alexa Polycystic Ovary Syndrome (PCOS) | OMICS International
ISSN: 2375-4508
Journal of Fertilization: In Vitro - IVF-Worldwide, Reproductive Medicine, Genetics & Stem Cell Biology
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Polycystic Ovary Syndrome (PCOS)

Flavia Denaday1,2*
1Gynecologist, Reproductive Medicine Reproductive Medicine Clinic, Argentina
2Argentina Society of Reproductive Medicine, Argentina
*Corresponding Author : Dr. Flavia Denaday, M.D
Gynecologist particular/Gynecologist-Reproductive
Medicine Reproductive Medicine Clinic, Argentina
E-mail: [email protected]
Received October 15, 2012; Accepted November 22, 2012; Published November 24, 2012
Citation: Denaday F (2012) Polycystic Ovary Syndrome (PCOS). J Fert In Vitro 2:117. doi:10.4172/2165-7491.1000117
Copyright: © 2012 Denaday F. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The aim of this study is to describe the prevalence of emotional disorders in women with Polycystic Ovary Syndrome (PCOS) compared to women without PCOS as well as research on the infertility causes of the former ones to identify if their infertility is exacerbated by depression which could be the reason for delay in seeking medical consultation [1,2].
Polycystic Ovary Syndrome (PCOS) is the most common female endocrine disorder in women of reproductive age. Little is known about the etiology of this disorder. However, it can be described as a genetic disease and, moreover, it is considered that the post-natal and intrauterine environment and the plasticity during the age of puberty and through the whole life of the woman play an important etiologic role [3].
There is still little information about the etiology and pathogenesis of this enigmatic disease, so much so that it is still under investigation whether the PCOS is a disease or an adaptation. A disease is defined as a pathological condition of the body which shows a group of symptoms of its own and that establishes a separate condition as an abnormal entity which differs from the normal one or from the other pathological states of the body, whereas the adaptation is defined, as in biology, as the capacity of an organism to adapt to an environment’s change. Having these concepts in mind, we can analyze whether the PCOS is a disease, that is to say, a fixed group of genetic variants such as Small Nucleotide Polymorphism (SNP), mutations or regulatory region alterations with variable phenotypic penetrance, or a developmental disorder that would cause a response to a deleterious intrauterine environment, or a fixed change in a coding region of the genome [4].
Empirical studies and expert consensus related to the physiological and psychological medical aspects of the Polycystic Ovary Syndrome which were presented in this study were identified in articles through bibliographical research.
General Aspects
Infertile women with Polycystic Ovary Syndrome (PCOS) report oligomenorrea and anovulation.
Additionally, they tend to be insulin resistant, a characteristic which is more frequent in obese or overweight patients.
This syndrome was described in 1935 by Stein and Leventhal, who associated it with the classic symptoms of amenorrea, hirsutism and obesity in patients with enlarged polycystic ovaries [5,6].
It is interesting to underline that there are publications which state that the polycystic ovaries condition declared only by findings resulting from an ultrasound does not have a significant impact on fertility in asymptomatic women [7].
During the last few years, hyperinsulinism has been identified as a consequence of a peripheral insulin resistance [8].
Hyperinsulinemia can directly reduce Sex Hormone Binding Globulin (SHBG) levels which consequently contribute to the hyperandrogenism [9]. High levels of androgenic hormones interfere with the hypothalamus-hypophysis axis, leading to an increase in the Luteinizing Hormone (LH), with the subsequent anovulation and amenorrea and therefore causing infertility [10].
A beneficial effect has been demonstrated in these women in the use of metformin in ovarian steroidogenesis, especially in the effects of inhibition of the androgenoous productions [11,12].
Apart from the impact on the reproductive function, the importance of this Syndrome would be related to the long term risks of the symptoms mentioned above: chronic anovulation and extraovarian factors, such as high blood pressure, diabetes mellitus, coronary disease’s risks and dyslipidemia [13].
PCOS is a disease which has a high clinical heterogeneity. In fact, diagnostic criteria continue to be controversial and no consensus has been reached regarding the pathognomonic features of their characteristics.
Considering that Polycystic Ovary Syndrome (PCOS) is associated with several metabolic complications we were conscious of the fact that there was a higher rate of women with PCOS (14%) compared with the control group (1%) which, in previous tests, had showed anxiety symptoms.
Moreover, scientific publications have recently described a higher risk of depression in women with PCOS. There exists an evident and clear prevalence, in these women with PCOS, of mood and sleep disorders and consequently they live a less quality life [1,2,6].
On the cited references, there are published works that describe patient cases in which women with PCOS were evaluated with Primary Health Care Assistance through a questionnaire about Mental Disorders, thus analyzing Depression Beck Inventory. Conclusions showed that women with PCOS are at an increased risk of depressive disorders in comparison with the control group (21% versus 3%, odds ratio 5.11, 95% confidence interval).
The overall risk of depressive disorders in women with PCOS was 4.23 (95%) regardless of obesity and infertility. These patients may have suicidal attempts together with feeding disorders [1].
There are some published works which even relate changes in eating habits (bulimic type) to the polycystic ovarian morphology [14]. However, these findings cannot disentangle this complex relationship and the action mechanism in spite of the fact that they are empirically related to the insulin resistance showed in these patients [1].
There are extensive publications which describe the higher prevalence of factors which cause emotional disorders in patients with PCOS than in those which do not suffer from it. These disorders not only include depressive disorders but also anxiety and its correlation with hyperandrogenism, among other metabolic markers such as insulin resistance and their impact on infertility that are also present in these patients [1,15].
Other authors declare that infertile women with PCOS who have not sought medical advice are more likely to suffer from anxiety and depressive disorders, among other mental health problems, in comparison with infertile women who seek medical advice.
However, it is unlikely that women with depression attend a medical consultation to treat their infertility.
Anxiety and depression symptoms may be barriers which prevent them from seeking medical advice on their infertility [2].
To conclude this study, we, as physicians, should be aware of the importance of our role and expertise when treating women with PCOS, given the fact that they may have negative emotional impacts. We should do a follow up and evaluate them thoroughly and as a unique person; bearing in mind, at the same time, that the patient with PCOS that presents metabolic changes has a higher risk of suffering from infertility and that her altered emotions may be a cause for a delay in seeking medical advice, which will inevitably compromise her maternity even more.
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