As pointed out in the section on ovulation the pituitary gland in the brain plays an important role in the release of an oocyte from the ovary each month. Two hormones secreted by the pituitary gland are of importance:

FSH (Follicle Stimulating Hormone) - stimulates a follicle to grow to maturity

LH (Luteinizing Hormone) - causes a mature follicle to burst and to release the oocyte

The condition known as polycystic ovarian disease (P.O.D.) occurs when there is an abnormality with the secretion of FSH and LH. This abnormality results in an underdeveloped follicle developing, subsequently not rupturing and thus the oocyte is not released. With time many underdeveloped follicles are formed in the ovaries, the result is abnormal hormonal levels, specifically the LH/FSH ratio as well as the 'male hormones' produced in the ovaries.

SYMPTOMS

1. Irregular menstrual cycles.

2. Amenorrhoea.

3. Weight gain

4. Excessive hair growth with a male sexual hair distribution e.g. on the upper lip, breasts or below the navel.

5. Oily skin and acne.

DIAGNOSIS

1. Blood tests done at the commencement of the cycle day 2 or day 3. The test should include FSH, LH and male hormones, androgen, DHEAS and testosterone.

2. Further blood tests include a fasting insulin test and a further insulin level two hours after eating.

3. On ultrasound the ovaries will have a multicystic appearance

TREATMENT

1. Abnormal insulin levels can be treated with medication (glucophage) or more conservatively by correcting the diet.

2. The first line of treatment is usually fertility drugs such as "Clomid" or "Serophene" tablets. A word of warning though: patients with POD are very sensitive to these drugs and higher order multiple pregnancies are very common. This medication should be prescribed by an infertility specialist, ultrasonic monitoring of the ovarian response to the medication is essential. Ongoing monthly use has an adverse affect on the ovaries creating a 'contraceptive effect'.

3. Hormone injections containing FSH. These injections are very powerful and should only be administered by a specialist with a keen interest in infertility. The hormone injections are expensive.

4. Ovarian surgery. At laparoscopy the small ovarian cysts are removed. This is a highly specialised procedure and can damage the ovaries if not done correctly. Surgery is only performed if medical treatment fails.