Delayed (oligomenorrhea) and/or missed (amenorrhea) menses are the most common feature in group A and group B women with polycystic ovary syndrome. However,group-C women with polycystic ovary syndrome have regular menses.

The number of menses are usually equivalent to the number of ovulation. Although, a small group of women with polycystic ovary syndrome can menstruate without ovulation. Therefore, it is important to determine these women  who are menstruating regularly without ovulation in infertility practice, particularly, group-C women with polycystic ovary syndrome.

In the human ovary, 2 million eggs (oocytes) are found at birth. However, only 400 eggs are normally ovulated, because approximately 400 menstrual cycles oçcur during female reproductive life. At the time of menopause, no egg can be found in the ovary which results in termination of menstruation. What did happen to the rest of eggs which are present at birth?

99.9% of human eggs die (atresia) during female reproductive life.

The number of eggs (ovarian reserve) at birth is not different in women with polycystic ovary syndrome compared to normal women. However, these women lose less eggs than normal women, because delayed (oligomenorrhea) and/or missed (amenorrhea) menses. But, this difference does not change the time of menarche (first menstruation) and menopause (last menstruation) in women with polycystic ovary syndrome.

On ultrasound examination;  black, vesicular (saccular) shapes are small eggs which are present characteristically  in polycystic ovaries . The appearence of ovaries is different in normal women.

These eggs are simply arrested in their development without becoming death (atretic), which leads to the accumulation of multiple small eggs in polycystic ovaries.

                                                  Reference

Granulosa cell survival and proliferation are altered in polycystic ovary syndrome. J Clin Endocrinol Metab. 2008 Mar;93(3):881-7. 

Hacihanefioglu B, Das M, Djahanbakhch O, , Saridogan E, Ikram M, Ghali L, Raveendran M, Storey A.

Academic Department of Women's Health, Barts and The London, Queen Mary's School of Medicine, University of London, and Newham University Hospital National Health Service Trust, London, UK.