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A New Diagnostic Strategy for Polycystic Ovary Syndrome Combining Japanese and International Diagnostic Criteria
Hiroki Noguchi1, Takeshi Iwasa1, Akira Iwase2
1Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Aim:
We had defined the anti-Müllerian hormone (AMH) cut-off value level 2 aligned with the Rotterdam/International Evidence-based Guideline (IEBG) for the Assessment and Management of polycystic ovary syndrome (PCOS) 2023 criteria. In this study, we evaluated the utility of AMH cut-off value level 2 in patients who could not be diagnosed under the Japan Society of Obstetrics and Gynecology (JSOG) 2024 criteria due to the absence of endocrinological abnormalities and estimated the utility of a new diagnostic approach combining the JSOG 2024 and the Rotterdam/IEBG 2023 criteria.
Methods:
Through a nationwide survey in Japan, data were collected for 270 patients with irregular menstrual cycles and an antral follicle count of ≥ 10 to assess the new diagnostic approach.
Results:
Of 270 patients, 213 (78.9%) met the JSOG 2024 criteria due to the presence of endocrinological abnormalities. Of the remaining 57 patients (21.1%) who did not meet the JSOG 2024 criteria, 36 (63.2%) were additionally diagnosed with PCOS under the Rotterdam/IEBG 2023 criteria by applying elevated serum AMH (level 2). Consequently, the diagnostic rate of PCOS increased by 16.9% (obese/overweight: 9.8%, non-obese/overweight: 19.7%), and the overall diagnostic rate reached 92.2%. The diagnostic rate of this new diagnostic approach was significantly higher than that of the JSOG 2024 or the Rotterdam/IEBG 2023 criteria alone. Patients additionally diagnosed by this new diagnostic approach were significantly older and had a higher prevalence of oligomenorrhea and lower prevalence of amenorrhea compared with those diagnosed under the JSOG 2024 criteria.
Conclusion:
Applying elevated serum AMH (level 2) based on the Rotterdam/IEBG 2023 criteria improved the diagnostic rate of PCOS, particularly in non-obese/overweight patients and relatively older women with milder PCOS phenotypes. This new approach is practical, complementary, and can help overcome limitations of the diagnosis of PCOS and thus expand diagnostic opportunities.