Intraindividual right–left comparison of sonographic features in polycystic ovary syndrome (PCOS) diagnosis

Abstract

ObjectiveSonographic 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 designBoth 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. ResultsMean 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 Workshop Group. ConclusionSubstantial 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.