Ultrasound features of polycystic ovaries relate to degree of reproductive and metabolic disturbance in polycystic ovary syndrome

Associations between ultrasound features and reproductive and metabolic markers in women with polycystic ovary syndrome (PCOS) were assessed. Follicle populations reflected the severity of reproductive and metabolic dysfunction in PCOS.


Jacob P. Christ, B.S., Heidi Vanden Brink, M.Sc., Eric D. Brooks, B.S., Roger A. Pierson, Ph.D., Donna R. Chizen, M.D., Marla E. Lujan, Ph.D.

Volume 103, Issue 3, Pages 787-794



To reexamine associations between polycystic ovarian morphology (PCOM) and degree of symptomatology in polycystic ovary syndrome (PCOS) using a well-defined PCOS population, newer ultrasound technology, and reliable offline assessments of sonographic parameters.


Cross-sectional observational study.


Academic hospital and clinical research unit.


Forty-nine women with PCOS as defined by hyperandrogenism and oligoamenorrhea.



Main Outcome Measure(s):

Number of follicles per follicle size category, antral follicle count (AFC), ovarian volume (OV), follicle distribution pattern, stromal area, ovarian area, stromal to ovarian area ratio (S/A) and stromal echogenicity index (SI), total (TT), androstenedione, LH, FSH, cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, C-reactive protein, glucose, insulin, and hemoglobin A1C, menstrual cycle length, hirsutism score, body mass index (BMI), waist:hip ratio, and blood pressure.


AFC, but not OV, was positively associated with TT (ρ = .610), androstenedione (ρ = .490), and LH:FSH (ρ = .402). SI was positively associated with androgen markers and LH:FSH, while S/A was negatively associated with these variables. Follicles ≤4 mm were negatively associated with various metabolic markers, whereas larger follicles (5–8 mm) showed positive associations. Stromal markers were not associated with cardiometabolic measures. LH:FSH best predicted follicles ≤4 mm, and BMI predicted 5- to 9-mm follicles. Dominant follicles ≥10 mm were best predicted by age.


AFC, and not OV, reflected the severity of reproductive dysfunction in PCOS. Associations among different sized follicles were consistent with recruitable sized follicles, which reflects the severity of metabolic dysfunction in PCOS.

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