Abbey B. Kalay

Background/Objectives: Geographical differences exist in the clinical presentation of polycystic ovary syndrome (PCOS). The degree to which ovarian morphology contributes to this variability is unknown. Methods: This study compared ovarian ultrasound features between women with PCOS residing in two geographical regions (India and the United States) using stored de-identified ultrasound scans from 331 women with PCOS. Sonographic markers of interest included follicle number per ovary (FNPO), follicle number per cross-section (FNPS), ovarian volume (OV), ovarian area (OA), stromal area (SA), and stromal-to-ovarian area ratio (S/A). Results: Most participants in both regions met the accepted criteria for polycystic ovarian morphology (India 87% vs. U.S. 83%). The U.S.-based group had a higher prevalence of follicle excess (41% in U.S. vs. 29% in India; p = 0.037), whereas the prevalence of ovarian enlargement was similar across groups (India 37% vs. U.S. 31%, p = 0.252). FNPS was higher in the U.S.-based group (p = 0.046), while the India-based group had higher OV (p = 0.010). SA and S/A did not differ between groups, albeit OA was slightly larger in women with PCOS from India (p = 0.022). Associations between ovarian morphology and menstrual cycle length (ρ = 0.16–0.25), hirsutism score (ρ = 0.19–0.23), and total testosterone (ρ = −0.33–0.42) were noted in both groups (p < 0.05). Conclusions: Some variation in ovarian morphology may exist across geographic regions. However, the degree of variability is unlikely to warrant regional definitions for polycystic ovarian morphology at this time.

Objectives: Determine the diagnostic accuracy of ovarian morphology on ultrasonography for polycystic ovary syndrome (PCOS) across the menstrual cycle. Methods: Data from 25 women with PCOS (oligo‐anovulation + androgen excess) and 40 age‐ and BMI‐matched controls (regular cycles + normal androgens) with consecutive ultrasound scans over ≥2 menstrual cycle phases were included in this retrospective analysis. Phases of interest included: early follicular (1–6 days following menses onset), late follicular (1–7 days prior to ovulation in the presence of a dominant follicle), early luteal (1–7 days following ovulation), and late luteal (1–7 days prior to the onset of menses). Diagnostic accuracy (area under the ROC curve [AUC], sensitivity [Se], specificity [Sp]) of mean, maximum, and contralateral (ovary without dominant follicle or corpus luteum) sonographic measures for follicle number per ovary (FNPO), follicle number per single section (FNPS), and ovarian volume (OV) at each phase were determined. DeLong tests determined differences in diagnostic accuracy across phases. Results: FNPO, FNPS, and OV all had significant diagnostic accuracy for PCOS across menstrual cycle phases. OV _mean had the highest diagnostic accuracy for PCOS in the early follicular phase (AUC = 0.87, Se = 65%, Sp = 95%), whereas OV _{contralateral} had the highest accuracy in both the early (AUC = 0.81, Se = 62%, Sp = 92%) and late luteal phases (AUC = 0.93, Se = 100%, Sp = 70%). OV _{contralateral} outperformed all other measures in the late luteal phase ( P < .05). Conclusion: Ultrasonographic evaluations for PCOS may be performed across the menstrual cycle. The presence of a dominant follicle in the late follicular phase did not impact the performance of ovarian markers for PCOS status. By contrast, polycystic ovarian morphology is best defined in the luteal phase by assessments of FNPO and OV in the contralateral ovary.