Molecular progress in infertility: polycystic ovary syndrome.
OBJECTIVE
To review the evidence that polycystic ovary syndrome is a genetic disease.


METHODS
Review of published literature.


RESULTS
The existing literature provides a strong basis for arguing that PCOS clusters in families. However, the mode of inheritance of the disorder is still uncertain, although the majority of studies are consistent with an autosomal dominant pattern, modified perhaps by environmental factors. In addition, studies on PCOS cells (theca, muscle, and adipocytes) in culture have documented a persistent biochemical and molecular phenotype that distinguishes them from normal cells. Although several loci have been proposed as PCOS genes including CYP11A, the insulin gene, and a region near the insulin receptor, the evidence supporting linkage is not overwhelming. The strongest case can be made for the region near the insulin receptor gene, as it has been identified in two separate studies. However, the responsible gene at chromosome 19p13.3 remains to be identified. Association studies have provided a number of potential loci with genetic variants that may create or add to a PCOS phenotype, including Calpain 10, IRS-1 and -2, and SHBG.


CONCLUSIONS
Collectively, these findings are consistent with the concept that a gene or several genes are linked to PCOS susceptibility. Because the mutations/genotypes associated with PCOS are rare, and their full impact on the phenotype incompletely understood, routine screening of women with PCOS or stigmata of PCOS for these genetic variants is not indicated at this time. Currently the treatment implications for individually identified genetic variants is uncertain and must be addressed on a case by case basis.
Legro
Richard S
RS
Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey 17033, USA. rsl1@psu.edu
Strauss
Jerome F
JF
D002478:Cells, Cultured; D002786:Cholesterol Side-Chain Cleavage Enzyme / Q000235:genetics; D002874:Chromosome Mapping; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D005260:Female; D008040:Genetic Linkage; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000209:etiology; D008285:Major Histocompatibility Complex; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000453:epidemiology / Q000235:genetics* / Q000503:physiopathology; D015995:Prevalence; D011944:Receptors, Androgen / Q000235:genetics; D014481:United States / Q000453:epidemiology
D011944:Receptors, Androgen; D003577:Cytochrome P-450 Enzyme System; D002786:Cholesterol Side-Chain Cleavage Enzyme