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using ≥ 25 follicles per ovary (3) should be adopted promptly as it is clear that the former threshold of 12 follicles is obsolete due to the improvement in the resolution of ultrasound.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

Regarding the effects of fibroids on obstetrical outcomes

4 05 2012

To the Editor:

We read the recent article by Shavell et al. (1) regarding the effects of fibroids on obstetrical outcomes and have the following comments:

First, the number of women in each group was very small (n=95) and the number of women with fibroids >5cm was much smaller (n=42). Compare this with the study by Stout et al. (2) where 2,058 women with fibroids were compared with 61,989 without fibroids, all of whom had routine second trimester ultrasounds. Stout reported significant differences in OR for placenta previa, abruption, PROM, preterm birth 5 cm. It would be helpful for the authors to describe criteria for transfusion. Read the rest of this entry »