induce ovulation. This therapy may be used in conjunction with intra-uterine insemination of with IVF treatment. Both forms of treatment will require ultra-sound monitoring in order to assess follicular growth as ovarian hyper stimulation, and thus multiple ovulation, can occur. Treatment protocols for IVF vary from unit to unit but generally a period of ‘down regulation’ using gonadotrophin releasing hormone (GnRH) agonists are administered to prevent any release of LH from the pituitary. Endogenous FSH production is largely prevented by down regulation, so exogenous FSH is given to stimulate follicular growth and HCG, a protein similar to LH, is given to induce ovulation. Luteal support is essential as GnRH agonist therapy interferes with LH production and the corpus luteum will not function effectively
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