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PCOS and Male Hormone Levels During Pregnancy

A significant increase in the testosterone and other male hormones frequently occurs during the pregnancy in women with PCOS. This rarely affects the mother or causes male hormone effects in the female infant. In many ways the placenta appears to protect the female fetus from developing masculinizing changes of the external genitalia due to the increase of maternal male hormones from the ovaries.

The critical period of external genitalia development occurs between the gestational weeks 7-12. Significant first trimester exposure to very high levels of male hormones in this time frame may lead to irreversible changes of fusion of the labia and clitoral enlargement of a female fetus. There are women who may develop theca-lutein cysts of the ovaries or other types of usually benign ovarian tumors called luteomas which may be difficult to visually determine on ultrasonography until mid-gestation. These tumors are very uncommon, and in almost 50% of patients occur on both ovaries, but should be excluded if one is to minimize risk of having virilizing changes in the female infant.

Other even more rare tumors may be neoplastic and careful follow-up is necessary, and possible surgery considered. If the mother develops symptoms of virilization including a worsening of hirsutism and some enlargement of her clitoris it is likely that the female infant may become virilized as well.

Expert high-risk obstetric care is necessary in a team effort with a gynecologic oncologist and endocrinologist. One has to weigh the real risk of a procedure called percutaneous umbilical cord blood sampling to analyze the levels of testosterone and the sex of the fetus to the potential of fetal injury. Improvement and a decrease in size and regression of the theca-lutein cysts and luteomas usually occur in the postpartum period with a normalization of the elevated testosterone levels.

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