Polycystic Ovary Syndrome and Pregnancy: Is Metformin the Magic Bullet?

History of Polycystic Ovary Syndrome Although the first description of polycystic ovary syndrome (PCOS) is generally credited to Stein and Leventhal in 1935, it may have been observed as early as 1721, when the Italian scientist Antonio Vallisneri observed “young married peasant women, moderately obese and infertile, with two larger than normal ovaries, bumpy and shiny, whitish, just like pigeon eggs.” This depiction sounds strikingly similar to the subfertility and obesity commonly found in PCOS. It was not until 1921 that Achard and Theirs noticed a relationship between hyperandrogenism and insulin resistance in their study of the “bearded diabetic woman.” And in 1935, Stein and Leventhal made the connection between amenorrhea and polycystic ovaries. In addition, they also noticed the occurrence of masculinizing changes, such as hirsutism and acne, in many patients with polycystic ovaries. Several, but not all, of Stein and Leventhal’s original case studies involved women who were overweight. In all seven of their case reports, attempts to treat ovulatory dysfunction with estrogenic hormone failed, and wedge resection was employed. All of their patients gained normal menstruation, and two became pregnant. Surgery for PCOS is uncommon now, although some centers still employ laser drilling of the ovary as a means of inducing ovulation.