Transvaginal ultrasound appearance of the ovary in infertile women with oligomenorrhea: association with clinical and endocrine profiles

Objective: to assess the morphological findings of the ovary based on transvaginal ultrasound in infertile oligomenorrheic women and their predictivity for endocrine signs of polycystic ovary syndrome
Design: prospective controlled trial
Setting:KasrEl-AiniHospital
Participants: Fifty women were recruited and divided into two groups: Group I: 30 patients suffering from primary or secondary infertility with oligomenorrhea. Group II: 20 apparently normal parous women non-hirsute, non-obese, with normal menstrual rhythm and normal serum concentration of LH as control.
Interventions: All women were examined by transvaginal sonography, assessed for dody mass index and hirsutism. Blood withdrawal was performed for hormone estimates.
Main Outcome measures: Ovarian follicle number, volume, stromal width, cross sectional area, roundness index and uterine width / ovarian length. Estimates of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone were performed.
Results: All the ultrasonographic criteria for PCOS diagnosis showed highly statistically significant difference between the study and control group (P =0.0001). The hormonal characteristics in the form of high LH, LH/FSH ratio >3 and high testosterone showed statistically significant difference between study and control group (P<0.05). Polycystic ovaries could be observed in 20% of normal control population. About half of the patients in the study group were hirsute. There was statistically significant difference between hirsute and non-hirsute subgroups as regards the ultrasonographic criteria (P<0.05) but not the hormonal ones. There was no statistically significant difference between obese and non-obese patients in the study group as regards all ultrasonographic criteria except for increased cross sectional area (P=0.025) The mean stromal width as a single test and mean stromal width and/or mean roundness index as a combined test appear to be the most valuable sonographic parameters as screening test to predict endocrine abnormalities characteristic for PCOS diagnosis.
Conclusion: A wide spectrum of ultrasonographic ovarian findings can be demonstrated in PCOS, extending from apparently normal to markedly enlarged cystic ovaries. In addition some women show sonographic signs of PCO without hyperandrogenemia, others are hyperandrogenemic without clinical symptoms and without typical sonographic PCOS signs. Amongst all sonographic signs abnormal ovarian stroma alone or in combination was the most sensitive one in prediction for endocrine profiles.

Keywords
Oligomenorrhea, PCOS, infertility, transvaginal ultrasound. Hyperandrogenaemia.