Date of Award

Winter 12-16-2022

Document Type

Dissertation

Degree Name

Doctor of Medical Science (DMSc)

Department

Department of Physician Assistant Medicine

First Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA

Abstract

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder and the most common cause of infertility among females of reproductive age.1 While the name “polycystic ovary syndrome” implies people diagnosed with PCOS have numerous cysts on their ovaries, this is not always the case. Clinicians currently use the Rotterdam criteria to diagnose PCOS.2 These criteria include: irregular periods/anovulatory cycles, clinical or biochemical signs of androgen excess (acne, hirsutism, androgenic alopecia, etc.), and numerous ovarian cysts seen on imaging.2 A diagnosis of PCOS can be made when at least two of three criteria are met.2 As this has become a much broader diagnoses, between 4-20% women of reproductive age worldwide are diagnosed with PCOS, with an increase of prevalence in the last 10 years.2 This disorder causes a multitude of aesthetic and physiologic changes including weight gain, hair loss, dyslipidemia, and one of the most distressing, infertility.1,3 Treatment is symptom management with insulin sensitizing actions (lifestyle changes and metformin) and hormonal contraceptives (oral, intrauterine, or implantable).3,4 Systemic insulin resistance is thought to be a large contributing factor in the development of local insulin resistance of the ovaries, commonly believed to be the cause of PCOS and its sequalae. Treatment focuses more on androgen regulation with hormonal contraceptives rather than insulin sensitization. Sadly, focus on regulating androgens only masks some symptoms of PCOS rather than addressing the root cause of insulin resistance. It is well understood that improving insulin sensitivity helps to increase fecundity in infertile PCOS women,5 but the role prior use of hormonal contraceptives have in improving fertility is less clear. By evaluating the effects of hormonal contraceptives on various aspect of fertility, this review aims to address infertility in women with PCOS with respect to insulin sensitivity.

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