Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: “New” PCOS Info: 4 Types (AGAIN)
Date: November 5, 2025
Host: Dr. Chapa
Producer: Michael

Main Theme

This episode tackles the “new” research on the four subtypes of Polycystic Ovary Syndrome (PCOS), as recently published in Nature Medicine (October 29, 2025). Dr. Chapa highlights how these findings closely mirror previously discussed clinical phenotypes from March 2023, focusing on both the continuity and evolution of PCOS classification. He aims to make sense of the current literature, emphasize practical clinical implications, and keep the conversation engaging and relevant for students and practitioners.

Key Discussion Points and Insights

1. PCOS: A Brief Historical Background

• Origin of the Term (09:17)
  • The syndrome was first described in 1935 as Stein-Leventhal Syndrome, based on a case series of just seven women.
  • “[Polycystic ovary syndrome] truly is a syndrome... it is a constellation of presentations.” – Dr. Chapa (09:37)

2. The Four Traditional Clinical Phenotypes (A, B, C, D)

• Overview (14:27)
  • Dr. Chapa recaps the Rotterdam criteria—diagnosis requires two of three: hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology.
  • “Stop putting PCOS patients into a box. It is actually a spectrum.” – Dr. Chapa (12:35)
• Phenotype Details (15:55–17:10)
  • A: Classic PCOS – Hyperandrogenism + ovulatory dysfunction + polycystic ovarian morphology.
  • B: Non-polycystic ovarian morphology PCOS – Hyperandrogenism + ovulatory dysfunction, but normal ovarian morphology.
  • C: Ovulatory PCOS – Hyperandrogenism + polycystic ovaries, but regular ovulation/cycles.
  • D: Non-hyperandrogenic PCOS – Ovulatory dysfunction + polycystic ovaries, without hyperandrogenism.
  • “A patient may jump from A to B. She can go from B to A because it changes as... the body changes and adapts.” – Dr. Chapa (12:59)

3. New “Lab-Driven” Subtypes from Nature Medicine (Oct 2025)

• Data Overview (17:27–18:56)

  • The study applied clustering analysis to ~12,000 women across five international cohorts (China, US, Europe, Singapore, Brazil) using nine clinical/lab variables.
  • While methodologically more complex, findings reinforce the existence and clinical relevance of four subtypes.

• Lab-based Subtypes Explained (23:07–25:28)

  • HA PCOS (Hyperandrogenic): High testosterone/DHEAS, plus metabolic disorders.
  • OB PCOS (Obesity-related): Higher BMI, metabolic derangement (e.g., elevated fasting insulin/glucose).
  • SHBG PCOS: High sex hormone binding globulin variant.
  • LH/AMH PCOS: High luteinizing hormone + elevated anti-mullerian hormone (reflecting follicle numbers).

  “It’s the exact same thing—four different phenotypes, but now using lab criteria and/or biochemical classifications.”
  — Dr. Chapa (24:26)

• Clinical Takeaway

  • Regardless of “schema” (A–D vs. lab-based), recognize PCOS is heterogenous and not all patients fit the classic poster image.

4. Clinical Outcomes & Implications

A. Pregnancy & IVF Outcomes (25:32–28:45)

• Pregnancy risks remain similar across all subtypes—higher rates of gestational diabetes and hypertensive disorders.
  • “Of course PCOS is linked to things like gestational hypertension and all hypertensive disorders in pregnancy and gestational diabetes. And lo and behold, that's what they found. Again, nada new under the sun.” – Dr. Chapa (04:32)
• IVF Success Rates:
  • All subtypes saw >60% clinical pregnancy rates.
    • HA PCOS: 66%
    • OB PCOS: 62% (slightly lower due to metabolic impact of obesity)
    • SHBG PCOS: 67%
    • LH/AMH PCOS: 66%
  • However, miscarriage rates remain elevated (upper 20%–low 30%).
  • Ovarian hyperstimulation syndrome remains a known risk for PCOS patients.
  • Dr. Chapa suggests these findings are “good news,” but not surprising.

B. Practical Advice for Providers (28:46–30:17)

• Labs important for subclassification and management: fasting glucose, insulin, HbA1c, thyroid panel, ultrasound.
• Educate patients that classification may change over time, as their condition evolves.
• Use any schema (clinical or lab-based), but be consistent and individualized in care approach.

Notable Quotes & Memorable Moments

• Dr. Chapa, on “new” research:

  “Nothing. Nothing. Nada. That’s for my Hispanic brothers and sisters. Nada. Under the sun. That is new.” (02:19)

• On phenotypic flexibility:

  “A patient may jump from A to B. She can go from B to A because it changes as the system and the body changes and adapts.” (12:59)

• On clinical translation:

  “Stop putting PCOS patients in a box. It is actually a spectrum.” (12:35)

• Recurring banter from Producer Michael:

  “I told you. I told you. I told you.” (01:32, multiple times throughout, humorously underscoring the episode’s theme of déjà vu in medical literature)

• On the differences between classification systems:

  “Pick a schema, it doesn’t matter...The take home message here, guys, is whether you call this phenotype A, B, and C or HA PCOS or OB PCOS or SHBG PCOS, whatever, just know there’s four different phenotypes.” (24:30)

Important Segment Timestamps

| Timestamp | Segment | |:----------|:------------------------------------------------| | 00:38 | Introduction to previous episode & new research | | 09:17 | Brief history of PCOS/Stein-Leventhal syndrome | | 14:27 | Rotterdam Criteria and Clinical Phenotypes | | 15:55 | Detailed A, B, C, D phenotype breakdown | | 17:27 | New 2025 publication (Nature Medicine) | | 23:07 | Breakdown of new lab-based subtype nomenclature | | 25:32 | IVF outcome data for PCOS subtypes | | 28:46 | Clinical takeaways & approach to PCOS management | | 31:11 | Episode wrap-up and community appreciation |

Conclusion

Dr. Chapa’s episode dispels the myth that recent publications on PCOS subtyping are genuinely novel, validating the four-phenotype framework he and others have long promoted. Whether via clinical or lab-based classification, recognizing PCOS as a heterogeneous, dynamic syndrome is critical for individualized patient care. The real “pearl”: Stay aware of phenotype diversity and evolving presentations, use a structured but flexible approach, and never underestimate the importance of patient education and thorough metabolic assessment.

For deeper learning: See show notes for links to the 2023 PCOS phenotypes episode and the referenced Nature Medicine article.