Polycystic ovaries are defined as enlarged ovaries with multiple small follicles. If there are 12 or more follicles in each ovary, this is classified as PCOS. Women with PCOS usually present with enlarged ovaries with numerous enlarged peripheral cystic follicles and increased central stroma (the middle section of the ovary which produces androgens).
Many studies suggest that the polycystic appearance is due to increased production of androgens, which leads to a lack of ovulation resulting in the follicle atresia (arrested development).
Many of the cysts that occur in a polycystic ovary are follicles that will eventually mature to produce an egg, but due to abnormal hormone levels, have never ovulated. The term polycystic ovaries does not imply that the ovaries contain many cysts, it only refers to the ultrasound finding of ovaries with many small follicles (usually 12 or more) in each ovary.
At AFCT, we like to manage our PCOS patients with regular ultrasounds and/or sonohysterograms. In cases that there are polyps, we may need to perform a hysteroscopy.