patients with PCOS suffer from acne, obesity, type 2 diabetes mellitus and may
be infertile. A diagnosis of PCOS is made on clinical grounds and assisted by
ultrasonography. Plasma LH is often increased in these patients but may be
normal, whereas the concentration of testosterone is increased. Treatment of
severe PCOS may involve using the antiandrogen drug, cyproterone but this
leads to infertility. If fertility is required, then clomiphene, an antiestrogen
drug, may be used and can induce ovulation in 75% of cases.
Infertility
Infertility is defined as a failure to conceive despite regular unprotected sexual
intercourse for one year. Female infertility may be due to failure to ovulate,
obstruction of the Fallopian tubes or to diseases of the uterine lining. In
females, failures to ovulate due to hyperprolactinemia or to hypothalamic-
pituitary dysfunction are responsible for 20% of cases of infertility. Damage
to the Fallopian tubes may also be a cause of female infertility. Male infertility
is usually due to decreased numbers or motility of sperm (oligospermia)
or complete absence of sperm (azoospermia). Infertility due to endocrine
dysfunction occurs only rarely in males. The normal volume of ejaculate is
REPRODUCTIVE HORMONES
CZhhVg6]bZY!BVjgZZc9Vlhdc!8]g^hHb^i]:YLddY &.*
Clinical history and
examination
Normal menses OligomenorrheaAmenorrhea
Perform
pregnancy
test
Positive
Negative
Measure [FSH], [LH]
and [prolactin] in serum
No further
tests required
Normal
ovulation
<10 nmol dm-3
30 nmol dm-3
Not ovulating
High FSH
High LH
High LH
Low FSH
High
prolactin
Normal FSH
Normal LH
Normal prolactin
Ovarian
failure
Polycystic ovary
syndrome
Investigate for
hyperprolactinemia
Further investigations
required
Measure [progesterone]
in serum to confirm
ovulation
Figure 7.41 Overview of the investigation of amenorrhea.