Polycystic Ovarian Syndrome (PCOS)

A polycystic ovary is a condition in which the follicles never erupt from the ovaries.  This may be associated with a pathological condition known as polycystic ovarian syndrome (PCOS). This is a very common disorder and occurs in nearly 1 out of 5 women.

Under normal circumstances, follicles grow, mature, and rise to the surface of the ovary, where they burst and release an egg to the fallopian tube. Pituitary hormones control this process. The remnants of the follicle then start to produce progesterone, which supports the lining of the uterus (endometrium) in case a fertilized egg finds it’s way into the uterine cavity. An increase in progesterone production will signal to the pituitary gland to stop stimulating the ovary for the development of eggs.

In polycystic ovaries, the follicles rise to just under the outer lining of the ovary, and are formed over and over because the pituitary has not been signaled to stop.  The ovaries become filled with these tiny cysts and can become enlarged.

These polycystic-appearing ovaries may be diagnosed based on their enlarged size.  Ovaries may get twice the normal size with small cysts present around the boundary and outside wall of the ovary.  These can be found in women who feel completely normal and have no symptoms, and also in women symptoms and significant endocrine disorders. Having polycystic-appearing ovaries do not necessarily mean that you have PCOS. PCOS requires that other criteria are met and includes other symptoms besides the presence of ovarian cysts.

PCOS increases your risk for metabolic and cardiovascular disease linked to insulin resistance, and endometrial cancer related to the prolonged exposure to persistant levels of Estrogen without Progesterone.

Risks of PCOS include:

  • Increased glucose intolerance
  • Type 2 diabetes
  • Infertility; Polycystic ovarian syndrome is associated with anovulatory infertility
  • High blood pressure
  • An increased risk for endometrial cancer
  • Abnormal periods and vaginal bleeding
  • Increased risk of infertility
  • Pregnancy-related complications

Although ultrasound is used to view the ovary as a diagnostic step in diagnosing the condition of polycystic ovaries, additional tests are required to diagnose PCOS. Since this condition is so common, many patients who undergo tubal ligation reversal will be affected by PCOS. A thorough evaluation by your primary gynecologist should rule out PCOS before you consider tubal reversal. Tubal reversal will not affect your PCOS condition, but in order to have success after a tubal ligation reversal, your risk of infertility from PCOS must be minimized.

To evaluate the risk of infertility from other causes beyond tubal disease, gynecologists will consider many additional tests. Having your tubal reversal performed by a skilled tubal reversal surgeon significantly improves your chance of getting pregnant. With an ideal tubal ligation reversal, your chance of achieving a pregnancy will be mostly affected by these other factors such as PCOS. Several medicines may be used after tubal reversal to cause increased ovarian stimulation for better follicle production to treat the underlying infertility caused by PCOS.

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