An Update on Polycystic Ovary Syndrome

[[author photo]]One of the most common endocrinologic conditions encountered by general gynecologists and infertility specialists in patients with anovulatory infertility or dysfunctional uterine bleeding is polycystic ovary syndrome (PCOS). In a recent questionnaire sent to its membership by the Society for Reproductive Endocrinology and Infertility on pathological conditions of interest to specialists in reproductive medicine, PCOS ranked at the top for the need of continued updating given the significant and continued advances that have been made with respect to the syndrome's pathogenesis and treatment. In the present issue of Seminars in Reproductive Medicine, a collection of monographs has been assembled with the intent of bringing the practicing physician up to date with the most clinically relevant issues in PCOS.

In the first monograph, Dr. Rick Legro, one of the premiere clinical investigators of PCOS, reviews the criteria for the diagnosis of PCOS and highlights some of the pitfalls and diagnostic dilemmas a physician may encounter with a patient presenting with signs and/or symptoms suggestive of PCOS.

In the second monograph, Dr. David Ehrmann, who has participated in clinical trials evaluating the use of insulin sensitizers for the treatment of patients with PCOS, reviews the issues facing the clinician trying to treat patients with PCOS medically.

Next, Dr. Randy Barnes describes the approach for the diagnosis and treatment of the patient with hirsutism, whether secondary to PCOS or not.

In the following article, Dr. Ricardo Azziz, who has been a pioneer in the clinical investigation for the diagnosis of nonclassical adrenal hyperplasia, describes late-onset 21-hydroxylase deficiency as the "great pretender" and suggests approaches to distinguish this condition from other causes of hyperandrogenism, including PCOS.

The next article, authored by Dr. Deborah Driscoll, who was a coinvestigator in the National Institutes of Health-funded cooperative program investigating the genetic basis of PCOS and who is the founder of the adolescent gynecology program at the University of Pennsylvania, describes the clinical approach to the adolescent with PCOS.

Next, Dr. David Guzick, presently Dean at the University of Rochester School of Medicine and who has had a long-time interest in the metabolic effects of chronic hyperandrogenism, addresses the very important issue of cardiovascular health in women with PCOS.

Finally, given that many infertile patients with PCOS need to undergo in vitro fertilization for treatment of their infertility, Dr. Christos Coutifaris addresses the difficulties and approaches to be considered by the clinician treating these patients.

It is important to note that some of the articles in this issue of Seminars are coauthored by residents in obstetrics and gynecology or fellows in reproductive endocrinology and infertility. Their contributions to these articles were significant, and they should be credited appropriately. As practitioners of the art and science of reproductive medicine, we should not forget that the future of our specialty belongs to these young trainees, who will contribute to the next advances in our field ultimately benefiting our patients. It is the editors' hope that the practicing physician will find the information in this issue of Seminars of clinical importance and of help in the management of patients with PCOS.