Keterangan
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, characterized by hormonal imbalances. PCOS can significantly impact fertility due to irregular menstrual cycles, anovulation, and follicular cysts on the ovaries. Insulin resistance and elevated levels of androgens, such as testosterone, are common features of PCOS that can further affect fertility. Women with PCOS may experience difficulties in conceiving naturally and may require assistance from fertility treatments. Ovulation induction medications, such as clomiphene citrate or letrozole, are often used to stimulate ovulation in women with PCOS.
In vitro fertilization (IVF) may be recommended for women with PCOS who do not respond to conventional fertility treatments. Lifestyle modifications, including weight loss and dietary changes, can improve fertility outcomes in women with PCOS, especially those who are overweight or obese. PCOS-related infertility can also be addressed through management of associated symptoms, such as acne, hirsutism, and irregular periods. Women with PCOS should work closely with healthcare providers specializing in reproductive endocrinology to optimize fertility and pregnancy outcomes.Despite challenges, many women with PCOS are able to achieve successful pregnancies with appropriate medical interventions and support.
Ringkasan
- Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women, characterized by oligo-anovulation, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries. Its prevalence ranges from 10-13% globally, but can be higher among South Asian populations due to ethnic predisposition. PCOS etiology is complex, involving genetic, exogenous, and prenatal factors, with no single gene confidently identified.
- PCOS pathophysiology involves a complex interplay of aberrant LH secretion, insulin resistance, and hyperandrogenism, forming a vicious cycle. Increased insulin resistance leads to hyperinsulinemia, inhibiting sex hormone-binding globulin (SHBG) production and increasing free androgen levels. Aberrant LH secretion inhibits follicular development, leading to anovulation and decreased progesterone secretion.
- Diagnosis requires two out of three Rotterdam criteria: oligo-anovulation, hyperandrogenism, and polycystic ovaries. Clinical features of hyperandrogenism include hirsutism, acne, and female-pattern balding. Polycystic ovary morphology is defined by having 20 or more follicles in at least one ovary, ovarian volume of 10 ml or more, or 10 or more follicles in cross-section.
- PCOS can lead to various complications including reproductive issues, cardio-metabolic problems like type 2 diabetes and hypertension, psychological issues like depression, and cosmetic concerns like hirsutism and acne. Pregnancy complications include increased risk of miscarriage, gestational diabetes, preterm labor, and cesarean section.
- Treatment focuses on lifestyle modification, including weight reduction through diet and exercise. First-line treatment involves letrozole, which has a higher pregnancy rate and fewer side effects compared to clomiphene citrate. Second-line therapies include parental gonadotropins and laparoscopic ovarian drilling, considered when first-line treatments fail.
- Laparoscopic ovarian drilling can be considered for patients resistant to first-line agents, secreting more LH, or unable to attend for close monitoring. IVF with elective single embryo transfer is used when other treatments fail, often with freeze-all strategies to prevent ovarian hyperstimulation syndrome (OHSS). Recent advancements include in vitro maturation (IVM) of oocytes, which retrieves oocytes from antral follicles without stimulation, minimizing OHSS risk.
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