How is infertility a symptom of PCOS?

Please respond to the 2 following discussion posts separately including separate reference lists. References to be no older than 5 years.
1. Case Study: A33-year-old obese female suffers from amenorrhea and infertility. After a thorough workup, PCOS is diagnosed.
Polycystic ovary syndrome (PCOS) is an endocrine disorder due to abnormal function of the hypothalamus and pituitary gland. This causes reproductive and metabolic system abnormalities occurring mostly in reproductive-aged women. An individual with this condition typically experiences menstrual irregularities and infertility. It is also known to produce multiple symptoms rather than a disease. Various studies believe that the exact cause of PCOS is not clearly determined. According to Smith (2019) states that considerable processes including hormonal imbalance, insulin resistance, genetic inheritance, and environmental factors are associated with the development of PCOS. This condition occurs when the follicles in the ovaries are dysfunctionally not ovulating thus resulting to a form cysts. The cyst serves as a representation of the failed ovulation process which greatly impacts not only an individual’s chance to conceive but also the entire endocrine system of the body.
Two additional symptoms are associated with PCOS in terms of pathophysiological principles
Two symptoms associated with PCOS development are hyperandrogenemia and hyperinsulinemia. In PCOS, PhysioPathoPharmaco (2020) explained the underlying causes start when the hypothalamus in the brain discharges a hormone called gonadotropin-releasing hormone (GnRH) in a rapid pulses frequency manner leading to excessive production of luteinizing hormone (LH) produced in the pituitary gland. This stimulates the ovarian thecal cell to secrete an excessive amount of androgens, a male hormone creating the symptoms characterizing the PCOS. Hyperandrogenemia, the overly excess secretion of androgen causes symptoms of hirsutism (abnormal production of facial and body hair), acne, baldness, and obesity. PCOS also has a strong connection to insulin, a hormone released by the pancreas which is responsible for blood sugar regulation can also stimulate the process of ovarian thecal cell to increase the production of androgens. This process negatively affects the hypothalamus and pituitary gland causing hormonal imbalance complications and decrease insulin sensitivity or also known as insulin resistance leading to the cause of hyperinsulinemia in which the body produces more insulin to compensate. As per Galan (2020) article, states that the increased level of insulin contributes to weight gain, obesity, and the development of type 2 diabetes which is a risk factor for other health problems including cardiovascular disease.
Metformin contribute to the PCOS treatment
Metformin is a known antidiabetic drug given to diabetic individuals as well as those diagnosed with PCOS, used to aid the reduction of insulin resistance. This drug helps the body improve the absorption of glucose and use it effectively in the cells which decreases the level of blood sugar. Elnashar (2011) article explained that the utilization of this drug also serves to enhance the ovulation induction in women with PCOS through various actions by lowering the insulin level and modifying the influence of insulin in ovarian androgen production, thecal cell proliferation, and endometrial growth.
Progesterone aid in PCOS treatment
According to Briden (2021) states that progesterone such as combined oral contraceptives has anti-androgen benefits to aid in regulating the menstrual period of women with PCOS. It works by inhibiting the action on the GnRH pulses producing negative feedback on the hypothalamus thereby decreasing androgen productions and promoting ovulation. Progesterone administration also decreases excess estrogen being produced and its effect is helpful in the symptoms of acne and hirsutism.
Infertility is a symptom of PCOS
According to De Pietro (2019) describe PCOS as a condition causing women’s hormonal imbalance including the sex hormone estrogen, responsible for producing a mature egg from the ovary during ovulation. This hormonal imbalance inhibits the growth and release of mature eggs. The absence of the mature egg results in failed ovulation process leading to no pregnancy or infertility occurrences.
References
Briden, L. (2021, September 27). Cyclic progesterone therapy for PCOS. Lara Briden – The Period Revolutionary. Retrieved February 3, 2022, from https://www.larabriden.com/cyclic-progesterone-therapy-for-pcos/
De Pietro, M. A. (2019, January 17). Polycystic ovary syndrome and fertility: Causes, symptoms, and effects. Medical News Today. Retrieved February 3, 2022, from https://www.medicalnewstoday.com/articles/312841
Elnashar, A. M. (2011, September 13). The role of metformin in ovulation induction: Current status. Middle East Fertility Society Journal. Retrieved February 3, 2022, from https://www.sciencedirect.com/science/article/pii/S1110569010001421
Galan, N. (2020, November 25). The Link Between PCOS and Insulin Resistance. Verywellhealth. Retrieved February 1, 2022, from https://www.verywellhealth.com/pcos-and-insulin-resistance-2616319
PhysioPathoPharmaco. (2020). Polycystic Ovarian Syndrome (PCOS) – Pathophysiology, Symptoms, Treatment. Retrieved February 2, 2022, from https://www.youtube.com/watch?v=u9qUdkYdiVw.
Smith, Y. (2019, February 27). Polycystic ovary syndrome pathogenesis. News. Retrieved February 2, 2022, from https://www.news-medical.net/health/Polycystic-Ovary-Syndrome-Pathogenesis.aspx
2. A 33-year-old obese female suffers from amenorrhea and infertility. After a thorough work up PCOS is diagnosed.
Discuss 2 additional symptoms associated with PCOS I terms of pathophysiological principles.
Polycystic Ovarian syndrome (PCOS) is considered to be one of the most common endocrine disorders in women of reproductive age. The etiology is mostly unknown, although it is thought to have some genetic predisposition component along with a strong correlation with obesity or weight gain (Dlugasch and Story, 2019). Theca cells of the follicle (located in the ovary) are responsible for producing some steroid homes, such as androgen. The pituitary and theca cells relay hormones that regulate each other in a positive and negative feedback loop. According to Dlugasch and Story (2019), excess androgen along with insulin resistance are the main associated hormones that effect the symptoms of PCOS. Along with amenorrhea and infertility, hirsutism (excess hair growth especially on the face, chest, and back) as well as loss or thinning of the hair on the head can occur (NHS, n.d.)
How does Metformin contribute to treatment?
It is believed that insulin resistance is a significant contributing factor of this disease. As the muscles start to become insulin resistant the pancreas excretes more insulin to compensate the increasing amount of glucose in the blood stream. While the muscles become less sensitive to insulin’s effects, it causes theca cells in the ovaries to thicken and change the receptors and hormone loop of the ovulation cycle (Dlugasch and Story, 2019). Metformin is used to help improve the sensitivity of the insulin resistant tissues which results in the reduction of insulin in the blood (Lashen, 2010). The effect on the insulin sensitive theca cells, with less circulating insulin the theca cells will send less feedback to the pituitary lessening the symptoms of PCOS.
How does progesterone aid in treatment?
“The excessive androgens also affect the granulosa cells as they normally rely on the theca cell coordination to start progesterone and continue preovulatory follicle development” (Dlugasch and Story, p.361, 2019). Progesterone production is decreased in patients with PCOS, as granulosa cells respond to increased LH (from the pituitary) to produce progesterone. Increased LH causes premature development and release of the follicle. Patients with PCOS who take a cyclic progesterone replacement helps to reduce LH production from excess androgens helping to balance hormone cycle of PCOS.
How is infertility a symptom of PCOS?
Androgens and estrogen production are critical components of fertility. According to Dlugasch and Story (2019), androgen is produced by the ovarian theca cells while estrogen is produced by the granulosa, which effect ovulation. The excess androgen causes a hormone reaction resulting in the follicle not maturing properly, which leads to oligo-anovulation (absence of ovulation) and the infertility associated with PCOS (Dlugasch and Story, 2019).
Reference
Dlugasch, L. & Story, L. (2019). Applied Pathophysiology for the Advanced Practice Nurse. Jones &Bartlett, MA.
NHS. (n.d.). Polycystic Ovarian Syndrome. Retrieved from https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
Lashen H. (2010). Role of metformin in the management of polycystic ovary syndrome. Therapeutic advances in endocrinology and metabolism, 1(3), 117–128. https://doi.org/10.1177/2042018810380215