Polycystic Ovaries In Women Research Articles

The role of serum anti-Müllerian hormone (AMH) in the hormonal diagnosis of polycystic ovary syndrome

Background: The study was performed to validate the threshold for anti-Müllerian hormone (AMH) that suggests the presence of polycystic ovaries in women with polycystic ovary syndrome (PCOS).Methods: This prospective observational study included 59 infertile women: (A) 22 PCOS with hyperandrogenism (HA) and oligo-anovulation, (B) 15 suspected PCOS with either HA or oligo-anovulation and (C) 22 asymptomatic control women. The diagnosis of PCOS was made according to the NIH classification.Results: For serum AMH and follicle number, respectively, the areas under the receiver operating characteristic curve (A versus C) were 0.97 and 0.93. The best compromise between specificity (95% and 91%) and sensitivity (95% and 82%) was obtained with threshold values of 33 pmol/l and 13 follicles, respectively. Using a serum AMH > 33 pmol/l as a surrogate for either HA or oligo-anovulation in group B would lead to the diagnosis of PCOS in seven (46.6%) patients from this group.Conclusions: Our data confirms that the AMH assay has a high diagnostic potential, providing that an appropriate threshold is used. AMH measurement may be included as an ultimate diagnostic criterion for the diagnosis of PCOS when either HA or anovulation is missing and/or when no reliable antral follicle count can be obtained.

Hormonal profile and polycystic ovaries in women with acne vulgaris

Hormonal profile and polycystic ovaries in women with acne vulgaris

The utility of anti-mullerian hormone (AMH) measurements in the assessment of ovarian reserve in women with polycystic ovaries (PCO)

Even though AMH has been studied extensively as a test for ovarian reserve in infertility patients, little is known about using it in PCO patients. The exclusion of PCO patients from AMH age related normograms throughout the literature has rendered it more difficult to counsel PCO women about their ovarian reserve. Furthermore, the subgroup of patients with PCO and low AMH has not been well studied. We hypothesize that patients with PCO and low AMH are older and have different clinical characteristics than their counterparts with high AMH.

The effect of inhibin B on ovarian response in subjects with polycystic ovary

Background: Inhibin B hormone is one of the indicative parameters in measuring ovarian reserve ,which is important to be evaluated, since it is one of the markers of the female reproductive potential especially in polycystic ovary patients (PCOS) which is a common cause of anovulatory infertility.Patients and methods: Ninty four infertile polycystic ovaries women, attending the infertility clinic at Baghdad teaching hospital, during the period of October 2005 to December 2006, were compared to 62 control group women who have unexplained infertility. After exact history and examination, inhibin level measurement was done in cycle day 3, the patients are divided according to age into 2 groups (more than 35 years and less than 35 years) .Ovarian stimulation by one of 3 protocols (clomiphene citrate (CC), CC + gonadotropins, goadotropins alone) was applied. Then the ovarian response is measured after that.Results: It was found that inhibin is significantly higher in PCOS patients as compared to control [201.1 ±122.40 vs 71.81 ± 40.63 pg/ml] (P=0.0003).After treatment with ovulation induction drugs, those who are less than 35 years with inhibin level less than 75 pg/ml, have no significant difference in response between the 3 protocols, while in those with inhibin more than 75 pg/ml the response was significantly high to protocol 1(CC only). In more than 35 years patients with inhibin level less than 75 pg/ml ,there was no significant difference in response between protocols while in those with inhibin more than 75 pg/ml the response was significantly higher to protocol 2 (CC+ Gonadotropins).Conclusion: Polycystic ovary patients have significantly higher concentration of inhibin B. Young patients less than 35 years with inhibin level less than 75 pg/ml showed no difference in response between the 3 protocols (CC, CC+ Gonadotropins, and Gonadotropins), while those with higher inhibin level ,the response was significantly higher to protocol 1. In older patients with inhibin more than 75 pg/ml there is no significant difference in response among the 3 protocols.

Adding phytoestrogens (Cimicifugae racemosae) to clomiphene citrate induction cycles in polycystic ovary women raises pregnancy rates – A randomized trial

Adding phytoestrogens (Cimicifugae racemosae) to clomiphene citrate induction cycles in polycystic ovary women raises pregnancy rates – A randomized trial

Ovarian antral follicle number and the amount of gonadotropin used in ovarian stimulation in polycystic ovarian patients.

Background: Polycystic ovary syndrome is the most common cause of anovulation, and the number of antral follicles is of great importance in determining ovarian reserve, so identification of patients with diminished ovarian reserve help in choosing individualized and well managed ovulation induction protocol. The aim of the study is to find out if the number of ovarian antral follicles could affect the amount of gonadotropins used in ovarian stimulation in polycystic ovarian patients.Patients and methods: Ninty four infertile polycystic ovaries women, attending the infertility clinic at Baghdad teaching hospital, during the period of November 2005 to October 2006, were compared to 62 control group women who have unexplained infertility. After exact history and examination, ultrasound was done to both groups at cycle day 3 for antral follicle counting. Then ovarian stimulation was started with gonadotropins, and another ultrasound was done on cycle day 13 for mature follicles confirmation.Results: Antral follicle number was found to be significantly higher in patients than control groups (9.98 ± 2.09 vs 5.40±2.02). Age was found to be negatively correlated with antral follicle size and number in patient and control groups. After measuring the number of mature follicles at cycle day 13 it was observed that the antral follicle number was correlating positively and significantly with the number of follicles at cycle day 13, but negatively with the amount of gonadotropin used for ovarian stimulation in patients and control groups.Conclusion: Antral follicles number is significantly higher in polycystic ovary patients and they correlate negatively with age. Antral follicle number is a good predictor of the number of gonadotropin ampouls used for ovarian stimulation.

Ultrasonographic extended-view technique for evaluation of abdominal fat distribution in lean women with polycystic ovary syndrome

To estimate whether, by using a new ultrasonographic technique (extended view; XTD view), young lean women with polycystic ovary syndrome (PCOS) have a more android fat distribution in comparison with normally menstruating women with ultrasonographic evidence of polycystic ovaries (PCO) and healthy control subjects, matched for both age and body mass index. Prospective observational study. University Hospital. Forty-nine lean women with PCOS, 42 eumenorrheic women with bilateral PCO and 40 healthy volunteers with regular ovulatory cycles. Fasting blood sampling, ultrasonographic and Doppler analyses and blood pressure monitoring. Medical examination, biochemical and hormonal parameters, ultrasonographic abdominal fat measurements, ultrasonographic evaluation of carotid intima-media thickness and Doppler analysis of ophthalmic artery. An oral glucose tolerance test was performed to analyze glucose, insulin and C-peptide levels. The XTD ultrasonographic preperitoneal area was significantly larger in women with PCOS than in control subjects (p=0.011). The preperitoneal/subcutaneous ratio was significantly higher in women with PCOS (1.1±0.26) compared with women with PCO (0.84±0.13; p=0.05) and control women (0.67±0.13; p<0.001). The mean pulsatility index of ophthalmic arteries was higher in the PCOS women (1.93±0.57) than in control subjects (1.84±0.38; p=0.041). Total cholesterol, triglycerides and LDL cholesterol were significantly higher in women with PCOS than in those with PCO and in control subjects. Women with PCOS have an android fat pattern correlated with an age-dependent increased risk of cardiovascular diseases.

Vascular Risk in Young Women With Polycystic Ovary and Polycystic Ovary Syndrome

To estimate if young polycystic ovary syndrome (PCOS) patients have subclinical risks of vascular disease compared with eumenorrheic polycystic ovary (PCO) women and healthy controls. Twenty-eight PCOS patients, 17 eumenorrheic PCO women, and 15 healthy eumenorrheic volunteers underwent medical examination; blood measurement of nitrites/nitrates, biochemical and hormonal parameters; uteroovarian ultrasonographic analysis and color Doppler evaluation of uterine, stromal ovarian, and ophthalmic arteries; brachial artery flow-mediated vasodilatation; 24-hour ambulatory blood pressure monitoring. An oral glucose tolerance test was performed to analyze glucose, insulin, and C-peptide. Doppler analysis revealed a significantly higher uterine pulsatility index in the PCOS group compared with controls. The lowest vascular resistances in the ovaries were found in PCOS and PCO compared with controls. The ophthalmic artery back pressure was significantly higher in women with PCOS than in controls. The brachial artery diameter, at baseline, was similar in all the participants. After the reactive hyperemia, a greater vasodilatation was observed in controls and PCO patients in comparison with PCOS women. Total cholesterol, triglycerides, and the atherogenic plasma index were significantly higher in PCOS than PCO and controls. Leukocytes and homocysteine were slightly higher in PCOS. The nitrites/nitrates plasma levels were lower in PCOS and PCO patients compared with controls. The insulin and C-peptide plasma values were higher in PCOS patients than controls. In PCOS patients the different estimates of insulin sensitivity and pancreatic beta-cell function were higher compared with PCO and controls. Polycystic ovary syndrome is a condition associated with an increased vascular risk. II.

Estrogenic ovulatory dysfunction or functional female hyperandrogenism: an argument to discard the term polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders seen among reproductive-age women, with a prevalence of 4%-9% depending on the criteria used to define the syndrome. The diagnostic criteria for PCOS have been surprisingly controversial and confusing for patients, clinicians, and researchers. We believe that the confusion surrounding PCOS arises almost entirely because its name refers to a trait that is inconsistently present and irrelevant to both the etiology and the treatment of the disorder. We suggest that merely abandoning the term PCOS will cure much of what has ailed us for decades and allow us to focus on the etiology and treatment of the causes of what the experts in this field have come to recognize as functional female hyperandrogenism.

Characterization of Insulin Secretion in Valproate‐treated Patients with Epilepsy

Valproate (VPA) treatment has been reported to be associated with obesity and high fasting serum insulin concentrations in parallel with an unfavorable serum lipid profile and hyperandrogenism and polycystic ovaries in women. The pathogenetic mechanism underlying these changes has remained unknown, although several mechanisms have been implicated. Fifty-one patients receiving monotherapy (31 male and 20 female patients) were included in this study, with 45 (23 male and 22 female) healthy control subjects. These participants were interviewed, clinically examined, and blood samples for fasting plasma glucose, serum insulin, proinsulin, and C-peptide concentrations were taken after an overnight fast. The valproate-treated patients had fasting hyperinsulinemia (11.30 +/- 6.23 pM vs. 6.28 +/- 4.66 pM in the control subjects; p < 0.001), although the fasting serum proinsulin and C-peptide concentrations were not significantly higher in the patients than in the control subjects. In addition, proinsulin/insulin (0.30 +/- 0.14) and C-peptide/insulin ratios (35.48 +/- 24.09) were lower (p < 0.001) in the VPA-treated patients when compared with the control subjects (0.53 +/- 0.36 and 94.27 +/- 61.85, respectively), and they also had lower fasting plasma glucose concentrations (4.72 +/- 0.35 mM) than the control subjects (5.12 +/- 0.58 mM; p < 0.01). This study suggests that valproate does not induce insulin secretion but might interfere with the insulin metabolism in the liver, resulting in higher insulin concentrations in the peripheral circulation. These changes are seen irrespective of concomitant weight gain, suggesting that increased insulin concentrations induce weight gain and not vice versa.

P20.14: 3D power Doppler measurement of perifollicular vascularization in normal and polycystic ovaries during in vitro fertilization

Ovarian angiogenesis and subsequent intrafollicular O2 content is a critical point IVF outcome. We wanted to evaluate the differences in ovarian perifollicular blood flow (PFBF) in normal and polycystic ovaries (PCOS) during IVF by using three-dimensional power Doppler (3D pD). 80 unexplained infertile women and 74 women with ultrasound evidence of PCOS were enrolled. Controlled ovarian hyperstimulation (COH) was induced by long or short protocol + rFSH (β-follitropin). A GE 730Voluson machine with a transvaginal volume transducer was used. 3DpD was used to assess total follicle number per ovary (FNPO), ovarian volume (OV) and ovarian vascularization indexes (OVI). Stored volumes were analyzed by the VOCAL™ program. Mean greyness-MG, vascularization index, flow index and vascularization flow index were serially calculated throughout the follicular phase of ovarian stimulation. Serum FSH, LH and insulin were also checked. We observed conflicting results in PCOS women as OVI appeared positively related to FNPO rather than OV or FSH/LH levels. In the presence of FNPO ≥ 20 OVI were all significantly higher in PCOS women, than in normal ones, in every step of stimulated cycles independently from pituitary down regulation, whereas in the presence of FNPO ≥ 12 but⩽20 (consensus standard) OVI were lower in PCOS women following pituitary suppression. MG values were similar in both groups but total stromal area was significantly increased in PCOS. Normoandrogenic ovulatory women needed a higher amount of β-follitropin to get the same PFBF vascularization indexes than the PCOS ones. Insulin resistance appeared positively related with OVI increasing. PCOS is a heterogeneous disease. FNPO better relate with ovarian vascularization and angiogenesis during COH than FSH/LH levels or OV. Women with a total FNPO ≥ 20 are at higher risk of ovarian hyperstimulation. Insulin resistance may play a role in ovarian hyper response in PCOS.

Serum Anti-M??llerian Hormone as a Surrogate for Antral Follicle Count for Definition of the Polycystic Ovary Syndrome

At present, polycystic ovary syndrome (PCOS) is diagnosed ultrasonographically by an ovarian volume exceeding 10 mL and/or 12 or more follicles measuring 2 to 9 mm in each ovary. Counting follicles may, however, be difficult and unreliable, and it remains uncertain that a count greater than 12 is specific for polycystic ovaries. This study sought to determine whether assaying serum for anti-Mullerian hormone (AMH) can replace the antral follicle count in diagnosing PCOS. AMH was estimated using a second-generation immunoassay in 73 patients diagnosed as having PCOS using the Rotterdam system and in 96 control subjects. Mean serum AMH levels were 3-fold higher in patients with PCOS than in control subjects. There was a similar difference in the number of follicles per ovary, and these variables correlated significantly with one another in both patients and control subjects. Levels of AMH correlated positively with serum testosterone in both groups, but AMH levels did not correlate significantly with follicle-stimulating hormone levels in the PCOS group. A cutoff value of 60 pmol/L was 92% specific and 67% sensitive for PCOS. This figure is slightly higher than the 90th percentile of control subjects. Both AMH levels and follicle counts, but not age, differed in patients presenting with amenorrhea, oligomen-orrhea, or regular cycles. In patients with PCOS with abnormal cycles, AMH levels varied significantly depending on whether or not hyperandrogenism was present, but no such differences were found for follicle counts. If reliable ultrasound studies are not available, the serum AMH can point to the presence of polycystic ovaries in women with hyperandrogenism and/or oligoanovulation. Conceivably, the level of AMH could indicate the extent of ovarian dysfunction in patients with PCOS and predict the response to attempted induction of ovulation.

Treatment of Overweight Women With Polycystic Ovaries (PCO) and Insulin Resistance (IR) With Rosiglitazone vs. Ethinyl Estradiol-Cyproterone Acetate Administered Alone and in Sequential Combinations

Few studies evaluated insulin sensitizers in association with oral contraceptives (OC) in PCO with IR. The purpose of this study was to assess the efficacy and possible interaction of a thiazolidinedione vs. an anti-androgenic oestrogen-progestin on the endocrine-metabolic problems of overweight PCO women.

Comparison of in vitro fertilization outcome in women with and without sonographic evidence of polycystic ovarian morphology

Objective: This study compared the outcome of in vitro fertilization (IVF) treatment in women who had polycystic ovaries (PCO) seen on an ultrasound scan, but who had no clinical symptomatology associated with polycystic ovary syndrome, with that of women who had normal ovarian morphology on ultrasound examination. Methods: Outcome of IVF 39 women with PCO evidence by ultrasound compared with 102 women, who had normal ovarian morphology by ultrasound. All 141 women had normal early follicular phase serum follicle stimulating hormone (FSH) concentration, were less than 40 years of age and used the long protocol pituitary suppression with gonadotropin-releasing hormone agonist therapy. Results: On average, the women with PCO produced more follicles and oocytes than the women with normal ovaries, but the fertilization cleavage and pregnancy rates were similar. Conclusion: Although the response to follicular stimulation in PCO women is better than that for women with normal ovaries, the outcome of pregnancy in vitro fertilization is similar.

Correlation between endocrinological parameters and acne severity in adult women.

Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women >17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regularity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels (p<0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes.

The polycystic ovary syndrome per se is not associated with increased chronic inflammation

The syndrome of polycystic ovaries (PCOS) is a known risk factor for type 2 diabetes. It is not known, however, whether the increase in diabetes risk is related to endocrine abnormalities associated with PCOS such as hyperandrogenemia, or whether it is a consequence of the anthropometric or metabolic alterations frequently observed in PCOS women. Since markers of inflammation are supposed to predict type 2 diabetes, interleukin-6 (IL-6) and C-reactive protein (CRP) in combination with parameters of obesity, insulin resistance and hyperandrogenism were determined in 57 PCOS women and in 20 age-matched healthy controls. In addition, the C-174G IL-6 promoter polymorphism was analyzed as a determinant in influencing IL-6, obesity, and androgen levels in women. Neither CRP nor IL-6 were significantly elevated in lean or obese PCOS women compared with age-matched lean or obese controls. In PCOS patients, variables of body composition (body mass index (BMI), waist to hip ratio, dual-energy X-ray-absorptiometry fat mass) and of insulin resistance were correlated with IL-6 or CRP, while parameters of hyperandogenism were not. Multivariate linear regression analysis revealed that obesity is the dominant force, thus explaining 18% and 24% of the IL-6 or CRP levels, respectively, in PCOS women. No association of IL-6 or BMI to a certain genotype at C-174G could be demonstrated in 50 PCOS patients. The heterozygous GC genotype, however, was associated with lower androstendione levels. Metformin treatment of 9 obese, insulin-resistant PCOS patients over a period of 6 months caused a significant decrease in body weight, body fat mass and total testosterone, but showed no significant decline in IL-6 or CRP concentrations. In PCOS women, plasma levels of IL-6 and CRP were not increased when compared with age- and BMI-matched controls. BMI was, however, the parameter most strongly related to IL-6 and CRP in PCOS; thus PCOS-related endocrine abnormalities do not appear to activate inflammatory parameters thereby enhancing the risk of diabetes. In PCOS, the type 2 diabetes risk may, therefore, be confined to those with obesity and/or metabolic alterations rather than affecting all women suffering from the syndrome.

Prevalence of polycystic ovaries in women with self-reported symptoms of oligomenorrhoea and/or hirsutism: Northern Finland Birth Cohort 1966 Study.

The aim of this study was to investigate the prevalence of polycystic ovaries (PCO) among women with self-reported oligomenorrhoea and/or hirsutism and to see whether women with symptoms and PCO have less favourable levels of biochemical markers than controls or women with symptoms and normal ovaries. The ultrasonographic ovarian morphology and the hormonal and metabolic profile of female cases with self-reported symptoms typical of polycystic ovary syndrome (PCOS) (n = 196) and asymptomatic controls (n = 67) at the age of 31 years were examined in a general population-based Northern Finland Birth Cohort 1966. The prevalence of PCO (37.3 versus 18.2%; P = 0.004) was significantly higher in the cases (oligomenorrhoea and/or hirsutism) than in the controls. PCO morphology was detected in 18.4% of those who reported only hirsutism, in 47.9% of those reporting only oligomenorrhoea, and in 70.4% of those reporting both symptoms. In the cases with PCO compared to (i) the controls and (ii) the cases without PCO, body mass index (P = 0.026 and P = 0.011), ovarian volume [right P = 0.001, left P = 0.208 (non-significant) and right P < 0.001, left P = 0.022], mean follicle number (P < 0.001 and P < 0.001), testosterone (P = 0.063 and P = 0.029), free androgen index (P = 0.007 and P = 0.013) and insulin (P = 0.033 and P = 0.040) were higher, and sex hormone-binding globulin (P = 0.039 and P = 0.068) and glucose:insulin ratio (P = 0.060 and P = 0.054) lower. Cases with PCO also had higher waist:hip ratio (P = 0.011), infertility rate (P = 0.005) and glucose (P = 0.045) and lower insulin-like growth factor-binding protein-1 (P = 0.012) than controls. The clinical, hormonal and metabolic characteristics did not differ significantly between cases without PCO and controls with the exception of infertility rate, which was significantly higher in the cases without PCO (26.4 vs. 10.0%; P = 0.009). In a general population, women with symptoms of oligomenorrhoea and/or hirsutism more often have PCO than asymptomatic women. Levels of biochemical and clinical markers in symptomatic women with PCO differed from and were less favourable than those in symptomatic women without PCO or asymptomatic women, implying an increased risk for health.

Risk indicators for glucose intolerance in PCOS women with fasting normoglycemia

The syndrome of polycystic ovaries (PCOS) is a known risk factor for type 2 diabetes mellitus (DM). As the clinical symptoms of PCOS (e.g. hirsutism and menstrual irregularities) are easily recognized, this group of patients is ideal for strategies focusing on prevention and early diagnosis of altered glucose metabolism. The purpose of this study was to define a risk indicator for glucose intolerance in PCOS women with fasting normoglycemia.

Prevalence of polycystic ovaries in women with androgenic alopecia.

Although androgenic alopecia is recognised to be a symptom of polycystic ovary syndrome (PCOS), it is not known whether polycystic ovaries (PCO) and associated endocrine abnormalities are present in patients who present with alopecia as a primary complaint. We therefore set out to determine the strength of the association between androgenic alopecia and PCO. We examined the prevalence of ultrasound-based polycystic ovarian morphology and associated clinical and biochemical features in a large multiethnic group of women whose presenting complaint was of alopecia, and in a control group. We studied 89 women of mixed ethnic origin with androgenic alopecia and compared them to 73 control women. A detailed history was taken, anthropometry was performed and assessment of body-hair distribution was made. The presence of PCO was established by pelvic ultrasound scan. Serum gonadotrophins, testosterone, androstenedione, dihydrotestosterone and sex hormone binding globulin concentrations were measured. Women with alopecia had a higher prevalence of PCO and hirsutism than the control population (PCO: 67% vs 27%, P<0.00001; hirsutism: 21% vs 4%, P=0.003). Women with alopecia (with or without PCO) had higher testosterone, androstenedione and free androgen index than controls, even though few had frankly abnormal androgens. These findings confirm an association between androgenic alopecia and PCO, and other symptoms of hyperandrogenaemia. Thus most women who present with androgenic alopecia as their primary complaint also have PCO and have indices of abnormal androgen production. Since PCO is a well known risk factor for development of type 2 diabetes, this association has important implications for long-term management.

Ultrasound diagnosis of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome is not associated with subfecundity or subfertility

Objective: To evaluate the effect on fertility of the appearance of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome. Design: Case-control study. Setting: Teaching hospitals in Hull, United Kingdom. Patient(s): Women with the appearance of polycystic ovaries on ultrasound and women with normal ovaries. Intervention(s): A questionnaire about previous subfertility, pregnancies, menstrual pattern, features of polycystic ovary syndrome, gynecological history, and individual lifestyle factors. Main outcome measure(s): Time to pregnancy (TTP) and relative risk (RR) of subfertility in symptomatic and asymptomatic subgroups of both groups. Result(s): Women with PCOs took longer TTP and were significantly less fertile if they were obese (RR = 2.6), had menstrual disturbances (RR = 4.6), hirsutism (RR = 2.5), and/or acne (RR = 2.7). Further reductions in fecundity occurred with an increasing number of symptoms (threefold, sevenfold, and 10-fold longer TTP with two, three, and four symptoms, respectively). The TTP of women with no symptoms was not significantly longer and they were not more likely to be subfertile than women with normal ovaries. These symptoms were not associated with significantly reduced fecundity in women with normal ovaries. Conclusion(s): The appearance of polycystic ovaries has been shown to have no significant impact on fertility in women with no symptoms. Appearances alone do not reflect the pathological features of polycystic ovary syndrome, and additional diagnostic criteria should be considered. Obesity, menstrual disturbances, and/or hyperandrogenism are factors associated with subfertility in women with polycystic ovaries.