Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Ovarian volume is more closely related to the different manifestations of polycystic ovary syndrome than follicle number per ovary

  • Shazia Afrine (Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University) ;
  • Jasmine Ara Haque (Ultrasound Division, National Institute of Nuclear Medicine and Allied Sciences) ;
  • Md Shahed Morshed (Department of Emergency, Kurmitola General Hospital) ;
  • Hurjahan Banu (Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University) ;
  • Ahmed Hossain (Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University) ;
  • Muhammad Abul Hasanat (Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University)
  • Received : 2023.01.25
  • Accepted : 2023.05.02
  • Published : 2023.09.30
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Abstract

Objective: Polycystic ovary (PCO), a diagnostic component of polycystic ovary syndrome (PCOS), requires either an ovarian volume (OV) criterion or a follicle number per ovary (FNPO) criterion. This study investigated the association of OV and FNPO criteria with various manifestations of PCOS. Methods: This cross-sectional study was conducted at a university hospital among 100 patients newly diagnosed with PCOS (according to the revised Rotterdam criteria). Fasting blood samples were collected to measure glucose, total testosterone (TT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), lipid, insulin, and hemoglobin A1c levels. An oral glucose tolerance test was performed. Transabdominal or transvaginal ultrasound of the ovaries was done, depending on patients' marital status. All investigations were conducted in the follicular phase of the menstrual cycle. OV >10 mL and/or FNPO ≥12 indicated PCO. A homeostasis model assessment of insulin resistance (IR) value ≥2.6 indicated IR, and metabolic syndrome (MS) was defined according to the international harmonization criteria. Results: Seventy-six participants fulfilled the OV criterion, 70 fulfilled the FNPO criterion, and 89 overall had PCO. Both maximum OV and mean OV had a significant correlation with TT levels (r=0.239, p=0.017 and r=0.280, p=0.005, respectively) and the LH/FSH ratio (r=0.212, p=0.034 and r=0.200, p=0.047, respectively). Mean OV also had a significant correlation with fasting insulin levels (r=0.210, p=0.036). Multivariate binary logistic regression analysis showed that IR (odds ratio [OR], 9.429; 95% confidence interval [CI], 1.701 to 52.271; p=0.010) and MS (OR, 7.952; 95% CI, 1.821 to 34.731; p=0.006) had significant predictive associations with OV alone, even after adjustment for age and body mass index. Conclusion: OV may be more closely related to the androgenic and metabolic characteristics of PCOS than FNPO.

Keywords

Acknowledgement

We are grateful to the Department of Microbiology and Immunology and the Department of Biochemistry and Molecular Biology of Bangabandhu Sheikh Mujib Medical University for their technical support.

References

  1. Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2016;31:2841-55. https://doi.org/10.1093/humrep/dew218
  2. Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014;20:334-52. https://doi.org/10.1093/humupd/dmt061
  3. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018;33:1602-18. https://doi.org/10.1093/humrep/dey256
  4. Adams JM, Taylor AE, Crowley WF Jr, Hall JE. Polycystic ovarian morphology with regular ovulatory cycles: insights into the pathophysiology of polycystic ovarian syndrome. J Clin Endocrinol Metab 2004;89:4343-50. https://doi.org/10.1210/jc.2003-031600
  5. Palaniappan M, Menon B, Menon KM. Stimulatory effect of insulin on theca-interstitial cell proliferation and cell cycle regulatory proteins through MTORC1 dependent pathway. Mol Cell Endocrinol 2013;366:81-9. https://doi.org/10.1016/j.mce.2012.12.004
  6. Morshed MS, Banu H, Akhtar N, Sultana T, Begum A, Zamilla M, et al. Luteinizing hormone to follicle-stimulating hormone ratio significantly correlates with androgen level and manifestations are more frequent with hyperandrogenemia in women with polycystic ovary syndrome. J Endocrinol Metab 2021;11:14-21. https://doi.org/10.14740/jem716
  7. Vanden Brink H, Pea J, Lujan ME. Ultrasonographic features of ovarian morphology capture nutritional and metabolic influences on the reproductive axis: implications for biomarker development in ovulatory disorders. Curr Opin Biotechnol 2021;70:42-7. https://doi.org/10.1016/j.copbio.2020.10.008
  8. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25. https://doi.org/10.1016/j.fertnstert.2003.10.004
  9. Bhowmik B, Siddiquee T, Mujumder A, Rajib MM, Das CK, Khan MI, et al. Identifying insulin resistance by fasting blood samples in Bangladeshi population with normal blood glucose. J Diabetol 2016;7:4.
  10. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644
  11. Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J Clin Endocrinol Metab 2005;90:2571-9. https://doi.org/10.1210/jc.2004-0219
  12. Carmina E, Orio F, Palomba S, Longo RA, Lombardi G, Lobo RA. Ovarian size and blood flow in women with polycystic ovary syndrome and their correlations with endocrine parameters. Fertil Steril 2005;84:413-9. https://doi.org/10.1016/j.fertnstert.2004.12.061
  13. Hong SH, Sung YA, Hong YS, Jeong K, Chung H, Lee H. Polycystic ovary morphology is associated with insulin resistance in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2017;87:375-80. https://doi.org/10.1111/cen.13380
  14. Ahmed S, Pahwa S, Das CJ, Mir FA, Nisar S, Jehangir M, et al. Comparative evaluation of sonographic ovarian morphology of Indian women with polycystic ovary syndrome versus those of normal women. Indian J Endocrinol Metab 2014;18:180-4. https://doi.org/10.4103/2230-8210.129108
  15. Shi Y, Gao X, Sun X, Zhang P, Chen Z. Clinical and metabolic characteristics of polycystic ovary syndrome without polycystic ovary: a pilot study on Chinese women. Fertil Steril 2008;90:1139-43. https://doi.org/10.1016/j.fertnstert.2007.07.1375
  16. Inan C, Karadag C. Correlation between ovarian morphology and biochemical and hormonal parameters in polycystic ovary syndrome. Pak J Med Sci 2016;32:742-5. https://doi.org/10.12669/pjms.323.10082
  17. Schmidt TH, Khanijow K, Cedars MI, Huddleston H, Pasch L, Wang ET, et al. Cutaneous findings and systemic associations in women with polycystic ovary syndrome. JAMA Dermatol 2016;152:391-8. https://doi.org/10.1001/jamadermatol.2015.4498
  18. Le NS, Le MT, Nguyen ND, Tran NQ, Nguyen QH, Cao TN. A cross-sectional study on potential ovarian volume and related factors in women with polycystic ovary syndrome from infertile couples. Int J Womens Health 2021;13:793-801. https://doi.org/10.2147/IJWH.S329082
  19. Chun S. Serum luteinizing hormone level and luteinizing hormone/follicle-stimulating hormone ratio but not serum anti-Mullerian hormone level is related to ovarian volume in Korean women with polycystic ovary syndrome. Clin Exp Reprod Med 2014;41:86-91. https://doi.org/10.5653/cerm.2014.41.2.86
  20. van der Westhuizen S, van der Spuy ZM. Ovarian morphology as a predictor of hormonal values in polycystic ovary syndrome. Ultrasound Obstet Gynecol 1996;7:335-41. https://doi.org/10.1046/j.1469-0705.1996.07050335.x
  21. Reid SP, Kao CN, Pasch L, Shinkai K, Cedars MI, Huddleston HG. Ovarian morphology is associated with insulin resistance in women with polycystic ovary syndrome: a cross sectional study. Fertil Res Pract 2017;3:8.
  22. Sipahi M, Tokgoz VY, Keskin O, Atasever M, Mentese A, Demir S. Is ovarian volume a good predictor to determine metabolic syndrome development in polycystic ovary patients. J Obstet Gynaecol 2019;39:372-6. https://doi.org/10.1080/01443615.2018.1522530
  23. Bahri Khomami M, Ramezani Tehrani F, Hashemi S, Mohammadi N, Rashidi H, Azizi F. Does the risk of metabolic disorders increase among women with polycystic ovary morphology?: a population-based study. Hum Reprod 2016;31:1339-46. https://doi.org/10.1093/humrep/dew071
  24. Christ JP, Vanden Brink H, Brooks ED, Pierson RA, Chizen DR, Lujan ME. Ultrasound features of polycystic ovaries relate to degree of reproductive and metabolic disturbance in polycystic ovary syndrome. Fertil Steril 2015;103:787-94.  https://doi.org/10.1016/j.fertnstert.2014.12.094