Improved diagnostic performance for the diagnosis of polycystic ovary syndrome using age-stratified criteria

A cross-sectional study evaluating ovarian criteria thresholds for the diagnosis of PCOS was performed. Findings reflected that age-stratified thresholds demonstrated a superior diagnostic performance com- pared with a single threshold.

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Volume 111, Issue 4, Pages 787–793.e2


Asima K. Ahmad, M.D., M.P.H., Molly Quinn, M.D., Chia-Ning Kao, B.S., M.S., Eleni Greenwood, M.D., Marcelle I. Cedars, M.D., Heather G. Huddleston, M.D.



To determine optimal criteria for polycystic ovary morphology.


Cross-sectional study.


Multidisciplinary polycystic ovary syndrome (PCOS) clinic at a tertiary academic center.


Subjects with PCOS were seen between 2006 and 2015 and met PCOS 1992 National Institutes of Health criteria. Controls were from the Ovarian Aging (OVA) study (2006–2011), a longitudinal study including healthy women with regular menstrual cycles.


Clinical data collection.

Main Outcome Measure(s)

Follicle number per ovary (FNPO) and ovarian volume (OV).


A total of 245 subjects with PCOS and 756 OVA study subjects were included in the FNPO analysis and had a mean (± SD) FNPO of 22.6 ± 12.4 and 10 ± 5.3, respectively. Receiver operating characteristic curves were created for both FNPO and OV and analyzed across age group categories (25 to <30, 30 to <35, and 35 to <40 years). Youden's and minimum distance (d) were used to compare efficacies of FNPO and OV thresholds. The optimal threshold for distinguishing PCOS from OVA controls was FNPO > 13. There was a decreasing trend in FNPO threshold with increasing age group (>15, >14, and >12, respectively). A total of 297 PCOS subjects and 756 OVA study subjects were included in the OV analysis and had a mean maximum OV of 10 ± 5 cm3 and 6.5 ± 5 cm3, respectively. The overall threshold was OV > 6.75 cm3, with a trend toward decreasing OV with increase in age group (>8.5, >7, and >6.25 cm3, respectively).


Our findings reflect that age-stratified thresholds demonstrate superior diagnostic performance, with an improved balance of sensitivity and specificity compared with a single threshold. We propose age-specific thresholds for better diagnostic performance.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.