12th April 2024

Background

Polycystic ovarian syndrome (PCOS) is the commonest cause of infertility in the UK and affects up to 15% of females. The three main components of this condition are hyperinsulinaemia, excess androgens and the presence of multiple follicles. The pathogenesis involves follicular cysts in the ovary arresting during development. This leads to reduced amounts of progesterone, which normally inhibits gonadotropin-releasing hormone (GnRH). In turn, there is an increased luteinising hormone (LH) relative to follicle-stimulating hormone (FSH). There is an increased amount of androgen production in the ovaries and the adrenal gland. Both LH and high insulin levels cause excess androgens to be released.