Ovarian Hyperthecosis

Definition - What does Ovarian Hyperthecosis mean?

Ovarian hyperthecosis refers to an increase in the number of small, active theca (or lutein) cells of the ovary under the influence of hormones.

Theca cells are specialized cells of the ovary that respond to luteinizing hormone (LH) from the pituitary to become luteinized and produce androgens (male sex hormones). These nests of luteinized theca cells spread throughout the ovary, rather than becoming restricted to sites near the follicles as in polycystic ovary syndrome (PCOS).

Ovarian hyperthecosis can be considered as a severe form of PCOS, which interferes with a woman’s potential to get pregnant. An increase in the number of the ovarian connective tissue cells, referred to as stromal hyperplasia is also seen in both ovarian hyperthecosis and PCOS.

FertilitySmarts explains Ovarian Hyperthecosis

The signs and symptoms of hyperthecosis resemble PCOS and can include:

  • Acne
  • Hirsutism (abnormal male pattern hair growth) due to the high production of androgens
  • Excess weight gain
  • Menstrual irregularities due to ovulation impairment
  • Infertility due to increased androgens and ovulation disturbances
  • Endometrial polyps, endometrial hyperplasia, and endometrial cancer due to the high production of estrogens by the enlarged ovaries

To examine the status of the ovaries, the doctor performs a pelvic ultrasound and measure hormonal levels.

What triggers hyperthecosis is unclear; however, poor ovulation may trigger an excessive release of LH from the pituitary gland. Increased LH, in turn, causes an increase in androgen production by the theca cells within the ovary.

Doctors often use gonadotropin-releasing hormone (GnRH) agonists like Lupron to suppress the pituitary production of LH and boost pregnancy rates in these women. These women, however, exhibit an exaggerated response to ovarian stimulation protocols and are prone to the overproduction of ovarian follicles and the development of ovarian hyperstimulation syndrome (OHSS). IVF stimulation protocols are, thus, customized in ovarian hyperthecosis.

The treatment of choice with hyperthecosis is often surgical removal of the ovaries (oophorectomy), especially in a woman who is past menopause.

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