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About PCOS: Low Androgen Levels Can Lead to Female Infertility

Do you have high levels of AMH (Anti-Mullerian Hormone) relative to your age or corresponding FSH (Follicle Stimulating Hormone) levels?
In this video, Dr. Gleicher, from CHR, describes a new phenotype for Hypo-androgenic PCOS and what fertility specialists should consider when treating patients with low androgen PCOS.

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I want today to talk to you about a new phenotype of the polycystic ovary syndrome. Actually for the first time described here at CHR, it is called the hypoandrogenic PCOS phenotype and this name characterizes the main feature of this clinical presentation, which up till now was really unknown. Only over the last two years was the clinical presentation of this picture recognized by our investigators here at the center. The classical presentation involves clinical history and laboratory examinations (like most diagnoses).

In terms of clinical history, these are patients who obviously have a fertility problem. They do not conceive. They very frequently present, especially to us as a center of last resort where patients have had prior treatments, they present with a history of multiple failed IVF cycles characterized by unusually large egg numbers but poor quality and therefore also poor embryo quality and that is the major reason why they do not conceive.

On the laboratory side, this phenotype is characterized, like all PCOS polycystic ovary syndrome patients, by relatively high anti-mullerian hormone levels (AMH levels) and by relatively high we mean relatively high either for the age of the patient or in proportion to for example her FSH. Usually FSH and a AMH go in opposite direction. As women get older, FSH goes up and AMH goes down. And so if there’s a patient who has a relatively high FSH, you would expect a low AMH. But if her AMH is disproportionately high, that is a potential hint.

Another hint very frequently present (almost uniformly present) is that these patients have a history and laboratory evidence for autoimmunity. This can be overt autoimmune disease of one kind or another or alternatively sub clinical findings (just laboratory findings) that suggest that the patient may have a hyper-active immune system.

This is important because the low androgen levels which are so typical for this presentation and by that I mean primarily low testosterone hormone levels and therefore the name hypo androgenic PCOS. Those levels are caused by insufficiency of the adrenal gland and not of the ovaries. In women androgens are produced roughly half and half by adrenals and ovaries. It is the adrenal component and that is missing in those patients or that is insufficient in those patients and there is considerable evidence that this reduction adrenal androgen production is the consequence of an autoimmune attack on the adrenal glands.

So, these patients have a very typical presentation in laboratory as well as history as well as clinical presentation in general and they therefore are not difficult to diagnose once you recognize the syndrome. Why is diagnosis is so important? It is so important because these patients will not conceive As the history of multiple IVF failure so much shows, they will not conceive until you raise the androgen or testosterone levels. Once you do, you will be surprised how many amongst these women get pregnant very quickly. So this is another condition where low androgen levels lead to female infertility.

We now know that the ovaries do need good testosterone levels in order to make good eggs, both in quantity and especially in quality. So here with a hypo androgenic PCOS, a much more frequent condition than we ever thought it would be, androgen supplementation can literally change a patient’s fertility destiny. I hope this helped.