Researchers are calling for a revised criterion of what constitutes polycystic ovary morphology based on what is observed on ultrasound among patients after age 30 to 35 years, according to data presented at the conjoint meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine.
In an interview with Endocrine Today, senior study researcher Corrine K. Welt, MD, said the most significant finding is that the criteria to document polycystic ovaries on ultrasound must be revised based on the decreased ovarian volume and follicle number with aging.
“The ultrasound morphology for polycystic ovaries is found in virtually 100% of women with PCOS based on other criteria (ie, hyperandrogenism and irregular menses),” Welt said, “but the best threshold for documenting polycystic ovary morphology in women with polycystic ovary syndrome decreases with age.”
Corrine K. Welt
Welt and colleagues conducted a case-control study by reviewing the ultrasound data in women with PCOS (n=544) and a control group (n=666). PCOS was diagnosed in women by age 40 years with chronic oligomenorrhea (fewer than nine menstrual periods per year) and clinical and/or biochemical hyperandrogenism. This was in the absence of other disorders that cause the same phenotype, according to abstract data.
Follicle number and ovarian volume with age were observed in women split into 5 year age groups. The follicle number with a specificity of at least 75% and sensitivity of at least 68% at all ages and ovarian volume with a specificity of at least 66% and a sensitivity of at least 66% at all ages were chosen as “cutoffs” to determine the polycystic morphology, according to abstract data.
The data showed that follicle number and ovarian volume were always higher in women with PCOS. However, the cutoff follicle number and ovarian volume that distinguished PCOS from control fell from 13 to 9 and from 11 to 8, respectively, when comparing age 24 years or younger to older than 44 years. More patients aged 30 to 44 years with PCOS met these cutoffs than those in the control group.
Welt told Endocrine Today that this is a common finding in patients with PCOS and may speak to the reproductive life span, which could potentially be longer in women with PCOS.
“And that may be why this increased follicle number and bigger ovaries have persisted throughout history, even in a syndrome that , in theory, should make them less fertile,” Welt said.
Therefore, these findings continue to demonstrate the importance of the polycystic ovary phenotype on ultrasound with the increased number of follicles and larger ovarian volume in women with PCOS, Welt said.
In conclusion, these data indicate ovarian volume and follicle number cutoff should be lowered for each 5-year increment starting at age 35 years, according to abstract data.
The researchers plan to conduct a follow-up validation study, Welt said. – by Samantha Costa
For more information:
Kim HJ. Abstract O-123. Presented at: the Conjoint Meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine 69th Annual Meeting; Oct. 12-17, 2013; Boston.
Disclosure: Welt reports no relevant financial disclosures.