Hayfa Al- Shaheen
MB,ChB, DGO, CABGO, Department of Obstetrics & Gynecology, Basrah Maternity and Child Hospital
The aim of this study is to evaluate the ovarian morphological findings in infertile women given the diagnosis of polycystic ovarian syndrome (PCOS) based on chronic anovulation (menstrual disorders) and evidence of hyperandrogenism (hirsutism & acne), and whether clinical and selected hormonal findings correlate with ovarian volume.
Over 12 months period (from 1st of Jan 2005 till the 1st of Jan 2006), the ovarian morphology were determined by transabdominal ultrasound in107 patients included in this prospective study in infertility clinic in Basrah Maternity and Child Hospital. Clinical and endocrinological state was evaluated by history, physical examination and measurements of serum testosterone, Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactine and progesterone levels. Their ages ranged (18-40 years), mean (27.28 ± 4.4) and their mean body mass index (BMI) was (29.77± 4.0 kg/m2). Ultrasound studies showed all women studied (100%) had altered ovarian morphology (both ovaries had multiple small cyst of (2-9mm), mean total follicular number (12.3±1.7) & thick capsule. Bilaterally enlarged ovaries were found in 84 (78.5%), mean (15.6± 2.04 cm3) and normal ovarian size were found in 23(21.5%) mean (6.6± 1.1 cm3). All patients who had enlarged ovaries were compared with those who had normal ovarian size regarding clinical and hormonal findings in order to determine a possible association between these findings and ovarian volume. Hirsutism was present in (78.5%), acne in (68.2%), Obesity (BMI>25 kg/m2) in (87.8%), menstrual disorders in (100%), manifested as oligomenorrhoea in (77.6%) and secondary amenorrhea in (22.4%). Comparing these clinical findings between patient who had enlarged ovaries and those who had normal ovarian size, this study has confirmed that hirsutism, acne and obesity were significantly higher in women who had enlarged ovaries the values were: (84.5% versus 56.5%), (73.8 %versus 47.8%) and( 92.9% versus 69.6%) respectively, whereas oligomenorrhoea occurred more frequently in women with normal ovarian size (82.6% vs. 76.2%), the difference was statistically non significant p.value>0.05. No significant relationship was found between ovarian volume and amenorrhea. Analysis of biochemical data showed that women with PCOS were found to have elevated Serum testosterone levels (1.3±0.74ng/ml ), elevated LH (11.80 ± 4.2 miu/ml ) and elevated LH/FSH ratio (1.90 ± 1.03) whereas all women were found to have normal prolactin levels (10.8 ± 4.0ng/ml). Comparing these hormonal levels between women who had enlarged ovaries and those who had normal- sized ovaries we found that serum testosterone, LH & LH/FSH ratio were significantly higher in women who had enlarged ovaries. Subtle differences existed between ovarian volume in hypretestosteonemic & hyperluteinizenemic subgroups of polycystic ovarian syndrome compared to normotestosteronemic & normoluteinizenemic ones. With significant relationship was found between the ovarian size and testosterone & LH levels p. value< 0.05. A significant differences also existed between ovarian volume in elevated LH/FSH ratio subgroup of polycystic ovarian syndrome compared to normal LH/FSH ratio ones. P. value 0.001. Whereas no statistical significant difference was found between ovarian volume and FSH levels. Hirsutism, acne and obesity correlated positively with total ovarian volume (r=0.282, p- value 0.002), (r=0.229, p- value 0.009) (r=0.372, p. value 0.0001) respectively. While Oligomenorrhoea and amenorrhea showed negative correlations with total ovarian volume. Total ovarian volume correlated positively with Serum testosterone levels, LH and LH/FSH>2, (r=0.518, p- value 0.0001), (r=0.563, p- value 0.0001), (r=0.266, p- value 0.01) respectively. It can be concluded from the present study that ultrasound scanning provide a non- invasive and accurate procedure for the assessment of ovarian morphology (specifically ovarian volume).
Correlation of ovarian volume in women with polycystic ovary Hayfa Al- Shaheen
Bas J Surg, September, 12, 2006
And when clinical diagnosis of PCOS was made, virtually all women were found to have characteristic ovarian morphology that extending from apparently normal to markedly enlarged cystic ovaries. Hirsutism acne, obesity, serum testosterone levels, LH and LH/FSH ratio correlated sssstrongly with increased ovarian size. These results allow us to suggest that ovarian size > 10 cm3 in women with PCOS with hyperandrogenism & menstrual disorders might be predictive of endocrine profiles, and emphasized the importance of careful assessment of ovarian volume by Ultrasound.