Pubmed Result

1. Diagn Interv Radiol. 2015 Mar-Apr;21(2):118-22. doi: 10.5152/dir.2014.14094.
Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

.
rac S(1), Tan S, zcan A, Aslan A, Keskin HL, Ate F, Akay Y, Arslan H.
Author information:
(1)Department of Radiology, Ankara Training and Research Hospital, Ankara,
Turkey. drsinantan@gmail.com.
PURPOSE: We aimed to assess the feasibility and reproducibility of real-time
elastography (RTE) for displaying the effects of morphological changes in the
ovary in polycystic ovary syndrome (PCOS).
METHODS: Forty-eight patients diagnosed with PCOS and 48 healthy women were
enrolled in the study. Ultrasonography and RTE were performed on the 3rd day of
the menstrual cycle. Evaluations were performed independently by two
radiologists. Ovarian volume, number of follicles, elasticity pattern, and strai
n
ratio were measured. Elasticity patterns were assessed as hard (type 1; blue or
blue-green), moderate (type 2; green or green-yellow) or soft (type 3; red or
orange-red).
RESULTS: Both radiologists determined the elasticity pattern as mostly type 1 in
the PCOS group and type 3 in the control group (P < 0.01). The mean strain ratio
s
obtained by the first and second radiologist were 6.11.8 (2.7-10.1) and 6.01.5
(3.0-9.0) in PCOS and 3.31.2 (1.7-7.2) and 3.20.9 (1.7-6.8) in the control
group, respectively (P < 0.001). Interobserver agreement was moderate for the
elasticity pattern (=0.48) and good for the strain ratio (intraclass correlation
coefficient, 0.77). A strain ratio of 3.8 was determined as the optimized cutoff
point by receiver operating curve analysis. Strain ratio was correlated with the
ovarian volume and the number of detected follicles (P < 0.001).
CONCLUSION: Elasticity pattern and strain ratio can help identify morphological
changes that make PCOS ovaries stiffer than normal ovaries.
PMID: 25616270 [PubMed - in process]
2. Fertil Steril. 2015 Mar;103(3):787-94. doi: 10.1016/j.fertnstert.2014.12.094.

Epub 2015 Jan 6.
Ultrasound features of polycystic ovaries relate to degreeof reproductive and
metabolic disturbance in polycystic ovary syndrome.
Christ JP(1), Vanden Brink H(1), Brooks ED(1), Pierson RA(2), Chizen DR(2), Luja
n
ME(3).
Author information:
(1)Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell
University, Ithaca, New York. (2)Department of Obstetrics, Gynecology and
Reproductive Sciences, University of Saskatchewan, Saskatoon, Saskatchewan,
Canada. (3)Human Metabolic Research Unit, Division of Nutritional Sciences,
Cornell University, Ithaca, New York. Electronic address: MEL245@cornell.edu.
OBJECTIVE: To reexamine associations between polycystic ovarian morphology (PCOM
)
and degree of symptomatology in polycystic ovary syndrome (PCOS) using a
well-defined PCOS population, newer ultrasound technology, and reliable offline
assessments of sonographic parameters.
DESIGN: Cross-sectional observational study.
SETTING: Academic hospital and clinical research unit.
PATIENT(S): Forty-nine women with PCOS as defined by hyperandrogenism and
oligoamenorrhea.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Number of follicles per follicle size category, antral
follicle count (AFC), ovarian volume (OV), follicle distribution pattern, stroma
l
area, ovarian area, stromal to ovarian area ratio (S/A) and stromal echogenicity
index (SI), total (TT), androstenedione, LH, FSH, cholesterol, triglycerides,
low-density lipoprotein, high-density lipoprotein, C-reactive protein, glucose,
insulin, and hemoglobin A1C, menstrual cycle length, hirsutism score, body mass
index (BMI), waist:hip ratio, and blood pressure.
RESULT(S): AFC, but not OV, was positively associated with TT ( = .610),
androstenedione ( = .490), and LH:FSH ( = .402). SI was positively associated
with androgen markers and LH:FSH, while S/A was negatively associated with these
variables. Follicles 4mm were negatively associated with various metabolic

markers, whereas larger follicles (5-8mm) showed positive associations. Stromal
markers were not associated with cardiometabolic measures. LH:FSH best predicted
follicles 4mm, and BMI predicted 5- to 9-mm follicles. Dominant follicles
10mm were best predicted by age.
CONCLUSION(S): AFC, and not OV, reflected the severity of reproductive
dysfunction in PCOS. Associations among different sized follicles were consisten
t
with recruitable sized follicles, which reflects the severity of metabolic
dysfunction in PCOS.
Copyright 2015 American Society for Reproductive Medicine. Published by
Elsevier Inc. All rights reserved.
3. J Pediatr Endocrinol Metab. 2014 Nov 6. pii:

/j/jpem.ahead-of-print/jpem-2014-0307/jpem-2014-0307.xml. doi:
10.1515/jpem-2014-0307. [Epub ahead of print]
Is ultrasound useful in the diagnosis of adolescents with polycystic ovary
syndrome?
Senaldi L, Gopi RP, Milla S, Shah B.
Abstract Background: Diagnosis of adolescent polycystic ovary syndrome (PCOS)
remains a challenge despite several existing criteria, and may be difficult to
distinguish from pubertal changes. Different parameters to study ovarian functio
n
using ultrasonography have been proposed, but there is still no consensus about
their diagnostic value. Objective: To evaluate the role of ultrasonography in th
e
diagnosis of adolescent PCOS by reviewing available studies that assessed the
ovarian volume (OV) and other ovarian morphological features such as location an
d
number of follicles, stromal area, and volume. Methods: MEDLINE/PubMed database
were searched to identify studies that assessed ovarian characteristics of
adolescent PCOS patients by ultrasound. Studies on adults were also reviewed if
study population included adolescents and stromal characteristics were assessed
by three-dimensional (3D) sonogram. Results: Five studies, including 262 PCOS
adolescents (10-19 years of age) and two-dimensional (2D) ultrasound analysis,
were identified. Mean OV was 9.29 cm3 for PCOS patients and 4.77 cm3 for
controls. The morphology of ovarian follicles, when reported, showed multiple
(>10) peripheral follicles in 83% of cases. Two studies, including 157 PCOS
adolescents and young women (15-35 years of age) and 2D and 3D ultrasound
analysis, were identified. Patients with PCOS patients had a MOV 13.1 cm3,
multiple follicles (>15), and a statistically significant greater S/A ratio
compared to controls. Stromal volume indices were positively correlated with
hyperandrogenemia in PCOS patients. Conclusion: Pelvic ultrasound is an
increasingly important aid in the diagnosis of PCOS in adolescents. Besides
ovarian volume, ovarian morphology must be assessed with 2D ultrasound to look
for peripherally located multiple follicles. Further studies are warranted to
evaluate the utility of 3D ultrasonographic assessment in adolescents with PCOS.
PMID: 25381947 [PubMed - as supplied by publisher]
4. Clin Endocrinol (Oxf). 2015 Apr;82(4):584-91. doi: 10.1111/cen.12621. Epub 20

14
Nov 5.
Revised criteria for PCOS in WHO Group II anovulatory infertility - a revival of
hypothalamic amenorrhoea?
Lauritsen MP(1), Pinborg A, Loft A, Petersen JH, Mikkelsen AL, Bjerge MR, Nyboe
Andersen A.
Author information:
(1)The Fertility Clinic, Section 4071, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark.
OBJECTIVE: To evaluate revised criteria for polycystic ovarian morphology (PCOM)
in the diagnosis of polycystic ovary syndrome (PCOS) in anovulatory infertility.
DESIGN: Prospective cohort study.
PATIENTS: WHO Group II anovulatory infertile women (n=75).
MEASUREMENTS: Clinical, sonographic and endocrine parameters, including
anti-Mllerian hormone (AMH).
RESULTS: The Rotterdam criteria for PCOM (antral follicle count (AFC) 12 and/or
ovarian volume >10ml) were fulfilled in 93% of the women. The PCOM prevalence
was 68% when increasing the threshold to AFC >20 and 76% according to an
AMH-based threshold of >35pmol/l. The most recently proposed AFC25 threshold
reduced the PCOM prevalence to 52% (n=39), leaving 48% (n=36) without
features of PCOM. Comparing the 36 women with non-PCOM with the 39 women in the
PCOM group according to AFC25, 22% vs 59% (P=0001) had serum LH>10IU/l,
11% vs 41% (P=0003) had an LH/FSH ratio >2 and 19% vs 41% (P=004) had
hirsutism and/or elevated total testosterone, free testosterone, and/or
androstenedione. The non-PCOM group included significantly more women with
secondary infertility. The median AMH in the non-PCOM group was 47pmol/l, which
was twofold lower than in the PCOM group but above the upper limit of
normo-ovulatory women.
CONCLUSIONS: According to a revised threshold of 25 follicles, almost half the
anovulatory infertile women do not have PCOM. The characteristics of these women
may be compatible with hypothalamic anovulation, but according to AMH levels, th
e
ovaries remain multifollicular.
PERSPECTIVES: A better distinction between hypothalamic amenorrhoea and PCOS
could improve treatment strategies for anovulatory infertility.
2014 John Wiley & Sons Ltd.
5. Eur J Obstet Gynecol Reprod Biol. 2014 Oct;181:124-9. doi:

10.1016/j.ejogrb.2014.07.029. Epub 2014 Aug 4.
Intraindividual right-left comparison of sonographic features in polycystic ovar
y
syndrome (PCOS) diagnosis.
Kninger A(1), Koch L(2), Edimiris P(2), Nieen S(3), Kasimir-Bauer S(2), Kimmig
R(2), Strowitzki T(4), Schmidt B(3).
Author information:
(1)Department of Gynecology and Obstetrics, University of Duisburg-Essen,
Hufelandstrasse 55, 45122 Essen, Germany. Electronic address:
angela.koeninger@uk-essen.de. (2)Department of Gynecology and Obstetrics,
University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
(3)Institute for Medical Informatics, Biometry and Epidemiology (IMIBE),
University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
(4)Department of Gynecological Endocrinology and Reproductive Medicine,
University of Heidelberg, Vostrasse 9, 69115 Heidelberg, Germany.
OBJECTIVE: Sonographic features of polycystic ovaries consist of elevated antral
follicle count or ovarian volume of at least one ovary. The aim of this
prospective cross-sectional study was to estimate intraindividual differences in
sonographic measurements between the both ovaries of PCOS patients and controls
and clinical consequences.
STUDY DESIGN: Both ovaries of 85 PCOS patients and 48 controls were scanned
transvaginally and agreement of sonographic measurements was analyzed using the
Bland-Altman method. Concordance correlation coefficients (CCC) were computed.
RESULTS: Mean differences between right and left ovaries were 0.24 (95%
confidence interval [95% CI]: -0.32-0.80) follicles for AFC and 1.14 (95% CI:
0.34-1.92)ml for OV in the whole study population, 0.14 (95% CI: -0.68-0.96)
follicles for AFC and 1.48 (95% CI: 0.39-2.58)ml for OV in PCOS patients, 0.42
(95% CI: -0.19-1.02) follicles for AFC and 0.53 (95% CI: -0.50-1.56)ml for OV in
controls. Rather wide limits of agreement and low CCCs (<0.7 for all estimates)
indicated poor agreement between the ovaries for both sonographic measurements.
Width between lower and upper limits of agreement was higher for PCOS patients
than for controls. 23.5% of the PCOS patients showed polycystic ovarian
morphology (PCOM) only in one ovary, resulting in 9.4% potentially missed PCOS
diagnosis according to the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Worksho
p
Group.
CONCLUSION: Substantial differences in antral follicle count and ovarian volume
between the right and left ovary were observed. In approximately 10% of the PCOS
patients in our study only the examination of both ovaries has led to a reliable
diagnosis of PCOS. In clinical practice it is recommended to scan both ovaries
for a reliable diagnosis of abnormal sonographic findings in PCOM and PCOS
diagnosis.
Copyright 2014 Elsevier Ireland Ltd. All rights reserved.
6. J Clin Ultrasound. 2015 Mar;43(3):157-63. doi: 10.1002/jcu.22182. Epub 2014 J

un
4.
Prediction of polycystic ovarian syndrome based on ultrasound findings and
clinical parameters.
Moschos E(1), Twickler DM.
Author information:
(1)University of Texas Southwestern Medical Center, Division of Gynecology,
Department of Obstetrics and Gynecology, Dallas, TX.
OBJECTIVE: To determine the accuracy of sonographic-diagnosed polycystic ovaries
and clinical parameters in predicting polycystic ovarian syndrome.
METHODS: Medical records and ultrasounds of 151 women with sonographically
diagnosed polycystic ovaries were reviewed. Sonographic criteria for polycystic
ovaries were based on 2003 Rotterdam European Society of Human Reproduction and
Embryology/American Society for Reproductive Medicine guidelines: at least one
ovary with 12 or more follicles measuring 2-9 mm and/or increased ovarian volume
>10 cm(3) . Clinical variables of age, gravidity, ethnicity, body mass index, an
d
sonographic indication were collected. One hundred thirty-five patients had fina
l
outcomes (presence/absence of polycystic ovarian syndrome). Polycystic ovarian
syndrome was diagnosed if a patient had at least one other of the following two
criteria: oligo/chronic anovulation and/or clinical/biochemical hyperandrogenism
.
A logistic regression model was constructed using stepwise selection to identify
variables significantly associated with polycystic ovarian syndrome (p < .05).
The validity of the model was assessed using receiver operating characteristics
and Hosmer-Lemeshow (2) analyses.
RESULTS: One hundred twenty-eight patients met official sonographic criteria for
polycystic ovaries and 115 (89.8%) had polycystic ovarian syndrome (p = .009).
Lower gravidity, abnormal bleeding, and body mass index >33 were significant in
predicting polycystic ovarian syndrome (receiver operating characteristics curve
,
c = 0.86). Pain decreased the likelihood of polycystic ovarian syndrome.
CONCLUSIONS: Polycystic ovaries on ultrasound were sensitive in predicting
polycystic ovarian syndrome. Ultrasound, combined with clinical parameters, can
be used to generate a predictive index for polycystic ovarian syndrome. 2014
Wiley Periodicals, Inc. J Clin Ultrasound 43:157-163, 2015;
2014 Wiley Periodicals, Inc.
7. Indian J Endocrinol Metab. 2014 Mar;18(2):180-4. doi: 10.4103/2230-8210.12910
8.
Comparative evaluation of sonographic ovarian morphology of Indian women with
polycystic ovary syndrome versus those of normal women.
Ahmed S(1), Pahwa S(2), Das CJ(2), Mir FA(1), Nisar S(3), Jehangir M(4), Parveen
S(5), Rashid A(6), Ganie MA(7).
Author information:
(1)Department of Radiodiagnosis, Sheri-Kashmir Institute of Medical Sciences,
Srinagar, India. (2)Department of Radiodiagnosis, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India. (3)Department of Geriatric Medicine,
All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
(4)Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and
Kashmir, India. (5)Department of Obstetrics and Gynecolgy, Sheri-Kashmir
Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. (6)Department
of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu
and Kashmir, India. (7)Department of Endocrinology, Metabolism and Diabetes, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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 wa
s
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 o
f
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.
PMCID: PMC3987267
PMID: 24741513 [PubMed]
8. Fertil Steril. 2014 Jun;101(6):1747-56.e1-3. doi:

10.1016/j.fertnstert.2014.02.022. Epub 2014 Mar 21.
Ovarian morphology assessed by magnetic resonance imaging in women with and
without polycystic ovary syndrome and associations with antimllerian hormone,
free testosterone, and glucose disposal rate.
Leonhardt H(1), Hellstrm M(1), Gull B(2), Lind AK(2), Nilsson L(2), Janson
PO(2), Stener-Victorin E(3).
Author information:
(1)Department of Radiology, Institute of Clinical Science, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden. (2)Department of Obstetrics and
Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden. (3)Department of Physiology, Institute of
Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden; Department of Obstetrics and Gynecology, First Affiliated
Hospital, Heilongjiang University of Chinese Medicine, Harbin, People's Republic
of China. Electronic address: elisabet.stener-victorin@neuro.gu.se.
OBJECTIVE: To characterize ovarian morphology and perfusion by magnetic resonanc
e
imaging (MRI) in women with and without polycystic ovary syndrome (PCOS) and to
investigate associations with antimllerian hormone (AMH), free T, and glucose
disposal rate (GDR).
DESIGN: Explorative cross-sectional study.
SETTING: University hospital.
PATIENT(S): Fifty-eight women with PCOS and 31 controls from the general
population.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Antral follicle count (AFC), ovarian/stromal volume,
perfusion, AMH, free T, and GDR.
RESULT(S): Antral follicles of 1-3 and 4-6 mm, but not 7-9 mm, were more
numerous, and total AFC (1-9 mm) was higher in women with PCOS. Ovarian volume
was larger in women with PCOS. AMH and free T were higher and GDR was lower in
women with PCOS. All values were more deranged in classic compared with
nonclassic PCOS. There was a positive correlation between AMH and AFC, 1-3 mm (r
= 0.81), and between AMH and total AFC (r = 0.87). In receiver operating
characteristic analyses, the area under the curve was 0.89 for total AFC, 0.86
for AMH, and 0.90 for free T. PCOS was independently associated with AFC and fre
e
T but not with AMH or GDR when adjusted for age and body mass index.
CONCLUSION(S): Counting antral follicles down to 1 mm in size by MRI yielded
higher AFCs than previously reported. AFC, AMH, and free T discriminated with
high accuracy between women with PCOS and controls, but AMH was not independentl
y
associated with PCOS.
CLINICAL TRIAL REGISTRATION NUMBER: NCT00484705.
Copyright 2014 American Society for Reproductive Medicine. Published by
Elsevier Inc. All rights reserved.
PMID: 24661732 [PubMed - indexed for MEDLINE]
9. Hum Reprod Update. 2014 May-Jun;20(3):334-52. doi: 10.1093/humupd/dmt061. Epu

b
2013 Dec 16.
Definition and significance of polycystic ovarian morphology: a task force repor
t
from the Androgen Excess and Polycystic Ovary Syndrome Society.
Dewailly D(1), Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ,
Escobar-Morreale HF.
Author information:
(1)Department of Endocrine Gynaecology and Reproductive Medicine, Hpital Jeanne
de Flandre, Centre Hospitalier de Lille, University of Lille, Lille, France.
Comment in
Hum Reprod Update. 2014 May-Jun;20(3):463-4.
BACKGROUND The diagnosis of polycystic ovary syndrome (PCOS) relies on clinical,
biological and morphological criteria. With the advent of ultrasonography,
follicle excess has become the main aspect of polycystic ovarian morphology
(PCOM). Since 2003, most investigators have used a threshold of 12 follicles
(measuring 2-9 mm in diameter) per whole ovary, but that now seems obsolete. An
increase in ovarian volume (OV) and/or area may also be considered accurate
markers of PCOM, yet their utility compared with follicle excess remains unclear
.
METHODS Published peer-reviewed medical literature about PCOM was searched using
PubMed.gov online facilities and was submitted to critical assessment by a panel
of experts. Studies reporting antral follicle counts (AFC) or follicle number pe
r
ovary (FNPO) using transvaginal ultrasonography in healthy women of reproductive
age were also included. Only studies that reported the mean or median AFC or FNP
O
of follicles measuring 2-9 mm, 2-10 mm or <10 mm in diameter, or visualized all
follicles, were included. RESULTS Studies addressing women recruited from the
general population and studies comparing control and PCOS populations with
appropriate statistics were convergent towards setting the threshold for
increased FNPO at 25 follicles, in women aged 18-35 years. These studies
suggested maintaining the threshold for increased OV at 10 ml. Critical analysis
of the literature showed that OV had less diagnostic potential for PCOM compared
with FNPO. The review did not identify any additional diagnostic advantage for
other ultrasound metrics such as specific measurements of ovarian stroma or bloo
d
flow. Even though serum concentrations of anti-Mllerian hormone (AMH) showed a
diagnostic performance for PCOM that was equal to or better than that of FNPO in
some series, the accuracy and reproducibility issues of currently available AMH
assays preclude the establishment of a threshold value for its use as a surrogat
e
marker of PCOM. PCOM does not associate with significant consequences for health
in the absence of other symptoms of PCOS but, because of the use of inconsistent
definitions of PCOM among studies, this question cannot be answered with absolut
e
certainty. CONCLUSIONS The Task Force recommends using FNPO for the definition o
f
PCOM setting the threshold at 25, but only when using newer technology that
affords maximal resolution of ovarian follicles (i.e. transducer frequency 8
MHz). If such technology is not available, we recommend using OV rather than FNP
O
for the diagnosis of PCOM for routine daily practice but not for research studie
s
that require the precise full characterization of patients. The Task Force
recognizes the still unmet need for standardization of the follicle counting
technique and the need for regularly updating the thresholds used to define
follicle excess, particularly in diverse populations. Serum AMH concentration
generated great expectations as a surrogate marker for the follicle excess of
PCOM, but full standardization of AMH assays is needed before they can be
routinely used for clinical practice and research. Finally, the finding of PCOM
in ovulatory women not showing clinical or biochemical androgen excess may be
inconsequential, even though some studies suggest that isolated PCOM may
represent the milder end of the PCOS spectrum.
10. Acta Radiol. 2014 Mar;55(2):248-56. doi: 10.1177/0284185113495835. Epub 2013

Aug
7.
Ovarian volume and antral follicle count assessed by MRI and transvaginal
ultrasonography: a methodological study.
Leonhardt H(1), Gull B, Stener-Victorin E, Hellstrm M.
Author information:
(1)Department of Radiology, Institute of Clinical Sciences, Sahlgrenska
University Hospital, Sahlgrenska Academy at the University of Gothenburg,
Gothenburg, Sweden.
BACKGROUND: Ultrasonographic measurements of ovarian volume and antral follicle
count are of clinical importance as diagnostic features of polycystic ovarian
syndrome (PCOS), and as a parameter in estimation of ovarian follicular reserve
in infertility care.
PURPOSE: To compare two-dimensional (2D)/three-dimensional (3D) transvaginal
ultrasonography (TVUS) and magnetic resonance imaging (MRI) for estimation of
ovarian volume and antral follicle count, and to assess reproducibility and
inter-observer agreement of MRI measurements.
MATERIAL AND METHODS: Volumes of 172 ovaries in 99 women aged 21-37 years were
calculated (length x width x height x 0.523) with conventional 2D TVUS and 2D
MRI. Semi-automatic estimates of ovarian volumes were obtained by 3D MRI. Antral
follicles were counted manually on 2D MRI and automatically by 3D TVUS (SonoAVC)
,
and stratified according to follicle size.
RESULTS: Mean ovarian volume assessed by 2D TVUS (13.1 6.4 mL) was larger than
assessed by 2D MRI (9.6 4.1) and 3D MRI (11.4 4.5) (P < 0.001). Total
follicle count was higher by 2D MRI than by 3D TVUS, mean difference 14.3 16.2
follicles (P < 0.001). In the smallest size interval of 1-3 mm the mean
difference was 22.2 17.6 (P < 0.001). Intra- and inter-observer absolute
agreement assessment for MRI measurements of ovarian volume and total follicle
count showed ICC coefficients >0.77.
CONCLUSION: 2D MRI reveals more antral follicles, especially of small size, than
3D TVUS. Ovarian volume estimation by MRI provides smaller volumes than by the
reference standard 2D TVUS. Ovarian volume estimation by 3D MRI, allowing
independence of non-ellipsoid ovarian shape measurement errors, provides volumes
closer to 2D TVUS values than does 2D MRI. Reproducibility and inter-observer
agreement of 2D MRI measurements of ovarian volume and total follicle count are
good.
11. Hum Reprod. 2013 Jul;28(7):1929-42. doi: 10.1093/humrep/det114. Epub 2013 Ap

r 26.
Pregnancy and neonatal outcomes following luteal GnRH antagonist administration
in patients with severe early OHSS.
Lainas GT(1), Kolibianakis EM, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas
TG, Tarlatzis BC.
Author information:
(1)Eugonia Unit of Assisted Reproduction, 7 Ventiri Street, Athens 11528, Greece
.
STUDY QUESTION: Do high-risk patients who develop severe early ovarian
hyperstimulation syndrome (OHSS) and receive low-dose GnRH antagonist in the
luteal phase have lower live birth rates compared with high-risk patients who do
not develop severe early OHSS and do not receive GnRH antagonist in the luteal
phase?
SUMMARY ANSWER: Low-dose luteal GnRH antagonist administration in women with
severe early OHSS is associated with similar live birth rates to that of
high-risk patients who do not develop severe early OHSS and do not receive GnRH
antagonist in the luteal phase.
WHAT IS KNOWN ALREADY: It has been reported that luteal GnRH antagonist
administration in patients with established severe early OHSS appears to prevent
patient hospitalization and results in quick regression of the syndrome on an
outpatient basis. However, the effect of such treatment on pregnancy outcome has
been investigated in only a small number of animal studies.
STUDY DESIGN, SIZE, DURATION: This is a prospective cohort study of 192 IVF
patients who were at high risk for OHSS and who did not wish to cancel embryo
transfer and have all embryos cryopreserved. The study was conducted between
January 2009 and December 2011 at Eugonia Assisted Reproduction Unit.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients were <40 years of age, with
polycystic ovaries, at high risk for OHSS (defined by the presence of at least 2
0
follicles 11 mm on the day of triggering of final oocyte maturation) and not
willing to cancel embryo transfer and cryopreserve all embryos, if severe early
OHSS was diagnosed by Day 5 of embryo culture. Patients who were diagnosed with
severe early OHSS on Day 5 post-oocyte retrieval were administered 0.25 mg of
ganirelix for 3 days, from Day 5 until and including Day 7 (OHSS + antag group,
n
= 22). High-risk patients who did not develop the severe early OHSS did not
receive GnRH antagonist in the luteal phase (control group, n = 172). All
patients underwent embryo transfer on Day 5.
MAIN RESULTS AND THE ROLE OF CHANCE: Live birth rates (40.9 versus 43.6%),
ongoing pregnancy rates (45.5 versus 48.8%), clinical pregnancy rates (50 versus
65.1%), positive hCG (72.7 versus 75%), duration of gestation (36.86 0.90 weeks
versus 36.88 2.38 weeks) and neonatal weight (2392.73 427.04 versus 2646.56
655.74 g) were all similar in the OHSS + antag and control groups, respectively.
The incidence of major congenital malformations was 2.9% (3/103) in children bor
n
in the control group compared with no cases (0/14) in children born following
luteal GnRH antagonist administration. No stillbirths or intrauterine deaths, an
d
no cases of pregnancy-induced late OHSS were recorded in either group. None of
the 22 patients with severe early OHSS required hospitalization following luteal
antagonist administration. Ovarian volume, ascites, hematocrit, white blood cell
count, serum estradiol and progesterone decreased significantly (P < 0.001) by
the end of the monitoring period (Day 11 post-oocyte retrieval), indicating rapi
d
resolution of the severe OHSS.
LIMITATIONS, REASONS FOR CAUTION: This is a prospective cohort investigation wit
h
a very limited number of patients receiving the intervention and a larger number
of control patients. Our findings suggest that low-dose luteal GnRH antagonist
administration during the peri-implantation period may be safe, although larger
studies with follow-up of the children born are required.
WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests for the first time that
low-dose luteal GnRH antagonist administration in women with severe early OHSS i
s
associated with a favourable IVF outcome, comparable to control high-risk
patients without severe OHSS and not receiving the intervention. Regarding the
wider implications on the concept of an OHSS-free clinic, administration of GnRH
antagonist in the luteal phase may present a tertiary management level in
patients with established severe OHSS, along with the use of GnRH antagonist
protocols for primary prevention and the replacement of hCG with GnRH agonist fo
r
triggering final oocyte maturation for secondary prevention. However, at present
,
fresh embryo transfer combined with antagonist administration should only be use
d
with caution by experienced practitioners, after carefully deciding which
patients can have a fresh transfer or embryo cryopreservation, until the current
data are confirmed by larger trials.
12. J Hum Reprod Sci. 2012 Sep;5(3):274-8. doi: 10.4103/0974-1208.106340.

Comparison of anti-mullerian hormone and antral follicle count for assessment of
ovarian reserve.
Panchal S(1), Nagori C.
Author information:
(1)Dr. Nagori's Institute for Infertility and IVF, Ellisbridge, Ahmedabad,
Gujarat, India.
AIM: This study aims to compare the efficacy of AFC and AMH, as markers for
ovarian reserve.
MATERIALS AND METHODS: 75 patients with PCO (polycystic ovaries) undergoing IVF
were randomized with 75 non-PCO patients. On day 3, volume of ovary was acquired
,
ovarian volume was defined by VOCAL, and Sono AVC was used to count the number o
f
antral follicles. Sum total of antral follicles in both ovaries was taken as
total antral follicle count (AFC). AMH was measured on the same day. Long agonis
t
protocol with recombinant FSH (rFSH) was used for IVF stimulation till at least
two follicles of 18 mm were seen. hCG 10,000 iu was given and ovum pick up was
done after 34-35 h. Primary end point was number of follicles >12 mm seen on day
of hCG. Final end point was number of ova retrieved on ovum pick up. Correlation
of AFC and AMH was checked for both end points and with each other.
RESULTS: Correlation of AFC and follicles >12 mm on day of hCG in PCO group is
0.56 and non-PCO group is 0.63,(1) and for AMH and follicles >12 mm on day of hC
G
in PCO group is 0.42 and non-PCO group is 0.47. Correlation of AFC with number o
f
ova retrieved on OPU in PCO group is 0.44 and for non-PCO group is 0.50. The
value for AMH is 0.39 in PCO and 0.43 for non-PCO group. Comparing correlation o
f
AFC and AMH for primary end point in PCO group has 'z' value 1.11(onetailed
significance 0.1335, twotailed significance 0.267) and in non-PCO group
comparison shows a 'z' value of 1.39 (one tailed significance 0.0823, two-tailed
significance 0.1645). Therefore in both groups, AFC and AMH correlates with tota
l
number of follicles >12 mm on day of hCG, but both AFC and AMH have independent
significance. Comparing correlation of AFC and AMH with number of ova retrieved
on OPU, in non-PCO group has 'z' value of 0.54(one tailed 0.2946, two-tailed 0.
5892). In PCO group, this comparison shows, 'z' value of 0.36(one tailed 0.3594,
two tailed 0.7188).
CONCLUSION: AFC and AMH correlate with each other but have independent
significance for estimating follicles >12 mm on day of hCG. For ova retrieved on
OPU, in PCO group, AMH and AFC have similar significance. In non-PCO, AMH may
increase accuracy of estimation of number of ova retrieved on OPU over AFC, but
difference is not significant. AFC only may suffice for estimation of number of
ova retrieved on OPU for all practical purposes.
PMCID: PMC3604835
13. Hum Reprod. 2013 May;28(5):1361-8. doi: 10.1093/humrep/det062. Epub 2013 Mar
15.
Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds
for elevated follicle population and ovarian volume.
Lujan ME(1), Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, Haider E,
Pierson RA, Chizen DR.
Author information:
(1)Division of Nutritional Sciences, Cornell University, 216 Savage Hall, Ithaca
,
NY 14853, USA. mel245@cornell.edu
STUDY QUESTION: Do the ultrasonographic criteria for polycystic ovaries supporte
d
by the 2003 Rotterdam consensus adequately discriminate between the normal and
polycystic ovary syndrome (PCOS) condition in light of recent advancements in
imaging technology and reliable methods for estimating follicle populations in
PCOS?
STUDY ANSWER: Using newer ultrasound technology and a reliable grid system
approach to count follicles, we concluded that a substantially higher threshold
of follicle counts throughout the entire ovary (FNPO)-26 versus 12 follicles-is
required to distinguish among women with PCOS and healthy women from the general
population.
WHAT IS KNOWN ALREADY: The Rotterdam consensus defined the polycystic ovary as
having 12 or more follicles, measuring between 2 and 9 mm (FNPO), and/or an
ovarian volume (OV) >10 cm(3). Since their initial proposal in 2003, a heightene
d
prevalence of polycystic ovaries has been described in healthy women with regula
r
menstrual cycles, which has questioned the accuracy of these criteria and
marginalized the specificity of polycystic ovaries as a diagnostic criterion for
PCOS.
STUDY DESIGN, SIZE, DURATION: A diagnostic test study was performed using
cross-sectional data, collected from 2006 to 2011, from 168 women prospectively
evaluated by transvaginal ultrasonography. Receiver operating characteristic
(ROC) curve analyses were performed to determine the appropriate diagnostic
thresholds for: (i) FNPO, (ii) follicle counts in a single cross section (FNPS)
and (iii) OV. The levels of intra- and inter-observer reliability when five
observers used the proposed criteria on 100 ultrasound cases were also
determined.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Ninety-eight women diagnosed with PCOS
by the National Institutes of Health criteria as having both oligo-amenorrhea an
d
hyperandrogenism and 70 healthy female volunteers recruited from the general
population. Participants were evaluated by transvaginal ultrasonography at the
Royal University Hospital within the Department of Obstetrics, Gynecology and
Reproductive Sciences, University of Saskatchewan (Saskatoon, SK, Canada) and in
the Division of Nutritional Sciences' Human Metabolic Research Unit, Cornell
University (Ithaca, NY, USA).
MAIN RESULTS: Diagnostic potential for PCOS was highest for FNPO (0.969),
followed by FNPS (0.880) and OV (0.873) as judged by the area under the ROC
curve. An FNPO threshold of 26 follicles had the best compromise between
sensitivity (85%) and specificity (94%) when discriminating between controls and
PCOS. Similarly, an FNPS threshold of nine follicles had a 69% sensitivity and
90% specificity, and an OV of 10 cm(3) had a 81% sensitivity and 84% specificity
.
Levels of intra-observer reliability were 0.81, 0.80 and 0.86 when assessing
FNPO, FNPS and OV, respectively. Inter-observer reliability was 0.71, 0.72 and
0.82, respectively.
LIMITATIONS, REASONS FOR CAUTION: Thresholds proposed by this study should be
limited to use in women aged between 18 and 35 years.
WIDER IMPLICATIONS OF THE FINDINGS: Polycystic ovarian morphology has excellent
diagnostic potential for detecting PCOS. FNPO have better diagnostic potential
and yield greater diagnostic confidence compared with assessments of FNPS or OV.
Whenever possible, images throughout the entire ovary should be collected for th
e
ultrasonographic evaluation of PCOS.
STUDY FUNDING AND COMPETING INTEREST: This study was funded by Cornell Universit
y
and fellowship awards from the Saskatchewan Health Research Foundation and
Canadian Institutes of Health Research. The authors have no conflict of interest
s
to disclose.
14. J Obstet Gynaecol. 2013 Feb;33(2):165-70. doi: 10.3109/01443615.2012.745839.

Effects of low-dose metformin and rosiglitazone on biochemical, clinical,
metabolic and biophysical outcomes in polycystic ovary syndrome.
Mohiyiddeen L(1), Watson AJ, Apostolopoulos NV, Berry R, Alexandraki KI, Jude EB
.
Author information:
(1)Department of Gynaecology, Tameside General Hospital, Ashton-Under-Lyne, UK.
Lamiya.Mohiyiddeen@cmft.nhs.uk
The aim of this study was to compare the effect of low-dose metformin and
rosiglitazone on clinical, biochemical, ultrasound features and endothelial
function in patients with polycystic ovary syndrome (PCOS). After randomisation,
a group of 17women received metformin 500 mg b.d. (MG) and a group of 18
received rosiglitazone 4 mg o.d. (RG) for 3 months. Serum FSH, LH, testosterone,
fasting glucose, insulin, IGF-1, IGFBP-3, CRP were measured at baseline and
follow-up. Ovarian scan and microcirculation studies were also performed. It was
found that there was a reduction in hyperandrogenaemia, insulin resistance,
lipidaemia, CRP levels, ovarian volume and number of follicles in both groups. N
o
improvement in endothelial- dependent function was noted but a significant
improvement in endothelial-independent function in rosiglitazone group. It was
concluded that low-dose therapeutic regimen with rosiglitazone and metformin, ha
s
comparable beneficial impacts on metabolic, hormonal and morphological features
of PCOS but no obvious effect on vascular parameters in a population of
predominantly mild PCOS.
15. J Pediatr Endocrinol Metab. 2012;25(9-10):983-9. doi: 10.1515/jpem-2012-0013

.
Elevated serum anti-Mllerian hormone in adolescents with polycystic ovary
syndrome: relationship to ultrasound features.
Pawelczak M(1), Kenigsberg L, Milla S, Liu YH, Shah B.
Author information:
(1)Department of Pediatrics, New York University School of Medicine, New York,
NY, USA.
CONTEXT: Serum anti-Mllerian hormone (AMH) is linked to the ovarian follicle
pool. Little is known about the relationship between serum AMH and ovarian
ultrasound (US) features in adolescents with polycystic ovary syndrome (PCOS).
OBJECTIVES: To confirm that serum AMH is elevated in adolescents with PCOS and t
o
correlate serum AMH with ovarian US features in this population are the
objectives of this study.
DESIGN: A retrospective chart review of clinical, biochemical, and
ultrasonographic data in adolescents with PCOS and normal controls is the design
of the study. Serum AMH was measured and compared between groups and correlated
with ovarian US findings.
SETTING: The study was done in two urban tertiary academic medical centers.
PARTICIPANTS: Study groups included 23 adolescent females with PCOS and 12 age
and BMI-matched female controls.
MAIN OUTCOME MEASURES: We hypothesized that serum AMH would be elevated in the
PCOS group compared with the controls and would positively correlate with the
follicle number, distribution, and ovarian volume.
RESULTS: Serum AMH was 6.783.55 ng/mL in the PCOS group vs. 3.381.48 ng/mL in
the controls (p=0.0004). AMH positively correlated with ovarian volume (left
ovary r=0.65, p=0.0007, right ovary r=0.55, p=0.0065) and peripheral follicle
distribution (p=0.0027). Ten or more follicles were observed in 83% of USs.
CONCLUSIONS: There is a positive relationship between serum AMH and ovarian
volume as well as peripheral follicular distribution in adolescents with PCOS.
Our findings support the use of serum AMH as a useful marker to reflect ovarian
US features typical of PCOS in cases where accurate USs are not available and fo
r
follow-up.
PMCID: PMC3763943
16. Arch Gynecol Obstet. 2013 Jul;288(1):213-20. doi: 10.1007/s00404-013-2742-y.

Epub
2013 Feb 3.
The effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol
+ metformin on ovarian ultrasonographic markers, body fat mass index, leptin, an
d
ghrelin.
Cakiroglu Y(1), Vural B, Isgoren S.
Author information:
(1)Department of Obstetrics and Gynecology, Faculty of Medicine, Kocaeli
University, Umuttepe/Uctepeler, 41000 Kocaeli, Turkey. dryigit1@yahoo.com
PURPOSE: Polycystic ovary syndrome (PCOS) is considered as the most common
endocrinopathy among women of reproductive age. Oral contraceptives (OCs) and
metformin are one of the main drug groups in the long-term treatment of PCOS.
This study was undertaken to investigate the effects of drospirenone-ethinyl
estradiol and drospirenone-ethinyl estradiol + metformin on ultrasonographic
markers, body fat mass (BFM) index, leptin-ghrelin.
METHODS: This was a prospective clinical study conducted at Kocaeli University
Department of Obstetrics and Gynecology on 42 PCOS patients. Patients were
randomly allocated into two groups [Group I (n = 22): drospirenone-ethinyl
estradiol (DEE); Group II (n = 20): drospirenone-ethinyl estradiol + metformin
(M)] according to Body Mass Index (BMI) findings. Patients were evaluated in
terms of leptin-ghrelin, ultrasound, and body fat distribution before and 6
months after therapy. Main outcome measures were to investigate the effects of
drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on
ovarian ultrasonographic markers, BFM index, leptin, and ghrelin.
RESULTS: In patients with higher BMI, ovarian volume, numbers of follicles,
stromal area, and echogenicity have been reported to be larger. In group II, a
negative correlation between ghrelin and abdominal fat mass after treatment has
been noted, whereas in group I a positive correlation between leptin and
abdominal fat mass after treatment has been observed.
CONCLUSIONS: Addition of metformin could have beneficial effects on abdominal fa
t
mass. Stromal area measurement and assessment of fat mass with Dual X-ray
Absorptiometry could be helpful as a quantitative way of measurement.
17. J Magn Reson Imaging. 2013 Sep;38(3):689-93. doi: 10.1002/jmri.23992. Epub 2

013
Jan 4.
Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary
syndrome and age-matched controls.
Brown M(1), Park AS, Shayya RF, Wolfson T, Su HI, Chang RJ.
Author information:
(1)Department of Radiology, University of California, San Diego, La Jolla,
California 92093, USA.
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 wer
e
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 PCO
S
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 betwee
n
girls with and without PCOS. MRI may help evaluate young patients in whom
transvaginal ultrasound is contraindicated.
Copyright 2013 Wiley Periodicals, Inc., a Wiley company.
PMCID: PMC3620938
18. Zhonghua Yi Xue Za Zhi. 2012 Sep 4;92(33):2319-22.

[Ovarian ultrasonographic features in reproductive age females with polycystic
ovary syndrome and the establishment of ultrasonographic criteria].
[Article in Chinese]
Xie M(1), Li X, Zhou YQ, Zhao NQ, Lin JF.
Author information:
(1)Department of Ultrasonic Medicine, Fudan University, Shanghai, China.
OBJECTIVE: To understand the ovarian ultrasound imaging features in the
reproductive age females with polycystic ovary syndrome (PCOS).
METHODS: A total of 396 PCOS patients aged 18 - 35 years were recruited from our
gynaecology & endocrinology clinic, including obese (OB-PCOS group, n = 153) and
non-obese (NOB-PCOS group, n = 241). And 635 reproductive period females with
normal menstruation for the control group, including obese (OB-CON group, n = 72
)
and non-obese (NOB-CON group, n = 563). Questionnaire surveys were conducted on
their menstrual history. Vagina or rectum ultrasound methods were employed to
determine the values of ovarian follicle number (FN) and ovarian volume (OV).
Also the clinical symptom scores and endocrine and metabolic indices were
measured.
RESULTS: (1) As compared to the control group, the values of ovarian FN and OV
95% site for physiological high limit were 10 and 9.5 ml respectively. (2) In
PCOS patients, their ovarian volumes and the number of follicles were
significantly higher than those of the control group (P < 0.01). (3) In 90.4% of
these patients, their values were OV > 9.5 ml and/or FN 10. And in 66.9% PCOS
patients of reproductive age, the polycystic ovarian changes of ultrasound
imaging reached the Rotterdam consensus diagnostic criteria.
CONCLUSION: The features of ovarian ultrasound imaging in reproductive period
PCOS patients are enlarged ovarian volume and increased follicles numbers. The
preliminary Chinese ovarian ultrasonographic diagnostic cut-off points have been
proposed for reproductive period PCOS patients.
19. Hum Reprod. 2012 Sep;27(9):2729-36. doi: 10.1093/humrep/des199. Epub 2012 Ju

n 26.
Psychometric properties of the Iranian version of modified polycystic ovary
syndrome health-related quality-of-life questionnaire.
Bazarganipour F(1), Ziaei S, Montazeri A, Faghihzadeh S, Frozanfard F.
Author information:
(1)Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran.
STUDY QUESTION: Can the modified polycystic ovary syndrome health-related
quality-of-life questionnaire (MPCOSQ) be validated in Iranian patients with
polycystic ovary syndrome (PCOS) to provide an instrument for future outcome
studies in these patients?
SUMMARY ANSWER: We show initial reliability and validity of the Iranian version
of the MPCOSQ as a specific instrument to measure health-related quality of life
(QOL) in patients with PCOS in Iran.
WHAT IS KNOWN ALREADY: The prevalence of PCOS in Iran is relatively high and
studying QOL in these patients is important. The PCOSQ has previously been
translated and validated in Iran but no studies had examined the psychometric
properties of the MPCOSQ in Iran.
STUDY DESIGN, SIZE, AND DURATION: This was a cross-sectional study. After
linguistic validation of the Iranian version of MPCOSQ, an expert panel evaluate
d
the items by assessing the content validity index (CVI) and content validity
ratio (CVR). Then a semi-structured interview was conducted to assess face
validity. Consequently, exploratory factor analysis (EFA) and confirmatory facto
r
analysis (CFA) were performed to indicate the scale constructs (n = 200). In
addition, reliability analyses including internal consistency and test-retest
analysis were carried out.
PARTICIPANTS/MATERIALS, SETTING, AND METHODS: This study was carried out on wome
n
with PCOS (n = 200) who attended two private gynecology clinics in Kashan, Iran.
Patients were eligible if they met each of the following criteria: 15-40 years o
f
age; married; not having non-classic adrenal hyperplasia, thyroid dysfunction an
d
hyperprolactinemia; Iranian; not having problems in speaking or listening; havin
g
two of the following Rotterdam diagnostic criteria: (i) polycystic ovaries
visualized on ultrasound scan (presence of 12 follicles or more in one or both
ovaries and/or increased ovarian volume >10 ml), (ii) clinical signs of
hyperandrogenism (the hirsutism score based on the Ferriman-Gallwey score >7 or
obvious acne) and/or an elevated plasma testosterone (normal range testosterone
<2 nmol/l), (iii) having an interval between menstrual periods >35 days and/or
amenorrhea as the absence of vaginal bleeding for at least 6 months, i.e. 199
days.
MAIN RESULTS AND THE ROLE OF CHANCE: CVI and CVR scores for MPCOSQ were 0.96 and
0.92, respectively. A six-factor solution (emotional disturbance, weight,
infertility, acne, menstrual difficulties and hirsutism) emerged as a result of
an EFA and explained 0.64% of the variance observed. The result of the EFA
supported the item 'late menstrual period' being placed in the menstrual rather
than the emotional subscale. The results of the CFA for six-factor model for
MPCOSQ indicated an acceptable fit for the proposed model. Additional analyses
indicated satisfactory results for internal consistency (Cronbach's alpha rangin
g
from 0.76 to 0.92) and intraclass correlation coefficients (ranging from 0.71 to
0.92). Moving 'late menstrual period' from the emotional to the menstrual
subscale significantly improved the reliability coefficient for both subscales.
LIMITATIONS, REASONS FOR CAUTION: Study of patients with PCOS attending two
private gynecology clinics may limit generalization of the findings to the entir
e
population with PCOS. All patients in this study were married for cultural
reasons in Iran. Therefore, the results of the present study have to be
interpreted with some caution.
WIDER IMPLICATIONS OF THE FINDINGS: The Iranian version of the MPCOSQ will fill
an important gap in measuring the QOL in patients with PCOS in the research and
community settings in Iran.
20. J Ultrasound Med. 2012 Jul;31(7):1015-24.

Two- and three-dimensional sonographic and color Doppler techniques for diagnosi
s
of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new
diagnostic criterion.
Battaglia C(1), Battaglia B, Morotti E, Paradisi R, Zanetti I, Meriggiola MC,
Venturoli S.
Author information:
(1)Department of Gynecology and Pathophysiology of Human Reproduction, Alma Mate
r
Studiorum, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy,
cesare.battaglia@unibo.it
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 an
d
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 highe
r
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 wer
e
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 th
e
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
.
21. Psychoneuroendocrinology. 2012 Jun;37(6):742-51. doi:

10.1016/j.psyneuen.2011.09.005. Epub 2011 Oct 4.
Ovarian morphology in premenstrual dysphoria.
Eriksson O(1), Landn M, Sundblad C, Holte J, Eriksson E, Naessn T.
Author information:
(1)Department of Women's and Children's Health/Obstetrics and Gynecology, Uppsal
a
University, Uppsala, Sweden. olle.eriksson@kbh.uu.se
Ovarian cyclicity is a prerequisite for premenstrual dysphoria (PMD), as
illustrated by the fact that this condition is effectively eliminated by
ovariectomy or by treatment with a GnRH agonist. Despite the possibility of
differences in ovarian function between women with and without PMD, no study
comparing ovarian morphology in these two groups has ever been published.
Fifty-two women were recruited for this study; 26 had premenstrual dysphoria,
fulfilling criteria slightly modified from those of the premenstrual dysphoric
disorder, and 26 were asymptomatic age-matched controls. Ovarian morphology was
assessed using transvaginal 7 MHz ultrasonography on day 5 after the start of
menses, and venous blood was sampled for hormone analysis on days 3 and 8, the
expected day of ovulation, and day -4 of the menstrual cycle. There were no
significant differences between the groups with respect to the prevalence of
polycystic ovaries (PCO), the total number of follicles, the total ovarian volum
e
or serum levels of androgen hormones. In addition, serum free testosterone level
s
in late premenstrual phase showed an inverse association to premenstrual symptom
s
of irritability and a similar inverse association trend to symptoms of depressed
mood. Unexpectedly, the prevalence of ovaries with fewer than five antral or
growing follicles was significantly higher in women with PMD than in controls
(p=0.016). While the results do not support a role for PCO or androgen hormones
in eliciting late luteal phase irritability, the possible relationship between
oligofollicular ovaries and PMD deserves further study.
Copyright 2011 Elsevier Ltd. All rights reserved.
22. Hum Reprod. 2011 Nov;26(11):3123-9. doi: 10.1093/humrep/der297. Epub 2011 Se

p 16.
Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values o
f
follicle count on ultrasound and of the serum AMH level for the definition of
polycystic ovaries.
Dewailly D(1), Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, Duhamel A,
Catteau-Jonard S.
Author information:
(1)Service de Gyncologie Endocrinienne et de Mdecine de la Reproduction,
Hpital Jeanne de Flandre, CHRU, 59037 Lille, France.
didier.dewailly@chru-lille.fr
Comment in
Hum Reprod. 2012 May;27(5):1543; author reply 1543-4.
Hum Reprod. 2011 Nov;26(11):3118-22.
BACKGROUND: Polycystic ovarian morphology (PCOM) at ultrasound is currently used
in the diagnosis of polycystic ovary syndrome (PCOS). We hypothesized that the
previously proposed threshold value of 12 as an excessive number of follicles pe
r
ovary (FN) is no longer appropriate because of current technological
developments. In this study, we have revisited the thresholds for FN and for the
serum Anti-Mllerian hormone (AMH) level (a possible surrogate for FN) for the
definition of PCOM.
METHODS: Clinical, hormonal and ultrasound data were consecutively recorded in
240 patients referred to our department between 2008 and 2010 for exploration of
hyperandrogenism (HA), menstrual disorders and/or infertility.
RESULTS: According to only their symptoms, patients were grouped as: non-PCOS
without HA and with ovulatory cycles (group 1, n = 105), presumption of PCOS wit
h
only HA or only oligo-anovulation (group 2, n = 73) and PCOS with HA and
oligo-anovulation (group 3, n = 62). By cluster analysis using androgens, LH,
FSH, AMH, FN and ovarian volume, group 1 appeared to be constituted of two
homogeneous clusters, most likely a non-PCOM non-PCOS subgroup (n = 66) and a
PCOM, non-PCOS (i.e. asymptomatic) subgroup (n = 39). Receiver operating
characteristic curve analysis was applied to distinguish the non-PCOM non-PCO
members of group 1 and to group 3. For FN and serum AMH respectively, the areas
under the curve were 0.949 and 0.973 and the best compromise between sensitivity
(81 and 92%) and specificity (92 and 97%) was obtained with a threshold values o
f
19 follicles and 35 pmol/l (5 ng/ml).
CONCLUSIONS: For the definition of PCOM, the former threshold of >12 for FN is n
o
longer valid. A serum AMH >35 pmol/l (or >5 ng/ml) appears to be more sensitive
and specific than a FN >19 and should be therefore included in the current
diagnostic classifications for PCOS.
23. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011 Aug;31(8):1070-3.

[Therapeutic efficacy of modified zigui decoction in treatment of polycystic
ovary syndrome of gan-shen yin deficiency syndrome].
Li XP(1), Lin S, Ye S.
Author information:
(1)Department of Gynecology, The People's Hospital of Fujian Province, Fuzhou
350004. lxp6105@163.com
OBJECTIVE: To study the therapeutic efficacy of Modified Zigui Decoction (MZD) i
n
treatment of polycystic ovary syndrome of Gan-Shen yin deficiency syndrome.
METHODS: 66 polycystic ovary syndrome patients of Gan-Shen yin deficiency
syndrome were randomly assigned to the MZD group (Group A) and the Westem
medicine group (Group B), 33 patients in each. Patients in Group A orally took
MZD, while those in Group B orally took Diane-35. Their menstrual cycle rate,
basal body temperature (BBT), the ovarian size, the number of follicles, and
changes of endocrine hormones were observed before treatment, the first menstrua
l
cycle, and the sixth menstrual cycle after treatment.
RESULTS: (1) The normal rate of one menstrual cycle after stopping taking
medicine was 57.58% in Group A and 63.64% in Group B. There was no statistical
difference between the two groups (P>0.05). The normal rate of six menstrual
cycles after stopping taking medicine was 45. 45% in Group A and 21.21% in Group
B. The former was superior to the latter, showing statistical difference
(P<0.05). (2) The biphasic BBT rates of one menstrual cycle after stopping takin
g
medicine were somewhat elevated in the two groups, better than before treatment
respectively (P<0.01). But there was no statistical difference between the two
groups (P>0.05). The biphasic BBT rate of six menstrual cycles after stopping
taking medicine was 45.45% in Group A and 18.18% in Group B. The former was
superior to the latter, showing statistical difference (P<0.05). (3) The
bilateral ovarian volume of one menstrual cycle after stopping taking medicine
was obviously reduced in both groups (P<0.01). The bilateral ovarian volume of
six menstrual cycles after stopping taking medicine was still more reduced than
before treatment in Group A (P<0.01), while it returned to the size of before
treatment in Group B (P>0.05). (4) The number of follicles of one menstrual cycl
e
after stopping taking medicine was obviously reduced in both groups (P<0.01). Th
e
number of follicles of six menstrual cycles after stopping taking medicine was
still reduced in Group A (P<0.01), while it returned to the number before
treatment in Group B (P>0.05). (5) The luteinizing hormone (LH), testosterone
(T), LH/FSH ratio of one menstrual cycle after stopping taking medicine were
obviously reduced in both groups (P<0.01). They were still more reduced six
menstrual cycles after stopping taking medicine than before treatment in Group A
(P<0.01), while they returned to the levels of before treatment in Group B
(P>0.05).
CONCLUSIONS: MZD could effectively treat patients with polycystic ovary syndrome
of Gan-Shen yin deficiency syndrome. Besides, its long-term efficacy was more
stable and lasting.
24. Zhonghua Fu Chan Ke Za Zhi. 2011 May;46(5):350-4.

[Clinical significance of counting follicles in diagnosis of polycystic ovary
syndrome by the three-dimensional ultrasound imaging with sonography based
automated volume calculation method].
He LR(1), Zhou LX, Pan RK, Zhang X.
Author information:
(1)Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun
Yat-sen University, Guangzhou 510120, China.
OBJECTIVE: To investigate clinical significance of counting follicles
classification by three-dimensional imaging with sonography based automated
volume calculation (SonoAVC) in the diagnosis of polycystic ovary syndrome
(PCOS).
METHODS: Eighty cases with PCOS were counted classified follicles and determined
ovarian volume by three-dimensional (3D) imaging with SonoAVC method matched wit
h
60 infertile women with fallopian tube or male factors as control. Main clinical
,
biological and other ultrasonographic markers were assessed during the early
follicular phase, and the relationship between the follicle number range per
ovary or the volume per ovary and the major hormonal features of PCOS was
studied.
RESULTS: Three-dimensional ultrasound imaging with SonoAVC method provides a new
path for objective quantitative assessment of follicle count, ovarian volume,
total follicle numbers. The volume of (11 8) ml, total numbers of 27 14
follicle and number of 22 19 follicle with diameter of 2 - < 6 mm in PCOS
patients were significantly higher than (6 4) ml in ovarian volume, 6 4 in
total follicles and 2 3 in follicle with diameter of 2 - < 6 mm in controls
(P < 0.05), while follicles were similar for the 6 - 9 mm range (P > 0.05).
Total follicle numbers and follicles 2 - < 6 mm had significantly positive
relationships with ovarian volume (r = 0.600, 0.618, P < 0.01) and level of
testosterones (r = 0.364, 0.291, P < 0.05), follicles 2 - < mm also had
significantly positive relationships with total follicle number (r = 0.916, P <
0.01). The follicles within the 6 - 9 mm range was significantly and
negatively related to ovarian volume and total follicle numbers (r = -0.618,
-0.263, all P = 0.001), but no significantly related to the major hormonal
features of PCOS. The ovarian volume was significantly positively related with
luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio (r = 0.282, P
=
0.010) but negatively related to FSH level (r = -0.226, P = 0.042).
CONCLUSIONS: Ovarian volume, total follicle numbers and follicles 2 - < 6 mm in
PCOS patients were significantly higher than those in controls. The larger
ovarian volume might produce more total follicle and follicles 2 - < 6 mm. The
higher level of testosterone might produce more total follicle probably, which
mainly result in more follicles 2 - < 6 mm. These morphologically
ultrasonographic characteristics could reflect pathophysiological changes in
PCOS. Obviously, it has important clinical significance to count follicles in
patients with PCOS by the three-dimensional ultrasound imaging with SonoAVC
method.
25. J Endocrinol. 2011 Jun;209(3):307-15. doi: 10.1530/JOE-11-0022. Epub 2011 Ma

r 23.
The New Zealand obese mouse model of obesity insulin resistance and poor breedin
g
performance: evaluation of ovarian structure and function.
Radavelli-Bagatini S(1), Blair AR, Proietto J, Spritzer PM, Andrikopoulos S.
Author information:
(1)Department of Medicine (Austin Health/Northern Health), Heidelberg
Repatriation Hospital, The University of Melbourne, Heidelberg Heights,
Melbourne, Victoria 3081, Australia.
Infertility, associated with oligo/anovulation, increased ovarian volume,
numerous follicular cysts, and metabolic disturbances such as obesity and insuli
n
resistance (IR) are characteristics common to polycystic ovary syndrome (PCOS),
the most common endocrine disorder in women of reproductive age. Here, we show
that New Zealand obese (NZO) mice display similar metabolic characteristics such
as obesity, leptin insensitivity, glucose intolerance, and IR. Importantly, NZO
mice are poor breeders; however, the mechanism for this has not been
investigated. The aim of this study was to assess the ovarian
structure/morphology and sex hormone levels in female NZO and lean C57BL/6J
control mice. Twenty-five NZO and twenty female control mice were studied at
three different ages (young, adult, and aged). The animals were weighed, an
insulin tolerance test was carried out, and blood was collected for measurement
of hormone levels. The ovaries were removed for histological analysis. As
expected, NZO mice presented higher body weights (P=0.001), increased basal
plasma glucose (P=0.007), and insulin levels (P=0.001) as well as IR, compared
with control mice. NZO mice showed an increased ovarian volume, reduced numbers
of corpora lutea, and higher total follicle numbers (P=0.0001). The number of
primordial follicles increased (P=0.02) at the young stage, as well as the amoun
t
of atretic follicles (P=0.03), in NZO compared with control mice. NZO mice also
displayed reduced plasma LH and increased estradiol levels. In conclusion, NZO
mice show a poor breeding performance due to decreased ovulation, increased
number of primordial and atretic follicles, and ovarian size. Given that NZO mic
e
are obese, hyperinsulinemic and insulin resistant, they are suitable for
investigating pathophysiological mechanisms linking metabolic alterations with
reproductive defects.
26. Eur J Obstet Gynecol Reprod Biol. 2011 Jun;156(2):181-5. doi:

10.1016/j.ejogrb.2011.01.023. Epub 2011 Feb 25.
Phenotypic expression, body mass index and insulin resistance in relation to LH
levels in women with polycystic ovary syndrome.
Katsikis I(1), Karkanaki A, Misichronis G, Delkos D, Kandaraki EA, Panidis D.
Author information:
(1)Division of Endocrinology and Human Reproduction, Second Department of
Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.
OBJECTIVE: To evaluate LH levels in women with the classic (1990 criteria) and
the newer (2003 criteria) PCOS phenotypes, and to examine the impact of BMI and
insulin resistance indices on hormone levels.
STUDY DESIGN: In this controlled clinical study 936 women with PCOS, classified
as classic (n=729) and newer (n=207), and 204 controls were included. All women
were divided into normal-weight (BMI<25 kg/m(2)) and overweight plus obese
(BMI25 kg/m(2)). Serum LH, FSH, anthropometrics, androgens, fasting insulin and
glucose, HoMA-IR, number of follicles, and ovarian volume were assessed.
RESULTS: Women with classic PCOS presented significantly higher LH and LH/FSH
ratios, and lower glucose/insulin levels than those with the newer phenotype and
controls. Overweight plus obese women of all groups had lower LH levels than
normal-weight women. Independent positive correlations between LH and androgens
and negative correlation between LH and BMI were found.
CONCLUSIONS: The higher LH concentrations of the classic phenotypes of PCOS coul
d
be attributed to the higher androgen levels, which desensitize the hypothalamus
to the negative feedback regulation by progesterone. Moreover, the lower LH
levels of overweight plus obese women of all groups could be attributed to the
increased peripheral aromatization of androgens to estrogens in adipose tissue
leading to suppression of LH secretion.
CONDENSATION: Both normal-weight and overweight women with classic PCOS
phenotypes present higher LH levels and LH-to-FSH ratios than women with similar
BMI but the newer phenotypes.
Copyright 2011 Elsevier Ireland Ltd. All rights reserved.
27. J Clin Endocrinol Metab. 2011 May;96(5):E821-4. doi: 10.1210/jc.2010-1725. E
pub
2011 Feb 9.
The metabolic status modulates the effect of metformin on the antimullerian
hormone-androgens-insulin interplay in obese women with polycystic ovary
syndrome.
Romualdi D(1), De Cicco S, Tagliaferri V, Proto C, Lanzone A, Guido M.
Author information:
(1)Department of Obstetrics and Gynecology, Universit Cattolica del Sacro Cuore,
L.go Agostino Gemelli, 8, 00168 Rome, Italy. danielaromualdi@libero.it
CONTEXT: In the adult ovary, antimullerian hormone (AMH) is produced by the
granulosa cells of preantral and small antral follicles and negatively regulates
folliculogenesis. AMH is overproduced in the polycystic ovary and was recently
proposed to play a role in the ovulatory dysfunction of polycystic ovary syndrom
e
(PCOS).
OBJECTIVE: The aim of the study was to investigate the effects of metformin
administration on AMH levels in relation with the clinical and
endocrine-metabolic parameters in obese women with PCOS.
DESIGN AND SETTING: We conducted a pilot prospective study in an academic
research environment.
PATIENTS: We studied 28 obese PCOS women.
INTERVENTIONS: We performed ultrasonographic pelvic exams, hirsutism score
evaluation, hormonal profile assays, oral glucose tolerance test, euglycemic
hyperinsulinemic clamp, and lipid profile at baseline and after 6 months of
metformin treatment (850 mg twice a day orally).
MAIN OUTCOME MEASURES: We measured AMH, hormonal assays, ultrasound aspect of th
e
ovaries, and indexes of glucose and insulin metabolism.
RESULTS: Insulin secretion and body mass index significantly decreased after
treatment. Almost 70% of subjects experienced an amelioration of menstrual
irregularities. Mean androstenedione, testosterone, and 17-hydroxyprogesterone
levels and hirsutism score were significantly improved by metformin. However, no
significant changes in AMH levels occurred. Data were further analyzed after
dividing patients on the basis of pretreatment insulinemic response to the oral
glucose tolerance test; metformin was effective in reducing insulin secretion,
AMH levels, and, interestingly, ovarian volume exclusively in PCOS patients with
hyperinsulinism; none of these changes occurred in the normoinsulinemic group.
CONCLUSIONS: Metformin differentially affects the interplay between insulin and
the ovarian function in obese PCOS women; the presence of hyperinsulinemia seems
to be predictive of the efficacy of the treatment.
28. Rev Bras Ginecol Obstet. 2010 Mar;32(3):118-25.

[Serum markers of oxidative stress and assisted reproduction procedures results
in infertile patients with polycystic ovary syndrome and controls].
[Article in Portuguese]
Rodrigues JK(1), Dib LA, Ferriani RA, Jordo Junior AA, Navarro PA.
Author information:
(1)Area de Concentrao Biologia da Reproduo pelo Departamento de Ginecologia e
Obstetrcia da Faculdade de Medicina de Ribeiro Preto - USP - Ribeiro Preto,
SP, Brasil.
PURPOSE: To compare the serum levels of five markers of oxidative stress and
assisted reproduction (AR) outcomes among infertile patients, with tubal and/or
male factor and with polycystic ovary syndrome (PCOS).
METHODS: 70 patients were included, 58 with tubal and/or male factor infertility
and 12 with PCOS, who underwent controlled ovarian stimulation to perform
intracytoplasmic sperm injection (ICSI). A blood sample was collected between th
e
third and fifth day of the menstrual cycle in the month prior to ovarian
stimulation. We analyzed the levels of malondialdehyde, hydroperoxides, protein
oxidation products, glutathione and vitamin E, by reading the absorbance with a
spectrophotometer and by high performance liquid chromatography (HPLC). Data wer
e
analyzed statistically by the Student's t-test and Fisher's exact test.
RESULTS: Significant increases in the body mass index, ovarian volume and number
of antral follicles were observed in PCOS patients, as well as the use of a lowe
r
total dose of follicle stimulating hormone for these patients. There were no
differences in the response to ovarian stimulation, in the results of AR or seru
m
levels of malondialdehyde, hydroperoxides, advanced oxidation protein products,
glutathione and vitamin E between groups.
CONCLUSIONS: The present data did not demonstrate a difference in the levels of
serum markers of oxidative stress or in AR results when comparing non-obese
infertile patients with PCOS and controls. These data suggest that the results o
f
AR may not be compromised in this specific subgroup of patients with PCOS.
However, interpretations of the action of oxidative stress on the results of AR
are still not clear and the reproductive implications of oxidative stress need t
o
be better evaluated.
29. J Pediatr Endocrinol Metab. 2010 Jan-Feb;23(1-2):87-95.

Unilateral ovarian enlargement in adolescents with polycystic ovary syndrome: a
variant of bilateral disease.
Shah B(1), Golden E, Milla S.
Author information:
(1)Department of Pediatric Endocrinology, NYU School of Medicine, New York, NY,
USA. bina.shah@nyumc.org
AIMS: To evaluate clinical, biochemical and radiological features in adolescent
females with unilateral polycystic ovary (UniPCO) versus bilateral polycystic
ovary (BiPCO) in patients with polycystic ovarian syndrome (PCOS), and to compar
e
the association of insulin resistance (IR) and metabolic syndrome (MS) between
the two groups.
SETTING: Pediatric endocrine clinic.
METHODS: A retrospective chart review of girls with the diagnosis of PCOS was
performed. They were divided into two groups: PCOS with UniPCO and BiPCO.
RESULTS: No difference was seen between the two groups in regard to clinical
parameters. LH/FSH ratio was significantly higher in patients with BiPCO. No
difference was seen in free testosterone, lipids, MS or IR between groups.
Ultrasound showed a mean ovarian volume of 13.2 +/- 1.5 ml on the affected side
in UniPCO and 16.1 +/- 1.2 ml in BiPCO. Ovarian follicle location was mostly
peripheral in both UniPCO and BiPCO. Multiple follicles were found in the
majority of cases. IR and MS were present in 40% of girls with UniPCO and 38% an
d
23%, respectively, in girls with BiPCO.
CONCLUSION: UniPCO may be a forerunner of BiPCO and may represent an early point
along the continuum. Later, the unaffected ovary continues to increase in volume
,
resulting in BiPCO. Metabolic abnormalities of patients with UniPCO highlights
that as well as being a precursor of BiPCO, it also imparts considerable health
risks.
30. Ann Endocrinol (Paris). 2010 May;71(3):183-8. doi: 10.1016/j.ando.2010.02.00

8.
Epub 2010 Apr 9.
Which morphological investigations and how to interpret them to make the
diagnosis of PCOS?
Dewailly D(1), Catteau-Jonard S, Poncelet E.
Author information:
(1)Department of Endocrine Gynaecology and Reproductive Medecine, hpital
Jeanne-de-Flandre, CHRU de Lille, avenue Eugne-Avine, 59037 Lille, France.
ddewailly@chru-lille.fr
The need for a calibrated imaging of polycystic ovaries (PCO) is now stronger
than ever since the consensus conference held in Rotterdam in 2003. However,
imaging PCO is not an easy procedure and it requires a thorough technical and
medical background. The two-dimensional (2-D) ultrasonography (U/S) remains the
standard for imaging PCO and the current consensus definition of PCO determined
at the joint ASRM/ESHRE consensus meeting on PCOS rests on this technique: eithe
r
12 or more follicles measuring 2 to 9mm in diameter and/or increased ovarian
volume (>10cm(3)). However, these thresholds need being revisited with the use o
f
the new machines that have better spatial resolution and with the advent of the
3-D U/S. Doppler study and magnetic resonance imaging (MRI) are seldom useful fo
r
diagnosis but may be interesting for clinical research.
Copyright 2010. Published by Elsevier Masson SAS.
31. Reprod Biomed Online. 2010 Apr;20(4):553-8. doi: 10.1016/j.rbmo.2009.12.021.

Epub
2009 Dec 24.
Histology of genital tract and breast tissue after long-term testosterone
administration in a female-to-male transsexual population.
Grynberg M(1), Fanchin R, Dubost G, Colau JC, Brmont-Weil C, Frydman R, Ayoubi
JM.
Author information:
(1)AP-HP, Service de Gyncologie-Obsttrique et Mdecine de la Reproduction,
Hpital Antoine Bclre, 157 rue de la Porte de Trivaux, Clamart, France.
michael.grynberg@abc.aphp.fr
Growing evidence indicates that androgens play a positive role in follicle
proliferation and growth. Hence, many authors have assumed that androgen
supplementation in women with poor ovarian reserve might improve the number of
antral follicles available for ovarian stimulation. As androgen administration
may become more frequently used in reproductive medicine, this study aimed at
describing the histological changes observed in the genital tract and the breast
of female-to-male (FTM) transsexuals. A pathological analysis of the genital
tract of 112 FTM subjects who were given androgen for at least 6 months before
hystero-salpingo-oophorectomy was performed. In addition, 100 bilateral
mastectomies were performed, allowing a study of the breast tissue. Mean ovarian
volume was increased, with histological characteristics of polycystic ovaries
(PCO), defined as >12 antral follicles per ovary, observed in 89 patients
(79.5%). Endometrial atrophy was observed in 45%. Breast examination revealed
marked reduction of glandular tissue and increase of fibrous connective tissue i
n
93%, without atypical hyperplasia or carcinoma. The present data confirms and
expands the putative associations between long-term androgen administration and
abnormalities in ovarian architecture with macroscopic and microscopic
characteristics of PCO, increased risk of endometrial atrophy and fibrotic breas
t
tissue with marked glandular reduction.
Copyright (c) 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All
rights reserved.
32. Eur Radiol. 2010 May;20(5):1207-13. doi: 10.1007/s00330-009-1643-8. Epub 200

9 Nov
5.
Patterns of ovarian morphology in polycystic ovary syndrome: a study utilising
magnetic resonance imaging.
Barber TM(1), Alvey C, Greenslade T, Gooding M, Barber D, Smith R, Marland A,
Wass JA, Child T, McCarthy MI, Franks S, Golding SJ.
Author information:
(1)Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and
Metabolism, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LJ, UK.
tom.barber@drl.ox.ac.uk
OBJECTIVE: To evaluate and compare MRI-based ovarian morphology in groups of
women with polycystic ovary syndrome (PCOS) and controls.
METHODS: All PCOS cases (n = 44) had oligo-amenorrhoea and hyperandrogenism
irrespective of ovarian morphology, and fulfilled NIH/Rotterdam diagnostic
criteria for PCOS. All control women (n = 40) had normal menses and
normoandrogenaemia. All subjects were of white British/Irish origin and
pre-menopausal. Group comparisons were based on independent-sample t tests.
Polycystic ovarian morphology was defined by at least 12 follicles 2-9 mm in
diameter and/or an ovarian volume greater than 10 cm(3).
RESULTS: Ovarian morphology differed significantly in PCOS cases and controls
(follicle number geometric mean [SD range] 18.6 [9.9, 35.0] vs 6.6 [3.1, 14.2],
unadjusted P = 1.3 x 10(-16); calculated ovarian volume 8.8 cm(3) [5.0, 15.5] vs
5.1 cm(3) [2.5, 10.3], unadjusted P = 3.0 x 10(-7); peripheral follicle location
in 55% vs 18% of ovaries, P = 7.9 x 10(-6); visible central ovarian stroma in 61
%
vs 24% of ovaries, P = 2.3 x 10(-5)). Follicle number and calculated ovarian
volume were not concordant with clinical/biochemical assignment of PCOS/control
status in 36 (23%) and 52 (34%) of ovaries, respectively.
CONCLUSION: Ovarian morphology overlaps in PCOS cases and controls, emphasising
the importance of considering clinical/biochemical presentation together with
imaging ovarian morphology in the diagnosis of PCOS.
33. J Pediatr Adolesc Gynecol. 2010 Jun;23(3):146-52. doi:

10.1016/j.jpag.2009.07.002. Epub 2009 Sep 3.
Endometrial thickness, uterine, and ovarian ultrasonographic features in
adolescents with polycystic ovarian syndrome.
Shah B(1), Parnell L, Milla S, Kessler M, David R.
Author information:
(1)Department of Endocrinology, NYU School of Medicine, New York, New York 10016
,
USA. bina.shah@nyumc.org
OBJECTIVE: Our aim was to evaluate uterine and ovarian ultrasonographic features
including endometrial thickness (ET) in adolescent females with PCOS, which is
limited in this population.
METHODS: We performed a retrospective chart review of young females (n=51)
ranging in age from 10 to 18 years with the diagnosis of PCOS. Clinical,
biochemical and pelvic sonography data were reviewed. Sonographic data included
uterine parameters of ET, length, and volume as well as ovarian volume and
follicular morphologic features.
RESULTS: Data in 51 girls were analyzed. Menstrual periods were reported as
irregular in 26/51 (50.9%), amenorrheic in 19/51 (37.2%), regular in 4/51 (7.8%)
and metrorrhagia in 2/51 (3.9%). Uterine features revealed that the endometrial
stripe was enlarged (>7mm) in 16/51 (31.4%) of girls, all with homogeneous
appearance. The uterine length was lower than normal in 22/51 (43.1%) of girls,
normal in 21/51 (41.2%), and higher than normal in 8/51 (15.7%). Uterine volume
was normal in 31/51 (60.7%) and higher in 20/51 (39.3%) of girls. Enlarged
ovarian volume was found in 22/51 (43%) of patients. Mean ovarian volumes were
16.1cm(3) and 13.1cm(3) in bilateral and unilaterally enlarged ovaries,
respectively. The morphology of ovarian follicles was studied in a subset of 40
patients. The location of ovarian follicles was peripheral in 81% and mixed in
19%. The number of follicles was also examined in 43 patients. They were few (<5
)
in 12%, moderate (5-10) in 5% and multiple (>10) in 84% cases. There was the
presence of at least one >10mm cyst in 25% of girls.
CONCLUSION: Majority of the adolescents with PCOS demonstrated multiple
peripheral ovarian follicles, with large ovarian volumes in some, indicating an
important role of ultrasonography in the diagnosis of PCOS, even at a younger
age. Endometrial thickness, uterine length, ovarian size, and follicular
morphology should be carefully examined in cases of adolescent PCOS.
Copyright 2010 North American Society for Pediatric and Adolescent Gynecology.
Published by Elsevier Inc. All rights reserved.
34. J Cell Mol Med. 2010 Oct;14(10):2460-9. doi: 10.1111/j.1582-4934.2009.00841.

x.
Lysyl oxidase interacts with AGE signalling to modulate collagen synthesis in
polycystic ovarian tissue.
Papachroni KK(1), Piperi C, Levidou G, Korkolopoulou P, Pawelczyk L,
Diamanti-Kandarakis E, Papavassiliou AG.
Author information:
(1)Department of Biological Chemistry, Medical School, University of Athens,
Athens, Greece.
Connective tissue components--collagen types I, III and IV--surrounding the
ovarian follicles undergo drastic changes during ovulation. Abnormal collagen
synthesis and increased volume and density of ovarian stroma characterize the
polycystic ovary syndrome (PCOS). During the ovulatory process, collagen
synthesis is regulated by prolyl hydroxylase and lysyl oxidase (LOX) activity in
ovarian follicles. LOX catalyzes collagen and elastin cross-linking and plays
essential role in coordinating the control of ovarian extracellular matrix (ECM)
during follicular development. We have recently shown accumulation of advanced
glycation end products (AGEs), molecules that stimulate ECM production and
abnormal collagen cross-linking, in ovarian tissue. However, the possible link
between LOX and AGEs-induced signalling in collagen production and stroma
formation in ovarian tissue from PCOS remains elusive. The present study
investigates the hypothesis of AGE signalling pathway interaction with LOX gene
activity in polycystic ovarian (PCO) tissue. We show an increased distribution
and co-localization of LOX, collagen type IV and AGE molecules in the PCO tissue
compared to control, as well as augmented expression of AGE signalling
mediators/effectors, phospho(p)-ERK, phospho(p)-c-Jun and nuclear factor B
(NF-B) in pathological tissue. Moreover, we demonstrate binding of AGE-induced
transcription factors, NF-B and activator protein-1 (AP-1) on LOX promoter,
indicating a possible involvement of AGEs in LOX gene regulation, which may
account for the documented increase in LOX mRNA and protein levels compared to
control. These findings suggest that deposition of excess collagen in PCO tissue
that induces cystogenesis may, in part, be due to AGE-mediated stimulation of LO
X
activity.
2009 The Authors Journal compilation 2010 Foundation for Cellular and
Molecular Medicine/Blackwell Publishing Ltd.
35. J Ovarian Res. 2009 Jun 10;2:6. doi: 10.1186/1757-2215-2-6.

Assessment of ultrasonographic features of polycystic ovaries is associated with
modest levels of inter-observer agreement.
Lujan ME(1), Chizen DR, Peppin AK, Dhir A, Pierson RA.
Author information:
(1)Division of Nutritional Sciences, Cornell University, Ithaca, USA.
mel245@cornell.edu.
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.
PMCID: PMC2700106
36. Hum Reprod. 2009 Jul;24(7):1732-8. doi: 10.1093/humrep/dep074. Epub 2009 Apr
2.
Anti-Mllerian hormone concentrations in androgen-suppressed women with
Carlsen SM(1), Vanky E, Fleming R.
Author information:
(1)Unit of Applied Clinical Research, Department of Cancer Research and Molecula
r
Medicine, Norwegian University for Science and Technology, Olav Kyrres gate 9,
Trondheim 7489, Norway. sven.carlsen@ntnu.no
BACKGROUND: Current data suggest that excessive androgen exposure can lead to th
e
development of polycystic ovaries and polycystic ovary syndrome (PCOS).
Anti-Mllerian hormone (AMH) levels reflect the number of small antral follicles
in the ovaries and are elevated in PCOS. We hypothesized that protracted
reduction of circulating androgens and/or insulin resistance would reduce
circulating AMH concentrations in women with PCOS.
METHODS: A prospective, randomized, double-blind 26 week long study was
undertaken in 50 women with PCOS. They all received diet and lifestyle
counselling, and metformin 850 mg three times daily. Concomitantly, they were
randomized to either dexamethasone 0.25 mg daily (n = 25) or placebo (n = 25).
Thirty-eight women completed the study. AMH (primary outcome) and other hormone
levels were measured at inclusion and after 8 and 26 weeks of treatment.
RESULTS: At baseline in univariate regression analyses, AMH levels associated
positively with testosterone levels (P = 0.041) and ovarian volume (P = 0.002).
In multivariate regression analyses, AMH associated positively with testosterone
P = 0.004), and negatively with dehydroepiandrosterone sulphate (DHEAS) (P =
0.001) and C-peptide levels (P = 0.020). Circulating AMH concentrations were
unaffected by 6 months of lifestyle counselling with metformin and placebo
treatment. AMH levels were also unaffected by 6 months of androgen suppression
with dexamethasone in addition.
CONCLUSIONS: AMH levels in untreated PCOS women associated positively with
testosterone, and negatively with DHEAS and C-peptide levels. Six months of
androgen suppression by either metformin or low-dose dexamethasone treatment
failed to influence circulating AMH levels.
37. Rofo. 2009 Jun;181(6):543-8. doi: 10.1055/s-0028-1109179. Epub 2009 Feb 24.
[Magnetic resonance imaging of the pelvis in patients with polycystic ovary
syndrome].
[Article in German]
Hauth EA(1), Umutlu L, Libera H, Kimmig R, Forsting M.
Author information:
(1)Institut fr diagnostische und interventionelle Radiologie und
Neuroradiologie, Universittsklinikum Essen. elke.hauth@ukmuenster.de
INTRODUCTION: MRI evaluation of parameters of the ovaries for the diagnosis of
polycystic ovaries in patients with polycystic ovary syndrome (PCOS).
MATERIALS AND METHODS: An MRI of the pelvis was performed in 51 patients with
PCOS and 50 healthy volunteers. The volume and maximum diameter of the bigger
ovary, the number of follicles, and the maximum diameter and volume of the
biggest follicle of the bigger ovary were determined in relation to patient age
and were statistically compared. ROC analysis was performed to evaluate the
prognostic quality of the parameters of the ovaries regarding the diagnosis of
PCOS.
RESULTS: In a cohort aged 21 - 30 a significant difference between patients with
PCOS and healthy volunteers was able to be determined for all 5 parameters (p <
0.001). In the cohort aged 31 - 40 neither one of the parameters showed a
significant difference. In the group of 21 - 30 year-olds the AUC was
significantly different from 0.5 in all parameters. The maximum diameter, the
volume and the number of follicles of the bigger ovary presented the highest AUC
.
The parameters needed to diagnose PCOS in MRI in a group of women aged 21 - 30
are a maximum diameter of an ovary of 30 mm, an ovarian volume of 5.6 cm(3) and
at least 12 follicles. In regard to these parameters a diagnostic sensitivity of
90.32%, 90.32 % und 80.65% and a specificity of 68.42%. 63.16% und 86.42% can be
reached.
CONCLUSION: In the cohort aged 21 - 30 PCOS can be diagnosed in MRI with high
diagnostic sensitivity.
38. Hum Reprod. 2009 May;24(5):1176-83. doi: 10.1093/humrep/den482. Epub 2009 Ja

n 24.
Long-term follow-up of patients with polycystic ovary syndrome: reproductive
outcome and ovarian reserve.
Hudecova M(1), Holte J, Olovsson M, Sundstrm Poromaa I.
Author information:
(1)Department of Women's and Children's Health, Uppsala University 751 85
Uppsala, Sweden. miriam.hudecova@kbh.uu.se
BACKGROUND: The purpose of the present study was to examine long-term
reproductive outcome and ovarian reserve in an unselected population of women
with polycystic ovary syndrome (PCOS). METHODS A total of 91 patients with
confirmed PCOS and 87 healthy controls were included in the study. Patients had
been diagnosed between 1987 and 1995 and at the time of the follow-up, subjects
were 35 years of age or older.
RESULTS: Among women who had attempted a pregnancy, 86.7% of PCOS patients and
91.6% of controls had given birth to at least one child. Among PCOS patients who
had given birth, 73.6% had done so following a spontaneous conception. Mean
ovarian volume and the number of antral follicles in PCOS patients were
significantly greater than in control women (P < 0.001, respectively). PCOS
patients also had higher serum concentrations of anti-Mllerian hormone and lower
follicle-stimulating hormone levels.
CONCLUSIONS: Most women with PCOS had given birth, and the rate of spontaneous
pregnancies was relatively high. Together with the ultrasound findings and the
hormonal analyses, this finding could imply that PCOS patients have a good
fecundity, and an ovarian reserve possibly superior to women with normal ovaries
.
39. Hum Reprod. 2008 Apr;23(4):952-7. doi: 10.1093/humrep/den015. Epub 2008 Feb
6.
The relationship between anti-Mullerian hormone, androgen and insulin resistance
on the number of antral follicles in women with polycystic ovary syndrome.
Chen MJ(1), Yang WS, Chen CL, Wu MY, Yang YS, Ho HN.
Author information:
(1)Department of Obstetrics and Gynecology, National Taiwan University Hospital,
No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
BACKGROUND: Anti-Mllerian hormone (AMH) is a biomarker that predicts the number
of antral follicles and is involved in follicle arrest for women with polycystic
ovary syndrome (PCOS). We investigated the association between the characteristi
c
hyperandrogenemia, insulin resistance (IR), AMH, and the morphology and size of
ovaries for women with PCOS.
METHODS: A total of 99 Taiwanese women with PCOS who were willing to undergo
vaginal ultrasonography were enrolled in this cross-sectional study.
RESULTS: The number of antral follicles and the ovarian volume showed a
significant correlation with AMH, total testosterone and the free androgen index
,
but not with age, body mass index (BMI) or the homeostasis model assessment of
insulin resistance (HOMA-IR). AMH had a significant negative association with
both BMI and HOMA-IR. Multiple stepwise regression analysis demonstrated that
AMH, BMI and total testosterone were independently related to the number of
antral follicles. AMH and total testosterone were the main determinants for
ovarian volume in a stepwise regression model.
CONCLUSIONS: Our results suggest that not only the AMH level, but also obesity,
IR and elevated androgen levels may relate to the development of the large size
of antral follicle pool and ovarian volume in women with PCOS. Obesity and IR ma
y
enhance the follicular excess through the dysregulation of AMH or through the
pathway of hyperandrogenemia. These findings might partly explain why adequate
body weight management and improvement in IR can improve the ovulatory function
for women with PCOS.
40. Int J Fertil Womens Med. 2007 Jan-Feb;52(1):41-7.

Ultrasonography of the ovaries and its correlation with clinical and endocrine
parameters in infertile women with PCOS.
Sikka P(1), Gainder S, Dhaliwal LK, Bagga R, Sialy R, Sahdev S.
Author information:
(1)Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical
Education and Research, Chandigarh, India.
OBJECTIVES AND METHODS: In 100 anovulatory infertile women with polycystic ovary
syndrome attending the infertility clinic of this institute, transvaginal
ultrasound findings of ovaries were correlated with both clinical and hormonal
parameters using Chi-square test.
RESULTS: All women in the study had oligomenorrhea or amenorrhea, 70% had
hirsutism and more than half were obese. On transvaginal ultrasound, ovarian
volume was more than 10 cm3 in all, 90% had more than 10 follicles in each ovary
,
75% had stromal thickness more than 1 cm and more than half had increased stroma
l
echogenicity. Seventy percent had high testosterone levels and 60% were detected
to have insulin resistance. Ovarian volume correlated positively with body mass
index, waist/hip ratio and menstrual cycle irregularity (p < 0.05). The
correlation between ovarian size, LH/FSH ratio and hyperinsulinemia was highly
significant (p < 0.005), but was low for serum androgens and also hirsutism.
Number of follicles per ovary correlated positively with body mass index,
menstrual irregularity (p < 0.01), insulin resistance as well as androgens (p <
0.005). Positive predictive value of ovarian follicle number was 100% for insuli
n
resistance as well as D4 androstenedione. Increased stromal thickness also showe
d
70% positive prediction for clinical parameters, 66% for insulin resistance and
82% for serum D4 androstenedione. Contrary to the other ultrasound parameters of
polycystic ovary, stromal echogenicity did not significantly correlate with any
of the clinical or hormonal parameters except serum testosterone.
CONCLUSION: Transvaginal ultrasonography of the ovaries confirms the clinical
profile and also gives an insight to the hormonal milieu of the women with PCOS.
41. Nat Clin Pract Endocrinol Metab. 2007 Oct;3(10):688-95.

The reproductive phenotype in polycystic ovary syndrome.
Chang RJ(1).
Author information:
(1)Division of Reproductive Endocrinology, Department of Reproductive Medicine,
University of California, San Diego School of Medicine, La Jolla, CA 92093-0633,
USA. rjchang@ucsd.edu
The symptoms of women with polycystic ovary syndrome (PCOS) include hirsutism an
d
irregular menstrual bleeding due to ovarian androgen excess and chronic
anovulation. Typically, these features emerge late in puberty or shortly
thereafter. The proposed mechanism(s) responsible for increased ovarian androgen
production include heightened theca cell responsiveness to gonadotropin
stimulation, increased pituitary secretion of luteinizing hormone, and
hyperinsulinemia. The cause of ovulatory dysfunction is not well understood, but
is linked to abnormal follicle growth and development within the ovary. As a
result, infertility is common among women with PCOS and, in many instances, is
the initial presenting complaint. Insulin resistance and obesity are frequently
associated with PCOS and probably contribute to the severity of symptoms. The
polycystic ovary that accompanies the syndrome has recently been defined as
having 12 or more follicles per ovary or an ovarian volume greater than 10 ml as
determined by ultrasonography. In addition, there is an increased number of
growing follicles in the polycystic ovary. Despite this distinctive appearance,
the cause and development of the polycystic ovary are completely unknown.
42. Gynecol Endocrinol. 2007;23(8):455-60.

Ovarian reserve in women with polycystic ovary syndrome who underwent
laparoscopic ovarian drilling.
Weerakiet S(1), Lertvikool S, Tingthanatikul Y, Wansumrith S, Leelaphiwat S,
Jultanmas R.
Author information:
(1)Department of OB-GYN, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand. raswt@mahidol.ac.th
OBJECTIVE: To evaluate ovarian reserve assessed by hormones and sonography in
women with polycystic ovary syndrome (PCOS) undergoing laparoscopic ovarian
drilling (LOD).
METHODS: This was a cross-sectional study. Twenty-one PCOS women undergoing LOD
were enrolled in the study (the LOD group). Their day-3 anti-Mllerian hormone
(AMH), inhibin B, follicle-stimulating hormone (FSH) levels, antral follicles
count (AFC) and summed ovarian volume representing ovarian reserve were compared
with those of PCOS women who did not undergo LOD (the PCOS group) and those of
normal ovulatory women (the control group).
RESULTS: There were no differences in age and body mass index between groups. AM
H
levels seemed to be lower in the LOD (4.60 +/- 3.16 ng/ml) than in the PCOS (5.9
9
+/- 3.36 ng/ml) groups, but did not reach statistical significance. Day-3 FSH
levels were significantly higher and AFC was significantly lower in the LOD than
in the PCOS group. AMH levels, AFC and summed ovarian volume were significantly
greater, but FSH was significantly lower, in the PCOS group compared with the
control group. There were no differences in inhibin B levels between groups.
CONCLUSION: This study showed that ovarian reserve assessed by hormonal levels
and sonography seems to be lower in the LOD than in the PCOS group. The PCOS
women both with and without LOD had significantly greater ovarian reserve than
the age-matched controls having normal ovulatory menstruation.
43. Ginecol Obstet Mex. 2007 Apr;75(4):181-6.

[Clinical effects of metformin in patients with polcystic ovarian syndrome].
[Article in Spanish]
Galindo CG(1), Hernndez I, Ayala AR.
Author information:
(1)Departamento de la Reproduccin Humana, Direccin de Investigacin y
Enseanza, Hospiatal Jurez de Mxico.
OBJECTIVE: To verify the medical effects of metformin in polycystic ovary
syndrome patients.
METHOD: 10 women with polycystic ovary syndrome were including in this
prospective clinical study. After a baseline workup, body mass index (BMI) and
waist hip index (WHI) were measured; the diagnosis of polycystic ovary syndrome
was achieved with the following basal clinical studies: vaginal ultrasound,
prolactin, thyroid profile, glucose, insulin, testosterone, androstenedione,
17-hidroxiprogesterone, dehydroepiandrosterone sulfate and cortisol. The
diagnosis of insulin resistance was achieved by model homeostasis assessment and
the relationship glucose/insulin. Patients were given 500 mg of metformin twice
a
day for 3 months and reevaluated.
RESULTS: 8 of 10 patients who completed treatment, showed significant improvemen
t
in insulin resistance (only by homeostasis model); there were decrease in
hirsutism (mean of 35.07%), without improve menstrual cyclicity, although we
achieved at least one menstruation in 42.85% in cases with amenorrhea after 2 or
3 months of treatment. There were no changes in weight, BMI neither in ovarian
volume and number of follicles.
CONCLUSION: A 3 month course of metformin therapy in women with polycystic ovary
syndrome did not improve menstrual cyclicity, albeit significant decrease in
insulin, insulin resistance and hirsutism was obtained.
44. Clin Endocrinol (Oxf). 2007 Nov;67(5):735-42. Epub 2007 Aug 29.
Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospectiv
e
study of 634 women with PCOS.
Diamanti-Kandarakis E(1), Panidis D.
Author information:
(1)Division of Endocrinology, First Department of Medicine, Laiko Hospital,
Medical School, University of Athens, Athens, Greece.
BACKGROUND: The phenotypic spectrum of PCOS has been broadened but the prevalenc
e
and clinical significance of PCOS phenotypes continue to challenge the scientifi
c
community.
OBJECTIVE: Analysis of the phenotypic spectrum of PCOS and determination of the
association between metabolic, hormonal and new ultrasonographic criteria.
DESIGN: Clinical prospective study.
PATIENTS: Six hundred and thirty-four women with PCOS (18-35 years) and
comparable body mass index (BMI), diagnosed by ESHRE/ASRM criteria, were
categorized into two major groups of phenotypes: classic (NIH) and nonclassic
(ESHRE/ASRM), and then subdivided into phenotypes with all possible combinations
of diagnostic characteristics. One hundred and eight healthy women of
reproductive age, matched for BMI, were recruited as the control group.
MEASUREMENTS: Ultrasonographic (ovarian follicle number and volume), hormonal an
d
metabolic parameters.
RESULTS: Classic PCOS phenotype was more frequent (85.96%) than the nonclassic
phenotype (14.04%). The patients were also classified according to the presence
of biochemical (80.60%) or clinical hyperandrogenaemia (12.62%), and, in the
newly introduced group, to absence of evidence of hyperandrogenaemia (6.78%).
Subjects with classic PCOS with biochemical hyperandrogenaemia (74.76%) were mor
e
insulin resistant than controls. In women with PCOS, follicle number was
positively related to both insulin resistance and biochemical hyperandrogenaemia
.
Additionally, women with PCOS had a 6.58-fold increased relative risk (RR) of >
12 follicles on intravaginal ultrasound and a 2.94-fold increased RR of ovarian
volume > 10 cm(3) compared to controls.
CONCLUSION: The most frequent PCOS phenotype is the subgroup with biochemical
hyperandrogenaemia only within the classic phenotype, which is more insulin
resistant than the control group. The follicle number, a newly introduced
ultrasonographic marker, is related to both metabolic and hormonal features of
PCOS.
45. Tunis Med. 2007 Jun;85(6):485-9.

[Effects of drilling on ovarian volume and follicle count in polycystic ovary
syndrome].
[Article in French]
Mrazguia C(1), Chevalier N, El Fekih C.
Author information:
(1)Service de Gyncologie Obsttrique, Hpital Antoine Bclre, Clamart, France.
AIM: To evaluate the effects of drilling on the reduction of the ovarian volume
and on the count of antral follicles in case of resistance to clomifene citrate
induction,
METHODS: We carried a prospective study over two years (2004-2005) in Antoine
Beclre hospital. We compared two groups of patients, the first, including 20
patients with PCOS and undergoing an ovarian drilling, the second group involvin
g
19 patients with PCOS and without any medical help to procreate.
RESULTS: From our study, the ovarian drilling seems to reduce the number of
antral follicles, as well as the ovarian volume.
CONCLUSION: the ovarian drilling, easy and reproducible procedure reduces the
number of antral follicles and ovarian volume, leading to normalization of
ovarian functioning and thus better results on fertility.
46. Hum Reprod. 2007 Sep;22(9):2501-8. Epub 2007 Jul 17.

Ultrasound in polycystic ovary syndrome--the measuring of ovarian stroma and
relationship with circulating androgens: results of a multicentric study.
Fulghesu AM(1), Angioni S, Frau E, Belosi C, Apa R, Mioni R, Xamin N, Capobianco
GP, Dessole S, Fruzzetti F, Lazzarini V, Minerba L, Melis GB, Lanzone A.
Author information:
(1)Dipartimento Chirurgico Materno Infantile e di Scienze delle Immagini, Sezion
e
Ostetrica e Ginecologica, Universit degli Studi di Cagliari, Via Ospedale 46,
09124 Cagliari, Italy. fulgh@tiscali.it
BACKGROUND: The introduction of transvaginal approach in ultrasound (US) has
enabled the accurate evaluation of the structure of the ovary and stroma. Stroma
represents an acknowledged US marker for polycystic ovary syndrome (PCOS). The
proportion revealed between the stroma and the ovary surface in the median
section (S/A ratio) had been indicated as a reliable marker for hyperandrogenism
.
In order to verify the feasibility of this determination in routine use and to
confirm the efficacy of S/A ratio in predicting hyperandrogenism in PCOS, a
multicentric study was performed in association with five Italian research
groups.
METHODS: A total of 418 subjects of fertile age presenting oligomenorrhoea or
secondary amenorrhoea, enlarged ovaries measuring >10 cm(3) and/or >12 follicles
measuring 2-9 mm in diameter took part in the study. Clinical, US and hormonal
evaluations were performed in the early follicular phase or on random days in
amenorrhoeic subjects. US assessment included ovarian volume, follicle number,
ovarian and stroma area in median section. The hormonal study included a baselin
e
plasma determination of LH, FSH, estradiol (E(2)), androstenedione (A),
testosterone (T), dehydroepiandrosteronesulphate, 17-hydroxy-progesterone, sex
hormone-binding globulin and prolactin. Correlations and receiver operator curve
s
were used in statistical analysis of data.
RESULTS: S/A was found to be the best significant predictor of elevated A and T
levels. In order to ascertain significant cut-off values in relation to A and T
levels Youden indexes were calculated and indicated 0.32 as the best cut-off for
the S/A ratio.
CONCLUSIONS: This work underlines the importance of stroma measure in improving
US diagnosis of PCOS and suggest that this parameter may be used in routine
clinical practice. In fact, multicentre study demonstrated the easy feasibility
of such procedure without need of sophisticated machines or intensive training
for operators.
47. Pediatr Radiol. 2007 Feb;37(2):233-6. Epub 2006 Dec 20.

Complicated giant polycystic ovary mimicking tumor: MR imaging findings.
Oztoprak I(1), Eqilmez H, Oztoprak B, Gms C.
Author information:
(1)Radiology Department, Faculty of Medicine, Cumhuriyet University, AD Sivas
58140, Turkey. oztoprak@cumhuriyet.edu.tr
A previously healthy 14-year-old girl presented with a 1-year history of
abdominal pain that had worsened during the past 4 days. She had a right lower
abdominal mass that was initially diagnosed as an ovarian tumor. MR imaging
revealed a unilaterally enlarged and partially torted left polycystic ovary.
Polycystic ovary is a common cause of increased ovarian volume in women of
reproductive age. It is characterized by numerous small peripherally located
follicles and increased stroma. It may mimic a neoplasm and lead to difficulties
in diagnosis. In this case report, we discuss the unusual MR imaging findings an
d
the pitfalls in diagnosis.
48. Clin Exp Obstet Gynecol. 2006;33(3):154-8.

Significance of Doppler ultrasonography in the diagnosis of polycystic ovary
syndrome.
Tugrul S(1), Oral O, Gl M, Kutlu T, Uslu H, Pekin O.
Author information:
(1)Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital,
Istanbul, Turkey.
OBJECTIVE: To investigate the importance of transvaginal color Doppler
ultrasonography of uterine and intraovarian arteries in the clinical diagnosis o
f
polycystic ovary syndrome (PCOS).
MATERIAL & METHOD: This study was planned as a cohort, controlled, prospective
study. A total of 80 participants (40 with PCOS and 40 as a control group) were
enrolled in the study. A Doppler system with a 6.0 MHz transvaginal probe was
used when performing ultrasonography (USG) and Doppler examinations. Ovarian siz
e
and volume, number of follicles and stromal echogenity were evaluated by USG.
Doppler flow studies were targeted to uterine and intraovarian arteries and the
pulsatility index (PI) was assessed. The concentrations of luteinizing hormone
(LH), follicle stimulating hormone (FSH), total testosterone (T) and
dihydroepiandrostenedione sulphate (DHEAS) were measured by immunometric methods
.
RESULTS: The mean values of the number of follicles and the ovarian volume of
both the right and left ovaries were higher in the group with PCOS than the
control group (p < 0.05). The mean PI values of the right and left ovaries,
respectively, were 0.84 +/- 0.23 and 1.09 +/- 1.17 in the group with PCOS, and
0.88 +/- 0.14 and 0.92 +/- 0.15 in the control group. The mean PI values of the
right and left uterine arteries, respectively, were 3.25 +/- 0.98 and 3.33 +/-
1.12 in the group with PCOS, and 3.17 +/- 0.93 and 3.2 +/- 1.38 in the control
group (p > 0.05). The correlation analysis of the ovarian volume, the number of
follicles and Doppler parameters revealed that there was a positive correlation
and statistically significant difference between the right ovarian volume and
right uterine artery PI in the group with PCOS and the left ovarian volume and
left uterine artery PI in the control group (p > 0.05). The mean stromal PI of
the ovarian and uterine arteries were 0.96 +/- 0.61 and 3.29 +/- 1.02 in the
group with PCOS and 0.9 +/- 0.12 and 3.19 +/- 1.14 in the control group,
respectively (p > 0.05). In the group with PCOS, the mean ovarian volume and the
mean number of follicles were 11.46 +/- 4.43 and 13.91 +/- 4.11, respectively,
whereas they were 7.63 +/- 2.44 and 5.55 +/- 2.34 in the control group (p <
0.05).
CONCLUSION: It is not beneficial to use color Doppler transvaginal
ultrasonography in the clinical diagnosis of patients with PCOS.
49. Paediatr Drugs. 2006;8(5):311-8.

Polycystic ovary syndrome in adolescents: current and future treatment options.
Mastorakos G(1), Lambrinoudaki I, Creatsas G.
Author information:
(1)Second Department of Obstetrics and Gynecology, University of Athens,
Aretaieion Hospital, Athens, Greece. mastorak@mail.kapatel.gr
Polycystic ovary syndrome (PCOS) is a very common disorder affecting 5-10% of
women of reproductive age. The pivotal endocrine abnormalities of this syndrome
are insulin resistance and ovarian and, to a lesser degree, adrenal
hypersensitivity to hormonal stimulation. PCOS may manifest itself as early as
the first decade of life by premature pubarche or menarche. Oligoamenorrhea in
the first postpubarchal years, although very common, may be an early symptom of
PCOS, especially in overweight girls with hirsutism or acne. Girls with low birt
h
weight as well as a family history of diabetes mellitus or premature
cardiovascular disease are at high risk for developing PCOS. Circulating
bioavailable testosterone levels are usually elevated, while total testosterone
may be normal due to low levels of sex hormone-binding globulin. The typical
sonographic appearance of PCOS ovaries consists of high ovarian volume (>10 mL)
and the presence of 12 or more follicles in each ovary measuring 2-9 mm in
diameter. However, this finding is not specific, since it may occur in >20% of
healthy girls. The therapeutic goals in adolescents with PCOS is first to restor
e
bodyweight and menses and to reduce the signs of hyperandrogenism. The reduction
of bodyweight in this young age group may require the collaboration of the
pediatrician, dietitian, and psychotherapist. The adolescent should be urged to
adopt a healthy lifestyle with the aim to maintain a normal body mass index
throughout adolescence and adult life. The choice of medical therapy depends on
the clinical presentation. Oral contraceptives are a good option when acne and
hirsutism are the principal complaints. Adolescents with isolated cycle
irregularity may be placed on a cyclical progestin regimen to induce withdrawal
bleeding. Metformin, by decreasing insulin resistance, alleviates many of the
hormonal disturbances and restores menses in a considerable proportion of
patients. It may be used alone or in combination with oral contraceptives.
Independently of medical treatment, restoration and maintenance of bodyweight
within normal range is of paramount importance.
50. Exp Clin Endocrinol Diabetes. 2006 Apr;114(4):175-81.

The combination of increased ovarian volume and follicle number is associated
with more severe hyperandrogenism in German women with polycystic ovary syndrome
.
Hahn S(1), Bering van Halteren W, Roesler S, Schmidt M, Kimmig R, Tan S, Mann K,
Janssen OE.
Author information:
(1)Division of Endocrinology, Department of Medicine, University of
Duisburg-Essen, Essen, Germany. susanne.hahn@uni-essen.de
The prevalence and relevance of polycystic ovaries (PCO) in German women with
polycystic ovary syndrome has not been evaluated. This retrospective study
included 212 PCOS patients (mean age 28 years) diagnosed by the NIH-criteria and
consecutively recruited since 2003. Clinical features including anthropometric
variables and the degree of hirsutism, family history, menstrual cyclicity as
well as endocrine biochemical parameters were recorded. In addition, 3-h oral
glucose tolerance testing for indices of insulin resistance and glucose
metabolism was performed in each patient. Transvaginal ultrasound was used to
detect polcystic ovaries, defined as the presence of at least one ovary > 10 ml
or with at least 12 follicles of 2-9 mm diameter. In this German PCOS cohort, PC
O
were identified in 166 women (78%). Women with PCO (PXO+) had significantly
higher LH/FSH ratios (median 2.1 vs. 1.7) and IGF-1 levels (median 182.5 vs.
160.5 ng/ml) compared to patients without PCO (PCO-). In addition, a
significantly higher prevalence of acne (50% vs. 33%) and higher hirsutism score
s
(median 9 vs. 7) were found in PCO+ patients. Testosterone levels and the free
androgen index (FAI) correlated significantly with ovarian volume and the number
of ovarian follicles. Also, a subgroup of PCO+ women with a combination of
increased ovarian volume and follicle number had higher testosterone levels
(median 3.1 vs. 2.1 nmol/l) and FAI (median 7.6 vs. 4.5) compared to women with
increased follicle count but normal volume. No differences were found in
metabolic parameters or insulin resistance indices. PCO are common finding in
German PCOS women. PCO appear to be associated with a more pronounced
hyperandrogenemia, especially when both ovarian volume and follicle number are
increased.
51. Fertil Steril. 2006 Jan;85(1):214-9.

Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound.
Allemand MC(1), Tummon IS, Phy JL, Foong SC, Dumesic DA, Session DR.
Author information:
(1)Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
allemand.michael@mayo.edu
OBJECTIVE: To study diagnostic thresholds for polycystic ovary (PCO).
DESIGN: Retrospective cohort study.
SETTING: Academic hospital.
PATIENT(S): Normoandrogenic ovulatory women and patients with polycystic ovary
syndrome (PCOS).
INTERVENTION(S): Two-dimensional (2D) and three-dimensional (3D) transvaginal
ultrasound.
MAIN OUTCOME MEASURE(S): The mean follicle number per ovary (FNPO) of both
ovaries and the maximum number follicles in a single sonographic plane (FSSP) of
either ovary were determined using 3D transvaginal ultrasound. Ovarian volume wa
s
determined using 2D transvaginal ultrasound.
RESULT(S): Twenty-nine normoandrogenic ovulatory women were compared with 10
patients with PCOS. Diagnostic thresholds for PCO with 100% specificity as
determined by receiver operator characteristic (ROC) curves were > or =20 for
mean FNPO, > or =10 for maximum FSSP, and > or =13 cm3 for ovarian volume. Both
2D and 3D transvaginal ultrasound were highly accurate in the diagnosis of PCO a
s
determined by areas under the curve (AUC) that were >90% for all three measures.
CONCLUSION(S): Mean FNPO and maximum FSSP by 3D transvaginal ultrasound have
comparable high accuracy for diagnosis of PCO. The diagnostic threshold with 100
%
specificity for mean FNPO is > or =20, which is greater than suggested by the
Rotterdam Consensus Workshop in 2003. Use of the consensus standard,
consequently, may result in overdiagnosis of PCO. A threshold of > or =20 mean
FNPO using 3D transvaginal ultrasound may be appropriate to minimize
false-positive diagnoses of PCO.
52. Fertil Steril. 2005 Oct;84 Suppl 2:1277-84.

Effects of testosterone on cancellous bone, marrow adipocytes, and ovarian
phenotype in a young female rat model of polycystic ovary syndrome.
Tamura N(1), Kurabayashi T, Nagata H, Matsushita H, Yahata T, Tanaka K.
Author information:
(1)Department of Obstetrics and Gynecology, Niigata University School of
Medicine, Niigata, Japan.
OBJECTIVE: To investigate the effects of testosterone on cancellous bone and
marrow adipocytes in a young female rat model of polycystic ovary syndrome
(PCOS).
DESIGN: Comparative and controlled study.
SETTING: University animal research laboratory.
PATIENT(S): Fifty-one Sprague-Dawley rats.
INTERVENTION(S): The rats were divided into four groups based on the day of
testosterone propionate (0.1 mg/weight (g)) injection: no testosterone treatment
(control group, C); injected on the ninth day after birth (9D); injected 4 weeks
after birth (4W); and injected 8 weeks after birth (8W). About 16 weeks after
birth, all animals were killed.
MAIN OUTCOME MEASURE(S): Bone mineral density (BMD) and bone and fat
histomorphometry for the proximal tibia and serum hormonal parameters were
measured.
RESULT(S): The ovaries of group 9D showed many cystic follicles without corpora
lutea. The BMD of group 9D (0.309 +/- 0.023 g/cm2) was significantly higher than
the other groups groups (CONT, 0.262 +/- 0.017; 4W, 0.256 +/- 0.017; 8W, 0.256
+/- 0.022 g/cm2; P < .0001). Based on bone histomorphometry, group 9D had a
higher bone volume (BV/TV), lower bone formation (OV/BV, OS/BS, sLS/BS, MAR,
BFR/BS), lower bone resorption (ES/BS, Oc.S/BS), and lower rate of longitudinal
growth compared to the other groups. Based on fat histomorphometry, group 9D had
a lower bone fat volume and number of fat cells in the bone marrow compared to
the other groups. On the other hand, groups 4W and 8W showed similar values of
bone and fat histomorphometric parameters to group C.
CONCLUSION(S): Female rats receiving testosterone within nine days of birth
develop polycystic ovaries, high bone volume, low bone turnover, and lower fat
content in the bone marrow.
53. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2005 Aug;25(8):704-6.

[Clinical study of ganshao capsule in treating clomiphene-resistant polycystic
ovarian syndrome].
Yang YS(1), Zhang YL.
Author information:
(1)First Hospital, Shanxi Medical University, Taiyuan. yxdwzh168@163.com
OBJECTIVE: To assess the efficacy and safety of Ganshao Capsule (GSC) in treatin
g
clomiphene (CC)-resistant hyperandrogenemic polycystic ovarian syndrome (PCOS),
and to explore the feasibility of using CC for improving ovulation induction
after withdrawal of GSC.
METHODS: Twenty-seven PCOS patients were given GSC for 8 weeks (2 cycles).
Changes in serum reproductive hormone, body mass index (BMI), adverse reaction,
as well as pelvic ultrasonographic feature were observed before treatment, at th
e
end of 4 weeks and 8 weeks after treatment. After stopping GSC medication, CC wa
s
used to induce ovulation in patients whose serum testosterone (T) < (2.1+/-0.8)
nmol/L but without ovulation. Condition of follicle growth and effect of GSC wer
e
monitored.
RESULTS: After 4 weeks of treatment, serum reproductive hormones were
significantly changed. At the end of 8 weeks, bilateral ovarian volume, number o
f
follicles, and diameter of follicles were significantly reduced, and endometrium
obviously thinned. Within 2 months after stopping medication, 6 in the 27
patients got natural ovulation, and 2 natural pregnancy. In the other 19 patient
s
who received ovulation induction during the 37th cycles, 17 had ovulation in the
25th cycles, 7 got pregnancy, the ovulation rate being 89.5%, ovulation cycle
rate 67.6%, pregnant rate 36.8%, and pregnant cycle rate 28.0%.
CONCLUSION: Endometrium, ovarian morphology and BMI got significant improvement
in PCOS patients with CC- resistance and hyperandrogenemia. The sensitivity to
ovulation induction with CC were also improved.
54. Gynecol Endocrinol. 2005 Jun;20(6):322-6.

Do basal inhibin A and inhibin B levels have value in the diagnosis of polycysti
c
ovary syndrome?
Torgac M(1), Kokcu A, Cetinkaya MB, Alper T, Malatyalioglu E.
Author information:
(1)Department of Obstetrics and Gynecology, School of Medicine, University of
Ondokuz Mayis, 55070 Samsun, Turkey.
In the present study we aimed to investigate whether basal inhibin A and B level
s
in women with polycystic ovary syndrome (PCOS) would be used in diagnosis of the
condition. Forty women with PCOS and 40 women with normal cycles (control group)
were evaluated. There was no statistically significant difference in mean age an
d
mean body mass index between the two groups (p > 0.05). Serum levels of inhibin
A
and B, follicle-stimulating hormone (FSH), luteinizing hormone and total
testosterone, and total ovarian volume, were determined in the PCOS group and th
e
control group on day 3. In the PCOS group, total follicle number was obtained by
counting follicles of diameter > or =2 mm in both ovaries. Results were evaluate
d
using Student's t test, Pearson correlation and regression tests. There was no
significant difference in mean basal inhibin A or inhibin B levels between the
two groups. Basal inhibin B levels showed a statistically significant negative
correlation with basal FSH levels and a positive correlation with total follicle
number in the PCOS group (p < 0.05 and p < 0.01, respectively). We conclude that
basal inhibin A or B levels cannot be used in the diagnosis of PCOS.
55. Ginecol Obstet Mex. 2005 May;73(5):261-4.

[Virilizing adrenal adenoma: a report of a case].
[Article in Spanish]
Mac Gregor Gooch AL(1), Guillermina Velasco Diaz G, Carranza Lira S.
Author information:
(1)Departamento de Ginecologia Endocrina, Hospital de Ginecoobstetricia Luis
Castelazo Ayala, IMSS, DF Mxico. scarranzal@mexis.com
Androgen excess can be due to different entities such as polycystic ovarian
syndrome, ovarian tumors or adrenal tumors. It is presented the case of a 26
year-old woman that suffered from amenorrhea, hirsutism, voice deepening,
reduction of mammary volume and 10 kg weight loss, without response to different
treatments. At physical exam she had hirsutism (24 points, Ferriman-Gallaway) th
e
clitoris had 3 cm length. Laboratory: androstenedione 29.5 ng/mL, DHEAS >1000
microg/dL, T 6.23 ng/mL, 17 OHP 4.9 ng/mL. At pelvic ultrasound the uterus and
left ovary were normal, the right ovary had subcortical follicles no greater tha
n
3 mm. The CAT scan and nuclear magnetic imaging of adrenal glands showed an oval
retroperitoneal image of 7.2 x 6.5 x 8.4 cm at the right adrenal gland. Surgery
was performed and the right adrenal gland excised. The histopathologic report
indicated a benign cortical adenoma. The patient's postsurgical evolution was
satisfactory with regression of the virilizing signs, with spontaneous return of
menstrual periods. Hirsutism can be the initial sign, and even in some occasions
the only one of different pathologies. The study of the hyperandrogenic patient
should be integral with clinical, hormonal and imaging evaluations to be able to
specify the origin of androgen production.
56. J Clin Endocrinol Metab. 2005 Jul;90(7):3939-45. Epub 2005 Apr 26.
Ovarian function during puberty in girls with type 1 diabetes mellitus: response
to leuprolide.
Codner E(1), Mook-Kanamori D, Bazaes RA, Unanue N, Sovino H, Ugarte F, Avila A,
Iiguez G, Cassorla F.
Author information:
(1)Institute of Maternal and Child Research, School of Medicine, University of
Chile, Casilla 226-3, Santiago, Chile. ecodner@med.uchile.cl
CONTEXT: An increased prevalence of polycystic ovary syndrome (PCOS) has been
reported in adult women with type 1 diabetes mellitus (DM1). We investigated
whether these hormonal abnormalities begin during puberty by evaluating the
ovarian steroidogenic response to leuprolide acetate.
METHODS: We studied 56 adolescent girls with DM1 (aged 12.3 +/- 0.2 yr) and 64
healthy girls (C) (aged 11.9 +/- 0.2 yr) up to 2 yr post menarche, matched by
age, body mass index, and pubertal development. We evaluated anthropometrical
data and Ferriman-Gallway score and performed a leuprolide test (500 microg sc)
to study ovarian function. Ovarian volume was determined by transabdominal
ultrasonography.
RESULTS: We found five DM1 but no C girls with abnormally located terminal hair
(Fisher's exact, P < 0.05). Free androgen index increased throughout puberty in
girls with DM1 (ANOVA, P < 0.0001), which was associated with a decrease in SHBG
levels in girls with DM1 (ANOVA, P < 0.0001). Stimulated 17OH progesterone
(17OHProg) increased throughout puberty only in girls with DM1 (ANOVA, P < 0.01)
.
Girls with DM1 at Tanner stage 5 had higher stimulated LH to FSH ratio,
testosterone, and 17OHProg levels than girls at Tanner stage 4. In contrast, in
C
girls the stimulated testosterone, 17OHProg, and LH to FSH ratio were similar at
Tanner stages 4 and 5. Ovarian volumes and uterine length were larger in girls
with DM1 (analysis of covariance, P < 0.05).
CONCLUSIONS: These data suggest that patients with DM1 have differences in
ovarian steroidogenic response to leuprolide, compared with C girls during
puberty. Future studies in young women should clarify whether these findings are
related to the pathogenesis of hyperandrogenism later in life.
57. Hum Reprod. 2005 Jul;20(7):1820-6. Epub 2005 Mar 31.

Serum anti-Mllerian hormone levels remain high until late reproductive age and
decrease during metformin therapy in women with polycystic ovary syndrome.
Piltonen T(1), Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanaine
n
JS.
Author information:
(1)Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu,
Finland.
BACKGROUND: Anti-Mllerian hormone (AMH) is secreted by granulosa cells of
ovarian early developing follicles and its serum levels have been shown to
correlate with small antral follicle number. Since the pronounced androgen
secretion from follicles/stroma in women with polycystic ovary syndrome (PCOS)
remains until late reproductive age, and since AMH reflects the number of antral
follicles, it was of interest to study the possible age-related relationship
between AMH, androgens and follicle number in women with PCOS and in control
women. Moreover, the possible effect of metformin on serum AMH levels and the
relationship to follicle count and volume were studied.
METHODS: Forty-four healthy women (aged 21-44 years) and 65 women with previousl
y
diagnosed PCOS (aged 16-44 years) participated in the study. Serum basal AMH
levels were correlated with those of serum androstenedione, testosterone,
estradiol (E2), LH, FSH and inhibin B, and with follicle number. The effect of
metformin on serum AMH concentrations, follicle number and ovarian volume was
studied in 26 women (aged 20-41 years) with PCOS after 6 months of treatment.
RESULTS: Serum AMH levels were 2- to 3- fold higher in PCOS women than in health
y
women. In control women, serum AMH levels correlated positively with those of
serum androstenedione (r = 0.564, P < 0.001) and testosterone (r = 0.328, P =
0.036) and negatively with serum FSH concentrations (r = -0.374, P = 0.012) and
age (r = -0.691, P<0.001). In women with PCOS, serum AMH levels correlated
positively with those of androstenedione (r = 0.311, P = 0.011) and testosterone
(r = 0.310, P = 0.011) and with follicle count (r = 0.352, P = 0.012), and
negatively with age (r = -0.300, P = 0.014). Serum AMH levels, the number of
antral follicles and ovarian volume decreased significantly during metfromin
treatment.
CONCLUSIONS: Serum AMH levels decreased with age both in healthy women and in
women with PCOS, although they were always 2- to 3-fold higher and remained
elevated until 40 years of age in PCOS subjects. Thus, since serum AMH levels
correlate well with antral follicle count and serum androgen levels, the
measurement of AMH could be used as a tool to assess ovarian ageing, to diagnose
polycystic ovaries/PCOS and to evaluate treatment efficacy.
58. Eur J Radiol. 2005 Feb;53(2):280-6.

Transabdominal pulse inversion harmonic imaging improves assessment of ovarian
morphology in virgin patients with PCOS: comparison with conventional B-mode
sonography.
Mahmutyaziciolu K(1), Tanriverdi HA, Ozdemir H, Barut A, Davanci H, Gndodu S.
Author information:
(1)Department of Radiology, Faculty of Medicine, Zonguldak Karaelmas University,
Kozlu 67600, Zonguldak, Turkey. kmyazicioglu@yahoo.com
OBJECTIVE: In virgin policystic ovary syndrome (PCOS) patients transabdominal
sonography is the preferential method of the pelvic examination. The purpose of
this study was to determine ovarian morphology by the transabdominal route by
pulse inversion harmonic imaging (PIHI) in virgin PCOS patients and to compare
the diagnostic image quality with conventional B-mode ultrasonography (CBU).
METHODS: Fifty-two ovaries in 26 virgin patients were evaluated by the
transabdominal approach. Each ovary was examined using both PIHI and CBU. The
sharpness of the follicular cysts walls, degree of internal echo definitions of
the follicle cysts and overall ovarian conspicuity was assessed subjectively,
using 4 point scoring (0, being worst; 3, being best score). The number of
countable follicles, the size of largest and smallest ovarian follicle and
ovarian volumes were assessed quantitively by both techniques. The effect of bod
y
mass index (BMI) on qualitative and quantitative scoring was evaluated.
RESULTS: The sharpness of the cyst wall and internal echo structure was
significantly better with PIHI than with CBU (P < 0.001 P < 0.001 and P < 0.001,
respectively). PIHI improved overall ovarian conspicuity in 41 (78.8%) of 52
examination. The number of countable follicles was significantly lower with CBU
(P < 0.001). The maximum diameter of the largest follicle was larger with PIHI
sonography to compared CBU (P < 0.001). Mean ovarian volume was significantly
larger with CBU (P < 0.001). When data were analyzed separately according to BMI
,
number of non-diagnostic overall ovarian conspicuity scores with CBU was markedl
y
high in obese patients (88% with CBU versus 3.8% with PIHI). On the other hand,
mean number of countable follicles with CBU became much more lower in the obese
group (P < 0.001).
CONCLUSION: In virgin PCOS patients, when compared to transabdominal CBU, PIHI
significantly improved the detection of ovarian follicles, especially in high BM
I
obese subjects, through increased contrast sensitivity for cystic structures and
decreased intrafollicular artifactual echoes. Transabdominal ultrasonographic
examination by PIHI mode can contribute to the evaluation of ovaries.
59. Int J Gynaecol Obstet. 2004 Dec;87(3):237-41.

Metformin therapy in women with polycystic ovary syndrome.
Aruna J(1), Mittal S, Kumar S, Misra R, Dadhwal V, Vimala N.
Author information:
(1)Department of Obstetrics and Gynecology, All India Institute of Medical
Sciences, New Delhi, India.
OBJECTIVE: To determine the clinical, biochemical, hormonal, and ultrasonographi
c
effects of 6 months of metformin therapy in women with polycystic ovary syndrome
(PCOS) and compare with pretherapy parameters.
METHOD: 50 Indian women with PCOS, 25 unmarried and 25 married, infertile women,
were enrolled in this prospective clinical study. After a baseline workup,
including body mass index (BMI), waist hip ratio (WHR), Ferriman Gallwey
hirsutism scoring, menstrual pattern, levels of fasting insulin, lipids, oral
glucose tolerance test (OGTT), serum gonadotropins, estradiol (E2), testosterone
,
androstenedione, sex hormone binding globulin (SHBG), and dehydroepiandrosterone
sulphate (DHEAS), patients were given 1000 gm of metformin for 6 months and then
reevaluated.
RESULT: In 41 of 50 women who completed treatment, significant improvement in
BMI, WHR, menstrual cyclicity (80.5%), ovulation rate (66%), and pregnancy rate
(28%) was noted. Statistically significant decrease in lutenising hormone (LH)
and LH/FSH ratio with an increase in follicle stimulating hormone (FSH) levels
were seen. Levels of high-density lipoprotein (HDL) cholesterol (Chol) increased
along with a decrease in total cholesterol. Improvement was noted in ovarian
volume, stromal thickness, and number of follicles. There was no change in
hirsutism, acne, levels of other sex steroid hormones, and lipids.
CONCLUSION: A 6-month course of metformin therapy may improve menstrual cyclicit
y
and fertility in women with PCOS.
60. Fertil Steril. 2004 Nov;82(5):1358-63.

Comparison of follicular vascularization in normal versus polycystic ovaries
during in vitro fertilization as measured using 3-dimensional power Doppler
ultrasonography.
Jrvel IY(1), Sladkevicius P, Kelly S, Ojha K, Campbell S, Nargund G.
Author information:
(1)Diana, Princess of Wales Centre for Reproductive Medicine, Academic Departmen
t
of Obstetrics and Gynaecology, St George's Hospital Medical School, London,
United Kingdom. ijarvela@cc.oulu.fi
OBJECTIVE: The growth of the follicles induced by gonadotropins during IVF
treatment is accompanied by physiologic angiogenesis, which is essential for the
maturation of the oocytes. We describe the IVF-induced changes in the
vascularization and compare normal with polycystic ovaries (PCOs).
DESIGN: Prospective study.
SETTING: Assisted reproductive unit at a university hospital.
PATIENT(S): Sixty women who underwent IVF cycles.
INTERVENTION(S): The ovarian vascularization was measured after pituitary
down-regulation, FSH stimulation, and hCG-injection using three-dimensional powe
r
Doppler ultrasonography.
MAIN OUTCOME MEASURE(S): The total ovarian vascularization was divided by the
number of follicles.
RESULT(S): After pituitary suppression, the ovarian vascularization/follicle was
lower in polycystic ovary (PCO) patients. During ovarian stimulation, follicles
in PCOs required a lesser amount of FSH to acquire the same level of
vascularization than the follicles in normal ovaries. In addition, hCG induced a
n
increase in the follicular vascularization in both normal and PCOs. The follicle
count correlated with the total vascularized volume in the ovaries throughout th
e
IVF cycle.
CONCLUSION(S): Follicles in PCOs seem to be less vascularized than the follicles
in normal ovaries after GnRH treatment but not after gonadotropin stimulation. I
t
is possible that restricted blood supply to the follicles in PCO might be
associated with the follicular arrest that is observed. We could confirm that
follicles in PCO are more sensitive to gonadotropin stimulation than follicles i
n
normal ovaries.
61. Ultrasound Obstet Gynecol. 2004 Feb;23(2):183-7.

Transvaginal ultrasound detection of multifollicular ovaries in non-hirsute
ovulatory women.
Phy J(1), Foong S, Session D, Thornhill A, Tummon I, Dumesic D.
Author information:
(1)Division of Reproductive Endocrinology and Infertility, Department of
Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA.
phy.jenniferlynn@mayo.edu
OBJECTIVES: To characterize ovarian morphology in a group of ovulatory,
non-hirsute women with infertility and normal circulating levels of gonadotropin
s
and sex steroids.
METHODS: Thirty-three women with normal physical examinations, regular ovulatory
menses, and absence of hirsutism (Ferriman-Gallwey score < or = 7) were studied.
No woman had thyroid disease, galactorrhea, polycystic ovary syndrome,
21-hydroxylase deficiency or diabetes. Two-dimensional (2D) transvaginal
sonography (TVS) was used to measure follicle size and ovarian volume on
menstrual cycle day 5. Three-dimensional (3D) TVS images were stored to determin
e
the number of follicles (measuring 2-10 mm in diameter) in the largest
sonographic plane. Fasting blood sampling and oral glucose tolerance testing wer
e
performed to assess serum gonadotropin and sex steroid levels as well as glucose
tolerance.
RESULTS: The median ovarian volume by 2D-TVS imaging was 7.2 (range, 2.3-15.8)
cm(3) (n = 64 ovaries). No follicles were > 10 mm in diameter. The median number
of follicles by 3D-TVS was 4 (range, 2-8) (n = 63 ovaries) in the largest
sonographic plane. Fourteen of 63 ovaries (22%) had six or more small follicles
in one plane distributed within normal stroma (multifollicular ovary, MFO). No
ovary had 10 or more follicles in one plane located within abundant stroma
(polycystic ovary). Of 33 women examined, 20 women (61%) had apparently normal
ovaries bilaterally, while 13 (39%) had at least one MFO. There were no
significant differences between women with and those without MFO in serum
gonadotropin and steroid levels or glucose tolerance.
CONCLUSIONS: MFO is a common morphological variant in non-hirsute ovulatory wome
n
with normal gonadotropin secretion and ovarian steroidogenesis.
Copyright 2004 ISUOG. Published by John Wiley & Sons, Ltd.
62. J Clin Endocrinol Metab. 2004 Jan;89(1):318-23.

Anti-Mllerian hormone serum concentrations in normoovulatory and anovulatory
women of reproductive age.
Laven JS(1), Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC.
Author information:
(1)Division of Reproductive Medicine, Department of Obstetrics and Gynecology,
Erasmus Medical Center, Rotterdam, The Netherlands. j.laven@erasmusmc.nl
Anti-Mllerian hormone (AMH) concentrations correlate with the number of antral
follicles as well as age and constitute an endocrine marker for ovarian aging. I
n
normogonadotropic anovulatory infertile women [World Health Organization (WHO)
class 2], the number of early antral follicles is usually increased. To
investigate whether AMH concentrations are increased, serum levels in 128 WHO 2
women were compared with those in 41 normoovulatory premenopausal women of
similar age. Serum AMH concentrations are significantly (P < 0.001) elevated in
WHO 2 patients [median, 7.6 micro g/liter (range, 0.1-40.0)], compared with
controls [median, 2.1 micro g/liter (0.1-7.4)]. In 106 patients presenting with
polycystic ovaries (PCOs) (>/==" BORDER="0">12 follicles/ovary measuring 2-9 mm
and/or an ovarian volume > 10 ml), AMH levels were elevated [9.3 micro g/liter
(1.8-40.0)], compared with 22 patients without PCOs [6.4 micro g/liter
(0.1-22.1)] (P < 0.0001). In WHO 2 patients, AMH concentrations correlated with
features characteristic for polycystic ovary syndrome such as LH concentrations
(r = 0.331; P = 0.0001), testosterone levels (r = 0.477, P = 0.0001), mean
ovarian volume (r = 0.421; P = 0.0001), and the number of ovarian follicles (r =
0.308; P = 0.0001). AMH levels correlated well with age in WHO 2 patients (r =
-0.248; P = 0.002) as well as in controls (r = -0.465; P = 0.005). However, the
relative decline in AMH with age is less pronounced in WHO 2 patients. In a
subset of patients no significant correlation was found between AMH serum
concentrations and the FSH response dose, the duration of stimulation, and the
total number of ampoules of FSH used. In conclusion, serum AMH concentrations ar
e
elevated in WHO 2 women, especially in those patients exhibiting PCOs. Because
AMH concentrations correlated well with other clinical, endocrine, and ultrasoun
d
markers associated with polycystic ovary syndrome, AMH may be used as a marker
for the extent of the disease. A less pronounced AMH decrease over time in these
women may suggest retarded ovarian aging. The latter hypothesis, however, should
be confirmed by longitudinal studies.
63. Hum Reprod Update. 2003 Nov-Dec;9(6):505-14.

Ultrasound assessment of the polycystic ovary: international consensus
definitions.
Balen AH(1), Laven JS, Tan SL, Dewailly D.
Author information:
(1)Department of Reproductive Medicine, Leeds General Infirmary, Leeds, UK.
adam.balen@leedsth.nhs.uk
The polycystic ovary syndrome (PCOS) is a heterogeneous condition, the
pathophysiology of which appears to be both multifactorial and polygenic. The
definition of the syndrome has been much debated. Key features include menstrual
cycle disturbance, hyperandrogenism and obesity. There are many extra-ovarian
aspects to the pathophysiology of PCOS, yet ovarian dysfunction is central. At a
recent joint ASRM/ESHRE consensus meeting, a refined definition of the PCOS was
agreed, encompassing a description of the morphology of the polycystic ovary
(PCO). According to the available literature, the criteria fulfilling sufficient
specificity and sensitivity to define the PCO should have at least one of the
following: either 12 or more follicles measuring 2-9 mm in diameter, or increase
d
ovarian volume (> 10 cm3). If there is a follicle > 10 mm in diameter, the scan
should be repeated at a time of ovarian quiescence in order to calculate volume
and area. The presence of a single PCO is sufficient to provide the diagnosis.
The distribution of follicles and a description of the stroma are not required i
n
the diagnosis. Increased stromal echogenicity and/or stromal volume are specific
to PCO, but it has been shown that the measurement of ovarian volume (or area) i
s
a good surrogate for quantification of the stroma in clinical practice. A woman
having PCO in the absence of an ovulation disorder or hyperandrogenism
('asymptomatic PCO') should not be considered as having PCOS, until more is know
n
about this situation. Three-dimensional and Doppler ultrasound studies may be
useful research tools but are not required in the definition of PCO. This review
outlines evidence for the current ultrasound definition of the polycystic ovary
and technical specifications.
64. Fertil Steril. 2003 May;79(5):1129-35.

Effect of pituitary down-regulation on the ovary before in vitro fertilization a
s
measured using three-dimensional power Doppler ultrasound.
Jrvel IY(1), Sladkevicius P, Kelly S, Ojha K, Campbell S, Nargund G.
Author information:
(1)Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu,
Finland. ijarvela@cc.oulu.fi
OBJECTIVE: To evaluate the changes taking place in the ovaries during pituitary
down-regulation.
DESIGN: Prospective observational study of women undergoing IVF treatment.
SETTING: A tertiary referral center for assisted reproduction.
PATIENT(S): Forty women who received the long buserelin acetate treatment
protocol. Transvaginal three-dimensional power Doppler ultrasound examinations
before and after pituitary down-regulation.
INTERVENTION(S): Ovarian volume, number of follicles, vascularization index (VI)
,
flow index (FI), vascularization flow index (VFI), and mean gray value (MG).
RESULT(S): Before the pituitary down-regulation, the dominant ovary was larger i
n
volume and had a lower MG than the nondominant ovary. After the down-regulation,
there was a significant decrease in the volume and number of follicles and an
increase in MG. After pituitary down-regulation, the dominant and nondominant
ovaries did not differ from each other in any of the parameters. Polycystic
ovaries were larger than normal ones before and after the down-regulation,
without any differences in MG, VI, FI, or VFI. Right and left ovaries did not
differ from each other after the down-regulation.
CONCLUSION(S): The differences observed between dominant and nondominant ovaries
seem to disappear after pituitary down-regulation. In addition, polycystic
ovaries were always larger than the normal ones, but no differences could be
detected in the stromal brightness or vascularity either before or after the
administration of GnRH agonist therapy.
65. J Assist Reprod Genet. 2002 Dec;19(12):582-90.

Characterization of normal and polycystic ovaries using three-dimensional power
Doppler ultrasonography.
Jrvel IY(1), Mason HD, Sladkevicius P, Kelly S, Ojha K, Campbell S, Nargund G.
Author information:
(1)Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu,
Finland. ijarvela@cc.oulu.fi
PURPOSE: To evaluate the characteristics of polycystic compared to normal ovarie
s
using three-dimensional (3-D) power Doppler ultrasonography.
METHODS: We recruited 42 volunteers, all of whom were commencing IVF treatment.
Each patient was examined in the cycle preceeding the start of drug therapy
during the late follicular phase. If eight or more subcapsular follicles of 2-8
mm in diameter in one two-dimensional (2-D) plane were detected in either of the
ovaries, the patient was categorized as having polycystic ovaries (PCO);
otherwise the ovaries were considered normal. The parameters examined were volum
e
of the ovary, vascularization index (VI), flow index (FI), vascularization flow
index (VFI), and mean greyness (MG). In addition, the ovary was arbitrarily
divided into cortex and stroma, and thereafter volume, VI, FI, VFI, and MG were
calculated for these two regions.
RESULTS: Twenty-eight women had normal ovaries and 14 had PCO. The comparison
between normal and PCO showed that as a group the PCO were larger, without any
differences in VI, Fl, VFI, or MG. In patients with PCO, the right ovary was
larger than the left one. In patients with normal ovaries, Fl was higher on the
left side. Division into cortex and stroma revealed that there were no
differences in cortical or stromal VI, FI, VFI, or MG between normal and PCO on
either side.
CONCLUSIONS: The ovaries defined as polycystic were larger than normal ovaries,
but there was no difference in the echogenicity of the stroma between polycystic
and normal ovaries. We were also unable to demonstrate that the polycystic
ovarian stroma was more vascularized than the stroma in the normal ovaries.
PMCID: PMC3455832
66. J Clin Endocrinol Metab. 2002 Dec;87(12):5559-65.

Serum inhibin B in polycystic ovary syndrome: regulation by insulin and
luteinizing hormone.
Welt CK(1), Taylor AE, Martin KA, Hall JE.
Author information:
(1)Reproductive Endocrine Unit and the National Center for Infertility Research,
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
02114, USA.
Inhibin B is a product of the granulosa cells of growing preantral and antral
follicles. Despite the large ovarian volume and increased follicle number
typically detected in women with polycystic ovary syndrome (PCOS), previous
studies demonstrate that inhibin B is not elevated as would be expected in PCOS,
but is inversely correlated with body mass index (BMI). We therefore hypothesize
d
that inhibin B levels in women with PCOS are regulated by a factor related to
BMI. Thus, LH, sex steroids, and metabolic parameters were measured in 50
anovulatory PCOS subjects in pools constituted from equal aliquots of serum draw
n
every 10 min for 4 h and were correlated with inhibin B. Based on the results of
these correlative studies, inhibin B regulation by human chorionic gonadotropin
(hCG) and insulin was tested directly. In PCOS subjects, inhibin B correlated
inversely with BMI (r = -0.413; P < 0.004) and fasting insulin (r = -0.409; P <
0.004). Inhibin B also correlated directly with pool LH (r = 0.419; P < 0.003),
LH pulse amplitude (r = 0.512; P < 0.0001), and SHBG (r = 0.429; P < 0.003). The
relationships demonstrated for inhibin B were not demonstrated for inhibin A, no
r
were they evident in normal subjects. To determine whether the correlations
represent regulation of inhibin B, i.e. stimulation of inhibin B by LH or
suppression by insulin, two interventional studies were performed. In the first
study hCG (5000 U) was administered to PCOS subjects (n = 15) to mimic the
effects of LH. Inhibin B was not increased, but was significantly reduced 24 h
after hCG administration (223.8 +/- 21.3 vs. 152.4 +/- 15.9 pg/ml; P < 0.0005).
In the second study, diazoxide (100 mg every 8 h) was administered for 3 d to
PCOS subjects (n = 9). Inhibin B increased (85.4 +/- 12.4 to 136.6 +/- 18.8
pg/ml; P < 0.05) in association with a decrease in the insulin area under the
curve (104 +/- 29 to 83 +/- 22 nmol/liter.min; P < 0.05) induced by diazoxide. I
n
PCOS subjects, inhibin B demonstrated significant relationships with BMI and
factors related to BMI, including LH, insulin, and SHBG. Although LH was
associated with inhibin B, hCG administration suppressed inhibin B secretion
after 24 h, whereas short-term insulin suppression increased inhibin B. These
findings suggest that both increased LH and insulin may account for the relative
suppression of inhibin B in patients with PCOS.
67. J Clin Endocrinol Metab. 2002 Jul;87(7):3148-54.

Isolated premature pubarche: ultrasonographic and color Doppler analysis--a
longitudinal study.
Battaglia C(1), Regnani G, Mancini F, Iughetti L, Bernasconi S, Volpe A, Flamign
i
C, Venturoli S.
Author information:
(1)Reproductive Medicine Unit, University of Bologna, Via Massarenti 13, 40138
Bologna, Italy. battaglia@med.unibo.it
Twenty-seven girls with premature pubarche were studied by ultrasonographic and
color Doppler analyses to determine the incidence of polycystic ovaries (PCO), t
o
longitudinally assess their evolution, and to search for any hormonal
correlation. The girls were submitted to auxological, clinical, and hormonal
evaluation, and 21-hydroxylase deficiency was ruled out by an ACTH test.
Furthermore, the girls underwent ultrasonographic and color Doppler ovarian and
uterine analyses. Among girls with premature pubarche, the prevalence of PCO was
41%. Advanced skeletal maturation, tall stature, and increased hair distribution
were constant in these patients. In patients with ultrasonographic and color
Doppler evidence of PCO, the ovarian volume, the number of small-sized
subcapsular follicles, the stromal echogenicity, and the ovarian stromal
vascularization progressively increased during the study. In the whole studied
population, ovarian volume correlated with the number of small-sized follicles (
r
= 0.719; P < 0.0001). Furthermore, a slight and inverse correlation has been
found between ovarian volume and ovarian stromal artery pulsatility index (r =
-536; P = 0.048). In conclusion, we affirm that PCO are greatly represented amon
g
girls with premature pubarche and progressively evolve.
68. Ultrasound Obstet Gynecol. 2002 Apr;19(4):386-91.

Pelvic sonography and uterine artery color Doppler analysis in the diagnosis of
female precocious puberty.
Battaglia C(1), Regnani G, Mancini F, Iughetti L, Venturoli S, Flamigni C.
Author information:
(1)Reproductive Medicine Unit and First Department of Obstetrics and Gynecology,
University of Bologna, Bologna, Italy. battaglia@med.unibo.it
OBJECTIVES: To evaluate the role of ultrasound and color Doppler analyses in the
diagnosis of precocious puberty.
METHODS: Gray-scale sonographic uterine and ovarian evaluation together with
color Doppler analysis of the uterine artery were prospectively performed in 29
girls presenting with premature breast development and pubic hair growth. The
values were compared with results obtained from the gonodotrophin releasing
hormone stimulation test. Excluded from the study were patients with isolated
thelarche or isolated pubarche and those patients with gonodotrophin releasing
hormone-independent puberty and with polycystic ovaries.
RESULTS: According to the Tanner scale, all the girls presented a breast stage o
f
2-3 and pubic hair stage 2-3. The uterine size was greater in those girls who
presented a pubertal response to the gonodotrophin releasing hormone test (Group
II; n = 20) (8.07 +/- 4.47 mL) than in those who did not (Group I; n = 9) (3.07
+/- 1.18 mL; P = 0.001). The ovarian volume and the number of small follicles wa
s
not significantly different between the groups. On Doppler analysis, more
elevated impedances were observed in Group I (pulsatility index = 3.28 +/- 0.37)
than in Group II (pulsatility index = 2.29 +/- 0.19; P = 0.001) girls. The
presence of a low pulsatility index (< 2.5) at the level of the uterine arteries
had a high diagnostic value for precocious puberty (sensitivity 86%, specificity
100%).
CONCLUSIONS: Uterine artery Doppler analysis may assist the diagnosis of
gonodotrophin releasing hormone-dependent precocious puberty, may be useful for
the selection of those girls needing treatment, and may simplify the follow-up o
f
girls treated for precocities.
69. Hum Reprod. 2002 Mar;17(3):771-6.

Polycystic ovaries in childhood: a common finding in daughters of PCOS patients.
A pilot study.
Battaglia C(1), Regnani G, Mancini F, Iughetti L, Flamigni C, Venturoli S.
Author information:
(1)Reproductive Medicine Unit, University of Bologna, Via Massarenti 13, 40138
Bologna, Italy. battaglia@med.unibo.it
BACKGROUND: Polycystic ovarian syndrome (PCOS) is a controversial endocrine
pathology and, recently, it has been suggested that the condition is hereditary.
The aim of this study was to prospectively determine in daughters of patients
with PCOS, by ultrasonographic (US) and colour Doppler analyses, the incidence o
f
polycystic ovaries and search any correlation with specific hormonal parameters.
METHODS: Fifteen prepubertal offspring (Group I) of patients with PCOS and 10
normal control prepubertal girls (Group II) were submitted to clinical,
auxological, and basal hormonal assay. In addition all patients were submitted t
o
US and colour Doppler ovarian and uterine evaluation.
RESULTS: Among Group I girls the prevalence of polycystic ovaries was 93%,
whereas no subjects among Group II had polycystic ovaries. The ovarian volume
(2.76 +/- 1.21 ml versus 0.87 +/- 0.46 ml; P < 0.001) and the number of small
sized follicles (5.36 +/- 2.2 versus 0.75 +/- 0.92; P < 0.001) were significantl
y
higher in Group I than Group II patients. In addition, a normal stromal score an
d
an absent stromal vascularization was observed in the control group. The hormone
levels did not differ between the two groups.
CONCLUSION: In conclusion we speculate that polycystic ovaries in childhood may
be considered a sign of genetic predisposition to PCOS and that environmental
factors may express the adult clinical and hormonal presentation of the syndrome
.
70. Eur J Endocrinol. 2001 Dec;145(6):749-55.

Age-related differences in features associated with polycystic ovary syndrome in
normogonadotrophic oligo-amenorrhoeic infertile women of reproductive years.
Bili H(1), Laven J, Imani B, Eijkemans MJ, Fauser BC.
Author information:
(1)Division of Reproductive Medicine, Department of Obstetrics and Gynecology,
Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
OBJECTIVE: To assess the effect of age on clinical, endocrine and sonographic
features associated with polycystic ovary syndrome (PCOS) in normogonadotrophic
anovulatory infertile women of reproductive years.
DESIGN: Cross-sectional study.
METHODS: Four hundred and seventy-two oligo-amenorrhoeic infertile patients,
presenting with normal FSH and oestradiol concentrations, aged 17-42 years
underwent a standardised initial evaluation including: cycle history, body mass
index, waist-to-hip ratio and transvaginal ultrasound scanning of ovaries.
Fasting blood samples were obtained for extensive endocrine evaluation. Cycle
duration, serum levels of gonadotrophins, androgens, oestradiol, insulin,
glucose, inhibin B as well as mean number of follicles, ovarian volume and
ovarian stroma echogenicity were assessed.
RESULTS: Older women had significantly lower LH and androgen and inhibin B serum
levels. Similarly, older women presented with a reduced number of ovarian
follicles. Age was inversely correlated with cycle duration (r=-0.112, P=0.02),
LH (r=-0.154, P=0.001), testosterone (r=-0.194, P=0.001), androstenedione
(r=-0.170, P=0.001), dehydroepiandrosterone (r=-0.157, P=0.001), insulin
(r=-0.126, P=0.02), inhibin B (r=-0.118, P=0.03) serum levels and mean follicle
number (r=-0.100, P=0.03). A positive correlation was observed between age and
glucose to insulin ratio (r=0.138, P=0.009).
CONCLUSIONS: Advanced age in normogonadotrophic anovulatory infertile women is
associated with lower LH and androgen levels and with a decreased number of
ovarian follicles. Although during reproductive years observed differences are
relatively small, these age-related changes may affect the observed incidence of
PCOS.
71. Hum Reprod. 2001 Nov;16(11):2263-6.

Cabergoline influences ovarian stimulation in hyperprolactinaemic patients with
Papaleo E(1), Doldi N, De Santis L, Marelli G, Marsiglio E, Rofena S, Ferrari A.
Author information:
(1)Department of Obstetrics and Gynecology, San Raffaele Scientific Institute,
University of Milan, Italy. enrypap@hotmail.com
BACKGROUND: Polycystic ovary syndrome (PCOS) is characterized by abnormal
gonadotrophin secretion, in particular an elevated serum concentration of LH,
depressed FSH, and an LH/FSH ratio of >or =2. Mild, transient hyperprolactinaemi
a
is frequently associated with PCOS (30% of patients); furthermore, it can be
observed during the late follicular and luteal phases of both natural and
stimulated cycles. It is suggested that a reduction of the dopamine inhibitory
effect might raise both prolactin (PRL) and LH.
METHODS AND RESULTS: We compared ovarian stimulation in two groups of
hyperprolactinaemic (hyperPRL)-PCOS patients; one group was treated with
cabergoline, reducing PRL plasma concentrations to the range normally observed
during ovulation induction. In the untreated hyperPRL-PCOS group, we noted a
reduced total number of ampoules of recombinant FSH (P < 0.04), fewer days to
reach HCG administration (P < 0.04), and significantly higher peak oestrogen
plasma concentrations (P < 0.03) compared with the treated group. By ultrasound
examination the same group showed significantly higher ovarian volume and an
increased total number of follicles of every size. In untreated hyperPRL-PCOS
patients, four cycles out of 65 were cancelled due to mild ovarian
hyperstimulation syndrome (OHSS) that occurred during ovulation induction. Only
one cycle out of 42 in the patients treated with cabergoline was cancelled. No
significant differences in pregnancy rate nor in multiple pregnancy were found.
CONCLUSION: Our data suggest a dopaminergic control of LH release and support th
e
use of cabergoline in the management of such patients, in order to provide bette
r
clinical control of ovarian response and consequently a reduction of the risk of
OHSS, with no decrease in pregnancy rate.
72. J Clin Endocrinol Metab. 2001 Apr;86(4):1589-95.

The rise of estradiol and inhibin B after acute stimulation with
follicle-stimulating hormone predict the follicle cohort size in women with
polycystic ovary syndrome, regularly menstruating women with polycystic ovaries,
and regularly menstruating women with normal ovaries.
Elting MW(1), Kwee J, Schats R, Rekers-Mombarg LT, Schoemaker J.
Author information:
(1)Research Institute for Endocrinology, Reproduction, and Metabolism, Departmen
t
of Obstetrics and Gynecology, Division of Reproductive Endocrinology and
Fertility, Vrije Universiteit Medical Center, 1007 MB Amsterdam, The Netherlands
.
m.etling@azvu.nl
Polycystic ovaries contain a larger number of antral follicles than control
ovaries. The aim of this study was to test whether the increase in estradiol
(E(2)) and inhibin B after stimulation with 300 IU recombinant FSH in the early
follicular phase and the ovarian volume can predict the size of the follicle
cohort in polycystic ovary syndrome (PCOS) patients (n = 10), patients with
polycystic ovaries detected by ultrasound but with regular menstrual cycles (PCO
;
n = 10), and regularly menstruating patients with normal ovaries (n = 10). The
follicle cohort size was measured as the FSH-sensitive follicles growing during
a
standardized in vitro fertilization stimulation. Linear regression analysis
showed that the slopes of the regression lines of the E(2) increment and the
inhibin B increment in relation to the number of follicles were not significantl
y
different among the three groups, meaning that an increased sensitivity for FSH
of the granulosa cells of polycystic ovaries was not found. For the total group
(n = 30) we calculated that an E(2) increment of 100 pmol/L predicts 5.5
follicles (95% confidence interval, 2.8--8.2; r = 0.617; P < 0.001), and an
inhibin B increment of 100 ng/L predicts 6.2 follicles (95% confidence interval,
3.5--9.0; r = 0.665; P < 0.001). The ovarian volume could not be used in a
prediction model because the association with the number of follicles was
different in the PCO group compared with the PCOS and the control group. Women
with PCO and women with PCOS both had a follicle cohort twice as big as the
cohort in control women (P < 0.01). The differences in menstrual cycle pattern
between the PCO and PCOS groups cannot be explained by differences in cohort
size.
73. Gynecol Endocrinol. 2000 Dec;14(6):417-24.

Polycystic ovary syndrome: a new ultrasonographic and color Doppler pattern.
Battaglia C(1), Regnani G, Artini PG, Giulini S, Genazzani AD, Genazzani AR,
Volpe A.
Author information:
(1)Department of Obstetrics and Gynecology, University of Modena, Via del Pozzo
71, 41100, Modena, Italy.
The aim of this study was to evaluate whether patients with partial bilateral
polycystic ovaries show different ovarian and uterine blood flow to those with
complete bilateral polycystic ovaries, and to investigate whether there is a
correlation between ultrasonographic and hormonal parameters. Fifteen patients
with partial polycystic ovaries and eighteen patients with complete bilateral
polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler
ultrasonographic evaluation. Hormonal (luteinizing hormone (LH),
follicle-stimulating hormone (FSH), LH/FSH concentration ratio, estradiol,
prolactin, androstenedione, testosterone), clinical (body mass index,
Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and
distribution of subcapsular follicles, stromal score) and Doppler (uterine arter
y
and intraparenchymal vessels pulsatility index, ovarian stromal vascularization)
parameters were evaluated, in the early follicular phase (cycle day 3-5) in
oligomenorrheic patients, or at random in amenorrheic patients. Significantly
higher androstenedione plasma levels and LH/FSH concentration ratios were
observed in complete bilateral polycystic ovaries. In partial polycystic ovaries
,
gray-scale and color Doppler ultrasonography showed different features in
affected and unaffected areas of the ovary, similar to polycystic and normal
ovary appearance respectively. In conclusion, PCOS does not predetermine a singl
e
ultrasonographic or Doppler pattern.
74. Hum Reprod. 2000 Dec;15(12):2570-6.

In-vitro ovarian steroidogenesis in women with pelvic congestion.
Gilling-Smith C(1), Mason H, Willis D, Franks S, Beard RW.
Author information:
(1)Department of Obstetrics and Gynaecology, Imperial College School of Medicine
at St Mary's, London W2 1PG, UK. cgs@chelwest.nhs.uk
Follicular fluid steroid content and theca and granulosa cell steroidogenesis in
pelvic congestion cystic ovaries were compared with steroidogenic function in
both normal and polycystic ovaries. Ovaries were obtained at oophorectomy for
benign gynaecological conditions, and classified according to gross morphology a
t
dissection. Individual follicles were dissected out, follicular fluid aspirated,
and granulosa and theca cells cultured in vitro. Androstenedione, progesterone
and oestradiol content of the follicular fluid and overlying culture medium were
measured by radioimmunoassay. There was a significant elevation of both basal an
d
LH-stimulated androstenedione production by theca from both polycystic ovaries (
n
= 10; P < 0.005) and pelvic congestion cystic ovaries (n = 8; P < 0.05 and < 0.0
1
respectively) as compared with normal ovaries (n = 5). Granulosa cells from
pelvic congestion ovaries (n = 7) had a diminished oestradiol response to FSH as
compared with those from normal ovaries (n = 8). Follicular fluid from the
majority of follicles in the pelvic congestion cystic ovaries had a high
androgen:oestrogen ratio consistent with atresia. For the first time, pelvic
congestion ovaries characterized by predominantly atretic follicles scattered
throughout the stroma in a normal volume ovary are reported. Follicular atresia
was reflected by reduced granulosa cell responsiveness to FSH, theca cell
hyperplasia and increased basal and LH-stimulated androgen production. These
ovaries are functionally distinct from polycystic ovaries, which do not have a
higher proportion of atretic follicles than normal ovaries.
75. J Gynecol Obstet Biol Reprod (Paris). 2000 May;29(3):298-301.

[Polycystic ovary syndrome].
[Article in French]
Dewailly D(1).
Author information:
(1)Service d'Endocrinologie et de Diabtologie, CHRU de Lille, Clinique Marc
Linquette, Lille, France.
Comment in
J Gynecol Obstet Biol Reprod (Paris). 2000 Dec;29(8):805-806.
The polycystic ovary syndrome (PCOS) is the most frequent endocrine disease in
women of reproductive age. Hyperandrogenism, anovulation and metabolic syndrome
are the cardinal features of PCOS. Hyperandrogenism results from a diffuse
enzymatic hyperactivity at the theca-interstitial cell level. Anovulation is due
to an impairment of the selection of a dominant follicle, while the number of
smaller follicles is exaggerated. The molecular grounds of insulin resistance
could be an increased Serine phosphorylation of the insulin receptor. The
clinical classification of PCOS distinguishes three forms: the classic PCOS,
where the three above mentioned features are present, the non classic PCOS and
the asymptomatic PCOS, revealed by ultrasonography. Only the increased ovarian
volume or surface (>11ml and> 5.5cm(2), respectively) must be viewed as a
specific ultrasonic sign of PCOS. Cyproterone acetate remains the basic treatmen
t
of hyperandrogenism. The treatment of anovulation and infertility follows a
consensual strategy. The insulin sensitizing treatment allows to decrease
hyperandrogenism, to reverse the menstrual cycle irregularity and to obtain
spontaneous or induced pregnancies.
76. Ultrasound Obstet Gynecol. 1999 Sep;14(3):183-7.

Polycystic ovary syndrome: it is always bilateral?
Battaglia C(1), Regnani G, Petraglia F, Primavera MR, Salvatori M, Volpe A.
Author information:
(1)Department of Obstetrics and Gynecology, University of Modena, Italy.
OBJECTIVE: To evaluate whether patients with unilateral polycystic ovary showed
different ovarian and uterine blood flow from those with bilateral polycystic
ovaries, and to investigate whether there was a correlation between the
ultrasonographic aspect and different hormonal parameters.
DESIGN: An observational study.
SUBJECTS: Sixteen patients with unilateral polycystic ovary and twenty patients
with bilateral polycystic ovaries underwent clinical, biochemical, gray-scale an
d
color Doppler ultrasonographic evaluation.
METHODS: The following parameters were evaluated: hormonal (luteinizing hormone
(LH), follicle stimulating hormone (FSH), LH/FSH concentration ratio, estradiol,
prolactin, androstenedione, testosterone), clinical (body mass index,
Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and
distribution of subcapsular follicles, stromal score) and Doppler (uterine arter
y
and intraparenchymal vessel pulsatility index, ovarian stromal vascularization),
in oligomenorrheic patients in the early follicular phase (cycle days 3-5) or in
amenorrheic patients at random.
RESULTS: Significantly higher androstenedione plasma levels and LH/FSH
concentration ratios were observed in bilateral polycystic ovaries. In unilatera
l
polycystic ovaries, gray-scale and color Doppler ultrasonography showed differen
t
features in the affected and the unaffected ovary, similar to the appearance of
a
polycystic and normal ovary, respectively.
CONCLUSION: Polycystic ovary syndrome does not predetermine a single
ultrasonographic and Doppler pattern.
77. Gynecol Endocrinol. 1999 Apr;13(2):123-9.

Doppler, ultrasonographic and endocrinological environment with regard to the
number of small subcapsular follicles in polycystic ovary syndrome.
Battaglia C(1), Genazzani AD, Salvatori M, Giulini S, Artini PG, Genazzani AR,
Volpe A.
Author information:
The aim of this study was to evaluate how, in patients with polycystic ovary
syndrome, the number of small subcapsular follicles correlates with uterine and
ovarian blood flow and with specific hormonal parameters. At an ultrasonographic
evaluation, 30 patients with polycystic ovary syndrome showed 5-10 (group I; n =
14) or > 10 (group II; n = 16) small follicles. These patients underwent
ultrasonographic (ovarian volume and stroma echodensity; number, diameter and
distribution of follicles) and color Doppler (uterine and intraovarian vessels)
analyses, and hormonal assay. In group II, significantly lower pulsatility index
values than in group I were observed in the ovarian stromal arteries. The
Ferriman-Gallwey score, plasma androstenedione level and luteinizing
hormone/follicle stimulating hormone (LH/FSH) ratio results were significantly
higher in group II than in group I. Androstenedione plasma levels correlated wit
h
the number of small follicles. Furthermore, the LH/FSH ratio correlated with bot
h
the number of small follicles and the stromal artery pulsatility index. The
combined assessment of ovarian morphology by transvaginal ultrasound and color
Doppler may provide insight into the pathological state of polycystic ovary
syndrome.
78. Rays. 1998 Oct-Dec;23(4):709-26.

Ovarian factor infertility.
Summaria V(1), Speca S, Mirk P.
Author information:
(1)Istituto di Radiologia, Universit Cattolica del S. Cuore, Policlinico A.
Gemelli, Roma.
The diseases of the ovary which most frequently cause infertility are:
anovulation from follicular atresia, the empty follicle syndrome, the luteinized
unruptured follicle syndrome; chronic anovulation syndromes, within which
polycystic ovarian syndrome plays a major role; ovarian endometriosis. Sonograph
y
and Color Doppler US are the first choice procedures in the monitoring of ovaria
n
cycles, which combined with serum hormone values, are able to identify possible
changes in the physiologic sequence of the cycle. In follicular atresia, ovaries
with minute follicles (3mm or less) and early disappearance of primary follicle
are observed on sonography. The empty follicle syndrome characterized by the lac
k
of oocytes within the primary follicle, is of difficult sonographic diagnosis, a
possible sign being the missed visualization of cumulus oophorus. The luteinized
unruptured follicle syndrome consists in the absence of oocyte expulsion from
primary follicle persisting more than 48 hours after LH blood peak. Doppler
spectra of blood flow in perifollicular ovarian arteries maintain the features o
f
the follicular phase, i.e. low diastolic velocities and high resistances. Among
chronic anovulation syndromes, hyper-and hypogonadotropism cause ovarian
amenorrhea where ovaries are similar to those of women in menopause: small size,
very few or absent follicles. The polycystic ovarian syndrome is characterized b
y
an abnormal pulsatile GnRH release which causes LH hypersecretion and FSH
hyposecretion. The latter is not able to stimulate the growth and maturation of
follicles, while the former causes hyperandrogenism with hirsutism and obesity
and is responsible for hypertrophy and stromal hyperechogenicity. The sonographi
c
diagnosis of polycystic ovarian syndrome is based on standardized
morphostructural signs as increased volume of the ovaries (> 10 cm3), the
presence of numerous (> or = 10) peripheral microfollicles (< or = 5 mm) with
hyperechoic stroma. The endometrial cyst, usually present in ovarian
endometriosis is visualized with sonography as a round neoformation with
ill-defined walls, filled with a uniformly hypoechoic, corpuscular, partly
hemorrhagic fluid; less frequently the appearance is that of a more complex
structure posing differential diagnostic problems, mainly with the hemorrhagic
corpus luteum; both pathological conditions appear poorly vascularized at Color
Doppler, with tracings of high resistance arterial flow. Among the procedures of
second choice, CT can show the high blood density common to the two conditions
while on MRI the signal is mostly hyperintense in T1-weighted sequences with
areas of lower signal intensity in T2-weighted sequences.
79. Aust N Z J Obstet Gynaecol. 1999 Feb;39(1):63-8.

Transvaginal ultrasound appearances of the ovary in normal women and hirsute
women with oligomenorrhoea.
Fox R(1).
Author information:
(1)University of Bristol, Department of Obstetrics and Gynaecology, St. Michael'
s
Hospital, United Kingdom.
The transvaginal ultrasound appearances of the ovary were determined in women
with clinical and endocrine features of polycystic ovarian disease (PCOD) and
apparently normal women. At scan the number of small follicles were counted and
ovarian volume was calculated. The maximum width of the ovarian cortex was also
measured. Blood was sent for measurement of LH, FSH and testosterone. The women
with oligomenorrhoea were scanned at random and the normal women were seen withi
n
the first 5 days of the start of menstruation. There were significant difference
s
between median values for the 2 groups in terms of number of small follicles,
ovarian volume and stromal width; the ovaries of the hirsute women had more
follicles, were of larger volume, and had greater stromal width. The 2 ranges fo
r
number of follicles did overlap, however. Four hirsute oligomenorrhoeic women ha
d
a normal number of follicles; all 4 had the several clinical and endocrine
features indicative of PCOD. These data suggest that the classical ultrasound
features of PCOD are not consistently present and that the absence of increased
follicularity at scan should not necessarily deter clinicians from making the
functional diagnosis of PCOD.
80. Ultrasound Obstet Gynecol. 1998 Sep;12(3):180-7.

Ultrasonographic and color Doppler analysis in the treatment of polycystic ovary
syndrome.
Battaglia C(1), Genazzani AD, Artini PG, Salvatori M, Giulini S, Volpe A.
Author information:
Comment in
Ultrasound Obstet Gynecol. 1998 Sep;12(3):154-5.
OBJECTIVE: To compare the effect of a gonadotropin releasing hormone (GnRH)
analog plus 'add-back' oral contraceptive (OC) therapy with OC therapy alone on
the clinical and hormonal parameters that are characteristic of polycystic ovary
syndrome (PCOS).
DESIGN: Prospective, randomized study.
SUBJECTS: Thirty PCOS patients were randomly assigned to treatment with
leuprolide acetate for depot suspension plus a combined monophasic OC (Group I)
or to OC alone (Group II).
METHODS: Hormonal (luteinizing hormone (LH), follicle stimulating hormone (FSH),
LH : FSH concentration ratio, estradiol, androstenedione, testosterone), clinica
l
(Ferriman-Gallwey score), ultrasonographic (ovarian volume, number of subcapsula
r
follicles, stromal score) and Doppler (uterine artery and ovarian
intraparenchymal vessels' pulsatility index, ovarian stromal vascularization)
parameters were evaluated during 6 months' therapy and 6 months' follow-up.
RESULTS: Significant changes in all the parameters analyzed occurred as a result
of therapy and the changes were more marked in the group undergoing treatment
with GnRH analog plus OC.
CONCLUSIONS: GnRH analog plus OC use has a more rapid and marked effect on the
hormonal milieu as well as the ovarian architecture and vascularization in
patients with PCOS than OC used alone. The former treatment may be a more
efficient therapy for PCOS.
81. Fertil Steril. 1998 Jun;69(6):1152-5.

The role of three-dimensional ultrasonographic images in ovarian measurement.
Wu MH(1), Tang HH, Hsu CC, Wang ST, Huang KE.
Author information:
(1)Department of Obstetrics and Gynecology, National Cheng-Kung University,
Medical College, Tainan, Taiwan, Republic of China.
OBJECTIVE: To determine whether three-dimensional ultrasonography can increase
the ability to evaluate the ovary and follicles, especially in women with
polycystic ovary disease (PCOD).
DESIGN: Prospective clinical study.
SETTING: University hospital endocrine and infertility center.
PATIENT(S): Sixty-six patients undergoing routine gynecologic evaluation were
divided into two groups: the normal control group consisted of 22 patients, and
there were 44 patients with PCOD.
INTERVENTION(S): Three-dimensional ultrasonography was performed to store and
document whole volumes of the ovaries for evaluation.
MAIN OUTCOME MEASURE(S): Three perpendicular planes of bilateral ovaries are
rotatable to obtain the largest dimensions. The three-dimensional volume was
measured using the trapezoid formula.
RESULT(S): The ovaries of the patients with PCOD were larger in size, area, and
volume than those of normal controls.
CONCLUSION(S): Stroma and volume determinations can be obtained more accurately
by three-dimensional images than by traditional ultrasonography.
Three-dimensional ultrasonography not only facilitates noninvasive evaluation an
d
volume calculation but also completes the examination in a short time without
increasing patient discomfort.
82. Biol Reprod. 1997 Nov;57(5):1211-6.

Characterization of intrafollicular steroid hormones, inhibin, and follistatin i
n
women with and without polycystic ovarian syndrome following gonadotropin
hyperstimulation.
Lambert-Messerlian G(1), Taylor A, Leykin L, Isaacson K, Toth T, Chang Y,
Schneyer A.
Author information:
(1)Women and Infants' Hospital, Department of Pathology and Laboratory Medicine,
Brown University School of Medicine, Providence, Rhode Island 02905, USA.
The etiology of polycystic ovary syndrome (PCOS) is unexplained. Since no major
deficiencies are reported in serum FSH or inhibin, we hypothesized that abnormal
levels of a paracrine modulator of FSH action within the ovary may be associated
with the arrest of follicular growth seen in the PCOS ovary. Follicular fluid
aspirates were collected from women with (n = 7) or without (n = 17) PCOS during
oocyte retrieval for in vitro fertilization. Aspirates were assayed for total
inhibin, inhibin A (InhA), inhibin B (InhB), and follistatin (FS), as well as fo
r
estradiol, progesterone (P4), androstenedione, and total protein. Hormone levels
were compared between women with and without PCOS using all aspirates (some of
which were collected from multiple follicles at once) and also between aspirates
containing fluid from a single follicle only (PCOS, n = 30; non-PCOS, n = 107).
P4 levels were significantly (p < 0.01) reduced in PCOS versus non-PCOS women as
evidenced by analysis of all follicles as well as in single-follicle aspirates
only. In addition, InhA, P4, and FS increased with follicle volume, and InhB
decreased significantly in non-PCOS, but not in PCOS, follicles. Therefore,
although follicular development can be induced in PCOS patients with
gonadotropins, hormonal responses within the ovary appear inappropriate in terms
of concentrations or patterns of secretion. These data support the concept that
PCOS is associated with a deficit in the paracrine control of folliculogenesis.
83. Gynecol Endocrinol. 1997 Apr;11(2):105-10.

Color Doppler analysis in oligo- and amenorrheic women with polycystic ovary
syndrome.
Battaglia C(1), Artini PG, Genazzani AD, Gremigni R, Salvatori M, Sgherzi MR,
Giulini S, Lombardo M, Volpe A.
Author information:
(1)Institute of Pathophysiology of Human Reproduction, University of Modena,
Italy.
The objective of this study was to determine whether amenorrheic women have more
severe blood flow variations and clinical-endocrinological patterns in compariso
n
with oligomenorrheic polycystic ovary syndrome (PCOS) patients. Twenty
oligomenorrheic women (cycle length > 35 days; Group I), and 20 amenorrheic wome
n
(no vaginal bleeding for at least 6 months; Group II) were submitted to
ultrasonographic evaluation of ovarian volume, follicle distribution, number and
diameter, color Doppler analysis of uterine and intraovarian blood flow, hormona
l
assay of different compartments, and plasma evaluation of lipid profile. The
number of subcapsular small-sized follicles, and the ovarian volume,
androstenedione and luteinizing hormone (LH) plasma levels, and the
LH/follicle-stimulating hormone (FSH) ratio were significantly higher in the
amenorrheic group compared with the oligomenorrheic patients. Furthermore,
significantly lower high-density lipoprotein (HDL) and HDL/total cholesterol
ratio were observed in Group II compared with Group I. In addition, in Group II,
higher resistance in the uterine arteries and lower impedance to blood flow in
the intraovarian arteries have been shown. The assessment of ovarian morphology
by transvaginal ultrasound and Doppler flow analysis of both intraovarian and
uterine arteries in patients with PCOS may provide an insight into the
pathological state and the degree of progression of the disease.
84. Hum Reprod. 1997 Feb;12(2):220-3.

Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness
to gonadotrophins in in-vitro fertilization.
Tomas C(1), Nuojua-Huttunen S, Martikainen H.
Author information:
(1)Department of Obstetrics and Gynecology, University of Oulu, Finland.
The objective of this study was to determine the predictive value of the number
of follicles seen by transvaginal ultrasound before gonadotrophin stimulation on
the ovarian responsiveness of 166 infertile women undergoing in-vitro
fertilization (IVF) treatment. The main variables were patient age, ovarian
volume and number of ovarian follicles measuring 2-5 mm on transvaginal
ultrasound before gonadotrophin stimulation. Based on the sum of ovarian
follicles in both ovaries the patients were divided into three groups of inactiv
e
(<5 follicles), normal (5-15 follicles) or polycystic (PCO)-like ovaries (>15
follicles). The main outcome measure was the number of recovered oocytes. The
number of follicles was correlated more strongly with the number of recovered
oocytes (r2 = 0.131; P = 0.0001) than age alone (r2 = -0.053; P = 0.005). Fewer
oocytes were recovered from patients with inactive ovaries (5.4 +/- 2.5; P =
0.006) than with normal (7.5 +/- 4.5) or PCO-like ovaries (10.5 +/- 5.1). Ovaria
n
volume was correlated with the number of follicles before stimulation (P =
0.0001), but not with the number of oocytes. The number of small follicles
present before ovarian stimulation was a better predictor of the outcome than
ovarian volume or age alone. Patients can be identified with inactive ovaries
which will have a poor response to IVF treatment, a key factor for counselling
couples and optimizing resources.
85. Acta Obstet Gynecol Scand. 1996 Nov;75(10):917-21.

The number of follicles and ovarian volume in the assessment of response to
clomiphene citrate treatment in polycystic ovarian syndrome.
Fiiciolu C(1), Api M, Ozden S.
Author information:
(1)Zeynep Kamil Maternity Hospital, Infertility Polyclinic Department, Istanbul,
Turkey.
OBJECTIVE: To evaluate whether the number of follicles and ovarian volume have
any significance in evaluating the response to clomiphene citrate treatment in
polycystic ovarian syndrome (PCOS).
DESIGN: A prospective study of 70 infertile women, 44 of which were diagnosed
with polycystic ovarian syndrome.
MAIN OUTCOME MEASURES: Follicle numbers and volumes in both ovaries, hormonal
profile, response to Clomiphene Citrate(CC).
RESULTS: Ovarian volume was significantly greater in cases with polycystic
ovarian syndrome than controls. However, ovarian volume in the Clomiphene Citrat
e
nonresponders was significantly greater than in Clomiphene Citrate responders in
the polycystic ovarian syndrome group. The number of small follicles was
significantly higher in cases with polycystic ovarian syndrome than controls, an
d
in the Clomiphene Citrate nonresponder group this number was also significantly
higher than in Clomiphene Citrate responders. Endocrine features of patients wit
h
polycystic ovarian syndrome revealed that Dehydroepiandrostenedione sulfate,
Androstenedione, follicle stimulating and luteinizing hormone do not discriminat
e
between patients who respond to Clomiphene Citrate and those who do not respond.
However, Testosterone and luteinizing hormone levels differ significantly in
responders and nonresponders.
CONCLUSIONS: Small multiple follicles (> 9) and enlarged ovarian volume (> 6.8
ml) were the most prominent transvaginal ultrasonographic features of ovaries in
Clomiphene Citrate nonresponsive patients with polycystic ovarian syndrome.
Higher levels of Testosterone, luteinizing hormone and significantly higher
number of small follicles were associated with lack of Clomiphene Citrate
response. These ultrasonographic features and laboratory assays could be
clinically useful for distinguishing better the Clomiphene Citrate nonresponders
from responders.
86. Gynecol Endocrinol. 1996 Oct;10(5):327-35.

Hypogonadotropic patients with ultrasonographically detected polycystic ovaries:
endocrine response to pulsatile gonadotropin-releasing hormone.
Schachter M(1), Balen AH, Patel A, Jacobs HS.
Author information:
(1)Cobbold Laboratories, University College, Middlesex Hospital, London, UK.
To characterize the endocrine response during induction of ovulation in patients
with hypogonadotropic hypogonadism and ultrasound findings of polycystic ovary,
we performed a retrospective analysis of 22 treatment cycles with pulsatile
gonadotropin-releasing hormone (GnRH) in such patients and of 17 treatment cycle
s
in similar patients with ultrasonographically normal ovaries. Of the 21 patients
studies, 11 had an ultrasound finding of polycystic ovaries and ten had ovaries
that appeared normal. Serum luteinizing hormone (LH), follicle-stimulating
hormone (FSH) and estradiol levels, number of follicles of diameter > 12 mm (by
ultrasound), and ovulation and conception rates were measured. Patients with
hypogonadotropic hypogonadism and ultrasound-diagnosed polycystic ovary had
pretreatment endocrine status similar to those with normal ovaries, but had much
higher baseline ovarian volume. Ovulation induction with pulsatile GnRH induced
much higher serum LH concentrations in the former group despite similar FSH
levels. This difference preceded any change in estradiol levels. The former grou
p
consistently recruited significantly more follicles during pulsatile GnRH
treatment. However, ovulation and conception rates were (non-significantly)
higher in the latter group. In conclusion, this study characterized a subgroup o
f
hypogonadotropic patients with ovarian morphology, volume and response to
ovulation induction similar to in patients with polycystic ovary syndrome. When
treated with pulsatile GnRH, those with polycystic ovary significantly
hypersecreted LH before their estradiol level changed significantly. The primary
lesion in polycystic ovary syndrome seems to be in the ovary, with pituitary
hypersecretion of LH secondary to disturbed ovarian feedback signalling.
87. Ultrasound Obstet Gynecol. 1996 May;7(5):335-41.

Ovarian morphology as a predictor of hormonal values in polycystic ovary
syndrome.
van der Westhuizen S(1), van der Spuy ZM.
Author information:
(1)Department of Obstetrics and Gynaecology, University of Cape Town Medical
School, Groote Schuur Hospital, Observatory, South Africa.
The objective of this investigation was to correlate the severity of ultrasound
abnormality in the ovaries of women suspected of having the polycystic ovary
syndrome (PCOS) with their endocrinopathy in an attempt to establish which
anatomical abnormalities best predict endocrine dysfunction. There were 90
patients in the study group--all suspected clinically of having PCOS--and 12
control subjects. Of the study patients, 74 were classified ultrasonically as
having polycystic ovaries, whereas 16 demonstrated no ovarian abnormality. On
ultrasound examination of the ovaries, the follicular size, the number and type
of distribution of follicles, ovarian volume and echogenicity of the stroma were
assessed. Levels of the following serum hormones were measured: luteinizing
hormone (LH), follicle stimulating hormone (FSH), estrone, estradiol, 17
alpha-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS),
sex hormone binding globulin and testosterone. Calculations were made using thes
e
results to obtain the LH:FSH ratio and the free androgen index. Endocrine
assessment of these 90 patients demonstrated significantly lower LH levels, lowe
r
LH:FSH ratio and lower testosterone levels in the women without ovarian
abnormality, compared to those with polycystic ovaries. The women with ultrasoun
d
evidence of polycystic ovaries had high. LH levels, a raised LH:FSH ratio and
higher testosterone, DHEAS and androstenedione levels than the control subjects.
Although a number of multivariate regressions of biochemistry on ovarian
morphology were statistically significant, ovarian morphology predicted only a
small proportion of the variability in the hormone levels. Multivariate
regression models predicting androstenedione and the LH:FSH ratio had the best
overall fit with ovarian volume and a rosary follicular pattern as factors, but
even for these variables the adjusted R2 value was very low (0.23 for
androstenedione and 0.20 for the LH:FSH ratio). It is therefore concluded that,
although ovarian morphology may accurately diagnose polycystic ovaries, it does
not predict the severity or presence of endocrine dysfunction. Management and
prognosis must be determined on an individual basis against the background of a
combination of the clinical, biochemical and ultrasound findings.
88. Clin Endocrinol (Oxf). 1996 Mar;44(3):269-76.

Polycystic ovaries in pre and post-menopausal women.
Birdsall MA(1), Farquhar CM.
Author information:
(1)Department of Obstetrics and Gynaecology, National Women's Hospital, Auckland
,
New Zealand.
OBJECTIVE: Polycystic ovaries have been diagnosed in more than 20% of
premenopausal women using ultrasound. The aim of this study was to determine
whether polycystic ovaries exist in post-menopausal women.
DESIGN: Two groups of women were studied; group 1 consisted of 18 post-menopausa
l
volunteers and group 2 comprised 142 women, 94 of whom were post-menopausal who
had recently undergone coronary angiography.
MEASUREMENTS: Transabdominal and transvaginal ultrasound scans were performed an
d
measurements made of uterine area, endometrial thickness and ovarian volume. The
morphological appearance of the ovaries was also noted. Fasting blood samples
were taken. Medical and menstrual questionnaires were completed.
RESULTS: Polycystic ovaries were found in 8/18 (44%) of group 1 and 60/142 (42%)
in group 2. Polycystic ovaries were detected in 35/94 (37%) of the
post-menopausal women in group 2. Post-menopausal women with polycystic ovaries
had larger ovaries containing more follicles compared with post-menopausal women
with normal ovaries. Post-menopausal women with polycystic ovaries had higher
serum concentrations of testosterone and triglycerides than had post-menopausal
women with normal ovaries.
CONCLUSIONS: Polycystic ovaries can be detected in post-menopausal women and hav
e
some of the same endocrine abnormalities which are evident in premenopausal wome
n
with polycystic ovaries, that is, raised serum concentrations of testosterone an
d
triglycerides.
89. Acta Eur Fertil. 1995 May-Jun;26(3):101-4.

The number of follicles and ovarian volume in the assessment of the response to
clomiphene citrate in polycystic ovarian syndrome.
Fiiciolu C(1), Api M, Ozden S.
Author information:
(1)Obstetrics and Gynecology Department, Zeynep Kamil Women and Children's
Hospital, Istanbul, Turkey.
OBJECTIVE: To evaluate whether the number of follicles and ovarian volume have
any significance in evaluating the response to clomiphene citrate treatment in
Polycystic ovarian syndrome (PCOS).
DESIGN: A prospective study of 70 infertile women, 44 of which were diagnosed
with PCOS.
SETTING: Zeynep Kamil Women and Children's Hospital Infertility Polyclinic.
MAIN OUTCOME MEASURES: Follicle numbers and volumes in both ovaries, hormonal
profile, response to Clomiphene Citrate (CC). Ovarian volume was significantly
greater in PCOS cases than controls. However ovarian volume in the CC
nonresponders was significantly greater than in CC responders in the PCOS group.
The number of small follicles was significantly higher in PCOS cases than
controls, and in the CC nonresponder group this number was also significantly
higher than in CC responders. Endocrine features of patients with PCOS revealed
that FSH, LH/FSH, DHEAS and Androstenedion do not discriminate between patients
who respond to CC and those who do not respond. However, Testosterone (T) and LH
levels differ significantly in responders and nonresponders. Small multiple
follicles (> 9) and enlarged ovarian volume (> 6.8 ml) were the most prominent
transvaginal ultrasonographic features of ovaries in CC nonresponsive patients
with PCOS. Higher levels of T, LH, and significantly higher number of small
follicles were associated with lack of CC response. These ultrasonographic
features and laboratory assays could be clinically useful for distinguishing
better the CC nonresponders from responders.
90. Am J Obstet Gynecol. 1995 Jan;172(1 Pt 1):108-13.

The role of color Doppler imaging in the diagnosis of polycystic ovary syndrome.
Battaglia C(1), Artini PG, D'Ambrogio G, Genazzani AD, Genazzani AR.
Author information:
OBJECTIVE: Our purpose was to evaluate whether intraovarian and uterine blood
flow variations are associated with clinical, ultrasonographic, and endocrine
polycystic ovary syndrome findings.
STUDY DESIGN: Thirty-two hirsute, oligomenorrheic patients and 18 volunteer wome
n
underwent in the early follicular phase ultrasonographic evaluation of ovarian
volume, echodensity, and follicle number; transvaginal color Doppler measurement
of the uterine and intraovarian vessel variations; and radioimmunologic dosage o
f
luteinizing hormone, follicle-stimulating hormone, estradiol, progesterone,
testosterone, androstenedione, and other hormonal compartments.
RESULTS: In the patients with polycystic ovary syndrome (increased luteinizing
hormone/follicle-stimulating hormone ratio, elevated androstenedione levels, hig
h
number of subcapsular follicles by ultrasonography-augmented ovarian volume and
echodensity) (n = 22) we observed, at Doppler analysis, significantly elevated
uterine artery pulsatility index values associated with a typical low resistance
index of stromal ovary vascularization. The pulsatility index was positively
correlated with the luteinizing hormone/follicle-stimulating hormone ratio, and
the resistance index was negatively correlated. The elevated uterine artery
resistance was correlated with androstenedione levels.
CONCLUSION: Doppler analysis can be a valuable additional tool for the diagnosis
of polycystic ovary syndrome.
91. Gynecol Obstet Invest. 1995;39(3):201-6.

Transvaginal ultrasonographic morphology in polycystic ovarian syndrome.
Takahashi K(1), Okada M, Ozaki T, Uchida A, Yamasaki H, Kitao M.
Author information:
(1)Department of Obstetrics and Gynecology, Shimane Medical University, Izumo,
Japan.
To assess the morphological findings based on transvaginal ultrasound, the
ovarian volume and the number and size of small follicles were studied in 47
patients with polycystic ovarian syndrome (PCOS) diagnosed clinically. Thirty
normal volunteers served as controls. The mean ovarian volume (10.3 ml) and
number of follicles (10.6) in patients with PCOS were significantly higher than
those of controls. An ovarian volume > 6.2 ml and follicles > 10 with a diameter
of 2-8 mm were the most prominent features in the ovaries of patients with PCOS
and 94% of 47 patients with PCOS had at least one of these ultrasonic findings.
However, marked asymmetry of the two ovaries was seen in about 50% of patients
with PCOS and a considerable overlap existed between controls and patients with
PCOS in the ovarian volume and in the number of follicles. Three (6%) patients
with normal ovarian volume and normal number of follicles were observed.
Therefore, it is difficult to clearly distinguish a patient with PCOS from a
normal woman only by transvaginal ultrasonic criteria using the ovarian volume
and/or the number of follicles, although these criteria could be clinically
useful for the screening of PCOS.
92. Fertil Steril. 1994 Jul;62(1):48-53.

Transvaginal ultrasonic assessment of the response to clomiphene citrate in
polycystic ovarian syndrome.
Takahashi K(1), Uchida A, Yamasaki H, Ozaki T, Kitao M.
Author information:
(1)Department of Obstetrics and Gynecology, Shimane Medical University, Izumo,
Japan.
OBJECTIVE: To study the relationship between some ovarian morphological findings
based on transvaginal ultrasound (US) and the clomiphene citrate (CC)
responsiveness in patients with polycystic ovarian syndrome (PCOS).
DESIGN: A comparative study of ovarian US features between the CC responders and
the CC nonresponders.
SETTING: Infertility and Endocrine Clinic, Department of Obstetrics Gynecology,
Shimane Medical University Hospital, Izumo, Japan.
PATIENTS: Forty-seven infertile patients with PCOS and 30 healthy volunteers.
INTERVENTIONS: A dose of 50 to 200 mg/d CC was given for ovulation induction in
patients with PCOS.
MAIN OUTCOME MEASURES: Ovarian volume and number of follicles; serum LH, FSH, T,
delta 4 androstenedione, and DHEAS.
RESULTS: The mean ovarian volume (11.9 mL) and the number of small follicles
(13.0) were significantly larger in the CC nonresponders compared with those of
the CC responders (7.9 mL and 7.0, respectively). Only 47% of the CC responders
and 79% of the CC nonresponders had bilaterally enlarged ovaries (> 6.2 mL).
Considerable overlap existed between the different groups. However, 96% of the C
C
nonresponders had a significantly increased number of follicles (> or = 10
follicles) in each ovary compared with that (16%) of the CC responders.
Furthermore, with the combination of these parameters, none of the CC
nonresponders had bilaterally normal ovaries, and 96% of patients with PCOS with
bilaterally abnormal ovaries were CC nonresponsive.
CONCLUSIONS: Small multiple follicles (> or = 10) and enlarged ovarian volume (>
6.2 mL) were the most prominent transvaginal US features of ovaries in patients
with PCOS with CC nonresponsiveness. These US features could be clinically usefu
l
for distinguishing clearly a CC nonresponder from a CC responder.
93. Contracept Fertil Sex. 1994 Jul-Aug;22(7-8):469-73.

[The ovary at puberty].
[Article in French]
Venturoli S(1), Porcu E, Macrelli S, Cavallari C, Flamigni C.
Author information:
(1)Clinica Ostetrica e Ginecologica, Bologna, Italy.
Our investigation includes two groups of subjects in which the relationships
between ovarian growth, steroidogenesis and gonadotropin secretion were studied.
The first group consists of premenarchal girls studied in a cross-sectional
program; the second group includes girls after menarche with irregular cycles wh
o
were investigated with a long term follow up. In the first group an increase in
ovarian volume and in the number of developing follicles were seen with
increasing chronological age and pubertal stages. With advancing pubertal
development, a progressive increase of LH pulse frequency and amplitude can be
observed. These variables appear strongly linked to the ovarian morphological an
d
functional development as the significant correlation between LH mean levels and
pulsatile characteristics on the one hand, and ovarian volume and steroid
production on the other hand demonstrate. In the maturational stage just before
menarche, the ovaries may show increased volume and a very dishomogeneous
structure; ovarian steroidogenesis may be often mainly directed towards the
androgen synthesis. After menarche ovarian volume and structure continue to
change and normal or enlarged ovaries, with homogeneous, multifollicular or
polycystic structure can be frequently observed. However normal and homogeneous
ovaries prevail in adolescents with regular and ovulatory cycles, while enlarged
and dishomogeneous ovaries prevail in irregular anovulatory cycles. A trend
towards normal adult ovarian morphology and structure is present in ovulatory
subjects with normal gonadotropin pulsatile release and steroid synthesis. On th
e
other hand, deranged gonadotropin profiles imply irregular cycles anovolation,
hyperandrogenemia and enlarged polycystic ovaries during adolescence.(ABSTRACT
TRUNCATED AT 250 WORDS)
94. Fertil Steril. 1993 Mar;59(3):544-9.
Association between ovarian changes assessed by transvaginal sonography and
clinical and endocrine signs of the polycystic ovary syndrome.
Pache TD(1), de Jong FH, Hop WC, Fauser BC.
Author information:
(1)Department of Obstetrics and Gynecology, Dijkzigt University Hospital,
Rotterdam, The Netherlands.
OBJECTIVE: To determine whether ovarian polycystic changes estimated by
transvaginal sonography correlate with clinical and endocrine findings associate
d
with the polycystic ovarian syndrome.
DESIGN: Prospective study.
SETTING: Reproductive Endocrinology Unit in the Department of Obstetrics and
Gynecology at a teaching hospital.
PARTICIPANTS: Ninety-five consecutive patients suffering from oligoamenorrhea
entering an infertility treatment program.
INTERVENTIONS: All women were examined by transvaginal sonography, assessed for
body mass index and hirsutism. Blood withdrawal was performed for hormone
estimates.
MAIN OUTCOME MEASURES: Ovarian follicle number, volume, and stroma echogenicity.
Estimates of immunoreactive and bioactive luteinizing hormone (LH), testosterone
(T), free T, insulin levels, and insulin resistance index were performed.
RESULTS: Hirsutism was present in 63% of the patients and correlated with the
number of follicles, ovarian volume, and stroma echogenicity. Follicle number,
ovarian volume, and stroma echogenicity values were significantly correlated wit
h
immunoreactive LH, bioactive LH, and T levels. Both T and immunoreactive LH were
independently correlated with ovarian structure sonography parameters. Insulin
and insulin resistance correlated with ovarian volume and stroma echogenicity.
Insulin resistance was of significant additional predictive value of ovarian
volume and amount of stroma. Evaluating the predictive value of immunoreactive L
H
and T together in regard to all sonography parameters, only T levels were
statistically significant predictors of increase in follicle number, ovarian
volume, and stroma amount.
CONCLUSIONS: Although immunoreactive LH and bioactive LH correlated with all
ovarian parameters, the effect of androgens on ovarian changes appeared to be
independent from LH. This further substantiates the apparent cardinal role of
androgens in the genesis of polycystic ovaries. Besides, transvaginal sonography
assessment of ovaries is a valuable additional tool for the diagnosis of PCOS. I
n
this regard, insulin resistance is of additional predictive value for ovarian
volume and stroma echogenicity.
95. J Reprod Med. 1992 Oct;37(10):834-40.

Ovulation induction with human menopausal gonadotropin versus
follicle-stimulating hormone after pituitary suppression by gonadotropin
releasing hormone agonist in polycystic ovary disease. A cross-over study.
Fulghesu AM(1), Lanzone A, Guida C, Nicoletti MC, Rossi P, Le Donne M, Caruso A,
Mancuso S.
Author information:
(1)Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
Ten patients with polycystic ovary disease (PCOD) had ovulation induction after
pituitary suppression by gonadotropin releasing hormone agonist (GnRHa) with
GnRHa plus pure follicle-stimulating hormone (FSH) or plus human menopausal
gonadotropin (hMG). Duration of the stimulation period and gonadotropin doses
were superimposable. A multifollicular response was observed in both treatments.
Bioassay and radioimmunoassay of luteinizing hormone, androstanedione and
testosterone plasma levels were higher in hMG cycles compared to FSH-treated
cycles. No differences was found in FSH and estradiol (E2) plasma concentrations
,
whereas in hMG-treated cycles the E2/number of follicles and E2/ovarian volume
ratios were greater than in the FSH-treated cycles. Clinical results in terms of
percentages of ovulation and pregnancies were the same in the two protocols. We
conclude that the presence of luteinizing hormone in induction of ovulation in
patients with PCOD does not seem to influence follicular recruitment and
development, but it may have a role in the enhancement of steroid production.
96. Fertil Steril. 1992 Jul;58(1):37-45.

Polycystic ovaries in patients with hypogonadotropic hypogonadism: similarity of
ovarian response to gonadotropin stimulation in patients with polycystic ovarian
syndrome.
Shoham Z(1), Conway GS, Patel A, Jacobs HS.
Author information:
(1)Cobbold Laboratories, University College and Middlesex School of Medicine,
London, United Kingdom.
Comment in
Fertil Steril. 1993 May;59(5):1139-41.
OBJECTIVE: To characterize the ovarian response in patients with isolated
hypogonadotropic hypogonadism with ultrasound (US) findings of polycystic ovarie
s
(PCO).
DESIGN: Twenty-seven treatment cycles in patients with hypogonadotropic
hypogonadism and US findings of normal ovaries were compared with 31 cycles in
patients with hypogonadotropic hypogonadism and US-diagnosed PCO. Forty-one
cycles in the hypogonadotropic hypogonadism and US-diagnosed PCO were compared
with 59 cycles of patients with polycystic ovarian syndrome (PCOS) to examine
pattern of response after ovulation induction.
SETTING: Specialist Reproductive Endocrine Unit.
PATIENTS, PARTICIPANTS: Twenty hypogonadotropic patients in whom 10 had US
findings of PCO and 13 patients with PCOS.
MAIN OUTCOME MEASURE: Serum estradiol (E2) concentration, number of leading
follicles on US, cancellation, and pregnancy rate.
RESULTS: Hypogonadotropic patients with US-diagnosed PCO had higher baseline
ovarian volume (P less than 0.02) compared with patients with hypogonadotropic
hypogonadism with normal ovaries. After ovarian stimulation, a higher mean serum
E2 concentration (P less than 0.001), endometrial thickness (P less than 0.001),
and increased number of leading follicles (P less than 0.0001) were found in
hypogonadotropic patients with US-diagnosed PCO, compared with hypogonadotropic
patients with US findings of normal ovaries. Patients with PCOS had a higher
serum E2 concentration (P less than 0.008), although they were treated for fewer
days (P less than 0.0001) and with fewer ampules of gonadotropin (P less than
0.001) compared with patients with hypogonadotropic hypogonadism with
US-diagnosed PCO.
CONCLUSIONS: We have characterized a group of hypogonadotropic patients with US
findings of PCO, in which the ovarian response to ovulation induction was simila
r
to patients with PCOS. The results have practical and theoretical implications
for the etiology and treatment of patients with PCO.
97. Radiology. 1992 May;183(2):421-3.

How to discriminate between normal and polycystic ovaries: transvaginal US study
.
Pache TD(1), Wladimiroff JW, Hop WC, Fauser BC.
Author information:
(1)Department of Obstetrics and Gynecology, Dijkzigt Academic Hospital,
Rotterdam, The Netherlands.
Transvaginal sonography was used in 29 women with regular menstrual cycles and 5
2
patients with the polycystic ovary syndrome to determine cutoff levels in the
size and number of ovarian follicles and ovarian echogenicity and volume for
diagnosis of polycystic ovaries. Median values of the mean size and number of
follicles and ovarian volume were, respectively, 5.1 mm, 5.0, and 5.9 mL in
control subjects and 3.8 mm, 9.8, and 9.8 mL in patients. Ovarian stroma
echogenicity was normal in 26 control subjects (90%) and moderately increased in
three control subjects (10%), whereas it was markedly increased in 28 patients
(54%), moderately increased in 21 patients (40%), and normal in 13 patients (6%)
.
The sensitivity and specificity of moderately or markedly increased echogenicity
of ovarian stroma in the diagnosis of polycystic ovaries was 94% and 90%,
respectively. The greatest power of discrimination between normal and polycystic
ovaries was obtained with combined measurement of follicular size and ovarian
volume (sensitivity, 92% [48 of 52 patients]; specificity, 97% [28 of 29 control
subjects]).
98. Clin Endocrinol (Oxf). 1990 Jul;33(1):53-64.
Insulin-like growth factor binding proteins in follicular fluid from normal
dominant and cohort follicles, polycystic and multicystic ovaries.
Holly JM(1), Eden JA, Alaghband-Zadeh J, Carter GD, Jemmott RC, Cianfarani S,
Chard T, Wass JA.
Author information:
(1)Department of Chemical Endocrinology, St Bartholomew's Hospital, London, UK.
There is now considerable evidence that the insulin-like growth factors (IGFs)
play an important role in the human ovary. It has also recently become apparent
that the physiological activity of the IGFs is modulated by a number of specific
binding proteins (IGFBPs). In order to understand the role of the IGFs in ovaria
n
physiology, the presence and functions of these IGFBPs will need to be
characterized. As an initial step towards this we have investigated the presence
of the various binding proteins by Western ligand blotting and have measured the
levels of one of them, IGFBP-1, in follicular fluid (FF) obtained from
unstimulated dominant and cohort follicles in 19 normal women and in eight
patients with polycystic and one with multicystic ovaries. In normal women,
IGFBP-1 levels in dominant follicles were similar to matched serum levels but
were significantly lower in cohort follicles. IGFBP-1 levels correlated with
FF-volume (r = 0.58, P less than 0.001) and with paired serum levels (r = 0.63,
P
less than 0.001). In post-LH surge dominant follicles this relationship with
serum levels no longer held and in three out of nine subjects FF levels were
higher than in serum. Thus IGFBP-1 in normal human FF appears to be partly
derived from the circulation but with additional local production in the larger
developing dominant follicles. Western ligand blotting revealed five IGF-binding
proteins in FF running parallel with those identified in serum, suggesting that
the IGFBP species previously identified in serum may also be present in FF. The
two bands in positions corresponding to the components of the large (150kDa)
binding complex were, as in serum, the predominant forms and in most FF samples
these were even more prominent than in the accompanying serum sample. This
contrasts with previous studies in lymph which suggested that the 150kDa complex
was largely retained in the circulation. All three small IGFBPs varied
considerably between FF samples even within an individual; each IGFBP varied
independently of the other IGFBPs. Our results demonstrate that at least four
discrete IGFBPs are present in FF and suggest that each may be produced
independently within the ovary.
99. Clin Endocrinol (Oxf). 1990 Apr;32(4):395-405.

Follicular fluid concentrations of insulin-like growth factor 1, epidermal growt
h
factor, transforming growth factor-alpha and sex-steroids in volume matched
normal and polycystic human follicles.
Eden JA(1), Jones J, Carter GD, Alaghband-Zadeh J.
Author information:
(1)Frank Rundle House, Royal Hospital for Women, Paddington, NSW, Australia.
Thirty-three samples of follicular fluid (FF) were collected from 14 patients
with the polycystic ovary (PCO) syndrome and matched for FF-volume with small
follicles collected from subjects with normal ovaries. The median (range) FF
concentration of insulin-like growth factor 1 (IGF1) in the group with PCO, 0.42
(0.13-1.20) U/ml was significantly higher than that of the controls, 0.33
(0.04-0.59) U/ml. All samples tested had less than 1 ng/ml of FF-epidermal growt
h
factor (EGF) and transforming growth factor-alpha (TGF-alpha). The patients with
PCO syndrome (PCOS) had similar FF-testosterone (T) and FF-progesterone (P)
concentrations to volume matched controls, but significantly higher levels of
FF-androstenedione (AD) and lower FF-oestradiol (E2). These results suggest that
the granulosa cells within the polycystic follicle have a functional defect in
their aromatase enzyme complex.
100. Fertil Steril. 1990 Mar;53(3):426-31.

Comparison of urinary human follicle-stimulating hormone and human menopausal
gonadotropin for ovarian stimulation in polycystic ovarian syndrome.
Larsen T(1), Larsen JF, Schiler V, Bostofte E, Felding C.
Author information:
(1)Department of Obstetrics and Gynecology, Herlev University Hospital,
Copenhagen, Denmark.
A randomized, double-blind, crossover study was carried out to compare purified
urinary follicle-stimulating hormone (FSH) and human menopausal gonadotropin
(hMG) for ovarian stimulation in polycystic ovarian syndrome (PCOS). Twelve
patients were stimulated with FSH and hMG in three alternate cycles. FSH,
luteinizing hormone (LH), estradiol, dihydroepiandrosterone sulphate, free and
total testosterone, delta 5-androstenedione, sex hormone binding globulin, and
ovarian volume were monitored during the stimulation. There was no difference
between the dose of FSH and hMG necessary to induce preovulatory follicles in th
e
individual patients. The mean increase of ovarian volume during stimulation with
FSH and hMG was 120% and 129% respectively (no significant difference). Two
patients became pregnant in the first cycle. Two other patients had delayed
bleeding and positive serum-human chorionic gonadotropin. No significant
difference was found in the endocrine changes during the two different
stimulation methods. The LH/FSH ratio was normalized after a few days of
treatment regardless of the type of stimulation. The size of the material does
not permit a comparison of the efficacy of the two treatment schedules. Our
clinical and ultrasonic observations do not support the theory that treatment of
infertility in PCOS with FSH is more safe than with hMG.
101. Clin Endocrinol (Oxf). 1989 Sep;31(3):345-53.
An attempt to alter the pathophysiology of polycystic ovary syndrome using a
gonadotrophin hormone releasing hormone agonist--Nafarelin.
Williams IA(1), Shaw RW, Burford G.
Author information:
(1)Academic Department of Obstetrics and Gynaecology, Royal Free Hospital,
London, UK.
The aim of this study was to see whether the pathophysiology of polycystic ovary
syndrome could be altered by suppressing the abnormal cycle of events associated
with abnormal gonadotrophins and androgens. Fifteen women with polycystic ovary
syndrome were treated with the GnRH agonist Nafarelin at a dosage of 200
micrograms twice daily intranasally for a period of 3 or 6 months. Eight of thes
e
women also had a dexamethasone suppression test 0.5 mg four times daily for 48 h
before and after treatment with Nafarelin, in order to differentiate between an
adrenal and ovarian source for the excess androgens. Gonadotrophins and androgen
s
were well suppressed, LH to a mean of 1.5 IU/l, testosterone to 1.1 nmol/l and
androstenedione to 6.4 nmol/l. Three months after discontinuing Nafarelin, all
these hormones had returned to pretreatment levels. The ultrasound appearance of
the ovaries showed no consistent reduction in ovarian volume or the disappearanc
e
of ovarian follicles. Hirsutism showed slight improvement in four out of seven
patients. After treatment one patient out of the eight complaining of
infertility, conceived spontaneously and one patient ovulated on a reduced dosag
e
of clomiphene. There was no change in the menstrual pattern of the others.
Despite the achievement of good hormonal suppression, there was no change in the
condition after therapy was discontinued suggesting that whatever the cause of
the condition it remains a permanent situation.
102. Clin Endocrinol (Oxf). 1988 Sep;29(3):327-36.

A comparison of follicular fluid levels of insulin-like growth factor-1 in norma
l
dominant and cohort follicles, polycystic and multicystic ovaries.
Eden JA(1), Jones J, Carter GD, Alaghband-Zadeh J.
Author information:
(1)Department of Gynaecology, Charing Cross Hospital, London, UK.
Erratum in
Clin Endocrinol (Oxf) 1988 Dec;29(6):694.
Fourteen ovulatory patients undergoing diagnostic laparoscopy had at least two
samples of clear follicular fluid (FF) collected in the late follicular phase.
The cohort concentrations of Insulin-like Growth Factor-1 (IGF1) were
significantly correlated with serum IGF1 and dominant follicles contained
significantly higher concentrations of IGF1 and oestradiol (E2) than their
cohorts. After the LH surge, a further significant increase in dominant FF-IGF1
occurred. FF-(log)E2 was significantly correlated with both FF-IGF1 and FF
volume. Nine women with the polycystic ovary syndrome (PCOS) and one patient wit
h
multicystic ovaries (MCO) associated with weight-loss related amenorrhoea also
had follicular aspiration performed. The mean (SD) FF-IGF1 in the PCOS group,
0.42 (0.15) U/ml, was not significantly different from that of the cohorts in th
e
control group, 0.39 (0.13) U/ml. The patient with MCO had both serum and FF-IGF1
concentrations less than 10th centile. These results support the hypothesis that
IGF1 has a paracrine (and possibly endocrine) role in the regulation of ovarian
function in the human female.
103. Gynecol Obstet Invest. 1988;25(3):192-201.

Ovarian morphology in patients with polycystic ovaries and in an age-matched
reference material. A statistical evaluation of 149 cases.
Lunde O(1), Hoel PS, Sandvik L.
Author information:
(1)Department of Obstetrics and Gynecology, National Hospital, University of Osl
o
and Medstat, Strmmen, Norway.
The ovarian morphology in 149 patients with the clinical syndrome of polycystic
ovaries (group I) is described. The ovaries from 10 age-matched women (group II)
with no signs of ovarian disorder were investigated as a reference material. The
number of cysts documented for group I was twice that of the reference group and
the ovarian volume three times that of the normals. No significant difference in
follicle number was seen between the two groups. The tunica albuginea was thicke
r
in group I with more pronounced atretic changes. The duration of symptoms for
group I correlated significantly with body mass index, thickening of tunica,
degree of stromal hyperplasia and the calculated means of ovarian volume. A
correlation was also seen between ovarian volume, degree of follicular atresia
and stromal hyperplasia, as well as between the thickness of the tunica
albuginea, number of follicles and degree of follicular atresia.
104. J Clin Endocrinol Metab. 1987 Dec;65(6):1253-8.

Successful induction of ovulation and conception with combined
gonadotropin-releasing hormone agonist plus highly purified follicle-stimulating
hormone in patients with polycystic ovarian disease.
Lanzone A(1), Fulghesu AM, Spina MA, Apa R, Menini E, Caruso A, Mancuso S.
Author information:
(1)Department of Obstetrics and Gynecology, Universit Cattolica S. Cuore, Rome,
Italy.
Five women (group A) with polycystic ovarian disease (PCOD) and sterility for at
least 3 yr were treated for 1 cycle for ovulation induction with a combined
regimen of GnRH agonist (GnRH-A) plus highly purified FSH. The patients received
GnRH-A (Buserelin; 200 micrograms, sc, twice a day) for 6 weeks and then GnRH-A
combined with FSH highly purified (2 ampules a day; 75 IU FSH and less than 0.11
IU LH in each ampule). Ovarian response was evaluated by plasma estradiol (E2)
assay and ultrasound examination, performed daily. Furthermore, plasma FSH and L
H
levels were assayed 3 times a week. Once a follicle was considered sufficiently
developed, the combined regimen was withheld, and 24-48 h later hCG (5000 IU, im
)
was given. The results are compared with those of 31 ovulatory cycles induced by
im FSH highly purified (group B) in PCOD patients with the same FSH
administration, clinical, and monitoring protocols. Ovulation was achieved in al
l
cycles treated by GnRH-A plus FSH. Two singleton and a twin pregnancy resulted.
Multiple follicular development occurred in all cycles. Plasma E2 levels were
generally in the normal range. Echographic and endocrine features in the 2 group
s
were as follows. 1) basal ovarian volume and ovarian enlargement were similar. 2
)
Group A had a greater number of follicles than did group B (P less than 0.01),
while E2 to number of follicles and E2 to ovarian volume ratios were greater (P
less than 0.01) in group B. 3) The linear correlations between plasma E2 levels
and ovarian volume were markedly different in groups A and B (P less than 0.01).
The regression line for group B had a steeper slope than that for group A. This
finding indicates that at a fixed ovarian volume plasma E2 levels were
significantly lower in group A than in group B. We conclude that the combined
GnRH-A and FSH regimen may constitute an alternative and promising tool for the
induction of ovulation in patients with PCOD.
105. Eur J Obstet Gynecol Reprod Biol. 1987 Jul;25(3):209-19.

Effect of a combination of ethinylestradiol and desogestrel in adolescents with
oligomenorrhea and ovarian hyperandrogenism.
Nappi C, Farace MJ, Leone F, Minutolo M, Tommaselli AP, Montemagno U.
Nine oligomenorrheic adolescent girls with a clinical and hormonal picture of
ovarian hyperandrogenism were treated with a monophasic oral contraceptive (OC)
containing 0.03 mg ethinylestradiol (EE) plus 0.150 mg desogestrel (DOG) for six
months. The same treatment was administered in eight eumenorrheic adolescents. I
n
both groups the treatment induced a decrease in LH, FSH, androstenedione (delta
4-A), testosterone (T) and dehydroepiandrosterone sulphate (DHEA-S) levels
associated with a significant sex-hormone-binding globulin (SHBG) increase. In
oligomenorrheic adolescents a marked decrease in both the total ovarian volume
and the number of cystic follicles was observed. All parameters, except SHBG and
ovarian volume in hyperandrogenic girls, returned to pre-treatment values 3
months after treatment. Subjective improvement of skin problems occurred in six
of the nine oligomenorrheic girls. Although temporary, the EE + DOG formulation
pill is effective in the treatment of ovarian hyperandrogenism in adolescents. I
t
may also be useful for the prevention of the progressive transformation in the
'classical' and 'irreversible' micropolycystic ovary of adult age.
PIP: The hormonal effects of a combined, monophasic oral contraceptive (OC)
containing 0.03 mg of ethinyl estradiol and 0.150 mg of desogestrel were compare
d
in 9 adolescents with oligomenorrhea and ovarian hyperandrogenism and 8 controls
with regular menstrual periods. All adolescents were treated for 6 consecutive
months. Before treatment, the females with irregular periods had significantly
higher basal luteinizing hormone (LH), delta 4-androstenedione (A), testosterone
(T), and dehydroepiandrosterone sulfate (DHEA-S) levels than controls. In

addition, the oligomenorrheic females had significantly lower sex hormone bindin
g
globulin (SHBG) levels and greater mean ovarian volume. OC treatment produced a
decrease in all hormones (LH, follicle-stimulating hormone, delta-4 A, T, and
DHEA-S) in girls in both groups and a significant increase in SHBG levels.
Oligomenorrheic subjects further manifested a significant decrease in total
ovarian volume, with reduced number or disappearance of all echo-free cystic
follicles in both ovaries. With the exception of SHBG and ovarian volume in
hyperandrogenic subjects, all parameters returned to pretreatment values 3 month
s
after discontinuation of the OC. 6 of the 9 oligomenorrheic subjects showed
subjective improvement of skin problems; in addition, 6 reported a longterm
decrease in hair growth. Post-treatment, oligomenorrhea and anovulation persiste
d
in 7 of the 9 subjects. Although the effect of this treatment is temporary, the
ethinyl estradiol-desogestrel OC appears to be effective in hyperandrogenic
adolescents and may delay the progression of hirsutism and prevent adult
micropolycystic ovarian disease.
106. Spec Top Endocrinol Metab. 1984;6:55-93.

Hirsutism and virilism in women.
Kirschner MA.
Hirsutism in women may be defined as excessive thick (terminal) hair growth in
facial and body regions. It is one of the early manifestations of virilization
that correlate closely with elevated testosterone production. Testosterone
production rates in normal women average 0.2 mg/day, with 25% secreted by the
ovaries, 25% by the adrenals, and 50% arising from the peripheral metabolism of
prehormones, notably androstenedione. Increased testosterone from adrenal and/or
ovarian sources induces 5 alpha-reductase activity within the susceptible hair
follicle. This results in the local production of dihydrotestosterone, the poten
t
androgen that is likely responsible for the growth and stimulation of the hair
follicle that leads to hirsutism. Activation of the hair follicle by androgens
provides a secondary pathway for testosterone metabolism, unfortunately at the
expense of undesirable hair growth. Although virilization in women may be caused
by exogenous androgens, it occurs primarily from diseases of the adrenals or
ovaries. Androgen-producing tumors of the adrenals cause virilization in
association with excessive production of a wide variety of C19 androgens. In
contrast, ovarian tumors tend to secrete a narrower range of androgens and their
presence may be more occult. The most common causes of hirsutism in women arise
from nontumorous states, chiefly ovarian in origin. The androgenized ovary
syndrome represents a spectrum of abnormalities ranging from idiopathic hirsutis
m
to the polycystic ovary syndrome to ovarian hyperthecosis. These states are
associated with mild to severe abnormalities of androgen production and
concomitant mild to severe abnormalities of ovarian histology. The pathogenesis
of these abnormalities is still speculative, but appears to be related to
increased pulsatile and tonic secretion of LH with ovarian hyperstimulation. Of
the various laboratory tests to evaluate hirsutism, simple measurements of plasm
a
testosterone, free testosterone, and most recently androstanediol glucuronide
seem to provide the best chemical evidence of androgen abnormalities. Treatment
of hirsutism/virilism in women is difficult and frequently unsatisfactory. At
present, treatment schemes include local methods, suppression of androgens via
glucocorticoids or oral contraceptives, and antiandrogens.
PIP: This volume focuses on hirsutism in women, defined as excessive thick hair
growth in facial and body regions. It is an early manifestation of virilization
and correlates closely with elevated testosterone production. Increased
testosterone from adrenal and/or ovarian sources induces 5 alpha-reductase
activity within the susceptible hair follicle, resulting in the local production
of dihydrotestosterone and subsequent stimulation of the hair follicle. The most
common causes of hirsutism in women arise from nontumorous states, largely
ovarian in origin. The androgenized ovary syndrome represents a spectrum of
abnormalities ranging from idiopathic hirsuitism to the polycystic ovarian
syndrome to ovarian hyperthecosis. The pathogenesis of these abnormalities
appears to be related to increased pulsatile and tonic secretion of luteinizing
horome with ovarian hyperstimulation. Simple measurements of plasma testosterone
,
free testosterone, and androstanediol glucuronide provide the best chemical
evidence of androgen abnormalities. Current treatment schemes include removal of
existing hair and suppression of hyperandrogenism through administration of oral

contraceptives, continous progestin, glucocorticoids, or anti-androgens. In most
cases, a combined approach is necessary; used alone, neither method is entirely
satisfactory.
107. Arch Gynecol. 1983;234(2):87-93.

Ultrasound study of ovarian morphology in women with polycystic ovary syndrome
before and during treatment with an oestrogen/progestogen preparation.
Venturoli S, Paradisi R, Saviotti E, Barnab S, Porcu E, Fabbri R, Flamigni C.
Women with polycystic ovarian disease were treated with oral estrogens and
progestogens and their ovarian volume, ovarian texture and uterine size were
studied by ultrasound before and during treatment. A significant decrease in the
volume and in the number of follicles in the ovaries was seen. Hormone therapy
thus temporarily restores normal ovarian morphology in subjects with polycystic
ovaries. The uterus did not change significantly during treatment.

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4. Clin Endocrinol (Oxf). 2015 Apr;82(4):584-91. doi: 10.1111/cen.12621. Epub 20

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6. J Clin Ultrasound. 2015 Mar;43(3):157-63. doi: 10.1002/jcu.22182. Epub 2014 J

8. Fertil Steril. 2014 Jun;101(6):1747-56.e1-3. doi:

9. Hum Reprod Update. 2014 May-Jun;20(3):334-52. doi: 10.1093/humupd/dmt061. Epu

10. Acta Radiol. 2014 Mar;55(2):248-56. doi: 10.1177/0284185113495835. Epub 2013

11. Hum Reprod. 2013 Jul;28(7):1929-42. doi: 10.1093/humrep/det114. Epub 2013 Ap

12. J Hum Reprod Sci. 2012 Sep;5(3):274-8. doi: 10.4103/0974-1208.106340.

14. J Obstet Gynaecol. 2013 Feb;33(2):165-70. doi: 10.3109/01443615.2012.745839.

15. J Pediatr Endocrinol Metab. 2012;25(9-10):983-9. doi: 10.1515/jpem-2012-0013

16. Arch Gynecol Obstet. 2013 Jul;288(1):213-20. doi: 10.1007/s00404-013-2742-y.

17. J Magn Reson Imaging. 2013 Sep;38(3):689-93. doi: 10.1002/jmri.23992. Epub 2

18. Zhonghua Yi Xue Za Zhi. 2012 Sep 4;92(33):2319-22.

19. Hum Reprod. 2012 Sep;27(9):2729-36. doi: 10.1093/humrep/des199. Epub 2012 Ju

20. J Ultrasound Med. 2012 Jul;31(7):1015-24.

21. Psychoneuroendocrinology. 2012 Jun;37(6):742-51. doi:

22. Hum Reprod. 2011 Nov;26(11):3123-9. doi: 10.1093/humrep/der297. Epub 2011 Se

23. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011 Aug;31(8):1070-3.

24. Zhonghua Fu Chan Ke Za Zhi. 2011 May;46(5):350-4.

25. J Endocrinol. 2011 Jun;209(3):307-15. doi: 10.1530/JOE-11-0022. Epub 2011 Ma

26. Eur J Obstet Gynecol Reprod Biol. 2011 Jun;156(2):181-5. doi:

28. Rev Bras Ginecol Obstet. 2010 Mar;32(3):118-25.

29. J Pediatr Endocrinol Metab. 2010 Jan-Feb;23(1-2):87-95.

30. Ann Endocrinol (Paris). 2010 May;71(3):183-8. doi: 10.1016/j.ando.2010.02.00

31. Reprod Biomed Online. 2010 Apr;20(4):553-8. doi: 10.1016/j.rbmo.2009.12.021.

32. Eur Radiol. 2010 May;20(5):1207-13. doi: 10.1007/s00330-009-1643-8. Epub 200

33. J Pediatr Adolesc Gynecol. 2010 Jun;23(3):146-52. doi:

34. J Cell Mol Med. 2010 Oct;14(10):2460-9. doi: 10.1111/j.1582-4934.2009.00841.

35. J Ovarian Res. 2009 Jun 10;2:6. doi: 10.1186/1757-2215-2-6.

38. Hum Reprod. 2009 May;24(5):1176-83. doi: 10.1093/humrep/den482. Epub 2009 Ja

40. Int J Fertil Womens Med. 2007 Jan-Feb;52(1):41-7.

41. Nat Clin Pract Endocrinol Metab. 2007 Oct;3(10):688-95.

42. Gynecol Endocrinol. 2007;23(8):455-60.

43. Ginecol Obstet Mex. 2007 Apr;75(4):181-6.

45. Tunis Med. 2007 Jun;85(6):485-9.

46. Hum Reprod. 2007 Sep;22(9):2501-8. Epub 2007 Jul 17.

47. Pediatr Radiol. 2007 Feb;37(2):233-6. Epub 2006 Dec 20.

48. Clin Exp Obstet Gynecol. 2006;33(3):154-8.

49. Paediatr Drugs. 2006;8(5):311-8.

50. Exp Clin Endocrinol Diabetes. 2006 Apr;114(4):175-81.

51. Fertil Steril. 2006 Jan;85(1):214-9.

52. Fertil Steril. 2005 Oct;84 Suppl 2:1277-84.

53. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2005 Aug;25(8):704-6.

54. Gynecol Endocrinol. 2005 Jun;20(6):322-6.

55. Ginecol Obstet Mex. 2005 May;73(5):261-4.

57. Hum Reprod. 2005 Jul;20(7):1820-6. Epub 2005 Mar 31.

58. Eur J Radiol. 2005 Feb;53(2):280-6.

59. Int J Gynaecol Obstet. 2004 Dec;87(3):237-41.

60. Fertil Steril. 2004 Nov;82(5):1358-63.

61. Ultrasound Obstet Gynecol. 2004 Feb;23(2):183-7.

62. J Clin Endocrinol Metab. 2004 Jan;89(1):318-23.

63. Hum Reprod Update. 2003 Nov-Dec;9(6):505-14.

64. Fertil Steril. 2003 May;79(5):1129-35.

65. J Assist Reprod Genet. 2002 Dec;19(12):582-90.

66. J Clin Endocrinol Metab. 2002 Dec;87(12):5559-65.

67. J Clin Endocrinol Metab. 2002 Jul;87(7):3148-54.

68. Ultrasound Obstet Gynecol. 2002 Apr;19(4):386-91.

69. Hum Reprod. 2002 Mar;17(3):771-6.

70. Eur J Endocrinol. 2001 Dec;145(6):749-55.