Diagnosis Of Polycystic Ovaries Research Articles

Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report

BackgroundRestorative reproductive medicine represents a comprehensive approach to subfertility (infertility and miscarriage) with investigations, diagnoses, and treatments combined with fertility charting to restore optimal reproductive function. Restorative reproductive medicine assumes that multiple factors need to be identified and treated (cycle optimization) for up to 12 cycles to achieve a successful pregnancy. Conception can occur during normal intercourse without intrauterine insemination or in vitro fertilization.Case presentationA 35-year-old Croatian female presented for fertility treatment in May 2019 with a previous diagnosis of polycystic ovaries, infertility of 16 years duration, and 8 unsuccessful embryo transfers with in vitro fertilization and intracytoplasmic sperm injection. She was gravida 3 para 0, with 2 miscarriages after spontaneous conception at 5–6 weeks gestation in 2002 and 2004, followed by a miscarriage after in vitro fertilization at 12 weeks gestation in 2011. We initially found poor follicle function and suboptimal progesterone levels. Restorative reproductive medicine treatment resulted in conception after two cycles of treatment. This pregnancy ended in miscarriage at 7 weeks 4 days. Additional investigations found a balanced Robertsonian translocation (13, 14) and a uterine septum. We achieved repeat fertilization with restorative reproductive medicine after three cycles of treatment following resection of the uterine septum and ovulation induction with letrozole and human chorionic gonadotrophin. She had a full-term healthy pregnancy and live birth in 2021.ConclusionWe propose that a full evaluation of underlying factors, and up to 12 cycles of cycle optimization, should be offered to subfertile patients before considering in vitro fertilization treatment.

Impact of the newly recommended antral follicle count cutoff for polycystic ovary in adult women with polycystic ovary syndrome.

What is the impact of the newly recommended antral follicle count (AFC) cutoff for polycystic ovary (PCO) on the diagnostic status of polycystic ovary syndrome (PCOS)? Among patients with phenotypes requiring the presence of PCO for diagnosis, approximately half (48.2%) were excluded from having PCOS based on the new AFC cutoff, although these excluded women had worse metabolic and hormonal profiles than the controls and were indistinguishable from the remaining patients with regard to major hormonal and metabolic parameters. In the Rotterdam criteria, PCO is defined as either 12 or more follicles measuring 2-9mm in diameter or an increased ovarian volume >10cm3. Recently, an international PCOS guideline development group recommended an AFC threshold for PCO of ≥20 in adult women when using transducers with a high-resolution frequency, including 8MHz. The current study used a case control design. PCOS was diagnosed according to the Rotterdam criteria. Ultrasonography examinations were conducted with wide band frequency (5-9MHz) transvaginal transducers and the centre frequency was 8MHz. In patients who show both irregular menstruation and hyperandrogenism (HA), a diagnosis of PCOS can be made irrespective of the ovarian criteria change. Patients who were diagnosed according to HA and PCO (n= 86) or irregular menstruation and PCO (n= 443) were initially included among a total of 1390 adult women with PCOS (aged 20-40years). Regardless of the AFC, if the ovarian volume is ≥10cm3, a diagnosis of PCO can still be made. Thus, only patients who had an ovarian volume of <10cm3 were analysed. Subjects who had an AFC of 12-19 and an ovarian volume <10cm3 were designated as the 'low AFC group' (n= 255) and were the main focus of the study because they were excluded from having PCOS based on the new cutoff. Subjects with an AFC ≥20 and an ovarian volume <10cm3 were designated as the 'high AFC group' (n= 101). A total of 562 premenopausal women without PCOS were enrolled as controls. Among patients with irregular menstruation and PCO or HA and PCO phenotypes, approximately half (48.2%, 255/529) were excluded from having PCOS, which corresponded to one-fifth (18.3%, 255/1390) of the total adult patients. However, compared to the control group, these excluded women had worse metabolic profiles and were more androgenised. Notably, they were indistinguishable from the 'high AFC group' with regard to major hormonal and metabolic parameters (BMI and diabetic classification status, and the prevalence of insulin resistance, metabolic syndrome and HA). We cannot exclude the possibility of inter- and intraobserver variation in the evaluation of AFC. With the newly recommended follicle count cutoff, a substantial proportion of women with PCOS might be classified as not having PCOS despite visiting a hospital due to irregular menstruation or hyperandrogenic symptoms. A practical approach to them would involve controlling the menstrual or hyperandrogenic symptoms in hand and regularly evaluating them regarding newly developed or worsening PCOS-related symptoms or metabolic abnormalities. This study was supported by a grant from the Seoul National University Hospital Research Fund (No. 2520140090), Republic of Korea. The authors have no conflicts of interest to disclose. Not applicable.

Ultrasonographic Assessment of Polycystic Ovaries: Ovarian Morphology versus Ovarian Volume in Diagnosis of Polycystic Ovaries.

Ultrasonographic Assessment of Polycystic Ovaries: Ovarian Morphology versus Ovarian Volume in Diagnosis of Polycystic Ovaries.

Predictors of reproductive health disorders

«Bell» indicating a change in reproductive health is menstrual cycle disorders. 10–28% of the total number of endocrine gynecological diseases is menstrual cycle disorders, its clinical manifestations are absence of menstruation or rare or poor menstruation, as well as subclinical manifestations in the form of infertility and miscarriage. If there is irregular menstrual cycle, it is necessary to consider the diagnosis of polycystic ovary syndrome.In the International evidence-based guideline for the assessment and management of polycystic ovary syndrome from 2018, a new treatment site appears phytotherapy, which has a hormone-correcting action. Its use is due to the fact that the polycystic ovaries syndrome is a life-long condition and need of long-term correction. For these purpose phytohormones without estrogenpositive activity flavonoids are used. Tazalok™ is one of such drugs. It blocks estrogen (androgen) receptors in the mammary glands, ovaries and uterus, normalizes estrogen-progestin balance (restores the hormonal balance).It has been established that correlation between the hormones of the adipose tissue and the indices of the functional activity of the hypothalamic-adrenal and hypothalamic-oocyte systems in patients with polycystic ovaries syndrome is lost. In this regard, a study was conducted to investigate the possibility of using the multicomponent herbal preparation Tazalok™ in the complex treatment of polycystic ovary syndrome in women with obesity and normal level of ovarian androgens. As a result, it was found that the inclusion in the treatment scheme of this drug gives possible normalize the function of adipose tissue and improve its relationship with the pituitary-adrenal and pituitar-ovarian systems, normalize the menstrual cycle.If it is necessary to restore the menstrual cycle the combined oral contraceptives should also be prescribed. They restore the menstrual cycle, which is the prevention of endometrial cancer, eliminating hypomenorrhea and hyperpolymenorrhea. The higher dose of estrogen in combined oral contraceptives is better kept the cycle, lead to less bleeding, but there is higher the thrombotic risk.

MEJORES TASAS DE ÉXITO DE FIV/ICSI CON EL USO DE METFORMINA EN MUJERES CON OVARIO POLIQUÍSTICO

Objetivo: Determinar el efecto de metformina en las tasas de éxito de fertilización in vitro (FIV) e inyección intracitoplasmática de espermatozoides (ICSI), en mujeres con ovario poliquístico. Diseño: Estudio retrospectivo. Institución: Centro de Fertilidad y Ginecología del Sur, Cusco. Participantes: Mujeres con infertilidad asociada a ovario poliquístico. Métodos: Se compara las tasas de éxito de FIV/ICSI de 7 mujeres con diagnóstico asociado de ovario poliquístico, usuarias de metformina, y de 9 mujeres con el mismo diagnóstico no usuarias del fármaco. Principales medidas de resultados: Embarazo. Resultados: La tasa de implantación fue 35%, la de embarazo bioquímico, 71,4%, y la de embarazo clínico, 57,1%, en las mujeres con ovario poliquístico usuarias de metformina. Las mujeres con ovario poliquístico no usuarias del fármaco tuvieron tasas de 0%, 11,1% y 0,0%, respectivamente. Conclusiones: El uso de metformina mejoro las tasas de éxito de FIV/ICSI en mujeres con ovario poliquístico.

OP11.04: Interobserver variability in the ultrasound diagnosis of polycystic ovaries using pattern recognition

OP11.04: Interobserver variability in the ultrasound diagnosis of polycystic ovaries using pattern recognition

Improvement in quality-of-life questionnaire measures in obese adolescent females with polycystic ovary syndrome treated with lifestyle changes and oral contraceptives, with or without metformin

We studied the effect of metformin or placebo in a lifestyle modification program combined with oral contraceptives (OC) on quality-of-life parameters measured by the polycystic ovary syndrome (PCOS) questionnaire in obese adolescent women with validated PCOS. The quality-of-life indicators were measured at baseline and conclusion for five domains on the PCOS questionnaire, with equal improvement in scores in both placebo and metformin groups, suggesting that the addition of metformin does not add improvement to quality-of-life measures above those observed with lifestyle modification and OC treatment.

Diagnosis of Polycystic Ovaries by Three-dimensional Transvaginal Ultrasound

Diagnosis of Polycystic Ovaries by Three-dimensional Transvaginal Ultrasound

Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound

To study diagnostic thresholds for polycystic ovary (PCO). Retrospective cohort study. Academic hospital. Normoandrogenic ovulatory women and patients with polycystic ovary syndrome (PCOS). Two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound. 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 was determined using 2D transvaginal ultrasound. 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 as determined by areas under the curve (AUC) that were >90% for all three measures. 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.

Comparison of Letrozole and Clomiphene Citrate in Women with Polycystic Ovaries Undergoing Ovarian Stimulation

Letrozole was compared with clomiphene citrate (CC) as a first-line treatment for ovulation induction in women with polycystic ovaries (PCOs). A total of 106 women with primary infertility and a diagnosis of PCOs were randomized to receive either 100 mg CC (n = 55) or 2.5 mg letrozole (n = 51) daily for 5 days. Human chorionic gonadotrophin (hCG) at a dose of 10000 IU was administered when at least one follicle with a mean diameter > or = 18 mm was observed using transvaginal ultrasound. The number of mature follicles was significantly lower, but endometrial thickness and ovulation and pregnancy rates were significantly higher in the letrozole group than in the CC group. In conclusion, letrozole is associated with a higher pregnancy rate than CC in PCO patients and may have a role as a first-line treatment for anovulatory patients with PCOs.

Determination of the best-fitting ultrasound formulaic method for ovarian volume measurement in women with polycystic ovary syndrome

Determination of the best-fitting ultrasound formulaic method for ovarian volume measurement in women with polycystic ovary syndrome

Polycystic ovaries and recurrent miscarriage—a reappraisal

The prevalence of polycystic ovaries (PCO) was established amongst 2199 consecutive women (median age 33 years; range 19-46) with a history of recurrent miscarriage (median 3; 3-14). A diagnosis of PCO was made if the ovarian volume was enlarged (>9 ml), there were >/=10 cysts of 2-8 mm in diameter in one plane and there was increased density of the stroma. In a cohort study, the prospective pregnancy outcome of 486 of the women scanned who were antiphospholipid antibody negative and who received no pharmacological treatment during their next pregnancy was studied. The prevalence of PCO was 40.7% (895/2199). The livebirth rate was similar amongst women with PCO (60.9%; 142/233) compared to that amongst women with normal ovarian morphology (58.5%; 148/253; not significant). Neither an elevated serum luteinizing hormone concentration (>10 IU/l) nor an elevated serum testosterone concentration (>3 nmol/l) was associated with an increased miscarriage rate. Polycystic ovarian morphology is not predictive of pregnancy loss amongst ovulatory women with recurrent miscarriage conceiving spontaneously. The search for a specific endocrine abnormality that can divide women with PCO into those with a good and those with a poorer prognosis for a future successful pregnancy continues.

What's new in the pathogenesis and prevention of ovarian hyperstimulation syndrome?

Several pathophysiological mechanisms have been proposed for the development of ovarian hyperstimulation syndrome (OHSS), such as activation of the ovarian renin-prorenin-angiotensin system, release of ovarian cytokines and nitric oxide, but numerous reports now attest to the role of vascular endothelial growth factor (VEGF), an endothelial cell mitogen, as an important mediator of the syndrome. Luteinizing hormone (LH) or human chorionic gonadotrophin (hCG) regulates VEGF production by the ovary. Formation of multiple follicles, as seen in regimens of ovarian stimulation used for in vitro fertilization (IVF), and intensified sensitivity towards human menopausal gonadotrophin (hMG) and hCG, as seen in women with polycystic ovaries (PCO) or polycystic ovary syndrome (PCOS), result in increased serum VEGF concentrations, probably due to enhanced VEGF production by the ovaries. It is possible that the hypersecretion of VEGF in women with PCO is due to an increase in the number of VEGF secreting cells or that the cells individually hypersecrete VEGF. This hypothesis was tested by in vitro studies on granulosa lutein cells. After the cells were stimulated with gonadotrophins and hCG, VEGF production was higher in granulosa cells obtained from women with PCO compared with those obtained from women with normal ovaries under similar culture conditions. The studies performed in vivo and in vitro were consistent with increased VEGF expression as a constitutive feature of PCO. Increased VEGF may be responsible for the fluid shift from the vascular bed to the extravascular space, which characterizes OHSS. Prevention of OHSS focuses on predicting the possibility of developing OHSS. Markers such as serum oestradiol concentrations and number of follicles on the day of hCG administration, the presence of PCO and the number of oocytes retrieved may be subject to inter-observer and inter-operator variations. As individual markers of OHSS, each of these factors predicts less than a quarter of cases of the syndrome. It has been shown that a combination of pretreatment diagnosis of PCO along with number of follicles on the day of hCG administration and ‘VEGF rise’ gives the highest prediction rates for the risk of developing OHSS. Neither pathogenesis nor prevention and treatment of OHSS are specific. Therefore, at present, OHSS remains a condition that cannot be avoided altogether.

Adolescent body mass index and infertility caused by ovulatory disorder

Objective: Our aim was to examine the association between body mass index at age 18 and subsequent primary ovulatory infertility.Study Design: A nested case-control study was conducted within a cohort of 116,678 female registered nurses residing in 14 U.S. states. Cases comprised 2527 married nulliparous nurses unable to become pregnant for at least 1 year because of ovulatory disorder; controls comprised 46,718 married parous nurses with no history of infertility. The risk of ovulatory infertility for women at different levels of body mass index at age 18 was compared with that for women whose body mass index at age 18 was 20 to 21.9 (median for the cohort). Logistic regression was used to adjust for age at infertility or first birth, year of birth, age at menarche, physical activity during ages 18 to 22, smoking at ages 15 to 19, ethnicity, alcohol use at ages 18 to 22, use of oral contraceptives before age 22, and diagnosis of diabetes mellitus.Results: Multivariate relative risks for infertility were: 1.2 (body mass index > 16), 1.1 (body mass index 16 to 17.9), 1.0 (body mass index 18 to 19.9), 1.0 (referent body mass index 20 to 21.9), 1.1 (body mass index 22 to 23.9), 1.3 (body mass index 24 to 25.9), 1.7 (body mass index 26 to 27.9),2.4 (body mass index 28 to 29.9),2.7 (body mass index 30 to 31.9), and 2.7 (body mass index ≤32). The relative risks for all categories of body mass index above 23~9 were statistically significantly elevated. Greater body mass index at age 18 was a predictor of ovulatory infertility in women with and without a diagnosis of polycystic ovary syndrome.Conclusion: These findings suggest that elevated body mass index at age 18, even at levels lower than those considered to be obese, is a risk factor for subsequent ovulatory infertility.

Transabdominal Versus Transvaginal Ultrasound in the Diagnosis of Polycystic Ovaries in a Population of Randomly Selected Women

Transabdominal Versus Transvaginal Ultrasound in the Diagnosis of Polycystic Ovaries in a Population of Randomly Selected Women

Transabdominal versus transvaginal ultrasound in the diagnosis of polycystic ovaries in a population of randomly selected women.

A study was conducted which compared transvaginal and transabdominal ultrasound in determining the prevalence of polycystic ovaries in a population of women. Women, chosen randomly from electoral rolls, were sent a letter inviting them to take part in a study determining the presence of polycystic ovaries. A transvaginal and transabdominal ultrasound scan was performed on day 5-9 of their menstrual cycles. A total of 187 women (mean age 33 years) took part in the study. The prevalence of polycystic ovaries was 21% (40/187) by transabdominal ultrasound and 27% (36/134) by transvaginal ultrasound. No differences existed between women with polycystic and normal ovaries with respect to uterine size and endometrial thickness. Mean ovarian volume was larger in women with polycystic ovaries irrespective of the use of hormonal contraception or breast feeding. There was no difference in the prevalence of polycystic ovaries diagnosed by transabdominal or transvaginal ultrasound in the group of randomly selected women. However, almost 20% of the women declined a transvaginal ultrasound examination.

Polycystic Ovaries Are a Common Finding in Untreated Female to Male Transsexuals

Summary OBJECTIVE We studied the pretreatment hormone profile and ovarian ultrasound appearance of female-to-male transsexuals. DESIGN Female-to-male transsexuals who were seen in the local Gender Identity Clinic were examined after psychiatric assessment. RESULTS Sixteen patients were assessed. Approximately 50% had symptoms and signs of the polycystic ovary syndrome (PCOS) and 15 had a pelvic ultrasound diagnosis of polycystic ovaries. The endocrine profiles of the patients were not markedly abnormal and were compatible with the diagnosis of PCOS. CONCLUSIONS Polycystic ovaries and the polycystic ovary syndrome are a common finding in female-to-male transsexuals who have had no previous exposure to exogenous androgen therapy.

The diagnosis of polycystic ovaries in women with oligo‐amenorrhoea: predictive power of endocrine tests

The ability of several endocrine tests to distinguish between women with and without polycystic ovaries (PCO) has been studied prospectively in a series of 65 patients with functional oligo-amenorrhoea using ultrasonography as a reference test. In terms of overall diagnostic accuracy, the free androgen index (FAI) (94%) and the progestogen challenge (89%) gave similar results (Cl = -5 to 15%) but both were significantly better than all the other tests including measurement of serum LH (69%), total testosterone (71%) and androstenedione (74%) (minimum Cl = 6 to 23%). The FAI together with LH measurement was the most accurate of the combinations (97%) but this was not significantly better than the best of the combinations incorporating the progestogen challenge (92%; Cl = -3% to 13%). Given the limited availability of the assay for SHBG, these results show that assessment of oestrogen state is a useful method for categorizing patients with functional oligo-amenorrhoea.

The diagnosis of polycystic ovaries in subfertile women

Laparoscopy was used to identify the polycystic ovary (PCO) in a group of subfertile women. A third were found to have PCO. These patients had higher levels of luteinizing hormone (LH), testosterone (T) and a higher free androgen index (FAI) than those with normal ovaries. Only 15% of patients with laparoscopic evidence of PCO were obese, hirsute and oligomenorrhoeic. Within the PCO group, hirsutism was strongly associated with obesity and a high FAI. A group of subfertile women with PCO and regular cycles was found who had no other identifiable cause for their infertility. These women had higher follicular phase concentrations of LH and higher FAI than ovulatory women with normal ovaries.

Stein–Leventhal Syndrome in a 12–Year–Old Girl

A girl at age 12 years, 8 months had virilization due to Stein-Leventhal syndrome. Studies of the patient's adrenal and ovarian androgen production employing adrenocorticotrophic hormone stimulation, dexamethasone suppression, and human chorionic gonadotrophin stimulation indicated that her ovaries were the major source of excess testosterone. The diagnosis of polycystic ovaries was confirmed at surgery.