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Male Factor

  1. Defective Spermatogenesis
    1. Congenital
      Undescended testes
    2. Thermal factor environmental heat
    3. Infection
      Mumps orchitis
      bacterial infection of Prostate / seminal vesicles
    4. General factors smoking
    5. Endocrinal GnRH deficiency (Kallman’s syndrome)
    6. Genetic
      Klinefelter’s Syndrome 47XXY
      (azoospermic males)
    7. latrogenic
      Radiation / cytotoxic drugs / cimetidine
    8. Immunological factors
  2. Obstruction of the efferent duct systems
    1. Congenital Absence of vas deferens
      Young’s syndrome epididymal
      obstruction with bronchiectasis
    2. Acquired Tuberculosis
      Trauma = Surgical / otherwise
  3. Failure to deposit sperm high in the vagina
    1. Impotency
    2. Absent / premature ejaculation]
    3. Retrograde ejaculation
    4. Hyospadiasis
    5. Psychosexual
  4. Defect in sperm / seminal fluid
    1. Immotile sperm (Kartgener syndrome defective absent tails / cilia)
    2. Low fructose content
    3. Sperm auto-antibodies
    4. Undue viscosity
    5. Low volume of ejaculate

Polycystic Ovarian Syndrome (PCOS)


Rotterdam 2003 criteria for diagnosis of PCOS/PCOD-at least two out of three should be present:

  1. Oligo/anovulation
  2. Hyperandrogenism: biochemical or clinical
  3. Twelve or more than 12 follicles 2-9 mm in size present within one or both ovaries on use and/ or ovarian volume >10 mL
  • Obesity is not required to make the diagnosis and even the ratio of FSH/LH = 1/2 or 1/3 not essential to make the of diagnosis of PCOS.

Hormonal changes in PCOS


Hormones Increased

Hormones Decreased

• Androqens (Testosterone, Androstenedione DHEAS)

• Luteinizing hormone? (LH > 10 IUI ml)

• Estrogen (Estrone> Oestradiol)

• Insulin (> 10 m IU / L due to insulin resistance)

• Prolactin (in some patients)

• LDUcholesterol and triglycerides

• Follicle stimulating hormone (FSH)

• Progesterone (due to anovulation)

• Sex hormone binding Globulin

• HDL & Apoprotein A-I


  1. Hyperthecosis (increase testosterone from the ovaries)
  2. Defective aromatization within the ovaries (hyperandrogenic micro-environment within the ovaries)
  3. Normal aromatization in periphery (unopposed estrogenic action as there is no progesterone due to anovulation)

Description: 1

  • Insulin resistance (lR) is considered to be the hallmark in pathophysiology of PCOS  
  • HAIR AN Syndrome
  • HA = hyperandrogenism
  • IR = insulin resistance
  • AN = acanthosis nigricans
  • USG = necklace of pearl pattern
    Laparoscopy = oyster ovaries (enlarged, white, smooth sclerotic ovaries with thickened capsule)
  • Long-term complications associated with PCOS:
    1. Diabetes mellitus.
    2. Endometrial hyperplasia
    3. Endometrial carcinoma
  • Metabolic syndrome/syndrome X: IR, obesity, hypertension, triglycerides, and T FBS associated with coronary artery disease



Principles of management include:

  • Irregular periods/ amenorrhea = regularization of menses with OC pills/ cyclical progesterone
  • Hirsutism/acne = suppression of androgens
  • Infertility = ovulation induction
  • Amenorrhea because of PCOD is estrogen-induced amenorrhea (unopposed estrogenic action as these is no ovulation and hence progesterone is absent), and it requires treatment as unopposed estrogenic action is a risk factor for endometrial hyperplasia/ cancer

Treatment depends on the complain of the patient




Irregular periods



Life style modifications

Insulin resistance

Metformin (Can be used-in pregnancy also)

Hirsutism/ acne

OCP's cyproterone acetate


Ovulation Inducing drugs like clomiphene citrate, letrozole

Surgery for Pcos

  • Laparoscopic ovarian drilling (LOD) or laparoscopic electrocoagulation of ovarian surface (LEOS)
  • In this surgery, monopolar current is passed within the ovary to destroy the ovarian theca -
  • This surgery is done only for infertile patients of PCOS who are resistant to ovulation with gonadotropin or when very high doses of gonadotropins are required for ovulation
  • Advantages: no risk of OHSS and multiple pregnancy
  • Disadvantages: surgical procedure, risk of premature ovarian failure if excessive ovarian tissue is damaged, & adhesion formation postsurgery

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