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Diagnosis: PCO Syndrome

A syndrome with a complex nature as the potential cause of the involuntary childlessness

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One evening, my friend Gudrun called, telling me that she had been diagnosed with PCO syndrome by her gynecologist. She asked me to exactly explain the disorder to her.

Gudrun is a healthy woman in her early 30s. She has taken the pill for several years for contraceptive purposes and to regulate her somewhat irregular menstrual cycle. Now that she has met Mr. Right and they wish to start a family, she has stopped taking the pill. But nothing happened so far – no menstrual bleeding and no pregnancy occurred.

At first, Gudrun took a wait-and-see attitude. After 4 months, she went to see her gynecologist and was diagnosed with PCOS (polycystic ovary syndrome). “But I have a healthy lifestyle with a balanced diet and sufficient exercise,” says Gudrun. She had used the Internet to learn more about possible causes. Now she was at a loss what to do. She needed a personal clarification and remembered that I work for a fertility center.

Definition of the PCO syndrome

The PCO syndrome can affect any type of woman: “slender and sporty” or “chubby and rather built for comfort”. In order to define this complex syndrome, the European Society of Human Reproduction and Endocrinology (ESHRE) and the American Society for Reproductive Medicine (ASRM) have laid down a series of criteria – the so-called “Rotterdam 2003 Criteria”:

  • Oligo- or amenorrhea (associated with infrequent or absent menstrual periods)
  • Typical structural changes in the ovary seen via ultrasound: many small follicular cysts with sizes below 10 mm can be seen via ultrasound; using modern ultrasound devices, sometimes more than 25 follicular cysts can be identified on each side; the ovaries are enlarged
  • Elevated serum levels of “male” hormones (women have them too!) or signs of hirsutism such as excessive hair growth (e.g. on the inside of the thigh or in a vertical line from the lower abdomen up to the navel), acne or hair loss

When two out of three criteria are met, the patient is likely to be diagnosed with PCO syndrome. In order to finally clarify the situation, we need blood tests to measure the levels of LH and FSH (hormones controlling the female cycle), serum anti-Mullerian hormone levels (AMH) as a hormonal marker of the ovarian follicle count and serum levels of estrogen and progesterone (hormones regulating the menstrual cycle).

Detailed review and evaluation of the diagnostic findings

We firmly believe in the prominent importance of a global assessment based on a summary of all the diagnostic results. Even “chubbier” dark-haired women of Mediterranean type do not necessarily have to be affected by PCOS. The presence of many follicles in the ovaries may also be associated with high fertility and good reproductive health. First, all other possible causes for the disturbances in the menstrual cycle or the androgen excess have to be ruled out.

If the diagnosis “PCOS” has been confirmed, it is important to provide the women affected with detailed and comprehensive information. Owing to menstrual disorders and hormonal imbalance, ovulation becomes rare and irregular. There are no fertile days if ovulation does not take place, and thus pregnancy cannot occur.

Apart from hormonal disorders, there may also be an impairment of the glucose metabolism – so-called insulin resistance – which may not only affect slightly overweight women. It may be advisable to visit your gynecologist or family doctor in order to get further clarification through blood testing and a glucose test. Because, if we learn at an early age that we have a predisposition to a specific disease, such as diabetes, we can make certain choices about our lifestyle in order to improve the situation by making changes to our diet.

Two out of three criteria laid down in the above mentioned “Rotterdam Criteria” applied to the case of Gudrun: absent ovulation (and absence of menstrual bleeding) and the typical ultrasound features of polycystic ovaries. The hormonal work-up, too, revealed changes in the serum levels of LH and FSH (hormones controlling the menstrual cycle) as well as significantly elevated AMH concentrations.

I said: “Don’t worry Gudrun. First of all, your boyfriend should see an urologist to have his sperm tested. The spermiogram (semen analysis) will help me decide how I can best help you”.

This topic may be addressed in one of my next Blog contributions.


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