Polycystic ovary syndrome (PCOS)
Hormonal dysbalance in women with PCOS are one of the major causes of female infertility. Polycystic ovary syndrome causes more than 75% of cases of anovulatory infertility. Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation is a common cause. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which, in turn, may be caused by abnormal interaction of insulin and luteinizing hormone (LH) on granulosa cells. Endocrine disruption may also directly decrease fertility, such as changed levels of gonadotropin-releasing hormone, gonadotropins (especially an increase in luteinizing hormone), hyperandrogenism, and hyperinsulinemia (increased insulin levels, resulting in insulin resistance).
Granulosa cell tumor
Granulosa cell tumors usually affects adults, juvenile forms are much rarer (usually up to 5% of granulosa cell tumors). Although in patients with early stages of the tumor, fertility-sparing surgery can be performed, in advanced stages of the disease, bilateral salpingo-oophorectomy and hysterectomy (surgical removal of the uterus, both Fallopian tubes and ovaries) has to be performed, resulting in sterility. The fertility-sparing approach does not, however, show a significantly lower rate of the overall patient survival, making it suitable especially for younger patients.