Polycystic Ovarian Morphology With Regular Ovulatory Cycles

Abstract

This study was an attempt to determine whether polycystic ovarian morphology (PCOM) is an important factor in the development of polycystic ovarian syndrome (PCOS). Among the 68 women studied, all of whom had regular ovulatory menstrual cycles and lacked clinical signs of hyperandrogenism, 39 had PCOM and 29 had morphologically normal ovaries. Ovarian morphology was examined by ultrasonography, usually performed transvaginally. Hormone levels were estimated at baseline in the early follicular phase (EFP) of the cycle and, in 36 women, studies were repeated each day during a complete cycle. Body mass index did not differ in women with PCOM and those with normal ovaries. Ovarian volume was twice as great in the PCOM group, and these women had higher numbers of follicles than did those with normal ovaries (8-15 vs. 4-8 per ovary). Baseline EFP levels of testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS) were higher in women with PCOM, and levels of sex hormone-binding globulin (SHBG) were lower. Four PCOM women had elevated testosterone levels. The difference in DHEAS levels was independent of age. Sampling across the cycle disclosed no significant group differences in luteinizing hormone, follicle-stimulating hormone, progesterone, or estradiol. In EFP and also at midcycle, women with PCOM had significantly higher testosterone levels compared with those with normal ovaries. SHBG levels tended to be lower in women with PCOM across the cycle, but not significantly so. Levels of free testosterone were higher in women with PCOM, especially in the EFP. Fasting insulin and insulin resistance were higher in women with PCOM; both parameters correlated inversely with SHBG. No group differences were found in blood pressure or serum lipid levels. Women with PCOM had greater androstenedione, testosterone, and 17-hydroxyprogesterone responses to human chorionic gonadotropin compared with women with normal ovaries. These findings indicate that PCOM is the mildest form of ovarian hyperandrogenism. Whether PCOM favors the development of PCOS remains to be determined.