Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome
van Santbrink EJ,Hop WC,Fauser BC
Published March 1997Fertility and Sterility, 67(3), 452-458
van Santbrink, E. J., Hop, W. C., & Fauser, B. C. (1997). Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome. Fertility and Sterility, 67(3), 452-458. https://doi.org/10.1016/s0015-0282(97)80068-4
van Santbrink EJ, Hop WC, Fauser BC. Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome. Fertil Steril. 1997;67(3):452-458. doi:10.1016/s0015-0282(97)80068-4
van Santbrink, Evert J. P., et al. "Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome." Fertility and Sterility, vol. 67, no. 3, 1997, pp. 452-458.
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Ultrasound polycystic ovaries only partly predict PCOS hormone signs
Ultrasound signs of polycystic ovaries predicted raised androgens or LH to a limited degree in 330 infertile women with irregular or absent periods, a 1997 Rotterdam study. Ultrasound found polycystic ovaries in 66 out of 100 of these women. Raised androgens affected 36 out of 100 and raised LH 47 out of 100.
Key Findings
In 330 infertile women with irregular or absent periods, ultrasound showed polycystic ovaries in 217 (66%), defined by increased ovarian volume, follicle number, or both.
Among the same women, the endocrine signs of polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS), were raised androgens in 120 (36%) and raised LH in 155 (47%).
Polycystic ovaries without endocrine signs occurred in 21% of women, 62 women (19%) met none of the criteria, and only 20% met all of them.
The best ultrasound test for raised androgens, increased mean ovarian volume, had a sensitivity of 57% and a specificity of 67%.
Among 48 healthy, regularly cycling volunteers, 8% had polycystic ovaries on ultrasound.
Interpretation
The authors describe a controlled descriptive study at one academic fertility clinic. Each of the 330 women had one ultrasound scan and one blood sample at a random time, and women whose hormone levels showed ovulation or the luteal phase were excluded. The authors note that sampling time may in some cases affect LH levels. Limits of normal came from 48 volunteers. One time point shows how often findings occur together and follows no outcomes. The authors state that a longitudinal follow-up study should come next.
RRM Context
Ovary scans and hormone tests pick out groups of women that overlap but differ. Restorative reproductive medicine looks for the cause of irregular cycles in each woman's hormone pattern before choosing treatment. A 2026 Lancet consensus gave PMOS / PCOS a name that reflects its hormone and metabolic features.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To investigate the predictive value of polycystic ovaries for endocrine signs of polycystic ovary syndrome (PCOS).
Design
Controlled descriptive study.
Setting
Academic tertiary care fertility clinic.
Patients
Normogonadotropic (FSH levels between 1 and 10 mIU/mL conversion factor to SI unit, 1.0) oligomenorrheic or amenorrheic women visiting our fertility clinic and a control group of regularly cycling, healthy, normal weight volunteers recruited by advertisement.
Interventions
Single blood samples and transvaginal sonography were performed.
Main Outcome Measures
Serum levels of FSH, LH, androstenedione (A), and T and ovarian volume, ovarian stroma density, and follicle number.
Results
In control women, the 95th percentile was calculated for ovarian volume, follicle number, and stroma count as well as endocrine parameters. The use of these upper limits of normal in the study group resulted in 217 (66%) patients with polycystic ovaries on ultrasound (defined as increased mean ovarian volume and/or mean follicle number per ovary), whereas only 120 (36%) patients exhibited elevated serum androgens (increased A and/or T concentrations) and 155 (47%) showed elevated LH levels. Sensitivity and specificity of single or combined sonographic parameters for prediction of elevated serum LH or androgen concentrations were limited.
Conclusions
In the study group of normogonadotropic oligomenorrhea or amenorrheic infertile women, we set strict cutoff levels for various criteria used in the literature for defining PCOS. Groups defined by sonographic or endocrine PCOS criteria did overlap, but sonographic parameters had limited predictive value for abnormal hormone serum levels.
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