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Incidence of Polycystic Ovary Syndrome (PCOS) among Women in Nigeria

Incidence of Polycystic Ovary Syndrome (PCOS) among Women attending Fertility Clinics in Port Harcourt City, Nigeria                                    

ABSTRACT

This study was conducted among women attending fertility clinics in Port Harcourt metropolis with the aim of determining the incidence of Polycystic Ovary Syndrome (PCOS). A total of 378 women were studied. These women sought help for their infertility problems and were required to undergo routine clinical evaluations that included: Assessment of menstrual irregularities, clinical signs of hyperandrogenism, infertility status, history of previous miscarriage(s), body mass index measurement, trans vaginal ultrasonography (TVS) for polycystic ovary (PCO), and biochemical hormonal profiles of follicle stimulating hormone(FSH), luteinizing hormone(LH), prolactin, testosterone, and calculated LH:FSH ratio tailored to the diagnosis of their infertile condition. Screening for Polycystic Ovary Syndrome was performed by adopting the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine consensus criteria. Out of the total number of 378 women screened in this study 133 subjects (35.19%) had PCO on TVS, PCOS was observed in 118 subjects (31.22%). Menstrual irregularities occurred in 104 (27.51%). Clinical and biochemical hyperandrogenism were identified in 122 (32.28%) and 102 (26.98%) of the subjects respectively. The incidence of PCOS was 31.22%.  PCOS and PCO were more prevalent in age groups 38 – 42 and 32 – 37 years. Features identified in PCOS subjects expressed as percentage occurrences were; infertility (secondary, 76.23%),oligomenorrhea (61.02%), hirsutism (61.02%), miscarriage (54.24%), pre-obesity (52.54%) and amenorrhea (secondary, 16.10%). There were significantly strong associations of LH:FSH ratio with LH and LH:FSH ratio with testosterone (p<0.05). Raised serum LH and testosterone predispose women to infertility and hirsutism. High incidence of PCOS was therefore observed in these subjects presenting with infertility. Thorough clinical assessment and expanded biochemical hormonal evaluations are important in every patient with PCO to reduce the incidence of PCOS.

CHAPTER ONE

   INTRODUCTION

1.1  Background information

Polycystic Ovarian Syndrome (PCOS) is the commonest cause of anovulatory infertility. It has been associated with a complex endocrine disorder affecting women in their reproductive years. These disorders consist of some clinical and biochemical features with aetiologies remaining poorly understood.

According to Walker and Toft (2002), PCOS is probably the common end point of a heterogeneous group of pathologies characterized by loss of coordinate control of the menstrual cycle. The chronic anovulation associated with PCOS is a sequel to increased androgen production and disordered gonadotropin secretion (Dunaif and Thomas, 2001).

PCOS is associated with disorders of reproduction, metabolism and general health, increased risk of miscarriage, insulin resistance, hyperlipidaemia, cardiovascular diseases and endometrial cancer.

          The identification of PCOS is generally made by a combination of clinical, ultrasonographic and biochemical criteria. Observed differences in various reports are however attributed to the variation in the definition of PCOS employed and the patient population studied (Chappel et al., 1993). Diagnosing various disorders before puberty is difficult because patients with PCOS are generally identified only after seeking help for irregular menstruation or skin changes that do not take place until puberty. Diagnosis can only be made when other aetiologies such as thyroid dysfunction, congenital adrenal hyperplasia, hyperprolactinaemia, androgen-secreting tumours and Cushings Syndrome have been excluded.

Satter et al., (1998) put the incidence of PCOS in pre-menopausal women at 5-10%. However, incidence data available reflect various national rather than a global trend. Studies carried out in the United States estimated the incidence of PCOS to be 4% to 12% among reproductive age women (Dunaif and Thomas, 2001). In a study from England, 37% of women with amenorrhea and 90% of women with oligomenorrhea had PCOS (Frank, 1995).

Evidence indicates that PCOS may be associated with lifelong disorders where certain precursors are present well before the full onset of disease. Also, the sequelae of PCOS beyond reproductive health and the adverse health consequences associated with it are substantial. Unfortunately, most women are not aware of these risks until they present for infertility treatment (Salmi et al., 2004; Wang and Wang, 2003).

Possible clinical symptoms include menstrual disturbance in the form of amenorrhea, severe oligomenorrhea or anovulation, hirsutism, androgenic alopecia, acne and infertility. Hence, when women present with infertility with or without the accompanying symptoms, it is important to screen for PCOS  (Kaja Shekar et al., 2008). PCOS is one of the most common (15-20%) endocrine disorder in women of Child bearing age. It is aheterogeneous collection of signs and symptoms which together form a spectrum of the disorders with mild presentation in some and severe disturbance of reproduction, endocrine and metabolic functions in others. PCOS is linked to a host of health problems including type 2 diabetes

mellitus,heartdisease,hypertension,endometrial cancer,ovarian cancer, subfertility, infertility, anaemia, and increased foetal risk such as miscarriage.

1.2  Aims and objectives

The aim of this study is to evaluate the incidence of PCOS in Port-Harcourt city using women attending fertility clinics in Fertility Centres at Prime Medical Consultants, Bridge Hospital and Gynescope Specialist Hospital all in Port Harcourtby identifying clinical and biochemical features closely related to the syndrome, thus providing incidence data for further research in this locality and toenable fertility specialists to proactively manage the disorder.

1.3  Specific objectives

Objectives of this study are:

  • To carryout biochemical hormonal profiles of Follicle Stimulating Hormones (FSH), Luteinizing Hormone (LH), Prolactin, Testosterone and LH:FSH ratio.
  • To determine the presence of polycystic ovaries (PCO) by ultrasonography.

To find possible association of age, age at menarche, and body mass index(BMI) in these subjects.

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