The physiological sonographic features of the ovary in healthy subjects: a joint systematic review and meta-analysis by the Italian Society of Gynecology and Obstetrics (SIGO) and the Italian Society of Endocrinology (SIE)

PURPOSE

There is a lack of uniformity in the definition of normal ovary ultrasound parameters. Our aim was to summarize and meta-analyze the evidence on the topic. Full-text English articles published through December 31, 2020 were retrieved via MEDLINE and Embase. Data available for meta-analysis included: ovarian follicular count, ovarian volume, and ovarian Pulsatility Index (PI) assessed by Doppler ultrasound.

METHODS

Cohort, cross-sectional, prospective studies with a single or double arm were considered eligible. Interventional studies were included when providing baseline data. Both studies on pre- and post-menopausal women were screened; however, data on menopausal women were not sufficient to perform a meta-analysis. Studies on pre-pubertal girls were considered separately. Eighty-one papers were included in the meta-analysis.

RESULTS

The mean ovarian volume was 6.11 [5.81-6.42] ml in healthy women in reproductive age (5.81-6.42) and 1.67 ml [1.02-2.32] in pre-pubertal girls. In reproductive age, the mean follicular count was 8.04 [7.26-8.82] when calculated in the whole ovary and 5.88 [5.20-6.56] in an ovarian section, and the mean ovarian PI was 1.86 [1.35-2.37]. Age and the frequency of the transducers partly modulated these values. In particular, the 25-30-year group showed the higher mean follicular count (9.27 [7.71-10.82]), followed by a progressive age-related reduction (5.67 [2.23-9.12] in fertile women > 35 years). A significant difference in follicular count was also found according to the transducer's upper MHz limit.

CONCLUSION

Our findings provide a significant input to improve the interpretation and diagnostic accuracy of ovarian ultrasound parameters in different physiological and pathological settings.

Analysis of the effect of hashimoto's thyroiditis and insulin resistance on ovarian volume in patients with polycystic ovary syndrome

OBJECTIVE

In this study, patients were divided into two groups. Patients with polycystic ovary syndrome (PCOS) and patients with polycystic ovary syndrome + Hashimoto's Thyroid (PCOS + HT). The effect of insulin resistance on ovarian volume in patients divided into two groups and the change in ovarian volume with the addition of HT to PCOS will be investigated.

MATERIAL AND METHODS

46 PCOS patients and 46 PCOS patients diagnosed with HT were included in this study. A detailed medical history was taken from all participants. Polycystic ovary image was evaluated as below or above 10 ml and antral follicles were counted by transvaginal ultrasound. Insulin resistance of the patients was evaluated according to the fasting insulin (HOMA) index.

RESULTS

Insulin resistance was found to be associated with fasting insulin, HOMA index, body mass index and right ovarian volume in patients diagnosed with PCOS. Among the patients diagnosed with PCOS + HT, insulin resistance was found to be significantly correlated with fasting insulin, HOMA index, (BMI), (SHBG) and left ovarian volume. An increase in right ovarian volume was found in 37.5% of patients with PCOS without insulin resistance and in 76.3% of patients with insulin resistance. An increase in left ovarian volume was found in 35.7% of patients without insulin resistance diagnosed with PCOS + HT and in 68.8% of patients with insulin resistance.

CONCLUSIONS

This study shows that ovarian volume should be evaluated in every PCOS patient in order to predict insulin resistance, which causes long-term metabolic diseases, and that all PCOS patients with increased ovarian volume should be investigated for insulin resistance. In addition, it has been observed that insulin resistance affects left ovarian volume in patients with PCOS + HT, whereas insulin resistance affects the volume of the right ovary more in patients with PCOS. At least one ovary has been found to be affected by long-term metabolic diseases. While there was a greater increase in ovarian volume with the addition of insulin resistance, no significant change was observed in the number of patients with increased ovarian volume (PCOS-58, PCOS + HT-57) with the addition of HT finding.

Ovarian volume partially explains associations of phthalate biomarkers with anti-Müllerian hormone and estradiol in midlife women

BACKGROUND/OBJECTIVES

Women are ubiquitously exposed to endocrine disruptors, including phthalates. Ovarian follicles undergoing folliculogenesis (indirectly measured by ovarian volume) produce anti-Müllerian hormone (AMH) and estradiol (E2). We evaluated associations of phthalates with ovarian volume to assess whether this explained prior positive associations of phthalates with AMH and E2.

METHODS

Women ages 45-54 years (n = 614) had transvaginal ultrasounds of right/left ovaries to calculate mean ovarian volume. Women provided up-to-four urine and blood samples for quantifying AMH (first serum sample), E2 (all serum samples), and nine phthalate metabolites (from pooled urine, representing six parent phthalates). Multivariable linear or logistic regression models (for individual phthalate biomarkers), as well as weighted quantile sum (WQS) regression (for mixture analyses) evaluated associations of phthalate biomarkers with ovarian volume. Using cross-sectional mediation analysis, we assessed whether associations of phthalates with ovarian volume partially explained those of phthalates with AMH or E2.

RESULTS

Most women were non-Hispanic White (68%) and pre-menopausal (67%) with higher urinary phthalate metabolite concentrations than U.S. women. In single-pollutant models, 10% increases in mono(3-carboxypropyl) phthalate (MCPP) and monobenzyl phthalate (MBzP) were associated with 0.44% (95% CI: -0.02%, 0.91%) and 0.62% (95% CI: 0.02%, 1.23%) larger ovarian volumes, respectively. As a cumulative mixture, 10% increases in the phthalate mixture were associated with 2.89% larger ovarian volume (95%CI: 0.27, 5.59) with MCPP (35%) and MBzP (41%) identified as major contributors. Higher ovarian volume due to a 10% increase in MBzP (indirect effect OR: 1.004; 95% CI: 1.00, 1.01) explained 16% of the positive association between MBzP and higher AMH, whereas higher ovarian volume due to a 10% increase in MCPP (indirect effect %Δ: 0.11; 95% CI: -0.01, 0.22) explained 23% of the positive association between MCPP and E2.

CONCLUSION

In this cross-sectional study, phthalates were associated with increased ovarian volume, with implications for midlife hormone production.

The effect of subclinical hypothyroidism on ovarian volume in prepubertal girls

OBJECTIVE

Enlargement and cystic changes in ovaries of patients with long-standing overt hypothyroidism have been described in numerous case reports. However, there are limited data about the effect of subclinical hypothyroidism (SH) on ovarian volume. The aim of the study is to evaluate the relationship between serum thyroid stimulating hormone (TSH) level and ovarian volume in prepubertal girls with SH.

METHODS

Patients who were aged between 6 and 10 years and diagnosed with SH and age-matched healthy euthyroid controls were enrolled in the study. All subjects were prepubertal.

RESULTS

Thirty-five children with SH (mean age; 7.6±1.0 years) and 50 euthyroid healthy girls (mean age; 7.7±1.2 years) were enrolled in the study. TSH and LH levels and both ovarian volumes were significantly higher in SH group than controls (p<0.05). In addition, TSH was positively correlated with ovarian volumes and LH in patients with SH (p<0.05).

CONCLUSION

The results of this study showed that ovarian volumes of prepubertal girls with SH were significantly greater than those with normal thyroid function. Although ovarian enlargement and cyst formation is well recognized in long-standing overt hypothyroidism, it has been shown for the 1^st time in patients with SH.

Ovarian volume, not follicle count, is independently associated with androgens in patients with polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is diagnosed based on chronic anovulation, androgen excess (clinical and/or biochemical), and polycystic ovaries in ultrasound. The aim of the present study was to evaluate which parameters in the transvaginal ultrasound (TVUS) of ovaries could be better associated with concurrent hormonal imbalance in the women with PCOS.

METHODS

Using a cross-sectional design, this study focused on 61 subjects (18-40 years) with PCOS. Patients were recruited at three academic hospitals during the 2017-2019 period. PCOS was defined according to the Rotterdam criteria. The association of ovarian morphology with hormonal and metabolic feature was investigated using linear regression models, adjusted for a set of possible confounding variables including age, mensuration status and body mass index (BMI).

RESULTS

The mean volume of both ovaries was positively associated with the total testosterone level (β = 0.025, P value < 0.001), free androgen index (β = 0.041, P value < 0.001) and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio (β = 0.032, P value = 0.004), even after adjustments made for age, mensuration status and BMI (fully-adjusted model). In contrast, in the fully-adjusted model, antral follicle count (AFC), follicle number per ovary (FNPO), ovarian area, stromal area, and ratio of stromal area to ovarian area (S/A) were not associated with androgen levels and LH/FSH ratio. In addition, after full adjustments, ovarian volume, AFC, FNPO, ovarian area, stromal area and S/A were not associated with insulin resistance, which was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR).

CONCLUSION

Increased ovarian volume is, thus, highly predictive of hyperandrogenemia and high LH/FSH ratio in PCOS patients.

Ovarian volume as an independent marker for metabolic dysfunction in women with suspected androgen excess

Objective

To determine whether ovarian volume (OV) alone is an independent marker for metabolic dysfunction in women with suspected androgen excess.

Design

Retrospective cohort study.

Setting

Tertiary academic reproductive endocrinology clinic.

Patients

Women aged ≥21 years recruited/referred for symptoms related to androgen excess.

Interventions

Transvaginal ovarian ultrasound, physical and medical evaluation, 2-hour 75-g oral glucose tolerance test (oGTT), and blood sampling.

Main Outcome Measures

Prevalence of hyperandrogenism and metabolic dysfunction.

Results

This study included 666 women, of whom 412 (61.9%) and 254 had OVs of >10 and ≤10 mL, respectively. An OV of >10 mL was associated with a higher prevalence of hirsutism (65.1% vs. 51.5%) than an OV of ≤10 mL. Polycystic ovary syndrome by the National Institutes of Health 1990 criteria was found in 67.3% and 51.4% of women with OVs of >10 and ≤10 mL, respectively. Metabolic parameters, including body mass index, waist circumference, and 1-hour insulin levels during the oGTT (odds ratio, 1.98; 95% confidence interval, 1.18-3.31), were significantly higher in women with an OV of >10 mL than in those with an OV of ≤10 mL. An OV of ≤10 mL had a 76.3% negative predictive value for hyperinsulinemia at 1 hour.

Conclusions

In women with suspected androgen excess, an OV of >10 mL in at least 1 ovary is not associated with metabolic syndrome but is associated with younger age; an increased body mass index and waist circumference; a higher prevalence of hirsutism, oligoovulation, and polycystic ovary syndrome; and a higher 60-minute insulin level during the oGTT. Overall, an increased OV appears to be a good marker for hyperinsulinemia and hyperandrogenism in women suspected of having an androgen excess disorder.

Predictive performance of peritoneal fluid in the pouch of Douglas measured five days after oocyte pick-up in predicting severe late-onset OHSS: A secondary analysis of a randomized trial

OBJECTIVES

To investigate if the amount of peritoneal fluid (PF) in the Pouch of Douglas at oocyte pick-up (OPU) or OPU + 5 days predict severe late-onset ovarian hyperstimulation syndrome (OHSS) in women undergoing ovarian stimulation for assisted reproductive technology (ART).

STUDY DESIGN

A secondary analysis of a dual-centre RCT on 1050 women referred for their first ART treatment in two public fertility clinics in Denmark and randomized 1:1 to GnRH-antagonist or GnRH-agonist protocol. All women from the two arms who were examined on day of OPU and OPU + 5 days were included in this study (n = 940). The ability of PF in the pouch of Douglas to predict severe late-onset OHSS was assessed by multivariate logistic regression analyses and receiver operator characteristics (ROC) curve analyses and compared with other known predictors of OHSS. The final models were cross-validated by the leave-one-out method to assess the models' generalizability.

RESULTS

A total of 28 (3%) women developed severe late-onset OHSS. PF in the pouch of Douglas measured on OPU + 5 days predicted severe late-onset OHSS. The optimal cut-off value was 17.5 mm at OPU + 5 days with a 61% sensitivity and 71% specificity (Area under the curve = 0.70 95% CI 0.61-0.80). PF on the day of OPU was not predictive of late on-set OHSS as the adjusted multivariate logistic regression analyses showed insignificant results.

CONCLUSION

Although PF in the pouch of Douglas could predict late-onset severe OHSS, the low sensitivity underlines that it is not useful as a sole marker to decide whether to perform blastocyst transfer or to use a freeze-all strategy.

Evaluation of safety, feasibility and efficacy of intra-ovarian transplantation of autologous adipose derived mesenchymal stromal cells in idiopathic premature ovarian failure patients: non-randomized clinical trial, phase I, first in human

Background

Premature ovarian failure (POF) is characterized by the loss of ovarian activity before the age of 40 years. Stem cell therapy has the capability to create a regenerative microenvironment and is a proposed treatment for POF-related infertility due to the presence of renewal folliculogenesis and germ cells in the adult ovaries. In this study, we assessed the safety, feasibility, efficacy and dose adjustment of autologous adipose-derived stromal cells (ADSCs) and their ability to improve ovarian function in POF patients.

Methods

This study was a non-randomized clinical trial, phase I. Nine women with a definitive diagnosis of POF were divided into three groups (n = 3 per group) that received either 5 × 10⁶, 10 × 10⁶, or 15 × 10⁶ autologous ADSCs suspension transplanted in the one ovary. Participants were followed-up at 24 h after the transplantation, and at 1 and 2 weeks, and 1, 2, 3, 6, and 12 months after the transplantation. The primary objective was to evaluate the safety of ADSCs transplantation. Secondary objectives included the effects of ADSCs transplantation on the resumption of menstruation, hormones level (Follicle-stimulating hormone (FSH) and anti-Müllerian hormone), ovarian function (Antral follicle count and ovary volume by ultrasonography evaluation) as well as dose escalation.

Results

Participants had not shown any early-onset possible side effects and secondary complications during follow-up. The menstruation resumption was observed in four patients which established for several months. In the 15 × 10⁶ group, two POF patients had a return of menstruation second months after the intervention. Two other POF patients in 5 × 10⁶ and 10 × 10⁶ cell groups reported menstruation resumption at 1 month after the intervention. We observed decreased serum FSH levels of less than 25 IU/l in four patients. In two patients in 5 × 10⁶ and 10 × 10⁶ cell groups, serum FSH showed an inconsistent decline during a 1 year follow up after ADSCs transplantation. The ovarian volume, AMH, and AFC were variable during the follow-up and no significant differences between cell groups (p > 0.05).

Conclusions

We showed the intra-ovarian embedding of ADSCs is safe and feasible and is associated with an inconsistent decline in serum FSH. This should be further investigated with a large RCT.

Trial registration

NCT02603744, Registered 13 November 2015 - Retrospectively registered, http://www.Clinicaltrials.gov

Ovarian volume ratio is a reliable predictor of ovarian torsion in girls without an adnexal mass

PURPOSE

The aims of this study were to identify ultrasound-based predictors of ovarian torsion in girls without an adnexal mass and establish a set of normal values for ovarian volume ratio (OVR).

METHODS

A retrospective review was performed of all premenarchal patients ≥3 years of age with a normal pelvic ultrasound between January 2016 and January 2019. A comparison group of premenarchal girls presenting between 2011 and 2019 with torsion in the absence of an adnexal mass was utilized.

RESULTS

Five-hundred and four premenarchal girls underwent pelvic ultrasound evaluation with a normal examination. The mean OVR was 1.6 ± 0.7 (range 1.0-6.5). OVR did not vary with age (r = -0.06) as compared to ovarian width which increased steadily with age (r = 0.53, p < 0.001). OVR was increased in girls with torsion (7.6 vs 1.4, p < 0.0001), and by receiver operating characteristic (ROC) analysis a cutoff value of >2.5 demonstrated the best diagnostic accuracy of any predictive variable (sensitivity 100%, specificity 94%, AUC 0.991, p < 0.001).

CONCLUSIONS

OVR is an excellent predictor of ovarian torsion in premenarchal girls without an adnexal mass. Unlike ovarian width, OVR does not increase with age, and a cutoff OVR > 2.5 demonstrates high sensitivity and specificity for identifying ovarian torsion in this population.

TYPE OF STUDY

Study of diagnostic test.

LEVEL OF EVIDENCE

Level III.

Compensatory Ovarian Hypertrophy after Unilateral Oophorectomy: Evaluation of Ovarian Volumes in Pediatric and Adolescent Populations

STUDY OBJECTIVE

Limited data exist on the morphologic and physiologic effect on the remaining ovary after unilateral oophorectomy, especially in the pediatric population. Our aim is to evaluate ovarian volumes following unilateral oophorectomy to determine whether compensatory ovarian hypertrophy occurs in the remaining contralateral ovary.

DESIGN

This was a retrospective chart review of ovarian volume measured on ultrasounds that were completed after unilateral oophorectomy. Postoperative ovarian volumes were compared to established radiologic standards.

SETTING

Large tertiary care academic children's hospital in Atlanta, GA.

PARTICIPANTS

Female patients less than 21 years old who underwent unilateral oophorectomy.

MAIN OUTCOME MEASURES

Ovarian volumes measured on postoperative ultrasounds.

RESULTS

A total of 93 patients met inclusion criteria for this study. Serial ultrasounds were performed in slightly more than half of the patients (n = 48, 51.6%), totaling 193 postoperative ovarian volumes. The average age of oophorectomy was 10.8 years. Prior to surgery, the majority of patients presented with abdominal pain (n = 51, 54.8%) or pelvic mass (n = 51, 54.8%), and most (n = 77, 82.8%) had benign final pathology. Ovarian volumes were compared to 4 published radiologic ultrasound standards. More than 62.2% of ovarian volumes from girls who had previously had unilateral oophorectomy were larger than age-matched standard ovarian volumes.

CONCLUSION

Ovarian enlargement occurs in the contralateral ovary following unilateral oophorectomy in the pediatric and adolescent population. This supports the concept of compensatory ovarian hypertrophy. This knowledge provides valuable information for interpretation of radiologic images in young female individuals who have undergone oophorectomy, and can assist with counseling on the risk of adnexal complications due to ovarian hypertrophy after unilateral oophorectomy.

Assessing the Usefulness of Severity Markers in Women with Ovarian Hyperstimulation Syndrome

The present study aims to assess the usefulness of severity markers in women with ovarian hyperstimulation syndrome (OHSS). An observational study was designed including 76 women with varying degrees of severity of OHSS. Clinical history, physical examination, laboratory tests, and ultrasound measurement of the ovarian size and ascites index were carried out in all patients. Intra-abdominal pressure (IAP) was measured using an intravesical Foley Manometer catheter. Ascites index and ovarian volume increased progressively being highest in the most severe stage of OHSS. The median IAP in mild OHSS was found to be lower than that in the moderate and severe OHSS (4.0 mm, 12 mm, and 16.0 mm, respectively). Critical cases of OHSS presented the highest IAP (25.0 mm). IAP did not reach the level of intra-abdominal hypertension in mild OHSS, whereas moderate and severe OHSS was associated with intra-abdominal hypertension grade I and grade II-III, respectively. Values of IAP in critical OHSS were found similar to those observed in abdominal compartment syndrome patients. The IAP showed a strong positive correlation with ovarian volume and ascites index. The reduction of IAP after paracentesis was greater among critical OHSS patients. The ovarian volume and the level of intra-abdominal hypertension are related to the severity of OHSS and are of particular importance in the initialization of the syndrome. Ascites index is simple and convenient and can serve as an indirect marker of the abdominal reserve volume. In conjunction with clinical and laboratory data, ascites index and IAP values might be indicators for paracentesis.

Role of 3-D Transvaginal Ultrasonography in Women Undergoing in Vitro Fertilization/Intra-cytoplasmic Sperm Injection

Both 2-D and 3-D transvaginal ultrasonography are effective imaging modalities for assessment of ovarian reserve. Our aim was to compare both modalities in assessment of ovarian reserve of women undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). Fifty women were scheduled according to their menstrual cycle to be examined by both 2-D and 3-D transvaginal ultrasonography. We found that the average time for computerized analysis of the 3-D ultrasound data was significantly shorter than that for analysis of the 2-D ultrasound data, for both total antral follicle count and ovarian volume. However, there were no statistically significant differences between the methods in total antral follicle count and ovarian volume. We conclude that, where available, 3-D ultrasonography can be used for assessment of ovarian reserve in addition to the biochemical marker, particularly in overcrowded in vitro fertilization centers that need to save time.

Evaluation of ovarian volume by transrectal ultrasonography in cattle; affect of the day of the estrous cycle and validation of a method of subtracting of corpora lutea and follicle volume

This research was conducted to evaluate a method for determining ovarian volume using ultrasonography; specifically, how the day of the estrous cycle affected ovarian volume, and the application of a formula for adjusted ovarian volume (ADJ VOL) and its relationship to actual ovarian volume. Cows (n = 22) were estrous synchronized and subjected to serial transrectal ultrasonographic evaluations, performed every 48 h from the day prior to ovulation until day 9 of the subsequent estrous cycle. Measurements obtained from recorded ultrasonographic images were used to determine actual ovarian volume cm³ = [0.523 X (D1 X D2 X D3)] and adjusted ovarian volume (ADJ VOL) cm³ = [0.523 X (D1 X D2 X D3)]- 43 (πrCL²) - 43 (πrF²) on days 1, 3, 5, 7, 9 of the estrous cycle. A third objective was to evaluate the concordance correlation coefficient (ρc) between post-mortem ovarian measurements and the water displacement test. Ovarian volume increased with each day of the estrous cycle from Day 1 to Day 7. Day of the estrous cycle affected ovarian volume (P <  0.001). When applying the formula for ADJ VOL, there was not an effect of day of the estrous cycle (P  = 0.509). Ovarian volume, results ex-vivo, were very consistent with the displacement volume results (ρ_c = 0.942). If large ovarian structures are present, and the day of the estrous cycle is unknown, then the formula for ADJ VOL can be used to estimate ovarian volume on Day 1 of the estrous cycle.

Analysis of ovarian volume of Korean children and adolescents at magnetic resonance imaging

BACKGROUND

Knowledge of ovarian volume is important for diagnostic evaluations; however, normal ovarian volume studies on children and adolescents are lacking.

OBJECTIVE

This study aimed to analyze age-specific ovarian volume and identify the diverse factors that contribute to ovarian diagnoses.

MATERIALS AND METHODS

We retrospectively enrolled 180 patients (0-18 years of age) with normal ovaries who underwent magnetic resonance imaging (MRI) between 2010 and 2018. MRI sequences included coronal and axial T2-weighted turbo spin echo (TSE) images and coronal T1-weighted TSE images. Ovarian volume was calculated by the standard ellipsoid formula. Age-specific ovarian volume, height, weight, height-adjusted total ovarian volume and body mass index were obtained. Linear regression analysis was used to predict ovarian volume.

RESULTS

Six age groups (infant; early and late child, and early, middle and late adolescent) were described. The early adolescent group (10-12 years) had the highest rate of increase. In the middle adolescent period (13-15 years), the curve of ovarian volume appeared flat.

CONCLUSION

Our findings provide age-specific references for ovarian volume.

Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

STUDY OBJECTIVE

Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative.

STUDY DESIGN

Prospective, randomized clinical trial (Canadian Task Force classification I).

SETTING

University maternity hospital.

PATIENTS

Women diagnosed with unilateral or bilateral ovarian endometriomas.

INTERVENTIONS

Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing.

MEASUREMENTS AND MAIN RESULTS

A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2.

CONCLUSION

Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.

2D and 3D Trans-vaginal Sonography to Determine Cut-offs for Ovarian Volume and Follicle Number per Ovary for Diagnosis of Polycystic Ovary Syndrome in Indian Women

BACKGROUND

The purpose of the study was to determine cut-off values for ovarian volume (OV) and follicle number per ovary (FNPO) in Indian women with polycystic ovary syndrome (PCOS).

METHODS

Eighty six PCOS women (Rotterdam criteria) and forty five matched ovulatory and normo-androgenic women were recruited. A detailed 2D and 3D trans-vaginal scan was carried out in early follicular phase (D2-D5) in all patients. Ovarian volume, follicle number per ovary, stromal volume, vascularization index (VI), vascularization flow index (VFI) and flow index (FI) were measured in PCOS and controls. Mann-Whitney test and logistic analysis using PROC LOGISTIC function of SAS^® (Version 9.3) were used to calculate the best cut-offs for the diagnosis of PCOS.

RESULTS

Mean ovarian volume was 13.7±5.89 and 5.06±2.44 (p<0.0001), FNPO was 19.18±6.89 and 7.13±3.51 (p<0.0001) in PCOS and controls, respectively. The cut-offs for the diagnosis of PCOS were 2D OV=6.15 cm³, 2D FNPO=12. By 3D scan, OV=7 cm³, FNPO=10, stromal volume=6 cm³, VI=4.546, VFI=2.925 and FI= 19.266. Youden's Index (To select optimal predicted probability cut-off) was the highest for 2D FNPO (0.88786). 2D FNPO showed the highest specificity and sensitivity (AUC), 0.95238 and 0.93548, for the diagnostic accuracy of PCOS.

CONCLUSION

2D and 3D trans-vaginal scans are equally accurate for assessment of ovarian morphology. FNPO has better diagnostic accuracy for PCOS compared to ovarian volume. Cut-off for FNPO and OV in Indian PCOS women is 12 and 6.15 cm³ by 2D, 10 and 7 cm³ by 3D trans-vaginal scan.

Ovarian morphology is associated with insulin resistance in women with polycystic ovary syndrome: a cross sectional study

Background

Polycystic ovary syndrome (PCOS) is a very common disorder well known to be associated with insulin resistance and metabolic disease. Insulin resistance is likely involved in the promotion of the PCOS reproductive phenotype and may mediate some of the ovarian morphology seen in the disorder. The phenotype of each individual woman with PCOS can vary widely as can her metabolic risk.

Methods

This is a cross-sectional study of patients seen in a multidisciplinary PCOS clinic at the University of California at San Francisco between 2006 and 2014.

All participants underwent systematic evaluation with anthropometric measurements, comprehensive skin exam, transvaginal ultrasound and laboratory studies at the time of their initial visit to the clinic. Serum samples were stored and androgen studies were carried out on all stored samples at the University of Virginia. Logistic regression was employed to evaluate the association between ovarian volume or follicle number and metabolic parameters (fasting insulin, HOMA-IR, fasting glucose, 2 h glucose, waist circumference) and hyperandrogenism (free testosterone, total testosterone, DHEAS, acanthosis nigricans), controlling for age.

Results

Three-hundred thirteen patients seen during the study period met Rotterdam criteria for PCOS and had sufficient measurements for inclusion in our analysis. The odds ratio of elevated HOMA-IR for patients with a maximum ovarian volume >10 cc was 1.9 compared to those with a maximum ovarian volume of ≤10 cc (95% CI 1.0–3.4). The odds ratio of abnormal fasting insulin for patients with higher ovarian volume was 1.8 (95% CI 1.0–3.4) compared with those with lower ovarian volume. Follicle number was not significantly associated with any metabolic parameters.

Conclusions

Increased ovarian volume is associated with markers of insulin resistance in PCOS. In concordance with prior studies, we did not find follicle number to be predictive of metabolic risk. Ovarian volume may serve as a useful tool to aid clinicians in their risk stratification and counseling of patients with PCOS.

Thyroperoxidase antibodies and polycystic ovarian morphology

OBJECTIVE

To evaluate the association between polycystic ovarian morphology (PCOM) and thyroperoxidase antibody level.

METHODS

A cross-sectional study was undertaken of women aged 15-49years living in one of four provinces in Iran recruited between February 2009 and November 2010. Eligible women did not have hirsutism and were eumenorrheic. All participants underwent a comprehensive interview, clinical examination, blood sampling, and ultrasonographic assessment. The serum concentration of thyroperoxidase antibodies was compared between women with and without PCOM.

RESULTS

Among 491 participants, 74 (15.1%) had PCOM. In total, 11 (14.9%) women with PCOM and 61 (14.6%) women with normal morphology tested positive for thyroperoxidase antibodies. The serum concentration of thyroperoxidase antibodies was higher among women with PCOM (48.45±135.74IU/mL) than among those with normal ovarian morphology (37.99±96.49IU/mL), but the difference was not significant (P=0.42).

CONCLUSION

Thyroperoxidase antibody levels were higher in Iranian women with PCOM than in women with normal morphology, although the difference was not significant. Larger longitudinal studies are needed to investigate whether the treatment of thyroid disorders can prevent the development of PCOM.

The Passo Fundo Cohort Study: design of a population-based observational study of women in premenopause, menopausal transition, and postmenopause

BACKGROUND

The Passo Fundo Cohort Study (PFS) is a population-based longitudinal observational study of pre-, peri-, and postmenopausal women that has been ongoing since 1995 in Passo Fundo, a city in southern Brazil. This paper describes the rationale and design of the PFS and summarizes objectives and procedures that have been updated during follow-up.

METHODS/DESIGN

Women in the PFS have been followed for a variety of diseases that are frequent in menopause. Sampling was conducted in 154 randomly selected census divisions (geographical subdivisions of the city as defined by the Brazilian Institute of Geography and Statistics). One block in each census division was chosen by lot and two women were randomly selected for interview in each block. The first cycle, conducted between 1995 and 1997, included a representative sample of 298 women aged 35 to 55 years. In the second cycle, conducted between 2001 and 2002, additional participants were enrolled based on the same sampling strategy used in 1995, for a final sample of 358 women. In 2010, a third follow-up was initiated, when all 358 participants or their relatives were located. Participants completed a standardized questionnaire on demographic and socioeconomic characteristics. They also answered questions about lifestyle, medical and reproductive characteristics, sexual life, hormone therapy and mental aspects by using validated instruments. Physical activity was assessed and anthropometric measurements, blood sampling and pelvic ultrasound examination were performed. In the third cycle, bone mineral density by dual-energy X-ray absorptiometry and abdominal fat and coronary artery calcium score by computed tomography were also determined.

DISCUSSION

The study findings provide relevant information to evaluate the association between menopausal status, female aging and the risk of cardiovascular diseases, and bone health aspects in a representative sample of women from southern Brazil.

Intraindividual right-left comparison of sonographic features in polycystic ovary syndrome (PCOS) diagnosis

OBJECTIVE

Sonographic features of polycystic ovaries consist of elevated antral follicle count or ovarian volume of at least one ovary. The aim of this prospective cross-sectional study was to estimate intraindividual differences in sonographic measurements between the both ovaries of PCOS patients and controls and clinical consequences.

STUDY DESIGN

Both ovaries of 85 PCOS patients and 48 controls were scanned transvaginally and agreement of sonographic measurements was analyzed using the Bland-Altman method. Concordance correlation coefficients (CCC) were computed.

RESULTS

Mean differences between right and left ovaries were 0.24 (95% confidence interval [95% CI]: -0.32-0.80) follicles for AFC and 1.14 (95% CI: 0.34-1.92)ml for OV in the whole study population, 0.14 (95% CI: -0.68-0.96) follicles for AFC and 1.48 (95% CI: 0.39-2.58)ml for OV in PCOS patients, 0.42 (95% CI: -0.19-1.02) follicles for AFC and 0.53 (95% CI: -0.50-1.56)ml for OV in controls. Rather wide limits of agreement and low CCCs (<0.7 for all estimates) indicated poor agreement between the ovaries for both sonographic measurements. Width between lower and upper limits of agreement was higher for PCOS patients than for controls. 23.5% of the PCOS patients showed polycystic ovarian morphology (PCOM) only in one ovary, resulting in 9.4% potentially missed PCOS diagnosis according to the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.

CONCLUSION

Substantial differences in antral follicle count and ovarian volume between the right and left ovary were observed. In approximately 10% of the PCOS patients in our study only the examination of both ovaries has led to a reliable diagnosis of PCOS. In clinical practice it is recommended to scan both ovaries for a reliable diagnosis of abnormal sonographic findings in PCOM and PCOS diagnosis.

Serum luteinizing hormone level and luteinizing hormone/follicle-stimulating hormone ratio but not serum anti-Müllerian hormone level is related to ovarian volume in Korean women with polycystic ovary syndrome

Objective

The aim of the present study was to investigate the relationship between ovarian follicle count and volume on ultrasonography and serum hormone levels including the levels of the anti-Müllerian hormone (AMH) and gonadotropin in women with the polycystic ovary syndrome (PCOS).

Methods

A total of 118 Korean women aged 18-35 years who were newly diagnosed with PCOS at a university hospital were included in this study. Serum LH, FSH, and AMH levels were measured in the early follicular phase, and the total antral follicle count (TFC) and the total ovarian volume (TOV) were assessed by ultrasonography. The correlations between serum hormonal parameters and ultrasonography characteristics in women with PCOS were evaluated using Pearson's correlation coefficients and a linear regression analysis.

Results

Serum AMH levels were significantly correlated with serum LH levels and LH/FSH ratios, and TFC and TOV were significantly correlated with each other on ultrasonography. Serum AMH and LH levels and the LH/FSH ratio were significantly correlated with TFC. Statistically significant correlations between TOV and the LH level (r=0.208, p=0.024) and the LH/FSH ratio (r=0.237, p=0.010) were observed. However, the serum AMH level was not significantly correlated with the ovarian volume, and this result did not change after adjusting for age and body mass index.

Conclusion

Serum AMH is not related to the ovarian volume in women with PCOS. My results suggest that serum LH level and the LH/FSH ratio may be more useful than the serum AMH level for representing the status of the ovarian volume in women with PCOS.

Evaluation of the ovarian reserve function in patients with metabolic syndrome in relation to healthy controls and different age groups

OBJECTIVE

To evaluate the ovarian reserve function in female patients with metabolic syndrome (MetS).

METHODS

This study evaluated 136 subjects, 67 with MetS and 69 controls. Subjects were divided into three age groups. Group I included 49 subjects aged 20-29 years, 22 with MetS and 27 controls; group II included 45 subjects aged 30-39 years, 22 with MetS and 23 controls; and group III included 42 subjects aged 40-49 years, 23 with MetS and 19 controls. Demographic characteristics, anthropometrics, blood biochemistry, and gonadotrophic hormones were compared as total ovarian volume and antral follicle count on ovarian transvaginal ultrasonography.

RESULTS

Serum levels of FSH, LH, E2 and progesterone were similar in the MetS and control groups, while testosterone levels were significantly higher in MetS patients than controls, both in the overall population (p = 0.024) and in those aged 20-29 years (p = 0.018). Total ovarian volume was significantly lower in MetS patients than controls, in both the overall population (p = 0.003) and those aged 20-29 years (p = 0.018), while antral follicle counts were similar. Ovarian volume correlated positively with antral follicle count (AFC) (r = 0.37; p < 0.001) and negatively with age (r = 0.34; p < 0.001) and FSH concentration (r = 0.21; p = 0.013). AFC was negatively correlated with age (r = 0.36; p < 0.001).

CONCLUSION

Ovarian reserve function is significantly lower in MetS patients than in healthy control subjects, particularly in women aged 20-29 years.

The association of bisphenol-A urinary concentrations with antral follicle counts and other measures of ovarian reserve in women undergoing infertility treatments

In this prospective cohort of women undergoing infertility treatments, we measured specific-gravity adjusted urinary BPA (SG-BPA) concentrations and used regression models to evaluate the association of BPA with antral follicle count (AFC), day-3 serum follicle stimulating hormone levels (FSH), and ovarian volume (OV). BPA, detected in >80% of women, had a geometric mean (±GSD) of 1.6±2.0, 1.7±2.1, and 1.5±1.8μg/L for the women contributing to the AFC (n=154), day-3 FSH (n=120), and OV (n=114) analyses, respectively. There was an average decrease in AFC of 12% (95% CI: -23%, -0.6%), 22% (95% CI: -31%, -11%), and 17% (95% CI: -27%, -6%), in the 2nd, 3rd, and 4th SG-BPA quartile compared to the 1st quartile, respectively (p-trend: <0.001). No association of SG-BPA with FSH or OV was observed. Among women from an infertility clinic, higher urinary BPA concentrations were associated with lower AFC, raising concern for possible accelerated follicle loss and reproductive aging.