1.What is polycystic ovary syndrome?
Polycystic ovary syndrome is a common disease state causing infertility in women of reproductive age, characterized by high androgens and long-term anovulation. Patients with polycystic ovary syndrome show varying degrees of menstrual disorders (including scanty menstruation, amenorrhea, low volume, dysfunctional uterine bleeding, etc.) and infertility, hirsutism, acne and obesity.
2.What is menstrual scarcity?
Patients with polycystic often present with scanty menstruation and amenorrhea. Sporadic menstruation refers to cycles greater than 35 days, with cycles ranging from 3 to 6 months or a year, which mostly indicates long-term ovarian anovulation, but occasional ovulation can occur in some patients.
3.What is frequent menstruation?
Frequent menstruation refers to abnormal uterine bleeding with shortened menstrual cycle and prolonged menstrual period with dripping.
4.What is amenorrhea?
Amenorrhea includes primary amenorrhea and secondary amenorrhea. In polycystic patients, amenorrhea is secondary amenorrhea, which refers to the cessation of menstruation for 6 months, or the cessation of menstruation for more than 3 cycles according to their own menstrual cycle.
5. Can polycystic ovary syndrome be ruled out by regular menstruation?
No, it cannot be ruled out. Menstrual disorders are the most common clinical manifestation of polycystic patients, but a few polycystic patients show regular menstrual cycles, and ovulation monitoring by ultrasound indicates that there is no ovulation in the natural cycle, and these polycystic patients also need clinical ovulation treatment to help them get pregnant.
6.When is the right time for sex hormone test for polycystic patients?
Most polycystic patients do not have regular menstrual cycle and endocrine hormones do not change periodically, so they can have blood test directly without waiting for menstruation, or they can perform progesterone withdrawal to let menstruation come and then have test.
7.What is polycystic ovaries?
Patients with polycystic ovaries are often diagnosed with ‘polycystic ovarian changes’ by ultrasound, which is characterized by 12 or more follicles of 2-9 mm on one or both ovaries, with follicles arranged in a wheel-like pattern or scattered along the ovarian envelope in a “honeycomb” or “necklace” pattern. “The ovaries are often enlarged. Polycystic ovaries are a kind of ovarian morphology. Most of the patients with polycystic ovaries show polycystic ovaries on ultrasound, but some women with normal ovulation may also show them on ultrasound.
8. Is polycystic ovary syndrome because there are many small follicles on the ovaries during ultrasound?
No, it is not. Although the diagnostic criteria for polycystic ovary syndrome are still controversial, it is generally believed that the diagnosis of polycystic ovary syndrome can be made only when both of the following three manifestations are present (1) ultrasound examination suggesting ≥ 12 small follicles on bilateral ovaries respectively; (2) irregular menstruation, or long-term anovulation found by other methods; (3) higher than normal androgen levels in the body, or obvious manifestations of abnormally high androgens in the body, such as acanthosis nigricans, acne, and dense body hair, etc.
9. Are polycystic ovary syndrome and polycystic ovaries the same thing?
No, they are not. Polycystic ovary refers to an ultrasound examination that reveals ≥12 small follicles on bilateral or unilateral ovaries, which is a kind of imaging performance; polycystic ovary syndrome is a kind of endocrine disorder disease, in addition to the above-mentioned ultrasound performance, there are ovulation abnormalities, menstrual disorders, high androgen levels and or overweight, abnormal blood sugar metabolism, etc.
10.What degree can be called obese?
Obesity means that the body mass index (weight/height2) exceeds 25kg/m2, and more than 50% of polycystic patients show obesity, with fat distribution mainly in the abdomen and viscera. Obesity may be related to genetics, adrenal gland dysfunction, exercise and diet, which can affect fat metabolism and dyslipidemia.
11.I was diagnosed with polycystic ovary syndrome and my doctor suggested me to do more exercise, why is that?
Because about 50% or even more of patients with polycystic ovary syndrome have insulin resistance in their bodies, and doing more exercise can help improve the body’s sensitivity to insulin, which is an auxiliary method in the treatment of polycystic ovary syndrome.
12.What does insulin resistance mean?
Insulin resistance means that the main parts of insulin metabolism in the body (liver, fat cells, skeletal muscle) are insensitive to insulin, which leads to abnormal blood glucose metabolism.
13.Why do polycystic patients need to have glucose tolerance and insulin release test?
Nearly 30% of patients have impaired fasting glucose or impaired glucose tolerance: impaired fasting glucose refers to fasting glucose ≥6.1 mmol/l (110 mg/dl) to <7.0 mmol/l (126 mg/dl); impaired glucose tolerance (previously called hypoglycemia or hypoglycemia) refers to glucose ≥7.8 mmol/l (140 mg/dl) 2 hours after glucose load to < 11.1 mmol/l (200 mg/dl). Whether obese or not about 50 to 70 of polycystic patients commonly have insulin abnormalities, with fasting insulin levels <20 mU/L in normal and maximum serum insulin concentrations <150 mU/L in normal, beyond which the presence of insulin resistance is often indicated. Numerous studies have shown that insulin resistance is the central aspect of polycystic ovary syndrome.
14. I was diagnosed with polycystic ovary syndrome, why did my doctor recommend me to take medication for diabetes?
Because about 50-70% of patients with polycystic ovary syndrome have disorders of blood glucose metabolism insulin resistance in their bodies, and taking medication for diabetes is an adjunctive treatment for polycystic ovary syndrome.
15.What kind of polycystic patients need oral metformin treatment?
Polycystic patients with impaired fasting glucose or impaired glucose tolerance and insulin resistance as determined by glucose tolerance and insulin release test examination need oral insulin sensitizers mainly including metformin and thiazolidinediones, among which metformin is most commonly applied. Metformin inhibits hepatic glucose synthesis, increases insulin sensitivity of peripheral tissues and promotes glucose uptake and utilization. patients with PCOS treated with metformin showed effective improvement in hyperinsulinemia or insulin resistance and improved fertility. Metformin alone or in combination with clomiphene increased the ovulation rate to 90% in obese polycystic patients. Studies have shown that the application of metformin for PCOS is safe and effective.
16.Should patients with polycystic continue to take metformin after pregnancy?
The current recommendation is to stop taking metformin once pregnancy is established in patients with polycystic. Studies over the years have shown that metformin does not lead to an increased rate of congenital malformations in the fetus and can reduce the incidence of spontaneous abortion and preterm delivery in patients with polycystic disease. There is no evidence that taking metformin when ovulation is induced or in early pregnancy increases the risk of fetal malformations.
17.Do obese polycystic patients need to lose weight?
Obesity is a serious health hazard and can aggravate endocrine abnormalities in polycystic patients, leading to poor results of various ovulation-promoting treatments, low pregnancy rate and high miscarriage rate. Even if the pregnancy is successful, the risk of both mother and child increases during delivery. In addition to difficult delivery, vascular embolism such as embolic phlebitis is likely to occur in the pelvis and lower limbs. Therefore, polycystic patients with obesity should reduce their body weight, low-calorie diet and appropriate exercise as the key.
18.How should obese polycystic patients adjust their living habits?
It is very important to adjust the living habits of polycystic patients with obesity. Mainly include: long-term adherence to moderate physical exercise, such as brisk walking for 1 hour each time no less than 2 times a week, eating fewer meals (4-6 times/d to avoid high blood sugar and not cause hunger), reducing the intake of simple sugars and fats, such as fruits and vegetables and coarse grains (tomatoes, cucumbers, green leafy vegetables, etc.), and avoiding high-sugar and high-fat food. It can control weight and obtain a series of benefits, such as reducing the risk of cardiovascular disease, improving the sensitivity to insulin, restoring the menstrual cycle and even ovulation and conception.
19. Do polycystic patients with high androgens have masculine manifestations?
Polycystic patients with hyperandrogenism usually show elevated testosterone levels (T≥50ng/dl) or acne, hirsutism, rough skin, etc. Due to the high level of androgens, their facial, areola, lower abdomen and extremities hair growth is dense. After the excessive androgens in the body of polycystic patients are transformed into active dihydrotestosterone, the sebaceous glands of the skin are enhanced by the action of 5α reductase, so in addition to abundant body hair and sexual hair, acne and oily skin also appear at the same time. Occasionally, mild masculine symptoms, such as low voice and protruding laryngeal nodes, may occur in men with mild masculinity. However, if masculine symptoms are obvious, further tests are needed to rule out other diseases causing hyperandrogenism.
20.Is the hair on my arms and legs too thick because of high androgens in my body?
Generally speaking, the thick body hair on the small arms and legs is more related to genetics than to androgen levels.
21.What is the main point of the thick body hair caused by high androgen level?
The dense body hair caused by high androgen level mainly refers to the dense hair on the perineum, around the anus, on the midline of the abdomen, around the areola, and on the front and back of the body.
22.Why is it often recommended for polycystic patients to have nail function test?
Female endocrine includes hypothalamic-pituitary-ovarian axis, hypothalamic-pituitary-thyroid axis and so on. Among them, the common part of hypothalamus-pituitary gland secretes gonadotropin which acts on ovaries and thyroid hormone which acts on thyroid gland. Polycystic ovary syndrome is caused by the loss of the cyclic feedback mechanism of the hypothalamic-pituitary-ovarian axis, and some patients have abnormal thyroid function due to the dysfunction of the hypothalamic-pituitary-thyroid axis. Therefore, thyroid function test is necessary for polycystic patients, and if the test is abnormal, it needs to be treated at the same time.
23. Is polycystic ovary syndrome hereditary?
In recent years, there have been more studies on the etiology of PCOS, but the exact cause is still unclear. It may be related to genetic susceptibility, abnormal gonadal and gonadal hormone synthesis, metabolic disorders and other factors. Medical experts around the world, including China, are currently working on screening for susceptibility genes for polycystic ovary syndrome.
24. Why are polycystic patients infertile?
Infertility is one of the main symptoms of polycystic patients. Due to long-term anovulation, the level of androgens in the blood is elevated and LH concentration starts to rise in the early follicular stage. Even if pregnancy occurs, spontaneous abortion and gestational diabetes are likely to occur, leading to infertility. Reducing the level of ovarian androgens through medication or surgery can normalize the endocrine hormones and restore ovulatory menstruation, leading to pregnancy.
25.Why do most polycystic patients need oral contraceptive treatment?
Oral short-term contraceptive pills are combined estrogen and progestin cycle therapy, which can not only effectively inhibit the synthesis and secretion of pituitary LH and reduce the production of ovarian androgens, but also act directly on the endometrium to prevent excessive endometrial hyperplasia and regulate the menstrual cycle. In addition, the estrogen component of short-term contraceptives (ethinyl estradiol) can promote the production of sex hormone binding proteins in the liver and reduce circulating levels of free androgens. Generally 3 consecutive cycles of application can result in significant improvement of endocrine disorders in polycystic patients. The course of treatment is usually 3-6 months and can be repeatedly applied.
26.Why do polycystic patients need pretreatment before ovulation treatment?
Due to the abnormal endocrine hormone status in polycystic patients, direct ovulation promotion is likely to lead to high adverse outcomes such as multiple follicle development, ovarian hyperstimulation syndrome and increased incidence of multiple pregnancies, while some patients have non-response to ovulation-promoting drugs or prolonged follicular phase and early luteinization. Therefore, a course of treatment for 3-6 months is generally needed before ovulation treatment to lower LH levels, reduce body weight, improve insulin resistance, and reduce or directly counteract the effects of hyperandrogenism in PCOS patients, so that the sinus follicles are in a good environment of low androgen and low insulin from the beginning of development, which makes the subsequent development of gonadotropin application more normal and lays the foundation for the next ovulation treatment and improves ovarian treatment and facilitate better ovulation promotion outcome.
27.What are the commonly used ovulatory drugs for polycystic patients?
Commonly used ovulatory drugs for PCOS patients include clomiphene, letrozole and gonadotropins. Among them, clomiphene (CC) is the first-line ovulatory drug, which is usually taken orally from the 5th day of menstrual cycle, and the minimum dose is 50 mg/d for five days, and the maximum dose can be increased to 200 mg/d for no more than 6 cycles. Of course clomiphene also suffers from the following problems: CC resistance, 20-30% of PCOS patients are insensitive to CC: relatively low pregnancy rate (40-50%) and high rate of early abortion after pregnancy. Some patients do not respond to CC or have follicular development but still cannot get pregnant, and ovulation promotion with gonadotropins can be used.
28.Why is ovarian hyperstimulation likely to occur in polycystic patients with ovulation promotion therapy?
Patients with polycystic disease are characterized by multiple sinus follicles developing in the ovary due to endocrine abnormalities, but no dominant follicles are produced, so there is no ovulation leading to infertility.
29.When should polycystic patients undergo hysterosalpingography?
If a polycystic patient has not conceived after 3-6 cycles of effective ovulation treatment, or has a history of tuberculosis, pelvic inflammatory disease, peritonitis, appendicitis and pelvic surgery, and has had a tubal lavage test indicating ‘poor tubal patency’, a hysterosalpingogram is recommended to clarify the tubal patency.
30.What should I do if I have abnormal bleeding during ovulation treatment in polycystic patients?
A small number of polycystic patients may have abnormal bleeding during ovulation treatment, which is usually caused by fluctuation of estrogen in the body, and can be treated with a small amount of estrogen supplementation such as Glivec. If the bleeding is not clear, the blood HCG and coagulation function should be checked as appropriate.
31.When should polycystic patients choose artificial insemination treatment?
If the hysterosalpingogram indicates that at least one of the fallopian tubes is patent and the patient has not conceived after 3-6 cycles of effective ovulation treatment, and if the male partner’s semen test indicates abnormalities and the gynecological examination shows cervical erosion, artificial insemination treatment can be recommended. IUI treatment can cross the cervical barrier and improve the outcome of clomiphene treatment.
32.Which kind of polycystic patients should choose IVF treatment?
IVF treatment is recommended for polycystic patients who have poor tubal patency as shown by hysterosalpingography, who have been diagnosed with ovulation disorder after multiple cycles of ovulation treatment, or when the male partner’s semen test indicates serious abnormalities.
33.Is surgery suitable for polycystic patients?
At present, surgery is not recommended for polycystic patients. Surgical treatment is another treatment option for patients with polycystic infertility. Surgical procedures include traditional bilateral ovarian wedge resection, laparoscopic bilateral ovarian windowing or perforation. However, because of its traumatic effect on ovarian tissues, prone to premature ovarian failure and possible complications of pelvic adhesions, surgical treatment of polycystic is generally not recommended unless individual patients are extremely severe.
34. Which patients with polycystic are suitable for minimally invasive surgery?
For individual patients with severe polycystic disease, minimally invasive surgery including ultrasound-guided small follicle aspiration and micro-laparoscopic ovarian perforation are now available, which can improve the endocrine status of polycystic patients, increase the success rate of assisted reproductive technology, reduce the cost of conventional IVF treatment, and reduce the occurrence of ovarian hyperstimulation.
35. Are all patients with polycystic ovaries suitable for in vitro culture of immature eggs?
The in vitro oocyte maturation technique is used to remove immature oocytes from the ovary to mature in vitro for use in assisted reproduction techniques, away from the local hyperandrogenic microenvironment of the ovary. It has fewer follow-up visits and shorter treatment cycles than conventional ovulation promotion, and greatly reduces the cost of drugs and the patient’s burden, avoiding the occurrence of adverse effects such as ovarian hyperstimulation. The current clinical pregnancy rate is about 30-35%. However, since the pregnancy rate is lower than that of conventional IVF, patients can make a well-informed choice by weighing the pros and cons.