This ovarian ultrasound of a 30-year-old woman with PCOS shows characteristic multiple small 'cysts' in the ovarian cortex. PCOS is a relatively common condition, affecting up to 10% of women of reproductive age. It is the most common form of anovulatory infertility. Clinical features include menstrual disturbance secondary to this chronic anovulation or oligo-ovulation, and hirsutism or acne secondary to hyperandrogenaemia. Typically, as in this case, the patient presents with concerns about irregular menstrual periods and/or infertility, along with weight gain.

Diagnosis is based on the combination of ultrasound scanning of the ovaries using a vaginal probe and biochemical measurements¹. Elevated free testosterone activity defined by the free androgen index is considered the most sensitive biochemical marker. A raised luteinising hormone (LH) concentration is also a useful indicator, but is now less favoured as a diagnositic tool.²

The pathogenesis of PCOS remains uncertain, but the link between this condition and insulin resistance is currently viewed as central, with resultant emerging therapies including the use of insulin-sensitising agents such as metformin.²

With regard to infertility, the most common therapeutic agent given is clomiphene citrate, generally taken daily from days 3-7 of the menstrual cycle. Intrauterine insemination is also frequently advised due to the adverse impact of clomiphene on cervical mucous quality.³.

References
1.Symonds EM, Symonds IM. Essential Obstetrics and Gynaecology. Churchill Livingstone 1998, 3rd ed.
2. Hopkinson ZEC, Sattar N, Fleming R, et al. Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology BMJ 1998;317:329-332.
3. Bay Area Fertility & Gynecology Medical Group Polycystic Ovary Syndrome (PCOS) http://www.ccnet.com/bafertil/pcos.html