PCOS Forum

Research in Polycystic Ovary Syndrome Today and Tomorrow

Renato Pasquali; Elisabet Stener-Victorin; Bulent O. Yildiz; Antoni J. Duleba; Kathleen Hoeger; Helen Mason; Roy Homburg; Theresa Hickey; Steve Franks; Juha S. Tapanainen; Adam Balen; David H. Abbott; Evanthia Diamanti-Kandarakis; Richard S. Legro

Disclosures

Clin Endocrinol. 2011;74(4):424-433. 

In This Article

Clinical Significance of Polycystic Ovaries in Normal Women

Polycystic ovaries are the morphological ovarian phenotype in women with the PCOS. Several studies have been performed to attempt to determine the prevalence of PCO as detected by ultrasound alone in the general population and have found prevalence rates in the order of 17–33%.[40] In 2003, a joint ESHRE/ASRM consensus meeting produced a refined definition of PCOS,[1] and the morphology of the polycystic ovary was defined as an ovary with 12 or more follicles measuring 2–9 mm in diameter and/or increased ovarian volume (>10 cm3).[38] It is interesting also to note that the presence of PCO is a marker for increased ovarian reserve and a reduced rate of ovarian ageing.[41] The question of whether PCO alone is pathological or a normal variant of ovarian morphology is debated. It has been found that some women with hypogonadotropic hypogonadism (HH) also have PCO detected by pelvic ultrasound and when these women were treated with pulsatile GnRH to induce ovulation, they had significantly higher serum LH concentrations than women with HH and normal ovaries.[42] These results suggest that the cause of hypersecretion of LH involves a perturbation of ovarian-pituitary feedback, rather than a primary disturbance of hypothalamic pulse regulation. A consensus statement on defining the morphology of the PCO stated that 'A woman having PCO in the absence of an ovulation disorder or hyperandrogenism ('asymptomatic PCO') should not be considered as having PCOS, until more is known about this situation'.[43] While the spectrum of 'normality' might include the presence of PCO in the absence of signs or symptoms of PCOS, there is evidence that women with PCO morphology alone show typical responses to stresses such as gonadotrophin stimulation during IVF treatment or to weight gain, whether spontaneous or as stimulated by sodium valproate therapy.[44] The difficulty in answering this question lies in the fact that to date there are no large-scale, longitudinal prospective studies of women with PCO.

Information about the prevalence of PCO can be obtained from cross-sectional studies of ovarian size and morphology in normal women without PCOS. For instance, a large-scale study of ovarian ageing among women enrolled in the Kaiser Permanente Health Plan in California found a high prevalence of PCO among younger women, which resolved with ageing.[45] However, a better study design would be a prospective longitudinal study to examine via imaging changes in the size and morphology of the ovary over time to establish the permanence of the polycystic ovary in affected and unaffected women with PCOS. This would also address the important and understudied issue of the fate of the polycystic ovary in the perimenopause and menopause.

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