Examining the ovaries by ultrasound for diagnosing hyperandrogenic anovulation: updating the threshold for newer machines

9 01 2014

To the Editor:

We enjoyed reading the article by Christ et al. (1). The discussion about ultrasound criteria, specifically where to put the threshold to distinguish between a polycystic and a normal ovary, has been ongoing for some time and will surely continue for a while yet. Although the results are somewhat predictable since this report is a reassessment of partial data from a previous study (2), the timing of this publication is important because it reinforces a recently published task force report (3). Change is long overdue, but we believe the recommendation of using ≥ 25 follicles per ovary (3) should be adopted promptly as it is clear that the former threshold of 12 follicles is obsolete due to the improvement in the resolution of ultrasound. However, physicians should be aware that a much lower threshold should be used when trying to identify women at high risk of having an excessive response to exogenous gonadotropins used in in vitro fertilization/intracytoplasmic sperm injection cycles. Women with a total antral follicle count (AFC) > 20, considering both ovaries, are already at a higher risk of ovarian hyperstimulation syndrome (4). Another important point to consider when choosing the best threshold are the differences observed in AFC during reproductive age (5). The question of using the same threshold or different thresholds depending on a woman’s age should be balanced between diagnostic test accuracy and ease of implementation. Read the rest of this entry »

Hepatotoxicity with flutamide

23 08 2012

To the Editor:

We read with great interest the article by Bruni et al. published in Fertility and Sterility (1). The article describes the hepatotoxicity with flutamide on hyperandrogenic young females. Bruni et al. found hypertransaminasemia in 19 patients during the first year of treatment.

Flutamide is an oral, non-steroidal antiandrogen drug primarily used to treat prostate cancer and excess androgen levels in hyperandrogenic women. Side effects of this drug include diarrhea, gynecomastia, muscle cramps, hematological alterations, and hepatotoxicity (2).

Drug-related hepatotoxicity is defined as an alanine aminotransferase (ALT) level of more than three times the upper limit of normal and a total bilirubin level of more than twice the upper limit of the normal range (3). In the study of Bruni et al., the cutoff levels of ALT and aspartate aminotransferase (AST) were determined by 40 U/L and hepatotoxicity was considered to be at least 2.5- to 3-fold higher in hypertransaminasemia. According to the definition of hepatotoxicity, in Table 3, which detailed patients with increasing levels of circulating AST/ALT, three patients have drug-related hepatotoxicity (patients 7, 17, and 18). Furthermore, in two patients (patients 17 and 18) hepatotoxicity may be associated with estroprogestagen oral contraceptives. On these grounds, hepatotoxicity with flutamide is seen in one patient (patient 7), and hepatotoxicity-based analysis might have influenced the outcomes of this study. Read the rest of this entry »

Re: Clinical and biochemical presentations of polycystic ovary syndrome among obese and nonobese women

29 12 2009

To the Editor:

I read the article by Liou et al. (1) with interest. The aim of the study was to investigate the impact of obesity on the clinical and biochemical presentations of polycystic ovary syndrome (PCOS). Obesity with PCOS was associated with hyperandrogenism and prolonged menstrual intervals. However, this group had a significantly lower frequency of acne in the study. Read the rest of this entry »