POLYCYSTIC OVARIAN SYNDROME: A MAJOR CAUSE OF INFERTILITY IN FEMALES

POLYCYSTIC OVARIAN SYNDROME: A MAJOR CAUSE OF INFERTILITY IN FEMALES 

By Hira Waseem

Metabolism is a set of all chemical reactions taking place in our body and it maintains the living state of an organism. Any error in the metabolism can lead to metabolic disorders such as obesity, hypertension, polycystic ovarian syndrome (PCOS) and insulin resistance etc.

What polycystic ovarian syndrome (PCOS) is?

PCOS is an endocrine disorder which is affecting 5–10% of women in reproductive age. It is a major cause of female infertility in the world. It is due to the disturbance in the hormones or poor diet but the actual reason is not yet identified. It causes multiple follicle formation in the ovaries. The male hormone (androgen) level increases in PCOS patients which causes baldness, irregular periods and hirsutism, a condition in which female has an abnormal hair growth in a man like a pattern on face and body.

Prolactin

Prolactin is also known as luteotropic hormone or luteotropin. It is a unique hormone responsible for making breast milk in the body when a female is pregnant or feeding her child. It is secreted from the pituitary gland but also from macrophages in the adipose tissue in response to inflammation and high glucose concentrations.

Prolactin performs many functions in our body which includes the development of breast, proliferation and survival of islet β cells and enhances the secretion of insulin. PRL is associated with many diseases such as insulin resistance, hypertension, stroke and coronary syndrome.

Prolactin and Infertility

A cohort study shows that infertility is caused by high prolactin level, also known as hyperprolactinemia, which is produced due to the high level of estrogen. If a normal woman has abnormally high levels of prolactin, it may cause her difficulty in becoming pregnant. It causes infertility in different ways i-e it may stop a woman from ovulating, due to which a woman’s menstrual cycles will stop. In less severe cases, it may also disrupt ovulation which causes infrequent or irregular periods, which results in infertility. Some women having high prolactin levels may ovulate regularly but doesn’t produce enough progesterone hormones after ovulation. This is known as a luteal phase defect. After ovulation, deficiency in the level of progesterone hormone may lead to the formation of the uterine lining which may cause difficulty in the implantation of an embryo.

The symptoms of high prolactin level includes irregular periods, cysts formation in the ovaries and breast discharge. The discharge is the result of high prolactin level that causes the breasts to stimulate milk production.

Image: https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

Measuring the prolactin (PRL) level

For determination of prolactin level, some laboratory tests were performed such as prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2)_, thyroid-stimulating hormone (TSH), triiodothyronine (FT3) and free thyroxin (FT4) levels in blood samples of PCOS patients. Estradiol E₂ which is the major female sex hormone, involved in the regulation of the menstrual cycle. It effectively stimulates PRL secretion through pituitary gland and hypothalamus. There is a negative relationship between serum PRL and LH or LH/FSH which is an indication that serum PRL in normal range would suppress the secretion of gonadotropin, a hormone which stimulates the testes in males and ovaries in females. PCOS patients tend to have low quality of life and low mood swings which is a leading cause of increased secretion of dopamine and reduced serum PRL levels. This tells us about the negative connection among PRL, LH and LH/FSH.

Body mass index of PCOS patients, a metabolic parameter

BMI of PCOS patients having age groups like 20–25 years, 25–35 years and over 35 years are notably higher than that of a normal person having no PCOS. Obesity significantly increases with age in PCOS patients. Due to elevated prolactin level, a woman with PCOS produces too much insulin or does not respond well to insulin that causes a person to become obese. Thus, high PRL is associated with higher BMI.PRL promotes the formation of adipose tissues and inhibits the breakdown of lipid in the adipose cells. The serum level of PRL of obese children is lower than that of non-obese children. The level of low-density lipoprotein in PCOS patients are still significantly higher than in non-PCOS patients. It can be inferred that lipid metabolism in PCOS patients is abnormal. As serum PRL is closely related to lipid metabolism, low level of PRL in physiological range would lead to more serious disorder of lipid metabolism.

Conclusion

PCOS is a common hormonal disorder that challenges the quality of life of women. We can thus conclude that high prolactin level and obesity are important factors to induce infertility in PCOS patients. By taking a healthy diet, doing exercise regularly and losing excess weight will be helpful. Also, by using such medications that control hormone level will be beneficial to reduce the infertility level in PCOS patients.

Author’s information

Hira Waseem, a student of BS biotechnology (6^th semester), has written this article. She was inspired motivated by her mentor Miss Iqra Aslam (MPhil Biochemistry), Lecturer of Biochemistry at University of Management and Technology, Sialkot, Punjab, Pakistan.

Reviewer and Editor information

This article is reviewed & edited by Anum Tariq (MPhil Biochemistry) and by Muhammad Numan (PhD Scholar Biochemistry).

References

Some are given as internal links within it and remaining are listed here.

https://www.ivf1.com/prolactin-infertility/

https://4617c1smqldcqsat27z78x17-wpengine.netdna-ssl.com/wp-content/uploads/Polycystic-Ovarian-Syndrome-and-Obesity.pdf

Yang, Haiyan et al. "The Association between Prolactin and Metabolic Parameters In PCOS Women: A Retrospective Analysis". Frontiers In Endocrinology, vol 11, 2020. Frontiers Media SA, doi:10.3389/fendo.2020.00263.

Panidis, Dimitrios et al. "Age- And Body Mass Index-Related Differences In The Prevalence Of Metabolic Syndrome In Women With Polycystic Ovary Syndrome". Gynecological Endocrinology, vol 29, no. 10, 2013, pp. 926-930. Informa UK Limited, doi:10.3109/09513590.2013.819079.