Is Polycystic Ovary Syndrome a Sexual Conflict? A Review

The document reviews the genetic and evolutionary aspects of polycystic ovary syndrome (PCOS), suggesting that it may be a result of sexual conflict. It discusses various genes associated with PCOS and their roles in the disease's pathogenesis, including their effects on glucose tolerance, hormone levels, and reproductive parameters. The review explores evolutionary theories behind the persistence of PCOS, despite its association with subfertility, suggesting that traits linked to PCOS may have offered reproductive or survival advantages in ancestral environments. These advantages include increased muscle and bone strength, a role as "allomothers," and protection against infectious diseases due to hyperandrogenism. The document posits that intralocus sexual conflict, where genetic traits beneficial in one sex are detrimental in the other, may explain the prevalence of PCOS. It concludes that PCOS-related genotypes may have been favored due to balancing selection, despite their negative impact on female fecundity, because of the advantages they provided in terms of survival and reproductive success in males.