EVALUATING OVARIAN VOLUME AS A SINGLE MARKER FOR POLYCYSTIC OVARY SYNDROME (PCOS) AND METABOLIC DYSFUNCTION

Abstract

To determine if ovarian volume alone is an adequate marker for Polycystic ovary syndrome (PCOS) and metabolic dysfunction. Tertiary-care based cohort study. Patients age >14 presented for consultation to 4 academic institutions from 1980 to 2010. Markers of hyperandrogenism (HA) included the modified Ferriman-Gallwey score (mFG), free testosterone (T), and dehydroepiandrosterone sulfate (DHEAS) values. Markers of metabolic dysfunction included body mass index (BMI), waist circumference (WC), high-density lipoprotein (HDL), triglycerides (TG), hypertension (HTN, defined as ≥ 135/85), and insulin and glucose levels during a 2-hour glucose tolerance test. Women were divided into two groups according to ovarian volume (OV): ≥10 mL (OV≥10) and volume <10 mL (OV<10). Categorical variables were compared using χ2 tests and continuous variables were compared using Student’s t-test or Wilcoxon rank-sum, as appropriate. Spearman’s rank correlation was calculated to correlate OV with antral follicle count (AFC). Seven-hundred eighteen women were included, of which OV≥10 was present in 362 women (50.4%) and OV<10 in 356. There was a positive correlation of OV with AFC (rs =0.54, p<0.0001). The mean ages of women (SD) in OV<10 and OV≥10 women were 30.1(7.3) and 29.1(5.8) years, respectively. (p=0.03). PCOS by Rotterdam criteria was found in 89.4% of the OV≥10 group and 68.0% of the OV<10 (p<0.001). Higher OV was associated with a higher prevalence of HA overall (73.1% vs 58.1%, p <0.001), and with an mFG ≥4 (67.5% vs 54.7%, p=0.001) and elevated free T (30.1% vs 19.1%, p=0.002) specifically. Metabolic parameters including BMI, WC, and 1-hr insulin levels were significantly higher in the OV≥10 group compared to OV<10 women; HTN, HDL, TG and 2-hr glucose values were similar between the groups. Ovarian volume of ≥10 mL, as a single marker, is associated with HA and metabolic dysfunction in PCOS. Given that the measurement of AFC is less precise, particularly in less experienced sites, the use of OV alone decreases the complexity of the evaluation and increases the ability to capture patients with risk for PCOS or metabolic dysfunction.