Ovarian morphology as a predictor of hormonal values in polycystic ovary syndrome

The objective of this investigation was to correlate the severity of ultrasound abnormality in the ovaries of women suspected of having the polycystic ovary syndrome (PCOS) with their endocrinopathy in an attempt to establish which anatomical abnormalities best predict endocrine dysfunction. There were 90 patients in the study group--all suspected clinically of having PCOS--and 12 control subjects. Of the study patients, 74 were classified ultrasonically as having polycystic ovaries, whereas 16 demonstrated no ovarian abnormality. On ultrasound examination of the ovaries, the follicular size, the number and type of distribution of follicles, ovarian volume and echogenicity of the stroma were assessed. Levels of the following serum hormones were measured: luteinizing hormone (LH), follicle stimulating hormone (FSH), estrone, estradiol, 17 alpha-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin and testosterone. Calculations were made using these results to obtain the LH:FSH ratio and the free androgen index. Endocrine assessment of these 90 patients demonstrated significantly lower LH levels, lower LH:FSH ratio and lower testosterone levels in the women without ovarian abnormality, compared to those with polycystic ovaries. The women with ultrasound evidence of polycystic ovaries had high. LH levels, a raised LH:FSH ratio and higher testosterone, DHEAS and androstenedione levels than the control subjects. Although a number of multivariate regressions of biochemistry on ovarian morphology were statistically significant, ovarian morphology predicted only a small proportion of the variability in the hormone levels. Multivariate regression models predicting androstenedione and the LH:FSH ratio had the best overall fit with ovarian volume and a rosary follicular pattern as factors, but even for these variables the adjusted R2 value was very low (0.23 for androstenedione and 0.20 for the LH:FSH ratio). It is therefore concluded that, although ovarian morphology may accurately diagnose polycystic ovaries, it does not predict the severity or presence of endocrine dysfunction. Management and prognosis must be determined on an individual basis against the background of a combination of the clinical, biochemical and ultrasound findings.