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Pea J, Bryan J, Wan C, Oldfield AL, Ganga K, Carter FE, Johnson LM, Lujan ME. Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: a systematic review and diagnostic meta-analysis. Hum Reprod Update 2024; 30:109-130. [PMID: 37804097 PMCID: PMC10762001 DOI: 10.1093/humupd/dmad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Polycystic ovary morphology (PCOM) on ultrasonography is considered as a cardinal feature of polycystic ovarian syndrome (PCOS). Its relevance as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM. OBJECTIVE AND RATIONALE The aim of this systematic review and diagnostic meta-analysis was to assess the diagnostic accuracy of various ultrasonographic features of ovarian morphology in the diagnosis of PCOS. SEARCH METHODS Relevant studies published from 1 January 1990 to 12 June 2023 were identified by a systematic search in PubMed, Web of Science, Scopus, CINAHL, and CENTRAL. Studies that generated diagnostic accuracy measures (e.g. proposed thresholds, sensitivity, specificity) for PCOS using the following ultrasonographic markers met criteria for inclusion: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Studies on pregnant or post-menopausal women were excluded. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. Diagnostic meta-analysis was conducted using a bivariate model of pooled sensitivity and specificity, and visualized using forest plots and summary receiver-operating characteristic (SROC) curves. OUTCOMES From a total of 2197 records initially identified, 31 studies were included. Data from five and two studies were excluded from the meta-analysis due to duplicate study populations or limited data for the index test, leaving 24 studies. Pooled results of 20 adult studies consisted of 3883 control participants and 3859 individuals with PCOS. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81-87%; specificity: 91%, CI: 86-94%; AUC: 0.905) in adult women. OV and FNPS had similar pooled sensitivities (OV: 81%, CI: 76-86%; FNPS: 81%, CI: 70-89%) but inferior pooled specificities (OV: 81%, CI: 75-86%; FNPS: 83%, CI: 75-88%) and AUCs (OV: 0.856; FNPS: 0.870) compared to FNPO. Pooled results from four adolescent studies consisting of 210 control participants and 268 girls with PCOS suggested that OV may be a robust ultrasonographic marker for PCOS diagnosis albeit the current evidence remains limited. The majority of the studies had high risk of bias for the patient selection (e.g. lack of randomized/consecutive patient selection) and index test (e.g. lack of pre-proposed thresholds for comparison) domains across all ultrasonographic markers. As such, diagnostic meta-analysis was unable to determine the most accurate cutoff for ultrasonographic markers to diagnose PCOS. Subgroup analysis suggested that stratification based on previously proposed diagnostic thresholds, age, BMI, or technology did not account for the heterogeneity in diagnostic accuracy observed across the studies. Studies that diagnosed PCOS using the Rotterdam criteria had improved sensitivity for FNPO. Studies from North America had lower diagnostic accuracy when compared to Asian studies (FNPO: sensitivity) and European studies (OV: specificity, diagnostic odds ratio and positive likelihood ratio). Geographic differences in diagnostic accuracy may potentially be due to differences in age, BMI, and diagnostic criteria of the PCOS group across regions. WIDER IMPLICATIONS This diagnostic meta-analysis supports the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS in adult women. OV and FNPS provide alternatives if total antral follicle counts cannot be accurately obtained. Our findings support the potential for ultrasonographic evidence of PCOM in adolescents as more data becomes available. Subgroup analysis suggests the need to investigate any relative contributions of geographical differences on PCOS phenotypes. These findings may provide the basis for the development of strategies and best practices toward a standardized definition of PCOM and a more accurate ultrasonographic evaluation of PCOS.
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Affiliation(s)
- Jeffrey Pea
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Jahnay Bryan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Cynthia Wan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Alexis L Oldfield
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Kiran Ganga
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Faith E Carter
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Lynn M Johnson
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY, USA
| | - Marla E Lujan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
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Chen Y, Wu WJ, Xing LW, Zhang XJ, Wang J, Xia XY, Zhao R, Zhao R. Investigating the role of mitochondrial DNA D-loop variants, haplotypes, and copy number in polycystic ovary syndrome: implications for clinical phenotypes in the Chinese population. Front Endocrinol (Lausanne) 2023; 14:1206995. [PMID: 37745710 PMCID: PMC10512090 DOI: 10.3389/fendo.2023.1206995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/11/2023] [Indexed: 09/26/2023] Open
Abstract
Background The presence of genetic variations in mitochondrial DNA (mtDNA) has been associated with a diverse array of diseases. The objective of this study was to examine the correlations between mtDNA D-loop, its haplotypes, and polycystic ovary syndrome (PCOS) in the Chinese population, and the associations between mtDNA D-loop and symptoms of PCOS. The study also sought to determine whether the mtDNA copy number in Chinese patients with PCOS differed from that of individuals in the control group. Methods Infertile individuals who only had tubal or male factor treatment were the focus of research by The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). mtDNA haplotypes were categorized using polymorphic D-loop sites. mtDNA D-loop, PCOS features, and mtDNA haplotypes were analyzed using R software to determine the strength of the association between the three. There are certain DNA haplotypes linked to PCOS. Microdroplet digital polymerase chain reaction (PCR) was used to determine the mtDNA copy number in a convenience sample of 168 PCOS patients and 83 controls. Results Among the research group, the majority of D-loop mutations were infrequent (frequency< 1%), with only 45 variants displaying a minimum allele frequency (MAF) of 5% or higher. No association was found between polymorphism loci in PCOS patients and body mass index (BMI). Noteworthy, C194T, 1A200G, 523delAC, and C16234T showed positive correlations with elevated LH/FSH levels. Additionally, specific polymorphic loci G207A, 16036GGins, and 16049Gins within the D-loop region of mtDNA potentially exerted a protective role in PCOS development. Conversely, no statistical significance was observed in the expression levels of C16291T and T489C. Chinese women with mtDNA haplotype A15 exhibited a decreased risk of developing PCOS. Moreover, a significant difference in mtDNA copy number was detected, with controls averaging 25.87 (21.84, 34.81), while PCOS patients had a mean of 129.91 (99.38, 168.63). Conclusion Certain mtDNA D-loop mutations and haplotypes appear to confer protection against PCOS in Chinese women. In addition, elevated mtDNA copy number may serve as an indicator during early stages of PCOS.
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Affiliation(s)
- Yang Chen
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Department of TCM (Traditional Chinese Medicine), Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Wei-jia Wu
- Department of Scientific Research, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Li-wei Xing
- Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Xiao-juan Zhang
- Department of TCM (Traditional Chinese Medicine), Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Jing Wang
- Department of TCM (Traditional Chinese Medicine), Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Xiao-yan Xia
- Department of TCM (Traditional Chinese Medicine), Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Rui Zhao
- Department of TCM (Traditional Chinese Medicine), Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Rong Zhao
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Yunnan University of Chinese Medicine, Kunming, Yunnan, China
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Current Guidelines for Diagnosing PCOS. Diagnostics (Basel) 2023; 13:diagnostics13061113. [PMID: 36980421 PMCID: PMC10047373 DOI: 10.3390/diagnostics13061113] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. Much of the confusion surrounding PCOS diagnosis stems from the broad heterogeneity of symptomology experienced by women with PCOS. The diverse features of the syndrome have led to a number of diagnostic criteria over the years. This manuscript describes each of the current composite criteria and individually breaks down each component. The importance of accurate diagnosis for both clinical care and research is emphasized.
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Moro F, Scavello I, Maseroli E, Rastrelli G, Baima Poma C, Bonin C, Dassie F, Federici S, Fiengo S, Guccione L, Villani M, Gambineri A, Mioni R, Moghetti P, Moretti C, Persani L, Scambia G, Giorgino F, Vignozzi L. The physiological sonographic features of the ovary in healthy subjects: a joint systematic review and meta-analysis by the Italian Society of Gynecology and Obstetrics (SIGO) and the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2023; 46:439-456. [PMID: 36422829 PMCID: PMC9938076 DOI: 10.1007/s40618-022-01939-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE There is a lack of uniformity in the definition of normal ovary ultrasound parameters. Our aim was to summarize and meta-analyze the evidence on the topic. Full-text English articles published through December 31, 2020 were retrieved via MEDLINE and Embase. Data available for meta-analysis included: ovarian follicular count, ovarian volume, and ovarian Pulsatility Index (PI) assessed by Doppler ultrasound. METHODS Cohort, cross-sectional, prospective studies with a single or double arm were considered eligible. Interventional studies were included when providing baseline data. Both studies on pre- and post-menopausal women were screened; however, data on menopausal women were not sufficient to perform a meta-analysis. Studies on pre-pubertal girls were considered separately. Eighty-one papers were included in the meta-analysis. RESULTS The mean ovarian volume was 6.11 [5.81-6.42] ml in healthy women in reproductive age (5.81-6.42) and 1.67 ml [1.02-2.32] in pre-pubertal girls. In reproductive age, the mean follicular count was 8.04 [7.26-8.82] when calculated in the whole ovary and 5.88 [5.20-6.56] in an ovarian section, and the mean ovarian PI was 1.86 [1.35-2.37]. Age and the frequency of the transducers partly modulated these values. In particular, the 25-30-year group showed the higher mean follicular count (9.27 [7.71-10.82]), followed by a progressive age-related reduction (5.67 [2.23-9.12] in fertile women > 35 years). A significant difference in follicular count was also found according to the transducer's upper MHz limit. CONCLUSION Our findings provide a significant input to improve the interpretation and diagnostic accuracy of ovarian ultrasound parameters in different physiological and pathological settings.
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Affiliation(s)
- F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - I Scavello
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - G Rastrelli
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - C Baima Poma
- Consultorio Familiare ASL Città di Torino, Turin, Italy
| | - C Bonin
- Unit of Obstetrics and Gynecology B, Department of Women and Children's Health, AOUI Verona, Verona, Italy
| | - F Dassie
- Department of Medicine, Clinica Medica 3-Azienda Ospedaliera, University of Padua, Padua, Italy
| | - S Federici
- Unit of Andrology and Reproductive Endocrinology, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | - S Fiengo
- Department of Obstetrics and Gynaecology, ARNAS Civico Hospital, Palermo, Italy
| | - L Guccione
- Department of Systems' Medicine, University of Tor Vergata, Rome, Italy
| | - M Villani
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - A Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R Mioni
- Department of Medicine, Clinica Medica 3-Azienda Ospedaliera, University of Padua, Padua, Italy
| | - P Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - C Moretti
- Department of Systems' Medicine, University of Tor Vergata, Rome, Italy
| | - L Persani
- Unit of Andrology and Reproductive Endocrinology, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20121, Milan, Italy
| | - G Scambia
- Istituto Di Clinica Ostetrica E Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - L Vignozzi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy.
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Vanden Brink H, Jarrett BY, Pereira N, Spandorfer SD, Hoeger KM, Lujan ME. Diagnostic Performance of Ovarian Morphology on Ultrasonography across Anovulatory Conditions-Impact of Body Mass Index. Diagnostics (Basel) 2023; 13:diagnostics13030374. [PMID: 36766481 PMCID: PMC9914229 DOI: 10.3390/diagnostics13030374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The study objectives were to determine whether ovarian morphology can distinguish between women with regular menstrual cycles, normo-androgenic anovulation (NA-Anov), and PCOS and whether body mass index (BMI)-specific thresholds improved diagnostic potential. Women with PCOS (biochemical and/or clinical hyperandrogenism and irregular cycles; N = 66), NA-Anov (irregular cycles without clinical and/or biochemical hyperandrogenism; N = 64), or regular cycles (controls; cycles every 21-35 days in the absence of clinical or biochemical hyperandrogenism; N = 51) were evaluated. Participants underwent a reproductive history, physical exam, transvaginal ultrasound, and a fasting blood sample. Linear regression analyses were used to assess the impact of BMI on ovarian morphology across groups. The diagnostic performance of ovarian morphology for anovulatory conditions, and by BMI (lean: <25 kg/m2; overweight: ≥25 kg/m2), was tested using Receiver Operating Characteristic (ROC) curves. Follicle number per ovary (FNPO) and ovarian volume (OV), but not follicle number per cross-section (FNPS), increased across controls, NA-Anov, and PCOS. Overall, FNPO had the best diagnostic performance for PCOS versus controls (AUCROC = 0.815) and NA-Anov and controls (AUCROC = 0.704), and OV to differentiate between PCOS and NA-Anov (AUCROC = 0.698). In lean women, FNPO best differentiated between PCOS and controls (AUCROC = 0.843) and PCOS versus NA-Anov (AUCROC = 0.710). FNPS better distinguished between NA-Anov and controls (AUCROC = 0.687), although diagnostic performance was lower than when thresholds were generated using all participants. In women with overweight and obesity, OV persisted as the best diagnostic feature across all analyses (PCOS versus control, AUCROC = 0.885; PCOS versus NA-Anov, AUCROC = 0.673; NA-Anov versus controls, AUCROC = 0.754). Ovarian morphology holds diagnostic potential to distinguish between NA-Anov and PCOS, with marginal differences in diagnostic potential when participants were stratified by BMI suggesting that follicle number may provide better diagnostic performance in lean women and ovarian size in those with overweight.
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Affiliation(s)
- Heidi Vanden Brink
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Department of Nutrition, Texas A&M University, College Station, TX 77840, USA
| | | | - Nigel Pereira
- Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Steven D. Spandorfer
- Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Kathy M. Hoeger
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY 14620, USA
| | - Marla E. Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Correspondence:
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Polycystic ovary syndrome and iron overload: biochemical link and underlying mechanisms with potential novel therapeutic avenues. Biosci Rep 2023; 43:232133. [PMID: 36408981 PMCID: PMC9867939 DOI: 10.1042/bsr20212234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder in women with components of significant genetic predisposition and possibly multiple, but not yet clearly defined, triggers. This disorder shares several clinical features with hemochromatosis, a genetically defined inheritable disorder of iron overload, which includes insulin resistance, increased adiposity, diabetes, fatty liver, infertility, and hyperandrogenism. A notable difference between the two disorders, however, is that the clinical symptoms in PCOS appear at much younger age whereas they become evident in hemochromatosis at a much later age. Nonetheless, noticeable accumulation of excess iron in the body is a common finding in both disorders even at adolescence. Hepcidin, the iron-regulatory hormone secreted by the liver, is reduced in both disorders and consequently increases intestinal iron absorption. Recent studies have shown that gut bacteria play a critical role in the control of iron absorption in the intestine. As dysbiosis is a common finding between PCOS and hemochromatosis, changes in bacterial composition in the gut may represent another cause for iron overload in both diseases via increased iron absorption. This raises the possibility that strategies to prevent accumulation of excess iron with iron chelators and/or probiotics may have therapeutic potential in the management of polycystic ovary syndrome.
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Giménez-Peralta I, Lilue M, Mendoza N, Tesarik J, Mazheika M. Application of a new ultrasound criterion for the diagnosis of polycystic ovary syndrome. Front Endocrinol (Lausanne) 2022; 13:915245. [PMID: 36120462 PMCID: PMC9478114 DOI: 10.3389/fendo.2022.915245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To define which ultrasound criteria could replace the classic Rotterdam criteria as the best indicator of the risk of developing endocrine-metabolic changes in women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS This multicenter cross-sectional study included 200 women with PCOS and one control group of 111 women without PCOS. The primary outcomes to be considered were follicular count, hirsutism, total testosterone levels, free androgen index (FAI), and insulin sensitivity (HOMA-IR), and the secondary outcome was the anti-Müllerian hormone (AMH) level. RESULTS The main finding in this study points toward a different ultrasound criterion-23 or more follicles of any size in at least one ovary, which is postulated as an alternative to the classic criterion described in the Rotterdam consensus. This criterion correlates better with the other two PCOS criteria and also identifies women at increased risk of hirsutism (Ferriman-Gallwey score: 6.08 ± 3.54 vs. 4.44 ± 3.75, p < 0.0001), total testosterone levels (2.24 ± 0.298 vs. 1.42 ± 1.530, p = 0.0001), FAI (4.85 ± 0.83 vs. 2.12 ± 1.93, p < 0.001), and insulin resistance (HOMA-IR: 1.74 ± 0.182 vs. 1.504 ± 0.230, p = 0.001) more accurately. Regarding AMH, large differences in their mean values were observed between the groups (7.07 vs. 4.846 ng/ml, p = 0.000). However, these differences depended on age. CONCLUSION The ovarian ultrasound examination with 23 or more follicles of any size in any of the ovaries constitutes a powerful tool to accurately diagnose PCOS and to associate it with metabolic-endocrine processes such as hyperandrogenism and insulin resistance.
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Affiliation(s)
| | | | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Granada, Spain
- Clínica MAR&Gen, Granada, Spain
| | - Jan Tesarik
- Clínica MAR&Gen, Granada, Spain
- *Correspondence: Jan Tesarik,
| | - Marina Mazheika
- Unidad de Reproducción Hospital Mediterráneo, Almería, Spain
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Islam H, Masud J, Islam YN, Haque FKM. An update on polycystic ovary syndrome: A review of the current state of knowledge in diagnosis, genetic etiology, and emerging treatment options. WOMEN'S HEALTH 2022; 18:17455057221117966. [PMID: 35972046 PMCID: PMC9386861 DOI: 10.1177/17455057221117966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age, which is still incurable. However, the symptoms can be successfully managed with proper medication and lifestyle interventions. Despite its prevalence, little is known about its etiology. In this review article, the up-to-date diagnostic features and parameters recommended on the grounds of evidence-based data and different guidelines are explored. The ambiguity and insufficiency of data when diagnosing adolescent women have been put under special focus. We look at some of the most recent research done to establish relationships between different gene polymorphisms with polycystic ovary syndrome in various populations along with the underestimated impact of environmental factors like endocrine-disrupting chemicals on the reproductive health of these women. Furthermore, the article concludes with existing treatments options and the scopes for advancement in the near future. Various therapies have been considered as potential treatment through multiple randomized controlled studies, and clinical trials conducted over the years are described in this article. Standard therapies ranging from metformin to newly found alternatives based on vitamin D and gut microbiota could shine some light and guidance toward a permanent cure for this female reproductive health issue in the future.
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Affiliation(s)
- Hiya Islam
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Jaasia Masud
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Yushe Nazrul Islam
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Fahim Kabir Monjurul Haque
- Microbiology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
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Kim JJ, Hwang KR, Chae SJ, Yoon SH, Choi YM. Impact of the newly recommended antral follicle count cutoff for polycystic ovary in adult women with polycystic ovary syndrome. Hum Reprod 2021; 35:652-659. [PMID: 32211797 DOI: 10.1093/humrep/deaa012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/17/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the impact of the newly recommended antral follicle count (AFC) cutoff for polycystic ovary (PCO) on the diagnostic status of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Among patients with phenotypes requiring the presence of PCO for diagnosis, approximately half (48.2%) were excluded from having PCOS based on the new AFC cutoff, although these excluded women had worse metabolic and hormonal profiles than the controls and were indistinguishable from the remaining patients with regard to major hormonal and metabolic parameters. WHAT IS KNOWN ALREADY In the Rotterdam criteria, PCO is defined as either 12 or more follicles measuring 2-9 mm in diameter or an increased ovarian volume >10 cm3. Recently, an international PCOS guideline development group recommended an AFC threshold for PCO of ≥20 in adult women when using transducers with a high-resolution frequency, including 8 MHz. STUDY DESIGN, SIZE, DURATION The current study used a case control design. PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was diagnosed according to the Rotterdam criteria. Ultrasonography examinations were conducted with wide band frequency (5-9 MHz) transvaginal transducers and the centre frequency was 8 MHz. In patients who show both irregular menstruation and hyperandrogenism (HA), a diagnosis of PCOS can be made irrespective of the ovarian criteria change. Patients who were diagnosed according to HA and PCO (n = 86) or irregular menstruation and PCO (n = 443) were initially included among a total of 1390 adult women with PCOS (aged 20-40 years). Regardless of the AFC, if the ovarian volume is ≥10 cm3, a diagnosis of PCO can still be made. Thus, only patients who had an ovarian volume of <10 cm3 were analysed. Subjects who had an AFC of 12-19 and an ovarian volume <10 cm3 were designated as the 'low AFC group' (n = 255) and were the main focus of the study because they were excluded from having PCOS based on the new cutoff. Subjects with an AFC ≥20 and an ovarian volume <10 cm3 were designated as the 'high AFC group' (n = 101). A total of 562 premenopausal women without PCOS were enrolled as controls. MAIN RESULTS AND THE ROLE OF CHANCE Among patients with irregular menstruation and PCO or HA and PCO phenotypes, approximately half (48.2%, 255/529) were excluded from having PCOS, which corresponded to one-fifth (18.3%, 255/1390) of the total adult patients. However, compared to the control group, these excluded women had worse metabolic profiles and were more androgenised. Notably, they were indistinguishable from the 'high AFC group' with regard to major hormonal and metabolic parameters (BMI and diabetic classification status, and the prevalence of insulin resistance, metabolic syndrome and HA). LIMITATIONS, REASONS FOR CAUTION We cannot exclude the possibility of inter- and intraobserver variation in the evaluation of AFC. WIDER IMPLICATIONS OF THE FINDINGS With the newly recommended follicle count cutoff, a substantial proportion of women with PCOS might be classified as not having PCOS despite visiting a hospital due to irregular menstruation or hyperandrogenic symptoms. A practical approach to them would involve controlling the menstrual or hyperandrogenic symptoms in hand and regularly evaluating them regarding newly developed or worsening PCOS-related symptoms or metabolic abnormalities. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a grant from the Seoul National University Hospital Research Fund (No. 2520140090), Republic of Korea. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, 07061, Korea
| | - Soo Jin Chae
- Department of Obstetrics and Gynecology, Maria Fertility Hospital, Seoul, 02586, Korea
| | - Sang Ho Yoon
- Department of Obstetrics and Gynecology, School of Medicine, Dongguk University, Seoul, 04620, Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Korea
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10
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A comparison of two- and three-dimensional ultrasonographic methods for evaluation of ovarian follicle counts and classification of polycystic ovarian morphology. Fertil Steril 2021; 115:761-770. [PMID: 33618897 DOI: 10.1016/j.fertnstert.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the level of agreement across assessments of follicle number per ovary (FNPO) and classifying of polycystic ovarian morphology (PCOM; FNPO ≥25) with the use of various real-time (RT) and off-line two-dimensional (2D) and three-dimensional (3D) ultrasonographic methods. DESIGN Method comparison study. SETTING University-based clinical research unit. PATIENT(S) Sixteen women with and without PCOM. INTERVENTION Thirty-two ovaries were analyzed with the use of eight ultrasonographic methods: 2D-Grid (reference method), 2D-RT, 2D-RT with Grid, multiplanar view (MPV), MPV-RT, tomographic ultrasound imaging (TUI), TUI-RT, and semiautomated volume calculation (SonoAVC). MAIN OUTCOME MEASURE(S) FNPO, PCOM status, and time to obtain FNPO. Clinical feasibility, defined as the time taken to obtain FNPO, also was evaluated. RESULT(S) 2D-RT overestimated FNPO versus 2D-Grid (3 ± 9 follicles) owing to overcounting in non-PCOM ovaries (6 ± 6 follicles). However, systematic bias was not detected when a grid overlay was incorporated (2D-RT with Grid). SonoAVC underestimated FNPO (-3 ± 5 follicles), particularly in PCOM ovaries (-4.1 ± 5.0 follicles). No bias in FNPO was detected between MPV, TUI, or TUI-RT versus 2D-Grid. 2D-RT significantly misclassified ovaries as PCOM. All methods except MPV took less time to complete FNPO assessments compared with 2D-Grid. CONCLUSION(S) Variability in FNPO across ultrasonographic methods limits their interchangeable use, particularly when a precise metric is needed. 2D-RT may be problematic owing to its propensity to misclassify PCOM. 2D-RT with Grid and MPV-RT could represent clinically feasible alternatives to obtain FNPO and classify PCOM. Efforts to reduce variation in FNPO will clarify the relevance of PCOM in women's health.
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11
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Bozkurt M, Kara Bozkurt D, Kurban D, Takmaz T, Sevket O, Ozcan P. 2-D and 3-D ultrasonographic characteristics of the ovary in women with PCOS and multifollicular ovaries. J OBSTET GYNAECOL 2020; 41:920-926. [PMID: 33064032 DOI: 10.1080/01443615.2020.1803244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this prospective study, seventy-six patients (PCOS group; n = 36, multifollicular ovary group; n = 40) were evaluated by 2-D and 3-D ultrasonography. VOCAL programme, echogenicity, number of follicles and blood flow parameters were evaluated. The patients with PCOS had a higher total ovarian volume, mean stromal volume and stromal echogenicity (18.6 ± 4.75 to 10.2 ± 3.4 p < .01; 12.23 ± 2.53 to 5.02 ± 2.44 p = .02; score 1:28 to 10 p < .01, respectively). There was no statistically significant difference in terms of mean RI and PI values between the groups (p > .05). 3 D power Doppler parameters included VI, FI, and VFI values of the patients with PCOS were higher when compared to those of the patients with multifollicular ovary (3.82 ± 2.65 to 1.78 ± 1.2, p < .01; 50.76 ± 4.45 to 40.6 ± 3.64, p = .03; and 2.34 ± 1.02 to 1.12 ± 0.65, p = .02, respectively). Our results revealed that total ovarian volume, stromal volume and echogenicity; VFI, VI, and FI could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.Impact statementWhat is already known on this subject? Ultrasonography is considered the new diagnostic tool for PCOS. Enlarged ovaries with multiple small follicles peripherally located around increased ovarian stroma with increased stromal echogenicity are the sonographic features of polycystic ovaries.What do the results of this study add? 3-D Doppler ultrasonography may be more specific in the determination of multifollicular and polycystic ovaries when compared to RI and PI in 2-D Doppler ultrasonography. Moreover, 3-D power Doppler ultrasonography could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.What are the implications of these findings for clinical practice and/or further research? In clinical practice, the differentiation of multifollicular ovaries and polycystic ovaries (PCO) is difficult with the use of 2-D sonography alone. Therefore, 3-D ultrasound and power Doppler may also be used in addition to 2-D ultrasound for the differentiation of multifollicular ovaries and PCO.
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Affiliation(s)
- Murat Bozkurt
- Department of Obstetrics and Gynecology, VM Medical Park Pendik Hospital, Istanbul, Turkey
| | | | - Didem Kurban
- Department of Obstetrics and Gynecology, Private Clinic, Ankara, Turkey
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Osman Sevket
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Pinar Ozcan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
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12
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Kim JJ, Hwang KR, Lee D, Choi YM. Reply: Impact of the newly recommended antral follicle count cut-off for polycystic ovary in adult women with polycystic ovary syndrome. Hum Reprod 2020; 35:2167-2169. [PMID: 32756986 DOI: 10.1093/humrep/deaa170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Dayong Lee
- Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea
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13
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Dwivedi AND, Ganesh V, Shukla RC, Jain M, Kumar I. Colour Doppler evaluation of uterine and ovarian blood flow in patients of polycystic ovarian disease and post-treatment changes. Clin Radiol 2020; 75:772-779. [PMID: 32660710 DOI: 10.1016/j.crad.2020.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/18/2020] [Indexed: 02/05/2023]
Abstract
AIM To assess the morphology and colour Doppler parameters in patients with polycystic ovarian syndrome (PCOS) and also to assess the changes in Doppler parameters in follow-up patients, who underwent treatment. MATERIALS AND METHODS The study was conducted on 50 women of reproductive age who had clinical and biochemical findings suggestive of PCOS. Clinico-hormonal parameters were recorded. Ultrasound and colour Doppler flow measurements of bilateral ovaries were performed in the early proliferative phase of the menstrual cycle. After assessment of the bilateral ovaries, colour Doppler ultrasound was used to evaluate the main uterine artery at the cervico-uterine junction. Follow-up imaging after 3 months was undertaken in patients who underwent treatment (metformin) and changes in the imaging and hormonal parameters were correlated. RESULTS The mean value of luteinising hormone (LH) and the ratio of LH: follicle-stimulating hormone (FSH) was significantly higher in PCOS patients. Ultrasound parameters were significantly higher in PCOS patients. Ovarian stromal vessels in PCOS patients had a significantly higher peak systolic velocity (PSV), low resistance index (RI), and pulsatility index (PI). The PSV of uterine arteries were significantly decreased and the RI and PI were significantly increased. On follow-up patients revealed changes in hormonal parameters. CONCLUSION PCOS is a heterogeneous disorder and is a convergence of multisystem endocrine derangements. Ultrasound is good diagnostic tool for PCOS and the use of Doppler aids in the evaluation of haemodynamic changes in small vessels of utero-ovarian circulation and in response assessment.
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Affiliation(s)
- A N D Dwivedi
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India.
| | - V Ganesh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India
| | - R C Shukla
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India
| | - M Jain
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, India
| | - I Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India
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14
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Ahmed AA, Moselhy SS, Kumosani TA, Huwait EA, AL-Ghamdi MA, AL-Madani KA, AlToukhi MH, Kumosani AT. Ultrasonographic and biochemical assessments as early prediction of polycystic ovarian syndrome in obese women. Afr Health Sci 2020; 20:676-681. [PMID: 33163031 PMCID: PMC7609108 DOI: 10.4314/ahs.v20i2.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is considered as a common cause of hormonal disturbance and obesity. The diagnosis of PCOS was done by different methods including clinical signs as anovulation, hyperandrogenism, biochemical markers and ultrasounographic investigation. This study investigated comparative outcomes of ultrasonographic and biochemical markers for early prediction of PCOS in obese women. Subjects and methods Seventy-five patients were clinically diagnosed with obese, PCOS and obese with PCOS and twenty-five normal age matched subjects were enrolled as control. Abdominal and transvaginal ultrasonographic for assessment of ovarian properties. In addition, BMI, serum free testosterone, dehydroepiandrosterone (DHEA), insulin, glycosylated hemoglobin (HbA1c) and LDL-c levels were evaluated. Result In obese patients with PCOs (20%) ovaries revealed normal appearance in morphology while the rest (80%) showed PCOs in the form of cysts of 2–8 mm in diameter peripherally arranged around stroma. A significant elevation of free testosterone, DHEA and insulin in obese with or without PCOS compared with obese group (p<0.001). A positive correlation with hormonal abnormalities of increased HA1c, LDL-c, free testosterone, DHEA and insulin compared with obese only. Conclusion According to our study findings, ovarian morphology combined with biochemical markers is more reliable for early prediction and diagnosis of PCOS for interpretation and management.
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Affiliation(s)
- Alaa A Ahmed
- Head of Radiology Department, Ghamra Armed Forces Hospital, Cairo-Egypt
| | - Said S Moselhy
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
- Corresponding author: Said S Moselhy, Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt.
| | - Taha A Kumosani
- Biochemistry Department, Faculty of science, King Abdulaziz University, Jeddah. Experimental Biochemistry unit, King Fahd Medical Research center and Production of bio products for industrial applications research Group, King Abdulaziz University
| | - Etimad A Huwait
- Biochemistry Department, Faculty of science, King Abdulaziz University, Jeddah. Experimental Biochemistry unit, King Fahd Medical Research center and Production of bio products for industrial applications research Group, King Abdulaziz University
| | - Maryam A AL-Ghamdi
- Biochemistry Department, Faculty of science, King Abdulaziz University, Jeddah. Experimental Biochemistry unit, King Fahd Medical Research center and Production of bio products for industrial applications research Group, King Abdulaziz University
| | - Khalid A AL-Madani
- Consultant in Clinical Nutrition,Member of the Boardof ILSI Middel East, Member of the Board of Saudi Society for Food and Nutrition. Advance Clinics, Jeddah, Saudi Arabia
| | - Majdi H AlToukhi
- Consultant Public Health & Infectious Diseases, Director Health & Environment Department, The General Authority of Metrology and Environmental Protection, Saudi Arabia
| | - Afnan T Kumosani
- Department of pathology and Laboratory Medicine, Transfusion Blood medicine Bank, King Abdulaziz Medical city, Jeddah, National Guards, , Jeddah, 21423
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15
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Rao P, Bhide P. Controversies in the diagnosis of polycystic ovary syndrome. Ther Adv Reprod Health 2020; 14:2633494120913032. [PMID: 32656532 PMCID: PMC7328349 DOI: 10.1177/2633494120913032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 02/13/2020] [Indexed: 01/15/2023] Open
Abstract
Polycystic ovary syndrome is a common endocrinological condition which is found to be prevalent in 5-10% of women of reproductive age. Historically, a combination of anovulation and androgen excess was considered a hallmark in the diagnosis of polycystic ovary syndrome. Addition of ultrasound features of polycystic ovary syndrome has improved the detection of variation in the polycystic ovary syndrome phenotype. Despite the widespread use of consensus diagnostic criteria, there remain several unresolved controversies in the diagnosis of polycystic ovary syndrome. Difficulty arises in methods of assessment and types of androgens to be measured to detect biochemical hyperandrogenism, setting a cut-off value for the diagnosis of clinical hyperandrogenism, setting an ultrasound threshold of antral follicle count to diagnose polycystic ovaries and also diagnosing this condition in adolescence where there is no clear definition for 'irregular cycles'. This article looks at various controversies in the diagnosis of polycystic ovary syndrome.
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Affiliation(s)
- Preetham Rao
- Homerton University Hospital NHS Foundation
Trust, London, UK
| | - Priya Bhide
- Homerton Fertility Centre, Homerton University
Hospital NHS Foundation Trust, London E9 6SR, UK
- Queen Mary University of London, London,
UK
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16
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Impact of right-left differences in ovarian morphology on the ultrasound diagnosis of polycystic ovary syndrome. Fertil Steril 2019; 112:939-946. [PMID: 31395310 DOI: 10.1016/j.fertnstert.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess right-left differences in ultrasonographic markers of ovarian morphology and determine the impact on the diagnosis of polycystic ovarian morphology (PCOM). DESIGN A cross-sectional study of data collected from 2006 to 2018. SETTING Academic clinical research centers. PATIENT(S) Women with polycystic ovary syndrome (PCOS; n = 87) and controls (n = 67). INTERVENTION(S) None. MAIN OUTCOMES MEASURE(S) Follicle number per ovary (FNPO), follicle number per cross-section (FNPS), and ovarian volume (OV) were assessed in both ovaries using transvaginal ultrasonography. PCOM was identified based on recent international consensus guidelines or proposed diagnostic thresholds. RESULT(S) Overall, mean right-left differences were two follicles for FNPO, one follicle for FNPS, and 2 mL for OV. FNPO showed the strongest correlation between ovaries. Its assessment in a single ovary did not impact the diagnosis of PCOM in women with PCOS. However, there were differences in the probability of unilateral versus bilateral PCOM based on FNPS and OV in both groups. CONCLUSION(S) FNPO is the most reliable unilateral marker of PCOM in light of right-left differences in ovarian morphology. Use of FNPS or OV to define PCOM is discouraged when only one ovary is visualized.
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17
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Inter-observer variability in the assessment of ultrasound features of polycystic ovaries. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Kim HJ, Adams JM, Gudmundsson JA, Arason G, Pau CT, Welt CK. Polycystic ovary morphology: age-based ultrasound criteria. Fertil Steril 2017; 108:548-553. [PMID: 28807396 DOI: 10.1016/j.fertnstert.2017.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/08/2017] [Accepted: 07/06/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine age-based criteria for polycystic ovary morphology. DESIGN Cross-sectional, case-control design. SETTING Outpatient setting. SUBJECT(S) Women with polycystic ovary syndrome (PCOS) defined by hyperandrogenism and irregular menses (n = 544) and controls with regular menses and no evidence of hyperandrogenism (n = 666) participated. Parameters were tested in a second cohort of women with PCOS (n = 105) and controls (n = 32) meeting the same criteria. INTERVENTION(S) Subjects underwent a pelvic ultrasound documenting ovarian volume and maximum follicle number in a single plane. MAIN OUTCOME MEASURE(S) A receiver operating characteristic curve was constructed to determine the ovarian volume and follicle number with the best sensitivity and specificity to define PCOS for age groups at approximately 5-year intervals from age 18 to >44 years. RESULT(S) The best sensitivity and specificity were obtained using a threshold volume of 12 mL and 13 follicles for ages ≤24 years, 10 mL and 14 follicles for ages 25-29 years, 9 mL and 10 follicles for ages 30-34 years, 8 mL and 10 follicles for ages 35-39 years, 10 mL and 9 follicles for ages 40-44 years, and 6 mL and 7 follicles for ages >44 years. Data from a second cohort confirmed the need to decrease volume and follicle number with increasing age to diagnose PCOS. Polycystic ovary morphology was most accurate at predicting the PCOS diagnosis for women ages 30-39 years. CONCLUSION(S) The ovarian volume and follicle number threshold to define polycystic ovary morphology should be lowered starting at age 30.
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Affiliation(s)
- Hyun-Jun Kim
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, School of Medicine, Konkuk University, ChungJu, South Korea
| | - Judith M Adams
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Jens A Gudmundsson
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland
| | | | - Cindy T Pau
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Corrine K Welt
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.
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19
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Nylander M, Frøssing S, Bjerre AH, Chabanova E, Clausen HV, Faber J, Skouby SO. Ovarian morphology in polycystic ovary syndrome: estimates from 2D and 3D ultrasound and magnetic resonance imaging and their correlation to anti-Müllerian hormone. Acta Radiol 2017; 58:997-1004. [PMID: 28273731 DOI: 10.1177/0284185116676656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Due to improved ultrasound scanners, new three-dimensional (3D) modalities, and novel Anti-Müllerian hormone (AMH)-assays, the ultrasound criteria for polycystic ovarian morphology are under debate and the appropriate thresholds are often requested. Purpose To quantify the differences in estimates of ovarian volume and antral follicle count (AFC) from two-dimensional (2D) and 3D transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Material and Methods A cross-sectional study on 66 overweight women with polycystic ovary syndrome (PCOS) according to Rotterdam criteria. Ovarian volume and AFC were estimated from MRI, 2D TVUS, and 3D TVUS, and serum AMH levels were assessed. Bland-Altman statistics were used for comparison. Results Participants had a median age of 29 years (age range, 19-44 years) with a mean BMI of 32.7 kg/m2 (SD 4.5). Ovarian volume from 2D TVUS was 1.48 mL (95% confidence interval [CI], 0.94-2.03; P < 0.001) and 1.25 mL (95% CI, 0.62-1.87; P < 0.001) smaller than from 3D TVUS and MRI, respectively. AFC from 2D TVUS was 18% (95% CI, 13-23; P < 0.005) and 16% (95% CI, 6-25; P < 0.005) smaller than estimates from 3D TVUS and MRI, respectively. Correlations between AMH and AFC from 2D TVUS, 3D TVUS, and MRI were 0.67, 0.78, and 0.70, respectively ( P < 0.001 for all). Conclusion In an overweight PCOS population, 2D TVUS underestimated ovarian volume and AFC as compared with 3D TVUS and MRI. Serum AMH correlated best with AFC from 3D TVUS, followed by MRI and 2D TVUS. The advantage of 3D TVUS might be of minor clinical importance when diagnosing PCOS, but useful when the actual AFC are of interest, e.g. in fertility counseling and research.
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Affiliation(s)
- Malin Nylander
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Signe Frøssing
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Endocrine Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Anne H Bjerre
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
| | | | - Helle V Clausen
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Faber
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Endocrine Unit, Herlev Gentofte Hospital, Herlev, Denmark
| | - Sven O Skouby
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Ali HI, Elsadawy ME, Khater NH. Ultrasound assessment of polycystic ovaries: Ovarian volume and morphology; which is more accurate in making the diagnosis?! THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocr Rev 2015; 36:487-525. [PMID: 26426951 PMCID: PMC4591526 DOI: 10.1210/er.2015-1018] [Citation(s) in RCA: 546] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous and complex disorder that has both adverse reproductive and metabolic implications for affected women. However, there is generally poor understanding of its etiology. Varying expert-based diagnostic criteria utilize some combination of oligo-ovulation, hyperandrogenism, and the presence of polycystic ovaries. Criteria that require hyperandrogenism tend to identify a more severe reproductive and metabolic phenotype. The phenotype can vary by race and ethnicity, is difficult to define in the perimenarchal and perimenopausal period, and is exacerbated by obesity. The pathophysiology involves abnormal gonadotropin secretion from a reduced hypothalamic feedback response to circulating sex steroids, altered ovarian morphology and functional changes, and disordered insulin action in a variety of target tissues. PCOS clusters in families and both female and male relatives can show stigmata of the syndrome, including metabolic abnormalities. Genome-wide association studies have identified a number of candidate regions, although their role in contributing to PCOS is still largely unknown.
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Affiliation(s)
- Daniel A Dumesic
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Sharon E Oberfield
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Elisabet Stener-Victorin
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - John C Marshall
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Joop S Laven
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Richard S Legro
- Department of Obstetrics and Gynecology (D.A.D.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095; Division of Pediatric Endocrinology (S.E.O.), Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Physiology (E.S.-V.), Karolinska Institutet, 171 77 Stockholm, Sweden; Center for Research in Reproduction and Division of Endocrinology (J.C.M.), Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903; Division of Reproductive Medicine (J.S.L.), Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
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Ultrasound features of polycystic ovaries relate to degree of reproductive and metabolic disturbance in polycystic ovary syndrome. Fertil Steril 2015; 103:787-94. [DOI: 10.1016/j.fertnstert.2014.12.094] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/12/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022]
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Ahmed S, Pahwa S, Das CJ, Mir FA, Nisar S, Jehangir M, Parveen S, Rashid A, Ganie MA. Comparative evaluation of sonographic ovarian morphology of Indian women with polycystic ovary syndrome versus those of normal women. Indian J Endocrinol Metab 2014; 18:180-4. [PMID: 24741513 PMCID: PMC3987267 DOI: 10.4103/2230-8210.129108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To study ovarian morphology by ultrasound in women with or without polycystic ovary syndrome (PCOS) and to establish cut-off values of these parameters in Indian women with PCOS. MATERIALS AND METHODS A total of 119 consecutive women diagnosed PCOS and 77 apparently healthy women were enrolled. Transabdominal ultrasound examination was carried out to assess ovarian volume, stromal echogenecity, follicle number and size. Cut-off values of the above ovarian parameters with sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated. RESULTS Sensitivity of 79.49% and specificity of 90.67% was achieved with a cut-off of 8 mL as ovarian volume. A cut-off value of 9 follicles to distinguish between PCOS and control women yielded a sensitivity of 82.35% and specificity of 92.0% while as a follicular size of 5 mm yielded sensitivity and specificity of 74.67% and 78.15% respectively. With all the three parameters sensitivity was 87.39% and specificity 87.84% with 92.04% PPV and 81.25% NPV. CONCLUSION Using two or three sonographic criteria in combination improves sensitivity and helps diagnose additional patients with PCOS. Our results are at variance with the established cut-off values highlighting the fact that American Society for Reproductive Medicine consensus cut-off values are not reproducible in Indian context.
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Affiliation(s)
- Sanjeed Ahmed
- Department of Radiodiagnosis, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Shivani Pahwa
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Farooq A Mir
- Department of Radiodiagnosis, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Sobia Nisar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Majid Jehangir
- Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shameem Parveen
- Department of Obstetrics and Gynecolgy, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Aafia Rashid
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohd Ashraf Ganie
- Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Clark NM, Podolski AJ, Brooks ED, Chizen DR, Pierson RA, Lehotay DC, Lujan ME. Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology: An Assessment of Over 100 Consecutive Women Self-reporting Features of Polycystic Ovary Syndrome. Reprod Sci 2014; 21:1034-1043. [PMID: 24520081 DOI: 10.1177/1933719114522525] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The prevalence of polycystic ovary syndrome (PCOS) and its distinct clinical phenotypes were assessed using 3 sets of international diagnostic criteria in women self-reporting concerns over outward features of PCOS. Revised ultrasonographic criteria for polycystic ovaries (PCO) based on modern ultrasound technology were used. Of the participants, 53%, 62%, and 70% were diagnosed with PCOS using National Institutes of Health, Androgen Excess and PCOS Society, and Rotterdam criteria, respectively. Prevalence of Frank, Ovulatory, Normoandrogenic, and Non-PCO PCOS were 66%, 13%, 11%, and 9%, respectively. Frank PCOS was associated with the severest metabolic disturbances whereas metabolic profiles in Normoandrogenic PCOS did not differ from controls, supporting reduced health risks in women without androgen excess. Metabolic disturbances and hyperandrogenism were linked to excess adiposity across all the groups. Using updated criteria for PCO, the prevalence of Non-PCO PCOS and PCO alone in healthy women recruited from the general population was reduced compared to the previous reports.
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Affiliation(s)
- Nina M Clark
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Amanda J Podolski
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Eric D Brooks
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - Donna R Chizen
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roger A Pierson
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Denis C Lehotay
- Department of Pathology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marla E Lujan
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
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Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6:1-13. [PMID: 24379699 PMCID: PMC3872139 DOI: 10.2147/clep.s37559] [Citation(s) in RCA: 551] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and polycystic ovaries. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include oligomenorrhea or amenorrhea, hirsutism, and frequently infertility. Risk factors for PCOS in adults includes type 1 diabetes, type 2 diabetes, and gestational diabetes. Insulin resistance affects 50%–70% of women with PCOS leading to a number of comorbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance, and diabetes. Studies show that women with PCOS are more likely to have increased coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS. Weight loss improves menstrual irregularities, symptoms of androgen excess, and infertility. Management of clinical manifestations of PCOS includes oral contraceptives for menstrual irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgen excess. Treatment options for infertility include clomiphene, laparoscopic ovarian drilling, gonadotropins, and assisted reproductive technology. Recent data suggest that letrozole and metformin may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications.
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Affiliation(s)
- Susan M Sirmans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA
| | - Kristen A Pate
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA
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Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, Escobar-Morreale HF. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2013; 20:334-52. [DOI: 10.1093/humupd/dmt061] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome. Fertil Steril 2013; 101:280-287.e1. [PMID: 24188871 DOI: 10.1016/j.fertnstert.2013.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the diagnostic potential of ultrasonographic markers of ovarian morphology, used alone or in combination, to predict polycystic ovary syndrome (PCOS). DESIGN A diagnostic test study using cross-sectional data collected from 2006-2011. SETTING Academic hospital and clinical research unit. PATIENT(S) Eighty-two women with PCOS and 60 healthy female volunteers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicle number per ovary (FNPO), ovarian volume (OV), follicle number per single cross-section (FNPS), follicle distribution pattern, stromal area, ovarian area, stromal-to-ovarian area ratio (S:A), and stromal index (SI). RESULT(S) Follicle number per ovary best predicted PCOS (R(2) = 67%) with 85% sensitivity and 98% specificity, followed by OV (R(2) = 44%), and FNPS (R(2) = 36%). Neither S:A nor SI had predictive power for PCOS. In combination, FNPO+S:A and FNPO+SI most significantly predicted PCOS (R(2) = 74% vs. 73%, respectively). The diagnostic potentials of OV and FNPS were substantially improved when used in combination (OV+FNPO, R(2) = 55%). CONCLUSION(S) As a single metric, FNPO best predicted PCOS. Although the addition of S:A or SI improved the predictive power of FNPO, gains were marginal, suggesting limited use in clinical practice. When image quality precludes a reliable estimation of FNPO, measurements of OV+FNPS provide the next closest level of diagnostic potential.
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Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, Haider E, Pierson RA, Chizen DR. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod 2013; 28:1361-8. [PMID: 23503943 DOI: 10.1093/humrep/det062] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, Cornell University, 216 Savage Hall, Ithaca, NY 14853, USA.
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Brown M, Park AS, Shayya RF, Wolfson T, Su HI, Chang RJ. Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls. J Magn Reson Imaging 2013; 38:689-93. [PMID: 23292744 DOI: 10.1002/jmri.23992] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 11/16/2012] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare ovarian morphology in adolescent girls with and without polycystic ovary syndrome (PCOS) using magnetic resonance imaging (MRI). MATERIALS AND METHODS In 21 adolescent girls (age 12-18 years) without and 19 adolescents with PCOS (diagnosis based on excessive hair growth and irregular menstrual cycles) ovarian volume, antral follicle count (AFC) per ovary, and follicle size were evaluated. MRI was performed at 1.5 T or 3 T and axial or angled-axial single-shot echo-train spin echo images of 6 mm slice thickness were acquired. In a subset of subjects, 2-mm images were also obtained. PCOS and non-PCOS groups were compared using mixed affects regression. RESULTS Mean AFC per ovary and ovarian volume were substantially greater in PCOS subjects compared to non-PCOS subjects. Mean follicle size was similar between groups. Follicles exceeding 10 mm were seen in 2/19 PCOS subjects versus 9/21 non-PCOS subjects. Consistently higher follicle counts were detected in images obtained at 2 mm compared to 6-mm slice thickness. CONCLUSION In adolescence, MRI of the ovary reveals distinct differences between girls with and without PCOS. MRI may help evaluate young patients in whom transvaginal ultrasound is contraindicated.
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Affiliation(s)
- Michele Brown
- Department of Radiology, University of California, San Diego, La Jolla, California 92093, USA
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30
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Guraya S. Prevalence and ultrasound features of polycystic ovaries in young unmarried Saudi females. J Microsc Ultrastruct 2013. [DOI: 10.1016/j.jmau.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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31
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Battaglia C, Battaglia B, Morotti E, Paradisi R, Zanetti I, Meriggiola MC, Venturoli S. Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1015-1024. [PMID: 22733850 DOI: 10.7863/jum.2012.31.7.1015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this work was to study the role of 2-dimensional (2D) and 3-dimensional (3D) sonographic and Doppler techniques in the diagnosis of polycystic ovary syndrome. METHODS A total of 112 young adult lean women with polycystic ovary syndrome and 52 healthy volunteers with regular ovulatory cycles, matched for age and body mass index, underwent a detailed history, medical examination, hormonal assay, and 2D and 3D sonographic and Doppler flow ovarian evaluation during the early follicular phase. RESULTS The Ferriman-Gallwey score, circulating androgen levels, ovarian volume, and mean number of small subcapsular follicles on 2D and 3D sonography were significantly higher in the patients with polycystic ovary syndrome than the controls (P < .001). A stromal score of 1 or 2 was found in all of the patients but none of the controls. The ovarian stromal/total area ratio was 0.32 or higher in 104 of 112 of the patients (93%), which was significantly higher than in the controls (P < .001). On Doppler analysis, the lowest ovarian stromal resistance levels were found in the patients. On 3D sonography, the total ovarian stromal volume, ovarian stroma/total ovarian volume ratio, and stromal mean grayness were significantly higher in the patients than the controls. With 3D power Doppler imaging, ovarian vascularization measurements were significantly lower in the controls than the patients. The ovarian stroma/total ovarian volume ratio was the most accurate predictor of both hyperandrogenemia (area under the curve, 0.915; P < .0001) and hirsutism (area under the curve, 0.891; P < .0001). CONCLUSIONS Our data strongly support the use of 3D sonography with analysis of stromal volume and vascularization in the diagnosis of polycystic ovary syndrome.
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Affiliation(s)
- Cesare Battaglia
- Department of Gynecology and Pathophysiology of Human Reproduction, Alma Mater Studiorum, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy,
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Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, Duhamel A, Catteau-Jonard S. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011; 26:3123-9. [DOI: 10.1093/humrep/der297] [Citation(s) in RCA: 341] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lujan ME, Kepley AL, Chizen DR, Lehotay DC, Pierson RA. Development of morphologically dominant follicles is associated with fewer metabolic disturbances in amenorrheic women with polycystic ovary syndrome: a pilot study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:759-766. [PMID: 20645396 DOI: 10.1002/uog.7751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine if amenorrheic women with polycystic ovary syndrome (PCOS) demonstrate ultrasonographically detectable changes in follicle population. METHODS Sixteen women with PCOS reporting the absence of menses for more than 3 months were enrolled in the study. Subjects had a physical examination, fasting blood tests and two transvaginal ultrasound scans spaced 1 month apart. In cases where evidence of a morphologically dominant follicle (≥ 10 mm in diameter) occurred, subsequent ultrasound scans were performed to determine the fate of the dominant follicle. Differences in total follicle population, maximum follicle diameter and clinical, hormonal and metabolic features were determined. RESULTS Forty-four percent of subjects showed changes in follicle population of 6-10 follicles and 37% showed changes in follicle population of > 10. Maximum follicle diameters ranged between 5.4 and 33.0 mm. Four subjects demonstrated follicle diameters ≥ 10 mm. Of those who developed dominant follicles, two subjects ovulated, one subject developed a persistent anovulatory follicle and the dominant follicle regressed in the remaining subject. Diagnostic criteria for PCOS were similar among women that did or did not develop dominant follicles (menstrual cycle length, P = 0.880; hirsutism score, P = 0.809; free androgen index, P = 0.991; total follicle count, P = 0.199). However, lower glycosylated hemoglobin (P = 0.047) and insulin levels (P = 0.049) and better insulin sensitivity (P = 0.048) were noted in women who attained dominant follicles. CONCLUSION Amenorrheic women with PCOS demonstrate changes in follicle population that are consistent with active follicle growth and regression despite prolonged periods of anovulation. Morphologic selection occurs in amenorrheic women and attainment of dominant follicles is associated with improved metabolic status.
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Affiliation(s)
- M E Lujan
- Department of Nutritional Sciences, Cornell University, College of Agriculture and Life Sciences, Ithaca, NY 14853, USA.
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Deb S, Kannamannadiar J, Campbell BK, Clewes JS, Raine-Fenning NJ. The interovarian variation in three-dimensional ultrasound markers of ovarian reserve in women undergoing baseline investigation for subfertility. Fertil Steril 2010; 95:667-72. [PMID: 20971465 DOI: 10.1016/j.fertnstert.2010.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 08/09/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate differences in the three-dimensional (3D) ultrasound markers of ovarian reserve between the ovaries within an individual undergoing investigation for subfertility. DESIGN Prospective observational study. SETTING University-based assisted conception unit. PATIENT(S) Two hundred seventy women undergoing baseline early follicular phase ultrasound as an investigation for subfertility. INTERVENTION(S) Three-dimensional ultrasound scan in early follicular phase between days 2 and 5 of the menstrual cycle. MAIN OUTCOME MEASURE(S) Variations in 3D ultrasound markers of ovarian reserve between the two ovaries within same individual. RESULT(S) Two hundred fifteen subjects were analyzed for ovarian volume and antral follicle count, and 205 subjects for 3D power Doppler indices. Significant differences were noted (median, range) in the number of antral follicles measuring >6.0 mm and ovarian volume. Significant correlation was noted between the two ovaries in antral follicles measuring 6.0 mm or less, ovarian volume, and 3D power Doppler indices. On stratifying the antral follicles according to size using sonography-based automated volume calculation with postprocessing, maximum variation was seen in follicles measuring more than 6.0 mm as measured using limits of agreement. CONCLUSION(S) There are significant differences in the antral follicles measuring >6.0 mm and ovarian volume, as measured using 3D ultrasound, that require consideration when comparing the two ovaries within an individual.
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Affiliation(s)
- Shilpa Deb
- Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom.
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35
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Which morphological investigations and how to interpret them to make the diagnosis of PCOS? ANNALES D'ENDOCRINOLOGIE 2010; 71:183-8. [DOI: 10.1016/j.ando.2010.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 11/19/2022]
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Lujan ME, Brooks ED, Kepley AL, Chizen DR, Pierson RA, Peppin AK. Grid analysis improves reliability in follicle counts made by ultrasonography in women with polycystic ovary syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:712-718. [PMID: 20381953 PMCID: PMC2893214 DOI: 10.1016/j.ultrasmedbio.2010.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/19/2010] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
Poor reliability has been reported when counting the total number of follicles in polycystic ovaries using conventional two-dimensional (2-D) ultrasound viewing methods. In the current study, we report good reliability in follicle counts when observers imposed a programmable grid system over the viewing window. Four observers estimated total follicle counts in 45 ovarian ultrasound scans by compartmentalizing the ovary into 9 to 12 grid sections and performing focused follicle counts per section. The mean number of follicles counted per ovary was 44.6 +/- 2.3. The level of inter-observer agreement when making follicle counts was 0.82 and total follicle counts did not differ among observers. The level of intra-observer agreement was 0.93 which further corroborated the utility of this method for making dependable follicle counts. In summary, the ability to obtain reproducible follicle counts will help to establish reliable diagnostic criteria for polycystic ovarian morphology.
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Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York 14853, USA.
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Deb S, Campbell BK, Clewes JS, Raine-Fenning NJ. Quantitative analysis of antral follicle number and size: a comparison of two-dimensional and automated three-dimensional ultrasound techniques. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:354-360. [PMID: 20069654 DOI: 10.1002/uog.7505] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To compare two-dimensional (2D) ultrasound imaging with automated three-dimensional (3D) ultrasound imaging for the measurement of antral follicle number and size. METHODS Twenty-four subjects aged < 40 years underwent transvaginal ultrasound examination (Voluson E8) in the early follicular phase of the menstrual cycle. A 2D ultrasound scan of both ovaries was performed; each antral follicle was identified and then measured by taking the mean of two diameters. A 3D ultrasound dataset of both ovaries was then acquired and analyzed using Sonography-based Automated Volume Count (SonoAVC). The time taken to measure the size of all antral follicles in both ovaries was recorded in seconds for each technique. Antral follicle size was recorded to the nearest millimeter and counts for each 1-mm group were obtained. Antral follicle counts were also grouped according to five predefined size categories: 2.0-5.0 mm, 2.0-6.0 mm, 2.0-8.0 mm, 2.0-9.0 mm and 2.0-10.0 mm. Limits of agreement (LOA) and a paired t-test or Wilcoxon signed ranks test were used to analyze the data depending on their distribution. RESULTS When antral follicle numbers were compared for each 1-mm follicle size group, 2D ultrasound imaging recorded more follicles measuring 3.0-3.99 mm (mean +/- SD, 4.11 +/- 3.70 vs. 2.63 +/- 2.31; P = 0.019) and 4.0-4.99 mm (mean +/- SD, 4.63 +/- 4.86 vs. 2.68 +/- 2.89; P = 0.013) than did SonoAVC. LOA were widest with follicles measuring 3.0-3.99 mm (LOA, 6.38 and -3.43) and 4.0-4.99 mm (LOA, 7.99 and -4.09). The antral follicle count in each of the five predefined size categories was significantly lower with SonoAVC than with 2D ultrasound imaging (P < 0.05). SonoAVC took significantly less time to measure the size and record the number of antral follicles than did 2D ultrasound imaging (mean +/- SD, 132.05 +/- 56.23 s vs. 324.47 +/- 162.22 s; P < 0.001). CONCLUSIONS Fewer antral follicles are evident overall when SonoAVC is used to analyze 3D ultrasound data. The clinical significance of this remains to be determined but the automated technique is significantly quicker than is making measurements using 2D ultrasound imaging.
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Affiliation(s)
- S Deb
- University of Nottingham, School of Clinical Sciences, Division of Human Development, Nottingham University Research and Treatment Unit in Reproduction (NURTURE), Nottingham, UK.
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Yu J, Tan J. Object density-based image segmentation and its applications in biomedical image analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2009; 96:193-204. [PMID: 19473717 DOI: 10.1016/j.cmpb.2009.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 04/16/2009] [Accepted: 04/23/2009] [Indexed: 05/27/2023]
Abstract
In many applications of medical image analysis, the density of an object is the most important feature for isolating an area of interest (image segmentation). In this research, an object density-based image segmentation methodology is developed, which incorporates intensity-based, edge-based and texture-based segmentation techniques. The proposed method consists of three main stages: preprocessing, object segmentation and final segmentation. Image enhancement, noise reduction and layer-of-interest extraction are several subtasks of preprocessing. Object segmentation utilizes a marker-controlled watershed technique to identify each object of interest (OI) from the background. A marker estimation method is proposed to minimize over-segmentation resulting from the watershed algorithm. Object segmentation provides an accurate density estimation of OI which is used to guide the subsequent segmentation steps. The final stage converts the distribution of OI into textural energy by using fractal dimension analysis. An energy-driven active contour procedure is designed to delineate the area with desired object density. Experimental results show that the proposed method is 98% accurate in segmenting synthetic images. Segmentation of microscopic images and ultrasound images shows the potential utility of the proposed method in different applications of medical image processing.
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Affiliation(s)
- Jinhua Yu
- Department of Biological Engineering, University of Missouri, Columbia, 65211, USA
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Lujan ME, Bloski TG, Chizen DR, Lehotay DC, Pierson RA. Digit ratios do not serve as anatomical evidence of prenatal androgen exposure in clinical phenotypes of polycystic ovary syndrome. Hum Reprod 2009; 25:204-11. [PMID: 19855107 DOI: 10.1093/humrep/dep363] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is heterogeneous in its clinical presentation and four major phenotypes have been identified. The precise etiology of PCOS is unknown; however, variable exposure to prenatal androgens may be responsible for the spectrum of endocrine and metabolic disturbances characteristic of this syndrome. Since prenatal testosterone exposure is known to decrease the ratio of the second to fourth finger lengths (2D:4D), we characterized the left and right hand 2D:4D in women with clinical variants of PCOS. We hypothesized that if prenatal androgens were involved in the development of the phenotypic spectrum of PCOS, then lower 2D:4D would be differentially expressed among clinical variants of the syndrome. METHODS Digit ratios were determined in 98 women diagnosed with PCOS by the 2003 international consensus guidelines and in 51 women with regular menstrual cycles, no clinical or biochemical signs of hyperandrogenism and normal ovarian morphology. Women with PCOS were categorized into four clinical phenotypes (i.e. Frank, Non-PCO, Ovulatory and Mild) and 2D:4D among groups were compared by Tukey-Kramer multiple comparisons tests. RESULTS Left (P = 0.77) and right (P = 0.68) hand 2D:4D were similar among the four clinical phenotypes and no phenotype of PCOS demonstrated a 2D:4D that differed from controls (Left Hand, P = 0.44 and Right Hand, P = 0.75). CONCLUSIONS Women with PCOS do not demonstrate finger length patterns that are consistent with increased prenatal androgen exposure. These findings do not preclude a role for prenatal androgens in the development of PCOS; however, low 2D:4D are not a characteristic of PCOS.
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Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, Cornell University, 216 Savage Hall, Ithaca, NY 14853, USA.
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Lujan ME, Chizen DR, Peppin AK, Dhir A, Pierson RA. Assessment of ultrasonographic features of polycystic ovaries is associated with modest levels of inter-observer agreement. J Ovarian Res 2009; 2:6. [PMID: 19515259 PMCID: PMC2700106 DOI: 10.1186/1757-2215-2-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/10/2009] [Indexed: 11/17/2022] Open
Abstract
Background There is growing acceptance that polycystic ovaries are an important marker of polycystic ovary syndrome (PCOS) despite significant variability when making the ultrasound diagnosis. To better understand the nature of this variability, we proposed to evaluate the level of inter-observer agreement when identifying and quantifying individual ultrasonographic features of polycystic ovaries. Methods Digital recordings of transvaginal ultrasound scans performed in thirty women with PCOS were assessed by four observers with training in Radiology or Reproductive Endocrinology. Observers evaluated the scans for: 1) number of follicles ≥ 2 mm per ovary, 2) largest follicle diameter, 3) ovarian volume, 4) follicle distribution pattern and 5) presence of a corpus luteum (CL). Lin's concordance correlation coefficients and kappa statistics for multiple raters were used to assess inter-observer agreement. Results Agreement between observers ranged from 0.08 to 0.63 for follicle counts, 0.27 to 0.88 for largest follicle diameter, 0.63 to 0.86 for ovarian volume, 0.51 to 0.76 for follicle distribution pattern and 0.76 to 0.90 for presence of a CL. Overall, reproductive endocrinologists demonstrated better agreement when evaluating ultrasonographic features of polycystic ovaries compared to radiologists (0.71 versus 0.53; p = 0.04). Conclusion Inter-observer agreement for assessing ultrasonographic features of polycystic ovaries was moderate to poor. These findings support the need for standardized training modules to characterize polycystic ovarian morphology on ultrasonography.
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Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, USA.
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Pascual MA, Graupera B, Hereter L, Tresserra F, Rodriguez I, Alcázar JL. Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography. Gynecol Endocrinol 2008; 24:631-6. [PMID: 19031220 DOI: 10.1080/09513590802308099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess whether there are differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler angiography (3D-PDA) between women with polycystic ovaries (PCO) and women with normal ovaries (NO). METHODS Eighty-three women were classified into two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 45) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 38) with oligo-anovulation, clinical and/or biochemical features of hyperandrogenism, and polycystic ovary morphology at two-dimensional ultrasound. All women were evaluated by means of 3D-PDA. The parameters studied in both groups were follicle number per ovary (FNPO), ovarian volume (OV), mean gray value (MG) and three vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). RESULTS The PCO group showed a higher mean OV as well as FNPO. No differences in MG, VI, FI and VFI were found between the groups. CONCLUSIONS 3D-PDA indices are not useful for discriminating between normal and polycystic ovaries.
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Affiliation(s)
- Maria Angela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
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Lujan ME, Chizen DR, Pierson RA. Diagnostic criteria for polycystic ovary syndrome: pitfalls and controversies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:671-679. [PMID: 18786289 PMCID: PMC2893212 DOI: 10.1016/s1701-2163(16)32915-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
It is estimated that as many as 1.4 million Canadian women may be afflicted with polycystic ovary syndrome (PCOS). Although PCOS is heralded as one of the most common endocrine disorders occurring in women, its diagnosis, management, and associated long-term health risks remain controversial. Historically, the combination of androgen excess and anovulation has been considered the hallmark of PCOS. To date, while these symptoms remain the most prevalent among PCOS patients, neither is considered an absolute requisite for the syndrome. Inclusion of ultrasonographic evidence of polycystic ovaries as a diagnostic marker has substantially broadened the phenotypic spectrum of PCOS, yet much debate surrounds the validity of these newly identified milder variants of the syndrome. Difficulty in resolving the spectrum of PCOS stems from the continued use of inconsistent and inaccurate methods of evaluating androgen excess, anovulation, and polycystic ovaries on ultrasound. At present, there is no clear-cut definition of biochemical hyperandrogenemia, particularly since we depend on poor laboratory standards for measuring androgens in women. Clinical signs of hyperandrogenism are ill-defined in women with PCOS, and the diagnosis of both hirsutism and polycystic ovarian morphology remains alarmingly subjective. Lastly, there is an inappropriate tendency to assign ovulatory status solely on the basis of menstrual cycle history or poorly timed endocrine measurements. In this review, we elaborate on these limitations and propose possible resolutions for clinical and research settings. By stimulating awareness of these limitations, we hope to generate a dialogue aimed at solidifying the evaluation of PCOS in Canadian women.
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Affiliation(s)
- Marla E Lujan
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon SK
| | - Donna R Chizen
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon SK
| | - Roger A Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon SK
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Abstract
Polycystic ovary syndrome is the most common endocrine disorder occurring in reproductive-age women. The syndrome is complex, multifactorial, and not always easily defined. Diagnosis is based upon a combination of clinical and biochemical criteria and ovarian morphology. The following review describes the clinical features, pathophysiology, diagnosis, and the role of imaging. Diagnostic imaging techniques are discussed, with emphasis on ultrasound as the main modality used worldwide. Contributions of 3-dimensional and Doppler ultrasound are addressed in addition to potential indications for magnetic resonance imaging in the evaluation of patients with suspected polycystic ovary syndrome.
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Barth JH, Yasmin E, Balen AH. The diagnosis of polycystic ovary syndrome: the criteria are insufficiently robust for clinical research. Clin Endocrinol (Oxf) 2007; 67:811-5. [PMID: 17760885 DOI: 10.1111/j.1365-2265.2007.02932.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common disorder but has considerable phenotypic variability and this has led to controversy over its exact definition and diagnosis. The objective of this study was to review the recently proposed diagnostic criteria to determine whether they were sufficiently robust for clinical and research practise. We have reviewed the literature pertaining to clinical measurement and quality of laboratory analysis in relation to clinical and biochemical hyperandrogenism. The recently published statements regarding the diagnosis of PCOS assume that the clinical, laboratory and imaging studies are dichotomous variables, without considering the effect of observer subjectivity or measurement variability on the outcome. The data suggest that there is considerable uncertainty of all measurements and lack of clarity of the definition of the term 'hyperandrogenaemia' which can lead to misdiagnosis. The current diagnostic strategies for PCOS are defined too vaguely to ascertain that individuals fit the definition of the syndrome. A pragmatic approach may be taken in the management of an individual depending upon her particular symptoms and needs. However, research into the epidemiology, pathophysiology and treatment of PCOS will require the production of robust definitions of the diagnostic criteria. We propose specific criteria that would answer the criticisms that we have raised.
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Affiliation(s)
- Julian H Barth
- Departments of Clinical Biochemistry & Immunology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
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Abstract
Up to 10% of women may suffer from polycystic ovary syndrome (PCOS). The clinical symptoms may vary, so the biochemical profile and ultrasonography are used to predict an accurate diagnosis. Many studies have indicated that a relationship may exist between hyperinsulineamia and hyperandrogenism but the exact pathogenesis remains obscure. PCOS is treated by a combination of surgery or pharmacological management. Treatment is not always successful therefore women in these cases require support and care from nursing staff to help overcome the disappointment of treatment failure. To support women with PCOS, nurses need to be knowledgeable about the condition and its clinical manifestations and available treatment options. This article aims to examine the current aetiology, clinical manifestations, pathophysiology, diagnosis and treatment options available to women with a diagnosis of PCOS.
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Affiliation(s)
- Maggi Banning
- Brunel University, School of Health Sciences and Social Care, Middlesex, UK
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Sun L, Fu Q. Three-dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome. Int J Gynaecol Obstet 2007; 98:34-8. [PMID: 17459387 DOI: 10.1016/j.ijgo.2007.02.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 02/15/2007] [Accepted: 02/18/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of 3-dimensional transrectal ultrasonography (3D-TRS) in adolescent patients with polycystic ovarian syndrome (PCOS). METHODS Ovarian follicle number, ovarian volume, ovarian stromal area, total ovarian area, and stromal area to total area ratio (S/A) were evaluated using 3D-TRS in 75 amenorrheic, oligomenorrheic, or asymptomatic virgin patients and 25 healthy controls. Serum biochemical markers of PCOS were assayed during the early follicular phase of the menstrual cycle in menstruating patients and controls, and on a randomly selected day in amenorrheic patients. RESULTS When assessing the delicate structure of the ovary in virgin patients, 3D-TRS was convenient, accurate, specific, sensitive, and more reliable overall than transabdominal ultrasonography. Ovarian stromal area and S/A ratio were significantly greater in patients with PCOS than in controls, and also in the patients who had ultrasonically diagnosed polycystic ovaries without clinical or biochemical evidence of PCOS. The S/A ratio was the studied variable most significantly correlated with androgen levels. CONCLUSIONS These findings indicated that, in adolescent patients, 3D-TRS combined with transabdominal ultrasonography can improve the precision of the diagnosis of PCOS. The S/A ratio may become the ultrasonographic diagnostic marker for PCOS.
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Affiliation(s)
- Li Sun
- Department of Obstetrics and Gynecology, Shandong University Qilu Hospital, Jinan, Shandong, China
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Timor-Tritsch IE, Monteagudo A. Three and four-dimensional ultrasound in obstetrics and gynecology. Curr Opin Obstet Gynecol 2007; 19:157-75. [PMID: 17353685 DOI: 10.1097/gco.0b013e328099b067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Developments in ultrasound in general, but even more so in three-dimensional ultrasound, parallel the growth in computing power and speed of computer technology. It is not surprising, therefore, that three-dimensional ultrasound technology is constantly evolving at a fast pace. The purpose of this article is to provide enhanced diagnostic capabilities for the obstetrical and gynecologic provider. RECENT FINDINGS The most recent advances in three-dimensional ultrasound have to do with two main features. First, an increasingly fast acquisition speed, enabling quick sequences of fast moving organs such as the heart to be captured. Second, the increasing number of different display modalities, making understanding and analysis of normal anatomy and pathology easier for clinicians. SUMMARY This article highlights a selected number of clinical situations in which three-dimensional ultrasound meaningfully enhances the contribution of this fast evolving diagnostic imaging tool.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA.
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Prevalencia, definición y manifestaciones clínicas del síndrome del ovario poliquístico. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1575-0922(06)71166-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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