Australia´s National Infertility Network
updated April 2011
You may have heard of polycystic ovaries – a common condition causing irregular
periods and infertility. This condition is thought to be caused by an imbalance in
the hormonal messages between the pituitary and the ovary. Far less common
is the situation of multicystic ovaries. These are ovaries responding normally to
lower than normal levels of pituitary hormones.
The diagnosis of these conditions is primar- pituitary is just starting to send the appro- are in any way abnormal. They still have
ily by ultrasound. In polycystic ovaries there priate messages to the ovary but these are a full complement of immature eggs and
are multiple tiny cysts (immature follicles) either not in sufficient quantity or are at so have the capacity to be stimulated to
approximately 2 - 8mm in size, usually on the wrong time to allow the normal fol- produce mature eggs.
the periphery of an enlarged ovary. licle development which leads to produc-
tion of an egg. If your doctor finds the multicystic pic-
In multicystic ovaries there are many fol- ture on ultrasound he or she will inevita-
licles of various sizes (from 3mm - 12mm) One of the main factors thought to con- bly ask about weight and personal stress.
in a normal sized ovary. These follicles are tribute to the establishment of the right The doctor is not accusing the patient of
distributed throughout the substance of pattern and timing of messages is body being anorexic. If there has been weight
the ovary giving a ‘swiss cheese’ appearance. weight. Stress can also play a negative role. loss, a diet to build up weight would be
recommended. If stress is a major factor,
In both polycystic and multicystic con- Therefore the situations when this ab- counselling may be beneficial.
ditions there is no need for any concern normal multicystic picture occurs are
that the ‘cystic’ pattern might be malig- when significant weight loss takes place Doctors have some reservations about
nant or potentially cancerous. The cysts (down to or below the weight at the time treating infertility if a women is seriously
are in fact follicles which under a normal of a woman’s first period) or when there underweight. There is good evidence that
hormone environment would develop to is severe stress and anxiety. A classical pregnancies in such circumstances are
produce mature eggs (oocytes). The lack situation with both of these situations is more likely to result in premature deliv-
of appropriate hormonal stimulation has anorexia nervosa. Multicystic ovaries are eries and small babies (growth retarda-
led to their growth but not to develop- seen more in the early stages and during tion) with long-term problems. In addi-
ment into mature eggs. the resolution of anorexia nervosa. In the tion, significant stress does not provide
severe situation the ovaries become inac- the best environment for child-bearing.
All girls going through puberty pass tive with no follicle activity. Weight gain and reduction of anxiety are
through a stage of having the multicystic the best cures.
appearance in their ovaries. It is usually Generally with multicystic ovaries, peri-
at the stage of development (but before ods will be absent or extremely irregular. However, with treatment excellent results
the first period) when they are starting to Oocyte (egg) production is rare or non- are possible. The two options are:
grow in height and gain weight, and the existent and so infertility is the norm.
breasts are developing. It is thought the However, this does not mean the ovaries n a pump connected by a needle under
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the skin which releases GnRH (the hor- Both options outlined above
mone which tells the pituitary to release have pregnancy rates of 60 to
its hormones (FSH – Follicle Stimulat- 70 per cent over a six month pe-
ing Hormone and LH – Luteinizing riod of treatment (assuming all
Hormone) in the correct amounts at the else is normal). These should
correct time be tried before any attempts at
in vitro fertilisation (IVF).
p direct stimulation of the ovaries by injec-
tions of the pituitary hormones on a daily basis Professor Michael Chapman
This publication was
supported by an untied,
educational grant from: