Patients present with various symptoms, including the following:

*Menstrual disorders (80%)
*Oligomenorrhea (not frequent menses) (70%)
*Amenorrhea (absence of symptoms) (28%)
*Infertility (74%) - Accounts for 30% of overall infertility
*Recurrent pregnancy losses (common)
*Hirsutism (69%)
*Obesity (49%) although some are lean
*Acne
*Asymptomatic

PCOD & Infertility

Most women with PCOD have ovulatory dysfunction or absent ovulation. If the egg is not released from the ovary each month in a normal fashion, this can obviously lead to infertility. Anovulation may also manifest itself by infrequent or irregular menstrual cycles. In the absence of ovulation, the ovary does not make the hormone progesterone in the second half of the menstrual cycle, which sometimes account for the heavy irregular periods.

Another common feature to PCOD is clinical or laboratory hyperandrogenism. This means that women with PCOS have either increased circulating amounts or increased responsiveness to male hormones like testosterone, androstenedione or DHEAS, which is normally present but in very low levels. This may result in oily skin or acne and excess hair on the face, between the breasts, or on the lower abdomen. Increased androgen production within the ovary affects directly the process of ovulation and also the quality of eggs.

DIAGNOSIS

* Although PCOD is a very common problem, there is little agreement when it comes to how PCOD is diagnosed. It is very important to diagnose PCOD accurately, there are many consequences comes after such a diagnosis. Meanwhile, if PCOD diagnosis was based only on imaging basis, which is present in over 25% of normal women, many would be misdirected and treated. Experts will consider this diagnosis after making sure you do not have other conditions such as Cushing's disease (overactive adrenal gland), thyroid problems, congenital adrenal hyperplasia or increased prolactin production by the pituitary gland. After reviewing your medical history, Dr. Hosam Zaki will determine which tests are necessary. Elevated androgen levels (male hormones), DHEAS or testosterone help make the diagnosis. Insulin resistance tests will be carried out. Many physicians tell their patients that insulin values are normal, when in fact the value indicates that insulin may be playing a role in stimulating the development of PCOS. Most labs report levels less than 25 mIU/ml as normal, while in fact, levels over 10miu/ml on a fasting blood sample suggests that PCOS may be related to hyperinsulinism. However, Insulin resistance is accurately evaluated with more than fasting insulin levels..

Laboratory studies

*Increased androgen levels in blood (testosterone and androstenedione 40%)
*Increased LH levels
*Serum LH-to-FSH ratio - Exceeds 2
*Positive insulin resistance tests
*Increased prolactin levels
*Increased oestradiol and oestrone levels
*Decreased SHBG levels

Imaging Diagnosis

Transvaginal Ultrasonography is the most sensitive diagnostic study. Most women with PCOS display changes in the ovaries as viewed by ultrasound. In fact, the name itself describes the typical ultrasound findings seen in this disorder: poly (many), cystic (small collections of fluid). When the eggs in the ovaries do not develop to maturity, many small "follicles" (small fluid-filled sacs – less than 9mm - containing immature eggs) develop and can be seen on ultrasound. The ovaries of women PCOS are often enlarged as well. However, most women with PCOS do not have the kind of "cysts on the ovary" that we normally think of as problematic or requiring surgery, as those who cause problems are very large cysts (over 5 cm = 2 inches).