HYPERANDROGENIC ANOVULATION (THE POLYCYSTIC-OVARY-SYNDROME) - BACK TOTHE OVARY

Hyperandrogenic anovulation is characterized by polycystic appearance of the ovaries, elevated free serum testosterone with decreased concen trations of serum sex hormone binding globulin, an increased ratio of luteinizing hormone to follicle stimulating hormone and varying degree s of insulin resistance, We hypothesize that this is the result of var iably increased 'ovarian androgenic insulin responsiveness' acting in combination with body mass. Women who develop hyperandrogenism and ano vulation when lean (having normal serum insulin concentrations) repres ent the more severely affected individuals, whereas those who can resu me ovulation by losing weight land lowering their elevated serum insul in) represent a milder form. The tendency of these women to develop ov arian hyperstimulation syndrome despite hypophyseal desensitization su ggests a primary ovarian defect which is apparently more pronounced in lean subjects. The unique ability of surgical damage to the ovary to induce ovulation, raises the possibility that inflammatory-like tissue remodelling has a major role in rescuing follicles from androgen-indu ced atresia, Approaches that may facilitate the study of this possible mechanism may include examination of in-vitro perfused, post-surgery mammalian ovaries and the elucidation of signal transduction mechanism (s) of insulin in the ovary, with special reference to cells emanating from affected women.