PCOS

Abstract

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder affecting up to 10% of women in reproductive age. The Consensus Workshop in Rotterdam (2003) was recognized as equal diagnostic criterion of the syndrome the sonographic appearance of polycystic ovarian morphology (PCOM), and it was further defined and simplified into the presence of either 12 or more follicles of 2–9 mm of diameter or an increased ovarian volume of more than 10 cm3. Thus, the current diagnosis of PCOS includes only two criteria out of three: hyperandrogenism, chronic anovulation (ovarian dysfunction), and PCOM. Thereafter, the technical refinement of the ultrasound equipment, the introduction of three-dimensional (3D) imaging, the rise of four distinct phenotypes of the syndrome, the connection of PCOS with metabolic disturbances and infertility implications, the results of well-designed studies, and, finally, the inherent trend for improvement of the clinical practice brought to the surface the necessity to fine-tune the definition of PCOM. In this direction, there have been proposals to modify the threshold in the number of the antral follicles and the ovarian volume. Three-dimensional screening provides better spatial perception and, consequently, more accurate follicle count. Additionally, 3D ultrasound offers the possibility to assess the degree of stromal echogenicity and vascularization that could be important features of the syndrome in combination with the peripheral distribution of the follicles. Indeed, 15 years after the Rotterdam consensus workshop, there is an urgent need of revisiting the ultrasound criteria in order to not artificially increase the prevalence of PCOS. This chapter tries to update recent research related to the aforementioned issues and proposes new ideas on how the definition of the criteria, specifically PCOM, could be modified according to new scientific data and clinical perspectives.