Introduction: Polycystic ovary syndrome is an intergenerational problem

The polycystic ovary syndrome (originally called the Stein–Leventhal syndrome), was popularized by the two Americans whose names have been attached to the condition for 70 years (Stein and Leventhal 1935), and was considered as a problem of anovulation and infertility. They described their treatment of anovulation using wedge resection with remarkable success. However as medical treatment became available with the utilization of clomiphene citrate (Greenblatt 1961), and subsequently the use of follicle stimulating hormone of pituitary (HPG) (Kovacs et al. 1989) and urinary source (Wang and Gemzell 1980), surgical treatment became less often used. Interestingly, surgical treatment of resistant anovulation has had a resurgence with the laparoscopic approach initially described by French gynecologists, but popularized by Gjoanness (1984). The history and current status of surgical treatment are discussed in Chapter 11. It was the use of ultrasound that transformed visualization of the ovaries (Swanson et al. 1981). (The use of imaging techniques is described in detail in Chapter 5.) It then became apparent that there were two diVerent clinical spectrums. Almost one quarter of the population had the appearance of polycystic ovaries when examined ultrasonically, but more than half of these had no clinical symptoms whatsoever (Lowe et al. 1995, Balen and Michelmore 2002). These women are referred to as having polycystic ovaries (PCO). If the ultrasonic appearance is accompanied by other symptoms, such as hyperandrogenism, the term used is polycystic ovary syndrome (PCOS). Although the exact definition of PCO/PCOS has had diVerent parameters when described by various experts, following a Consensus Conference held in Rotterdam in 2003, an internationally accepted definition has been adopted by the European Society for Human Reproduction and Embryology and the American