Polycystic ovary syndrome and infertility

Polycystic ovary syndrome (Polycystic Ovary Syndrome PCOS) in 1935 by Stein Leventhal and the first group of a syndrome. The diagnosis standards are : capsular thickening of bilateral ovarian and ovarian increased; No menstruation, infertility; Obesity and more hair. In recent years, with endocrine and ultrasound technology advances, the disease gradually deepening understanding, its clinical manifestations are clear ethnic differences. The abnormal increase of LH values and androgen levels, ultrasonic inspection of both sides of ovarian cystic changes over by the attention. But so far there is no unity of the disease in the diagnostic criteria. Japan's Institute of gynecology and obstetrics in 1993 based on the nation's 50 major hospitals, 424 patients in the survey results, Japan reported the disease incidence of clinical symptoms, endocrine test results, ovarian seen, and, accordingly proposed diagnostic criteria. ??Clinical symptoms -- Europe and the United States (white) and Japan (yellow) to the frequency of clinical symptoms of a significant difference (Table 15-1). Japanese 99% of PCOS patients infertile. With the high level of male hormones related to the symptoms were lower than Europe and the United States, Europe and the United States hairy only the l / 3, obesity Europe and the United States for the 1 / 2, masculine Europe and the United States were only 1 / 10. So they hair, obesity, masculine symptoms of yellow people diagnostic significance smaller. Europe and the United States and Japan PCOS symptoms of clinical symptoms compared symptoms Europe and the United States women's menstrual different Japanese women often 80% 92% 74% infertility over 99% 69% 23 MAO masculine% 21% 2% 41% fat 20% of cases 10 ??endocrine 79,424 -- an inspection. LH, FSH PCOS endocrine most typical inspection to see LH base value increased, FSH value remained at the normal level. Thus LH and FSH was significantly increased (usually> 2). LH right GnRH load test reaction hyperthyroidism, FSH is normal reaction. 2. PRL have observed that the clinical part of PCOS patients with PRL increased its proportion of the parties to report mixed Japan's national survey said PRL were increased to 9%. 3. Androstenedione the ovarian hormones from the adrenal cortex and half. From ovaries Androstenedione mainly in the theca cells, the Japanese extraordinarily high value of nearly 34.7%. 4. Ovarian testosterone secreted by the major. Androstenedione who converted about 60%, ovarian secretion directly accounted for about 20%. Japanese high-value rate of 49.5%. 5. Dehydroepiandrosterone Sulfate and dehydroepiandrosterone both are almost always secreted by the adrenal cortex. The Japanese abnormal increase of 14.2% to 22.6%. 6. Estrone PCOS patients with ovarian by excessive secretion of Androstenedione in the peripheral organizations be converted into estrone, it estrone and estradiol ratio is higher than normal. The ratio of two abnormal increases were as high as 87.4%. ??-- An ovarian seen. Ultrasound examinations showed ovarian were increased 46.5%, showing ovarian cystic changes were 82.9%. 2. Under open (laparoscopy or laparotomy) See ovarian swelling 71.9%, 77.1% hypertrophy albuginea. 3. See organizations within theca cell hypertrophy 60.4%, mesenchymal cell proliferation 51.2%, granulosa cell degeneration 34%. ??Diagnostic criteria -- at home and abroad there is no disease in this uniform diagnostic criteria. Japan maternity according to the National Institute of the investigation, the characteristics of the Japanese meet the diagnostic criteria : 1. Menstrual abnormalities (no menstruation, thin hair menstruation, springing anovulatory cycles). 2. Increased LH, FSH values normal, LH / FSH values have increased. 3. Ultrasonic see how ovarian cystic change. Not the standard clinical symptoms of masculine, which include obesity, because PCOS patients in the emergence of the lower rate. Also not included increased androgen, because increased androgen Japanese were far lower than Europe and the United States were high. ??Treatment -- whether patients can get married there fertility requirements and take appropriate treatment. 1. Fertility hope for active and ovulation. (1) CC therapy, cortisone (or dexamethasone) plus CC therapy, plus CC bromocriptine therapy. (2) HMG (FSH) - HCG therapy (see ovulation disorder and its treatment). (3) GnRHa - HMG (FSH - HCG) therapy (see ovulation treatment). (4) laparoscopic ovarian electrocautery or ultrasound-guided follicular puncture, received good treatment, Ovulation rate of 10% a 95% pregnancy rate of 10% to 90%. 2. Does not require fertile PCOS patients estrone (E1) higher levels of progesterone without ovulation lower level, a high-E1, Low P easily create long-term sustainability of endometrial and breast cancer, they need treatment, so as to make the cyclical withdrawal bleeding. (1) Medroxy Progesterone cyst or 10 mg / d for 7 to 10 days, once a month. (2) oral contraceptives, can inhibit the secretion of LH and reduce ovarian androgen production. (3) the treatment of hair, antisterone daily 100-200mg. Treatment of multi-drug hair at least half a year or more. Electrocautery with hair roots can attain good therapeutic effect