Defining the polycystic ovary Fig 393

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Polycystic ovaries are commonly detected by ultrasound or other forms of pelvic imaging, with estimates of the prevalence in the general population being in the order of 20-33% [8,9]. Although the ultrasound criteria for the diagnosis of polycystic ovaries have not, until now, been universally agreed, the characteristic features are accepted as being an increase in the number of follicles and the amount of stroma as compared with normal ovaries, resulting in an increase in ovarian volume. The 'cysts' are not cysts in the sense that they do contain oocytes and indeed are follicles whose development has been arrested. The actual number of cysts may be of less relevance than the volume of ovarian stroma or of the ovary itself, which has been shown to closely correlate with serum testosterone concentrations [10].

At the recent ESHRE/ASRM consensus meeting a refined definition of the PCOS was agreed, encompassing a description of the morphology of the polycystic ovary. According to the available literature, the criteria fulfilling sufficient specificity and sensitivity to define the polycystic ovary (PCO) are the presence of 12 or more follicles measuring 2-9 mm in diameter and increased ovarian volume (>10 cm3) [4]. If there is a follicle greater than 10 mm in diameter, the scan should be repeated at a time of ovarian

Ultrasound Follicles Ovaries Normal Ovaries Ultrasound

Fig. 39.3 (a) Transabdominal ultrasound scan of a normal ovary. (b) Transabdominal ultrasound scan of a polycystic ovary. (c) Transvaginal ultrasound scan of a polycystic ovary. (d) Transabdominal ultrasound scan of a multicystic ovary. (e) Magnetic resonance imaging (MRI) of a pelvis, demonstrating two polycystic ovaries (closed arrows) and a hyperplastic endometrium (open arrow). Reproduced from Infertility in Practice, 2nd edn., Balen & Jacobs, Churchill Livingstone 2003, with permission.

Fig. 39.3 (a) Transabdominal ultrasound scan of a normal ovary. (b) Transabdominal ultrasound scan of a polycystic ovary. (c) Transvaginal ultrasound scan of a polycystic ovary. (d) Transabdominal ultrasound scan of a multicystic ovary. (e) Magnetic resonance imaging (MRI) of a pelvis, demonstrating two polycystic ovaries (closed arrows) and a hyperplastic endometrium (open arrow). Reproduced from Infertility in Practice, 2nd edn., Balen & Jacobs, Churchill Livingstone 2003, with permission.

quiescence to calculate volume and area. The presence of a single polycystic ovary is sufficient to provide the diagnosis. The distribution of the follicles and the description of the stroma are not required in the diagnosis. Increased stromal echogenicity and stromal volume are specific to PCO, but it has been shown that the measurement of the ovarian volume (or area) is a good surrogate for the quantification of the stroma in clinical practice. A woman having PCO in the absence of an ovulation disorder or hyperandrogenism ('asymptomatic PCO') should not be considered as having PCOS, although she may develop symptoms over time, for example, if she gains weight.

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