OVERVIEW:

NORMAL OVULATION V/S POLYCYSTIC
OVULATION:

In every menstrual cycle, a mature follicle (a sac-like structure in which the egg rests) develops. The size of the mature follicle is 18 to 28 mm in diameter when it is ready to ovulate. Approximately 14 days after the ovulation phase of the menstrual cycle, the woman will anticipate getting a period if she is not pregnant.

Like normal ovaries, polycystic ovaries contain many antral follicles (future reserves of eggs). In PCOS, follicles cannot develop and mature, thus lacking ovulation.

In women who suffer from Polycystic ovarian syndrome (PCOS), their ovaries cannot ovulate regularly, so they do not have regular menstrual periods.    

  READ MORE: The Menopause Journey.

ETIOLOGICAL FACTORS ASSOCIATED WITH POLYCYSTIC OVARIAN SYNDROME (PCOS):

The exact cause of PCOS is still debatable. Most scientists think that it is a multifactorial phenomenon. Some main factors are discussed here:

GENETIC FACTOR:

Many researchers believe PCOS is associated with genetic factors. If a woman’s mother or sister suffers from PCO syndrome, there is a susceptibility for that woman to suffer from polycystic ovarian syndrome, too.

INSULIN RESISTANCE:

Insulin is an exocrine hormone that allows the body’s cells to use sugar as energy. Sometimes, the cells of the body become resistant to the action of glucose.
resulting in hyperglycemia (blood glucose levels become high). In these cases, more insulin will be released into the bloodstream to reach the blood glucose at optimum levels. A high level of insulin triggers
hypersecretion of Androgens (male hormone). It will cause disturbance in ovulation and its favoring hormone secretions.

HIGH LEVELS OF ANDROGENS:

Androgen is said to be a “Male hormone” because they are responsible for male characteristics like facial hairs, deep voice, male pattern baldness, etc. Androgens are also synthesized and released in the female body in minimal quantity. PCOS-associated women have higher levels of androgens than the normal ones. It will prevent egg release (ovulation) from the ovaries during each menstrual cycle. It also results in excessive hair growth on various body parts and acne on the face.

IMPAIRED OVARIAN FOLLICULAR DEVELOPMENT:

Polycystic ovarian syndrome (PCOS)  is also associated with impaired ovarian follicular development due to increased follicular development blocker paracrine factors such as anti-Mullerian hormone (AMH).

PATHOPHYSIOLOGY OF PCOS:

It is a group of symptoms with variable and diversified features. Therefore, it has different pathways that lead to its pathophysiology.

a) hormonal imbalances such as hyperandrogenism increased LH/ follicle-stimulating hormone (FSH)
ratio, increased estrogen levels, and decreased serum progesterone,

b) reproductive disorders such as non-ovulation and menstrual irregularities,

c) metabolic abnormalities such as impaired glucose tolerance and insulin resistance, obesity, cardiovascular disease, and type 2 diabetes, and

d) changes in serum lipid profile are factors for PCOS.

e)Hyperactivity of gonadotropin-releasing hormone (GnRH)  repetition and proportion, its impact on LH secretion is the most prominent feature of PCOS. Alignment in Gonadotropin Inhibitory Hormone (GnIH) is responsible for GnRH release disturbance.

f) Elevated serum androgen levels are features of PCOS. Hyperandrogenism disrupts the usual function of the ovary and irregulates the menstrual cycle. The hypothalamus-pituitary axis becomes dysregulated and causes hyperactivation of LH secretion, which affects the theca cells of the ovary and increases the androgen secretion.

g) Disturbed neural pathway of the Hypothalamus- Pituitary- ovary axis in the brain is associated with PCOS. The release of GnRH neuropeptide from the axon terminal of neurons into the median eminence and portal vein leads to the secretion of gonadotropins from the adenohypophysis gland, which in turn mediates ovarian
folliculogenesis and steroidogenesis. The maturation of follicles in the ovary stimulated by FSH binds with receptors of granulosa cells. The longer-term decline of FSH causes anovulation,, which inhibits follicular development. Later, these immature follicles will form cysts in the ovary.

e)Ovulation is the result of LH surge. The LH actions are carried out via binding to high-affinity LH receptor and luteinizing hormone/chorionic gonadotropin receptor (LHCGR), which also serves as the receptor of human chorionic gonadotropin (hCG). The unstable secretion of gonadotropins is the main attribute of PCOS.                                                                                                

WHAT ARE THE SIGNS AND SYMPTOMS OF PCOS?

• Amenorrhea (no periods) or Dysmenhoreea (irregular periods).
• Infertility.
• Weight gain (Obesity)
• Acne
• Depression and mood swings.
• Hirsutism (excessive hair on face, chin, and other body parts).
• Male pattern baldness (hair thinning or hair loss on the scalp)
• Hyperpigmentation.
• Relatively high blood glucose level.
• Skin tags.
• Pelvic pain. 

POLYCYSTIC OVARIAN SYNDROME AND FERTILITY CORRELATION:

Polycystic ovarian syndrome is a multifactorial disorder that adversely affects women’s fertility than healthy women. No doubt, women who suffer from PCOS take longer to fall pregnant than healthy women. Due to irregular menstrual cycles, PCOS-affected women do not ovulate monthly. Also, obesity is a factor that causes a decline in fertility and causes more struggle to get pregnant. Symptomatic medication and lifestyle modification will be helpful.

Women with PCOS are associated with obesity, insulin resistance, glucose metabolism impairment, and metabolic syndrome. These abnormalities influence oocyte development and endometrial competence, trophoblast invasion, placentation, and pregnancy outcome and act independently of PCOS in reducing
reproductive performance.

CONCLUSION:

In conclusion, dealing with Polycystic Ovarian Syndrome PCOS can be tough, especially when it comes to fertility. It’s like facing a challenge that affects your health and dreams of becoming a parent. But the good news is that awareness, early detection, and proper management can make a significant difference. Remember, you’re not alone in this journey. Seeking support, staying informed, and working closely with healthcare professionals can help navigate the path toward a hopeful and fulfilling future. So, while PCOS might present hurdles, it’s important to focus on the ways to overcome them and keep the dream of starting a family alive.