Evolution of PCO criteria

 

What compromise PCO? Evolution of PCOS ??   It was  one decade before Dr Pal was born in 1945). First thought of PCO was in the minds of  Stein and Leventhal (1935) .They reported a series of seven women with polycystic ovaries and oligo/amenorrhoea, later to be known as PCOS. The chief complaints of these women were oligo/amenorrhoea with subfertility, hirsutism or lower abdominal pain. Out of the seven women in the report, five were infertile, three were obese and three had hirsutism. All the seven women in the report gained normal menstruation after wedge resection and two of them became pregnant (Stein and Leventhal, 1935). Thus, the initial diagnosis of polycystic ovaries was related to patients’ outcomes.

Stein and Leventhal (1935) diagnosed polycystic ovaries with pneumoroentgenography and laparotomy. These diagnostic methods were abandoned with the advent of hormonal assays in the 1970s (Yen et al., 1970; Rebar et al., 1976; Yen, 1980) and the introduction of high-resolution real-time ultrasonography in the 1980s (Swanson et al., 1981; Adams et al., 1985).

After stein Leventhal (1935) & WHO then the discussions on anovulation didn’t stop .It was a headache to clinicians and researchers as meanwhile people came to know this syndrome not only affects fertility but also shortens life. So there was a long demand of a standard definition.  This was initiated as “First international conference of PCOS “which was held at National Institutes of Health in 1990. Sadly, in NIH criteria formulated present was –“No research: No long term study” !!!! : It was something like political meeting as it was based on opinion based criteria and majority of opinions were taken granted. !! 

As mentioned ,it was framed  on a consensus questionnaire of the attendees, rather than clinical research data and  the following diagnostic criteria were put forth: 1)  oligo-anovulation and 2) hyperandrogenism/hyperandrogenaemia both must be present  but in the absence of all other endocrinopathies. Therefore such a definition warrants all kinds of endocrine evaluation like Cortisol, DHEASO4 , PRL ,TSH , insulin FSH, LH etc. which is next to impossible in clinical practice .