Polycystic ovary syndrome as an autoimmune disease: a new concept

Abstract

Background: Polycystic ovary syndrome (PCOS) is characterized by a chronic hyperandrogenic anovulatory state. Several mechanisms have been proposed, but the pathogenesis is still under discussion.Objectives: To determine whether an autoimmune reaction could contribute to this syndrome, and to determine the association between this syndrome and one of immunological upset (ie, the antisperm antibodies).Methods: Thirty-five cases of proven PCOS were enrolled in the study (mean age 25.3 ± 5.2). The criteria of diagnosis are based on hyperandrogenemia, high LH, ultrasonographic appearance of polymicrocystic ovaries with stromal hyperthropathy detection of circulating antiovarian antibodies. Antisperm antibodies in the serum and cervical mucus were detected by ELISA using human ovaries as antigens were expressed as the ratio of the optical density (OD) of each serum to the reference OD equivalent to the mean ± 2 SD of that obtained by a reduced variable method with control samples from 25 normal healthy control women with a mean age of 26.5 ± 3.7. The controls were without any autoimmune disease. Values >8.1 were considered as positive.Results: There was a statistically significant higher mean ratio for the patients with PCOS than for the control: IgG, P <0.0002; IgA, P <0.001; and IgM, P <0.001.The specificity of these antiovarian antibodies was significantly higher in 15 women with positive antinuclear antibodies; and a positive ratio for IgG was present in 52%, IgA in 22%, and IgM in 38%. Positive association of cervical antisperm antibodies was found in 20 of 35 patients with PCOS, which is highly significant compared with normal controls (P <0.001). Serum antisperm antibodies were found in 15 cases of PCOS, mixed 2 types cervical, and serum sperm antibodies were found in 17 cases (highly statistically significant, P <0.005).Conclusions: A high concentration of antiovarian antibodies suggests that immune reaction is associated with PCOS; a high concentration of antisperum antibodies suggests an association of the two conditions with PCOS. A new theory has been proposed that this immunological reaction leads to inflammatory reaction, and they will lead to abnormal production of cytokines that will in turn lead to overt biochemical changes in PCOS. Steroid therapy is well known in the treatment of antisperm antibodies and it can be used as adjuvant in ovulation induction in PCOS.