Exp Clin Endocrinol Diabetes 2006; 114(4): 175-181
DOI: 10.1055/s-2006-924063
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

The Combination of Increased Ovarian Volume and Follicle Number is Associated with More Severe Hyperandrogenism in German Women with Polycystic Ovary Syndrome

S. Hahn1 , W. Bering van Halteren2 , S. Roesler2 , M. Schmidt2 , R. Kimmig2 , S. Tan1 , K. Mann1 , O. E. Janssen1
  • 1Division of Endocrinology, Department of Medicine, University of Duisburg-Essen, Essen, Germany
  • 2Department of Obstetrics and Gynaecology, University of Duisburg-Essen, Essen, Germany
Further Information

Publication History

Received: September 22, 2005 First decision: October 27, 2005

Accepted: November 10, 2005

Publication Date:
17 May 2006 (online)

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, with a prevalence of 5 - 10 % depending on their ethnic background ([Asuncion et al., 2000]; [Azziz et al., 2004]). Recently, a controversy of the diagnostic criteria of PCOS has arisen. While both NIH ([Dunaif, 1997]) and Rotterdam ([Carmina, 2004]; [ESHRE/ASRM, 2004]) definitions exclude other pituitary, adrenal and ovarian pathologies, the 1990 NIH criteria include chronic anovulation and hyperandrogenism, but the 2003 Rotterdam consensus meeting introduced polycystic ovaries (PCO) as an additional third criterion, requiring two out of three to diagnose PCOS. To fulfill the new PCO criteria, either 12 or more follicles measuring 2 - 9 mm or an increased ovarian volume greater than 10 ml has to be found on ovarian ultrasound. In a recent survey, gynaecologists were more likely to express that PCO on ultrasound were essential for the diagnosis of PCOS than endocrinologists ([Cussons et al., 2005]). The difficulties in finding a common definition of PCOS reflect the heterogeneity of this syndrome. In addition, data about the significance of polycystic ovaries for endocrine and metabolic characteristics in PCOS women are conflicting. Some researchers found a correlation between ovarian morphology and parameters of insulin resistance ([Adams et al., 2004]; [Pache et al., 1993]), while others failed to find an association of PCO with metabolic risk factors and insulin resistance ([Legro et al., 2005]; [Michelmore et al., 1999]; [Norman et al., 1995]; [Raskauskiene et al., 2005]). In PCOS women presenting with PCO, significantly higher LH to FSH ratios have been described ([Herter et al., 1993]; [Legro et al., 2005]; [van der Westhuizen and van der Spuy, 1996]). In oligomenorrhoic women, ovarian volume as well as follicle number correlated with clinical and biochemical signs of hyperandrogenism ([Pache et al., 1993]). In healthy volunteers without hormonal contraception, testosterone concentrations were found to be significantly higher in women presenting with PCO ([Michelmore et al., 1999]). However, no impact on androgen levels and steroid hormones was detected by other study groups ([Najmabadi et al., 1997]).

The Rotterdam 2003 PCO definition ([Balen et al., 2003]) includes the two main features of PCO, namely an increased number of follicles and an indirect measure of stromal hypertrophy by ovarian volume. The influence of these two factors, either alone or in combination with menstrual cyclicity, clinical signs of hyperandrogenism and fertility is still unclear. Recent studies using the current PCO definition focused only on the biochemical endocrine and metabolic aspects of PCOS and failed to quantify the number of ovarian follicles and its impact on typical clinical PCOS features.

We conducted this study to evaluate the prevalence of PCO in German PCOS women and whether there are clinical and biochemical differences in PCOS with and without PCO. In addition, we were interested in the question whether volume or follicle number or its combination are associated with typical PCOS features like hyperandrogenism or metabolic disturbances.

References

  • 1 Adams J M, Taylor A E, Crowley Jr W F, Hall J E. Polycystic ovarian morphology with regular ovulatory cycles: insights into the pathophysiology of polycystic ovarian syndrome.  J Clin Endocrinol Metab. 2004;  89 4343-4350
  • 2 Aizawa H, Niimura M. Elevated serum insulin-like growth factor-1 (IGF‐1) levels in women with postadolescent acne.  J Dermatol. 1995;  22 249-252
  • 3 Amer S A, Li T C, Bygrave C, Sprigg A, Saravelos H, Cooke I D. An evaluation of the inter-observer and intra-observer variability of the ultrasound diagnosis of polycystic ovaries.  Hum Reprod. 2002;  17 1616-1622
  • 4 Asuncion M, Calvo R M, San Millan J L, Sancho J, Avila S, Escobar-Morreale H F. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain.  J Clin Endocrinol Metab. 2000;  85 2434-2438
  • 5 Azziz R, Woods K S, Reyna R, Key T J, Knochenhauer E S, Yildiz B O. The prevalence and features of the polycystic ovary syndrome in an unselected population.  J Clin Endocrinol Metab. 2004;  89 2745-2749
  • 6 Balen A H, Laven J S, Tan S L, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions.  Hum Reprod Update. 2003;  9 505-514
  • 7 Barbieri R L, Makris A, Randall R W, Daniels G, Kistner R W, Ryan K J. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism.  J Clin Endocrinol Metab. 1986;  62 904-910
  • 8 Bili H, Laven J, Imani B, Eijkemans M J, Fauser B C. Age-related differences in features associated with polycystic ovary syndrome in normogonadotrophic oligo-amenorrhoeic infertile women of reproductive years.  Eur J Endocrinol. 2001;  145 749-755
  • 9 Cappel M, Mauger D, Thiboutot D. Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women.  Arch Dermatol. 2005;  141 333-338
  • 10 Cara J F. Insulin-like growth factors, insulin-like growth factor binding proteins and ovarian androgen production.  Horm Res. 1994;  42 49-54
  • 11 Carmina E. Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines.  Minerva Ginecol. 2004;  56 1-6
  • 12 Carmina E, Wong L, Chang L, Paulson R J, Sauer M V, Stanczyk F Z, Lobo R A. Endocrine abnormalities in ovulatory women with polycystic ovaries on ultrasound.  Hum Reprod. 1997;  12 905-909
  • 13 Cela E, Robertson C, Rush K, Kousta E, White D M, Wilson H, Lyons G, Kingsley P, McCarthy M I, Franks S. Prevalence of polycystic ovaries in women with androgenic alopecia.  Eur J Endocrinol. 2003;  149 439-442
  • 14 Cussons A J, Stuckey B G, Walsh J P, Burke V, Norman R J. Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management.  Clin Endocrinol (Oxf). 2005;  62 289-295
  • 15 De Leo V, Lanzetta D, D'Antona D, la Marca A, Morgante G. Hormonal effects of flutamide in young women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 1998;  83 99-102
  • 16 Dramusic V, Goh V H, Rajan U, Wong Y C, Ratnam S S. Clinical, endocrinologic, and ultrasonographic features of polycystic ovary syndrome in Singaporean adolescents.  J Pediatr Adolesc Gynecol. 1997;  10 125-132
  • 17 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis.  Endocr Rev. 1997;  18 774-800
  • 18 ESHRE/ASRM . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.  Fertil Steril. 2004;  81 19-25
  • 19 Gilling-Smith C, Story H, Rogers V, Franks S. Evidence for a primary abnormality of thecal cell steroidogenesis in the polycystic ovary syndrome.  Clin Endocrinol (Oxf). 1997;  47 93-99
  • 20 Hassan M A, Killick S R. Ultrasound diagnosis of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome is not associated with subfecundity or subfertility.  Fertil Steril. 2003;  80 966-975
  • 21 Herter L D, Magalhaes J A, Spritzer P M. Association of ovarian volume and serum LH levels in adolescent patients with menstrual disorders and/or hirsutism.  Braz J Med Biol Res. 1993;  26 1041-1046
  • 22 Iwashita M, Mimuro T, Watanabe M, Setoyama T, Matsuo A, Adachi T, Takeda Y, Sakamoto S. Plasma levels of insulin-like growth factor-I and its binding protein in polycystic ovary syndrome.  Horm Res. 1990;  33 21-26
  • 23 Jonard S, Dewailly D. The follicular excess in polycystic ovaries, due to intra-ovarian hyperandrogenism, may be the main culprit for the follicular arrest.  Hum Reprod Update. 2004;  10 107-117
  • 24 Jonard S, Robert Y, Cortet-Rudelli C, Pigny P, Decanter C, Dewailly D. Ultrasound examination of polycystic ovaries: is it worth counting the follicles?.  Hum Reprod. 2003;  18 598-603
  • 25 Legro R S, Chiu P, Kunselman A R, Bentley C M, Dodson W C, 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 2571-2579
  • 26 Loucks T L, Talbott E O, McHugh K P, Keelan M, Berga S L, Guzick D S. Do polycystic-appearing ovaries affect the risk of cardiovascular disease among women with polycystic ovary syndrome?.  Fertil Steril. 2000;  74 547-552
  • 27 Matsuda M, DeFronzo R. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.  Diabetes Care. 1999;  22 1462-1470
  • 28 Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
  • 29 Michelmore K F, Balen A H, Dunger D B, Vessey M P. Polycystic ovaries and associated clinical and biochemical features in young women.  Clin Endocrinol (Oxf). 1999;  51 779-786
  • 30 Najmabadi S, Wilcox J G, Acacio B D, Thornton M H, Kolb B A, Paulson R J. The significance of polycystic-appearing ovaries versus normal-appearing ovaries in patients with polycystic ovary syndrome.  Fertil Steril. 1997;  67 631-635
  • 31 Norman R J, Hague W M, Masters S C, Wang X J. Subjects with polycystic ovaries without hyperandrogenaemia exhibit similar disturbances in insulin and lipid profiles as those with polycystic ovary syndrome.  Hum Reprod. 1995;  10 2258-2261
  • 32 O'Driscoll J B, Mamtora H, Higginson J, Pollock A, Kane J, Anderson D C. A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia.  Clin Endocrinol (Oxf). 1994;  41 231-236
  • 33 Pache T D, de Jong F H, Hop W C, Fauser B C. Association between ovarian changes assessed by transvaginal sonography and clinical and endocrine signs of the polycystic ovary syndrome.  Fertil Steril. 1993;  59 544-549
  • 34 Raskauskiene D, Jones P W, Govind A, Obhrai M, Clayton R N. Do polycystic ovaries on ultrasound scan indicate decreased insulin sensitivity in sisters of women with polycystic ovary syndrome?.  J Clin Endocrinol Metab. 2005;  90 2063-2067
  • 35 Takahashi K, Uchida A, Yamasaki H, Ozaki T, Kitao M. Transvaginal ultrasonic assessment of the response to clomiphene citrate in polycystic ovarian syndrome.  Fertil Steril. 1994;  62 48-53
  • 36 Thierry van Dessel H J, Lee P D, Faessen G, Fauser B C, Giudice L C. Elevated serum levels of free insulin-like growth factor I in polycystic ovary syndrome.  J Clin Endocrinol Metab. 1999;  84 3030-3035
  • 37 van der Westhuizen S, van der Spuy Z M. Ovarian morphology as a predictor of hormonal values in polycystic ovary syndrome.  Ultrasound Obstet Gynecol. 1996;  7 335-341
  • 38 Vendola K A, Zhou J, Adesanya O O, Weil S J, Bondy C A. Androgens stimulate early stages of follicular growth in the primate ovary.  J Clin Invest. 1998;  101 2622-2629

MD Susanne Hahn

Division of Endocrinology
Department of Medicine
University of Duisburg-Essen

Hufelandstrasse 55

45122 Essen

Germany

Phone: + 492017232854

Fax: + 49 20 17 23 56 55

Email: susanne.hahn@uni-essen.de.