Polycystic ovary syndrome
The commonest cause of anovulatory infertility
Polycystic ovary syndrome is the most common endocrinopathy in females, affecting up to 10% of women of reproductive age.1
The syndrome is the most common cause of anovulatory infertility—that is, failure of the ovaries to release an egg during a menstrual cycle—and accounts for up to 80% of cases.2
The syndrome involves several pathological abnormalities, including abnormal ovarian morphology, excess ovarian androgen production, insulin resistance, and an excess of circulating luteinising hormone.
Excessive androgen production is central to the syndrome. Although the basic pathology occurs in the ovaries, the severity of symptoms is often determined by factors such as obesity, insulin resistance, and luteinising hormone concentration, of which the last two further exacerbate androgen production (box 1).1
Polycystic ovary syndrome has a varied presentation from mild hirsutism (excessive and increased hair growth), normal ovulation, and polycystic ovaries, to more severe manifestations including amenorrhoea, hirsutism, acne, subfertility, and obesity.2 Diagnosis is