April 10, 2012 (Phoenix, Arizona) — Women shown on ultrasound imaging to have polycystic ovary syndrome (PCOS) involving just 1 ovary have significantly lower rates of menstrual cycle irregularity than those with bilateral ovary involvement, according to research presented here at the American Institute of Ultrasound in Medicine (AIUM) 2012 Annual Convention.
The study of 2626 infertility patients seeking treatment in Ontario, Canada, from October 2010 to March 2011, showed that 1055 of the women (40.2%) had PCOS. Ultrasounds indicated that 302 (11.5%) had unilateral PCOS and 753 (28.7%) had bilateral involvement.
For those who did not have PCOS, 12.2% had irregular cycles, defined as a variation from the normal 21- to 35-day cycles.
The researchers found that 69.70% of women with bilateral PCOS had irregular cycles; among those with unilateral PCOS, the rate was 32.55%.
There were differences between the PCOS and non-PCOS groups in body mass index (BMI); however, the difference between unilateral and bilateral PCOS was not statistically significant.
The study is said to be the first of its kind to compare unilateral and bilateral PCOS in infertility patients, and the findings, particularly on cycle irregularity, offer new insight into the clinical manifestation of PCOS, said lead author Alexander Hartman, MD, from True North Imaging, in Thornhill, Ontario.
"We found statistical significance in terms of BMI between those with no PCOS and those with the condition, but what was really significant was the differences in cycle regularity," he said.
"This is of clinical importance for people with a single ovary indicating PCOS. I guess the whole idea of what to do with the Rotterdam criteria has to be rethought," he added. "Further research into this area is needed."
The Rotterdam criteria, established by the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine in 2003, indicate that for a woman to be diagnosed with PCOS, 2 of the following 3 manifestations should be present: irregular or absent ovulation, elevated levels of androgenic hormones, and enlarged ovaries containing at least 12 follicles each.
Other classic features of PCOS include hyperandrogenism and polycystic ovary morphology, and conditions with similar features, such as androgen-secreting tumors or Cushing's syndrome, should be ruled out.
However, many experts assert that the criteria are not definitive, and there is debate about how and when to diagnose PCOS.
"The study's findings are extremely interesting," said Steven R. Goldstein, MD, who moderated the session and is president-elect of the AIUM.
"I've long felt the Rotterdam convention made a mistake — that there are many women, sometimes with irregular cycles, with what I prefer to call multicystic ovaries, but who don't truly have a polycystic ovary syndrome," said Dr. Goldstein, who is professor of obstetrics and gynecology, director of gynecologic ultrasound, and codirector of bone densitometry in the Department of Obstetrics and Gynecology at New York University School of Medicine in New York.
Dr. Goldstein noted that he has seen first-hand the consequences of a PCOS diagnosis that might not be appropriate.
"With the Rotterdam criteria, if you have more than 12 follicles and irregular periods, you're considered PCOS, but I must see 1 or 2 girls a month who weigh something like 108 pounds who are oligoanovulatory or anovulatory and who have irregular cycles, and a lot of it is just that their hypothalamic-pituitary-adrenal axis isn't matured," he told Medscape Medical News.
"Then they get older and their hypothalamic-pituitary-adrenal axis matures and guess what — they wind up having regular cycles, have no problems getting pregnant, and they don't have type 2 diabetes later in life," he said.
However, "they have had to live with this PCOS diagnosis and the psychological burden that goes along with it," he explained.
Dr. Goldstein said a question to be followed-up from this study is how many follicles the patients had.
"I'm curious to see how many had more than 12 follicles and how many of these met the old sonographic criteria for PCOS, which is a 'string of pearls' presentation. That would be interesting to know."
Dr. Hartman and Dr. Goldstein have disclosed no relevant financial relationships.
American Institute of Ultrasound in Medicine (AIUM) 2012 Annual Convention: Abstract 1229012. Presented April 1, 2012.
Disclosure: Nancy Melville has disclosed no relevant financial relationships.
The study of 2626 infertility patients seeking treatment in Ontario, Canada, from October 2010 to March 2011, showed that 1055 of the women (40.2%) had PCOS. Ultrasounds indicated that 302 (11.5%) had unilateral PCOS and 753 (28.7%) had bilateral involvement.
For those who did not have PCOS, 12.2% had irregular cycles, defined as a variation from the normal 21- to 35-day cycles.
The researchers found that 69.70% of women with bilateral PCOS had irregular cycles; among those with unilateral PCOS, the rate was 32.55%.
There were differences between the PCOS and non-PCOS groups in body mass index (BMI); however, the difference between unilateral and bilateral PCOS was not statistically significant.
The study is said to be the first of its kind to compare unilateral and bilateral PCOS in infertility patients, and the findings, particularly on cycle irregularity, offer new insight into the clinical manifestation of PCOS, said lead author Alexander Hartman, MD, from True North Imaging, in Thornhill, Ontario.
"We found statistical significance in terms of BMI between those with no PCOS and those with the condition, but what was really significant was the differences in cycle regularity," he said.
"This is of clinical importance for people with a single ovary indicating PCOS. I guess the whole idea of what to do with the Rotterdam criteria has to be rethought," he added. "Further research into this area is needed."
The Rotterdam criteria, established by the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine in 2003, indicate that for a woman to be diagnosed with PCOS, 2 of the following 3 manifestations should be present: irregular or absent ovulation, elevated levels of androgenic hormones, and enlarged ovaries containing at least 12 follicles each.
Other classic features of PCOS include hyperandrogenism and polycystic ovary morphology, and conditions with similar features, such as androgen-secreting tumors or Cushing's syndrome, should be ruled out.
However, many experts assert that the criteria are not definitive, and there is debate about how and when to diagnose PCOS.
"The study's findings are extremely interesting," said Steven R. Goldstein, MD, who moderated the session and is president-elect of the AIUM.
"I've long felt the Rotterdam convention made a mistake — that there are many women, sometimes with irregular cycles, with what I prefer to call multicystic ovaries, but who don't truly have a polycystic ovary syndrome," said Dr. Goldstein, who is professor of obstetrics and gynecology, director of gynecologic ultrasound, and codirector of bone densitometry in the Department of Obstetrics and Gynecology at New York University School of Medicine in New York.
Dr. Goldstein noted that he has seen first-hand the consequences of a PCOS diagnosis that might not be appropriate.
"With the Rotterdam criteria, if you have more than 12 follicles and irregular periods, you're considered PCOS, but I must see 1 or 2 girls a month who weigh something like 108 pounds who are oligoanovulatory or anovulatory and who have irregular cycles, and a lot of it is just that their hypothalamic-pituitary-adrenal axis isn't matured," he told Medscape Medical News.
"Then they get older and their hypothalamic-pituitary-adrenal axis matures and guess what — they wind up having regular cycles, have no problems getting pregnant, and they don't have type 2 diabetes later in life," he said.
However, "they have had to live with this PCOS diagnosis and the psychological burden that goes along with it," he explained.
Dr. Goldstein said a question to be followed-up from this study is how many follicles the patients had.
"I'm curious to see how many had more than 12 follicles and how many of these met the old sonographic criteria for PCOS, which is a 'string of pearls' presentation. That would be interesting to know."
Dr. Hartman and Dr. Goldstein have disclosed no relevant financial relationships.
American Institute of Ultrasound in Medicine (AIUM) 2012 Annual Convention: Abstract 1229012. Presented April 1, 2012.
Authors and Disclosures
Journalist
Nancy A Melville
Nancy Melville is a freelance writer for Medscape.Disclosure: Nancy Melville has disclosed no relevant financial relationships.
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