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using ≥ 25 follicles per ovary (3) should be adopted promptly as it is clear that the former threshold of 12 follicles is obsolete due to the improvement in the resolution of ultrasound.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 »





Letter regarding “Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis”

12 07 2011

To the Editor:

We read with great interest the article of Escobar-Morreale et al., in which the authors report that women with polycystic ovary syndrome (PCOS) exhibit an elevation in circulating C-reactive protein (CRP) that was independent of obesity. We agree with their conclusion that this finding confirms the existing molecular evidence of a chronic low-grade inflammation possibly being involved in the pathogenesis of PCOS (1).

A possible autoimmune etiology of at least some cases of PCOS was mentioned in the early 1990s (2). Gleicher et al. have hypothesized that functional autoantibodies could contribute to its development, which represents hyperfunction of follicular recruitment in the ovaries (3). Moreover, the incidence of autoimmune thyroid diseases such as Hashimoto’s thyroiditis has been reported to be three-fold higher in women with PCOS than in the general female population (4). Read the rest of this entry »





Pregnancy in women with PCOS

17 01 2011

To the Editor:

I read the article of Palomba et al (1) with great interest. This is the first study that investigates the pregnancy outcomes according to different phenotypes of polycystic ovary syndrome. They conclude that “The increased risk for adverse obstetric or neonatal outcomes, which are observed in women with PCOS, varies widely according to their different PCOS phenotypes and features.” Although it is clear that the results are attractive, some of the data in this paper need further clarification. Read the rest of this entry »





PCOS is common in patients undergoing bariatric surgery in a British center

20 04 2010

To the Editor:

We read with great interest the article by Gosman et al (1). The authors highlight that 13.1% of female patients undergoing bariatric surgery had already been diagnosed with PCOS by a health care provider. Data on the incidence of polycystic ovary syndrome (PCOS) in this population from outside the U.S. and the U.K. in particular are limited. 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 »





Re: Serologic markers of autoimmunity in women with the polycystic ovary syndrome

6 08 2009

To the Editor:

I would like to thank Dr. Hefler-Frischmuth et al. for their fine article (1). In this study, they found that women with polycystic ovary syndrome (PCOS) had significantly elevated serum levels of antihistone and anti-double-stranded DNA (anti-dsDNA) antibodies, whereas serum levels of anti-nuclear antibodies (ANAs) and antinucleosome antibodies were similar between PCOS and healthy controls. When autoimmune markers were correlated with clinical and biochemical parameters, a significant correlation between serum levels of ANAs and serum thyroid stimulating hormone (TSH) were established. Read the rest of this entry »





Protocol for luteal-phase clomiphene citrate in women with PCOS

16 07 2009

To the Editor:

It was an interesting article by Badawy et al. on luteal-phase clomiphene citrate (1). There were two points on which I would like to request clarification.
Read the rest of this entry »