Ministry of Higher Education and Scientific Research

Ministry of Higher Education and Scientific Research

University of Thi-Qar

College of Medicine

Department of obstetrics and gynecology

By

Salam Jassim Ahmed Mohsen Zaman Hameed

Supervised By

Alaa Hussein Ali

Abstract

Background :Polycystic ovarian syndrome (PCOS) is a common endocrinopathy typified by oligoovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts. These signs and symptoms vary widely between women and within individuals over time. Women with this endocrine disorder also have higher

rates of dyslipidemia and insulin resistance, which increase long term health risks. As a result, women with PCOS may first present to various medical specialists, including pediatricians,gynecologists,internists,endocrinologists, or dermatologists.

Aim : the aim of this study was to estimate the prevalence of polycystic ovarian syndrome among married females in al-nasiriyah infertility center .

methodology : this was across sectional study.

The data was taken from recorded files of married females who were attend infertility center in AL-Hussein teaching hospital in Al-Nasiriyah at 2016.

Result : prevalence of PCOS among married females who were attend infertility center in AL-Hussein teaching hospital in Al-Nasiriyah was about 24.3% which was commonly among younger age group and higher in married females who were non employer and lives in urban area .

Introduction

Definition :PCOS is a syndrome of ovarian dysfunction alongwith the cardinal features of hyperandrogenism and polycystic ovary morphology. Its clinical manifestations include menstrual irregularities, signsof androgen excess (e.g. hirsutism) and obesity.Elevated serum LH levels and insulin resistance and

are also common features. PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.

Rotterdam criteria 2003 :

Two of the three

1-Clinical and/or biochemical hyperandrogenism

2-Oligo-/anovulationPolycystic ovaries.

Incidence and etiology:PCOS is the most common endocrine disorder ofreproductive agedwomen and affects approximately 4 to 12 percent in generalpopulation studies. Although symptoms of androgen excess mayvary among ethnicities, PCOS appears to affect all races andnationalities equally.The underlying cause o PCOS is unknown. However, a genetic basis that is both multi factorial and polygenic is suspected,as there is a well-documented aggregation o the syndromewithin families. Specifically, an increasedprevalence is noted between affected individuals and their sisters(32 to 66 percent) and mothers (24 to 52 percent) .twin studies also suggest a prominent heritable in uence.Some have suggested an autosomal dominant inheritancewith expression in both examples and males. For example, firstdegreemale relatives of women with PCOS have been shown tohave significantly higher rates of elevated circulatingdehydroepiandrosteronesulfate (DHEAS) levels, early balding, an insulinresistance compared with male controls .Identification of candidate genes linked to PCOS is a majorresearch focus, given the large potential benefit tor both diagnosisand management. In general, putative genes includethose involved in androgen synthesis and those associated withinsulin resistance. Genome-wide association studies in Chinesewomen have identified variants in 11 genomic regions as potentialrisk actors or PCOS .

Clinical features:The clinical features of PCOS are as follows:

1-oligomenorrhoea/amenorrhoea in up to 75 percent of patients, predominantly related to chronic anovulation.

2-hirsutism

3- subfertility in up to 75 per cent of women;

4- obesity in at least 40 per cent of patients;

5- recurrent miscarriage in around 50–60 per cent ofwomen;

6- acanthosis nigricans (areas of increased velvetyskin pigmentation occur in the axillae and otherflexures);

7- may be asymptomatic.

Diagnosis:Patients must have two out of the three features below:

1-amenorrhoea/oligomenorrhoea;

2- clinical or biochemical hyperandrogenism;

3- polycystic ovaries on ultrasound.

The ultrasound criteria for the diagnosis of a polycysticovary are eight or more sub capsular follicular cysts<10 mm in diameter and increased ovarian stroma While these findings support a diagnosis of PCOS, they are not by themselves sufficient to identify thesyndrome.

Management:Management of PCOS involves the following:

1- COCP: This should regulate menstruation.

2- Cyclical oral progesterone: This too can be used toregulate menstruation.

3- Metformin: This is beneficial in a subset ofpatients with PCOS, those with hyperinsulinaemiaand cardiovascular risk factors. It is less effectivethan clomiphene for ovulation induction and itdoes not improve pregnancy outcome. It shouldbe discontinued when pregnancy is detected.

4- Clomiphene: This can be used to induce ovulationwhere subfertility is a factor.

5- Lifestyle advice: Dietary modification and exerciseis appropriate in these patients as they are atan increased risk of developing diabetes andcardiovascular disease later in life.

6- Weight reduction.

Methodology

Data from the infertility component of the 2016 Health Survey were analyzed for married females. The study was a retrospective study carried out at " Al-Hussein teaching hospital" at subfertility center over previous year 2016 . Prevalence rate of current PCOS were estimated by selected characteristics.To determine the sample size of PCOS cases , the following equation was use

N=

Considering the significant level of d = 0.04 and (p) base on the study do in the Kurdish women attending IVF infertility center in maternity teaching hospital of Erbil City.

Site and Study Design:A cross-sectional survey was conducted on a conveniently selected married females, recruited from the outpatient center of al Hussein-hospital. This hospital was chosen because this is the largest hospital in the city and married females from all socio-economic and ethnic backgrounds visit this centers.

Data sources:Data for the research component were collected from center records from 1st of September 2016, the whole number was 600, until 1st of January 2017.

Study variables:Socio-demographic characteristics were examined including the age group in years of the married females (16-25 , 26-35, 36-45, 46-49). other characteristics were used include occupation (employer and non-employer) and resident (urban and rural area).

Result

In 2016, about 600married females consult subfertility center , from which 146females were diagnosed with poly cystic ovarian syndrome as a cause of infertility and 54.1% of females with poly cystic ovarian syndrome located among age 16-25 years old ,93.15% of them were non employer and 74.56% of them lived in urban area . other distribution by show by the following figures .

Table 1:percentage of PCOS in married females at studied year .

Females with
PCOS / Females without
PCOS / Total numbers of females
Count / percentage / count / percentage
146 / 24.3% / 454 / 75.66% / 600

Fig.1: percentage of PCOS in married females at studied year .

Table 2:distribution of females with PCOS among age

Age / Female number / percentage
16-25 / 79 / 54.1%
26-35 / 55 / 37.67%
36-45 / 10 / 6.84%
46-49 / 2 / 1.36%

Fig.2: distribution of females with PCOS among age

Table 3:distribution of females with PCOS among occupation

employer / Non employer / Total females with PCOS
Count / percentage / count / percentage
10 / 6.84% / 136 / 93.15% / 146

Fig.3:distribution of females with PCOS among occupation

Table 4:distribution of females with PCOS among resident

Rural area / Urban area / Total females with PCOS
Count / percentage / count / percentage
37 / 25.34% / 109 / 74.56% / 146

Fig.4:distribution of females with PCOS among resident

Discussion

The results of this study that do to estimate the prevalence of polycystic ovarian syndrome among married females in al-Nasiriya infertility center was that married females who are visits the Centre and diagnosed with PCOS was 24.3% and this result was more among the age 16-25 year old groups was about 54.1% ; and was more among the non-employer than employer women and more in urban area than rural area. The study results when compared it with other studies like study do in the Kurdish women attending IVF infertility center in maternity teaching hospital of Erbil City was 33% so the result of this study that do in al- Nasiriya was low ; but on other side the result of study do in Iran was only 19.5% it is low in compared with this study. The PCOS have unknown etiology, But from this study and when compared between the other studies found it high variation between the areas of same region and also in same country and between the countries also effect young age groups more than older groups during reproductive age.

Reference

1-Iran J Reprod Med. 2015 Oct;13(10):591-604.

2- Open Journal of Obstetrics and Gynecology

Vol.3 No.7(2013), Article ID:37028,9 .

3-williams gynecology third edition.

4- GYNAECOLOGY by Ten Teachers 19th edition .

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