Medical Advance

The discovery that Polycystic Ovarian Syndrome is caused by a metabolic disorder of insulin resistance is bringing hope to women who can't get pregnant and to many others who are overweight.

By Tracy Rasmussen (Eagle/Times)

Jennifer Hernandez of Exeter Township gained 100 pounds while she was pregnant with her son. Three years later, she was still bouncing from doctor to doctor looking for the reason she couldn't lose the weight.

"After a while they just look at you and say: 'You're fat. You've just got to lose the weight,' but you know it's not that easy and you've tried everything," Hernandez said.

At the same time, Hernandez was getting a medical run-around, Rebecca Zappacosta of Temple was visiting her own set of doctors trying to figure out why, after more than a year of trying, she was unable to get pregnant.

"I had been trying to get pregnant, but it was difficult because of irregular periods," said Zappacosta, a nurse. "I didn't really know what was wrong."

Both women ended up in the office of infertility specialist Dr. Vincent Pellegrini at the IVF-Fertility Division of Women's Clinic Ltd., West Reading, with the same diagnosis despite very different symptoms: Polycystic Ovarian Syndrome (PCOS).

"The diagnosis is not new," Pellegrini said. "But what is new and exciting is the the discovery that it's caused by a metabolic disorder of insulin resistance." Symptoms of the disorder that affects about 5 percent of women in their reproductive years include irregular menstrual periods, acne, male pattern hair growth (facial hair), obesity and infertility.

Pellegrini said that because it's a syndrome, there are many symptoms, but not all women have all the symptoms. What all cases do exhibit, though, is an excess of the hormones testosterone and insulin. "Every female makes testosterone," Pellegrini said. "But there's a problem with excess testosterone interfering with ovulation." The culprit, though, is not really testosterone, but insulin. In a normal cycle, carefully balanced hormones (including testosterone) rise and fall until a mature egg is released from a follicle.

In women with PCOS, excess insulin stimulates the ovary to produce too much testosterone, which causes the other hormones to be off balance as well. This causes the eggs to never reach maturity or be released and, instead, the egg dies in the ovary and the follicle swells with fluid and becomes small cysts.