Ultrasonographic threshold of ovarian structure in premenopausal women of different ethnicity
https://doi.org/10.29413/ABS.2024-9.3.5
Abstract
The polycystic ovarian morphology (PCOM) is a generally accepted ultrasound marker for ovulatory dysfunction, is one of the criteria for polycystic ovary syndrome (PCOS) and is established based on the assessment of ovarian volume (OV) and the follicle number per ovary (FNPO), taking into account the upper normal values determined in healthy premenopausal women. However, there is a necessity for regular revision of the PCOM characteristics depending on ethnic and age characteristics.
The aim. To develop differentiated standards for assessing the ultrasonographic ovary structure in premenopausal women of various ethnicity.
Materials and methods. From March 2016 to December 2019, a multicenter cross-sectional prospective study was conducted in Eastern Siberia (Irkutsk region) and in the neighboring Republic of Buryatia. The study included 1134 participants: 715 women of Caucasian origin, 312 Asian women, 107 women of mixed ethnic subpopulation.
Results. It has been established that for Caucasians, it is advisable to diagnose PCOM when the ovarian volume is 9 cm3 and/or FNPO ≥ 12; for women of the Asian population – when the ovarian volume is 7 cm3 and/or FNPO ≥ 11; for women of mixed ethnicity – when the ovarian volume is 8 cm3 and/or FNPO ≥ 9. An important advantage of our study is that all participants were recruited from a non-selective multi-ethnic population of women with comparable socio-demographic characteristics living in the same geographical conditions.
Conclusion. Differentiated approach for identifying the polycystic ovarian morphology in premenopausal women of different ethnic groups requires using ethnically differentiated normative readings
About the Authors
L. M. LazarevaRussian Federation
Lyudmila M. Lazareva – Cand. Sc. (Med.), Research Officer at the Laboratory of Gynecological Endocrinology
Timiryazeva str. 16, Irkutsk 664003
A. V. Atalyan
Russian Federation
Alina V. Atalyan – Cand. Sc. (Biol.), Senior Research Officer at the Laboratory of Socially Significant Problems of Reproduction
Timiryazeva str. 16, Irkutsk 664003
I. N. Danusevich
Russian Federation
Irina N. Danusevich – Dr. Sc. (Med.), Chief Research Officer at the Laboratory of Gynecological Endocrinology
Timiryazeva str. 16, Irkutsk 664003
I. G. Nadeliaeva
Russian Federation
Iana G. Nadeliaeva – Cand. Sc. (Med.), Research Officer at the Laboratory of Gynecological Endocrinology
Timiryazeva str. 16, Irkutsk 664003
L. V. Belenkaya
Russian Federation
Lilia V. Belenkaya – Cand. Sc. (Med.), Senior Research Officer at the Laboratory of Physiology and Pathology of the Endocrine System
Timiryazeva str. 16, Irkutsk 664003
I. Yu. Egorova
Russian Federation
Irina Yu. Egorova – Postgraduate at the Laboratory of Gynecological Endocrinology
Timiryazeva str. 16, Irkutsk 664003
N. I. Babaeva
Russian Federation
Natalia I. Babaeva – Junior Research Officer at the Laboratory of Gynecological Endocrinology
Timiryazeva str. 16, Irkutsk 664003
L. V. Suturina
Russian Federation
Larisa V. Suturina – Dr. Sc. (Med.), Professor, Chief Research Officer at the Laboratory of Gynecological Endocrinology
Timiryazeva str. 16, Irkutsk 664003
References
1. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19(1): 41-47. doi: 10.1093/humrep/deh098
2. Dewailly D, Alebić M, Duhamel A, Stojanović N. Using cluster analysis to identify a homogeneous subpopulation of women with polycystic ovarian morphology in a population of non-hyperandrogenic women with regular menstrual cycles. Hum Reprod. 2014; 29(11): 2536-2543. doi: 10.1093/humrep/deu242
3. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018; 89(3): 251-268. doi: 10.1111/cen.13795
4. Teede HJ, Tay CT, Laven J, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidencebased guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2023; 120(4): 767-793. doi: 10.1016/j.fertnstert.2023.07.025
5. Teede HJ, Norman RJ, Garad RM. A new evidence-based guideline for assessment and management of polycystic ovary syndrome. Med J Aust. 2019; 210(6): 285-285.e1. doi: 10.5694/mja2.50053
6. Chen X, Yang D, Mo Y, Li L, Chen Y, Huang Y. Prevalence of polycystic ovary syndrome in unselected women from southern China. Eur J Obstet Gynecol Reprod Biol. 2008; 139(1): 59-64. doi: 10.1016/j.ejogrb.2007.12.018
7. Köşüş N, Köşüş A, Turhan N, Kamalak Z. Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries? Eur J Obstet Gynecol Reprod Biol. 2011; 154(2): 177-181. doi: 10.1016/j.ejogrb.2010.10.007
8. Han YS, Lee AR, Song HK, Choi JI, Kim JH, Kim MR, et al. Ovarian volume in Korean women with polycystic ovary syndrome and its related factors. J Menopausal Med. 2017; 23(1): 25-31. doi: 10.6118/jmm.2017.23.1.25
9. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: The complete task force report. Fertil Steril. 2009; 91(2): 456-488. doi: 10.1016/j.fertnstert.2008.06.035
10. Hsu MI. Changes in the PCOS phenotype with age. Steroids. 2013; 78(8): 761-766. doi: 10.1016/j.steroids.2013.04.005
11. Adams JM, Taylor AE, Crowley WF, Hall JE. Polycystic ovarian morphology with regular ovulatory cycles: Insights into the pathophysiology of polycystic ovarian syndrome. J Clin Endocrinol Metab. 2004; 89(9): 4343-4350. doi: 10.1210/jc.2003-031600
12. Suturina L, Lizneva D, Danusevich I, Lazareva L, Belenkaya L, Nadeliaeva Ia, et al. The design, methodology, and recruitment rate for the Eastern Siberia PCOS Epidemiology & Phenotype (ES-PEP) Study. Proceedings of the 41st Annual Meeting of the Androgen Excess & PCOS Society (Lorne, Victoria, Australia, 10–12.11.2016). 2016: 76.
13. Atalyan VV, Kolesnikova LI, Kolesnikov SI, Grjibovski AM, Suturina LV. Research electronic data capture (REDCap) for building and managing databases for population-based biomedical studies. Human Ecology. 2019. 2019; 26(2): 52-59. (In Russ.). doi: 10.33396/1728-0869-2019-2-52-59
14. Klein DA, Paradise SL, Reeder RM. Amenorrhea: A systematic approach to diagnosis and management. Am Fam Physician. 2019; 100(1): 39-48.
15. Yildiz BO, Bolour S, Woods K, Moore A, Azziz R. Visually scoring hirsutism. Hum Reprod Update. 2010; 16(1): 51-64. doi: 10.1093/humupd/dmp024
16. Rao P, Bhide P. Controversies in the diagnosis of polycystic ovary syndrome. Ther Adv Reprod Health. 2020; 14: 2633494120913032. doi: 10.1177/2633494120913032
17. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: Towards a rational approach, polycystic ovary syndrome. In: Dunaif A, Dunaif AGJ, Haseltine F (eds). Polycystic ovary syndrome. Boston: Blackwell Scientific; 1992: 377-384.
18. Carmina E, Campagna AM, Fruzzetti F, Lobo RA. AMH measurement versus ovarian ultrasound in the diagnosis of polycystic ovary syndrome in different phenotypes. Endocr Pract. 2016; 22(3): 287-293. doi: 10.4158/EP15903.OR
19. Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, et al. Diagnosis of polycystic ovary syndrome (PCOS): Revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 2011; 26(11): 3123-3129. doi: 10.1093/humrep/der297
20. Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, et al. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 2013; 28(5): 1361-1368. doi: 10.1093/humrep/det062
21. Le NSV, Le MT, Nguyen ND, Tran NQT, Nguyen QHV, Cao TN. A cross-sectional study on potential ovarian volume and related factors in women with polycystic ovary syndrome from infertile couples. Int J Womens Health. 2021; 13: 793-801. doi: 10.2147/IJWH.S329082
22. Chen Y, Li L, Chen X, Zhang Q, Wang W, Li Y, et al. Ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome in Chinese women. Ultrasound Obstet Gynecol. 2008; 32(5): 700-703. doi: 10.1002/uog.5393
23. Jonard S, Robert Y, Dewailly D. Revisiting the ovarian volume as a diagnostic criterion for polycystic ovaries. Hum Reprod. 2005; 20(10): 2893-2898. doi: 10.1093/humrep/dei159
24. Wongwananuruk T, Panichyawat N, Indhavivadhana S, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, et al. Accuracy of anti-Müllerian hormone and total follicles count to diagnose polycystic ovary syndrome in reproductive women. Taiwan J Obstet Gynecol. 2018; 57(4): 499-506. doi: 10.1016/j.tjog.2018.06.004
25. Welt CK, Gudmundsson JA, Arason G, Adams J, Palsdottir H, Gudlaugsdottir G, et al. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: The impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab. 2006; 91(12): 4842-4848. doi: 10.1210/jc.2006-1327
26. Dewailly D. Diagnostic criteria for PCOS: Is there a need for a rethink? Best Pract Res Clin Obstet Gynaecol. 2016; 37: 5-11. doi: 10.1016/j.bpobgyn.2016.03.009
27. Lie Fong S, Laven JSE, Duhamel A, Dewailly D. Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: Redefining threshold levels for follicle count and serum anti-Müllerian hormone using cluster analysis. Hum Reprod. 2017; 32(8): 1723-1731. doi: 10.1093/humrep/dex226
28. Wiser A, Shalom-Paz E, Hyman JH, Sokal-Arnon T, Bantan N, Holzer H, et al. Age-related normogram for antral follicle count in women with polycystic ovary syndrome. Reprod Biomed Online. 2013; 27(4): 414-418. doi: 10.1016/j.rbmo.2013.06.016
29. Suturina L. The epidemiology of polycystic ovary syndrome. In: Kovacs GT, Fauser B, Legro RS (eds). Polycystic ovary syndrome; 3rd ed. Cambridge, UK: Cambridge University Press; 2022: 21-28.
30. Suturina L, Lizneva D, Atalyan A, Lazareva L, Belskikh A, Bairova T, et al. Establishing normative values to determine the prevalence of biochemical hyperandrogenism in premenopausal women of different ethnicities from Eastern Siberia. Diagnostics (Basel). 2022; 13(1): 33. doi: 10.3390/diagnostics13010033
31. Suturina LV, Belskikh AV, Sholokhov LF, Rashidova MA, Danusevich IN, Lazareva LM, et al. The experience in the development and validation of method for testosterone measurement in blood serum of premenopausal women using HPLC-MS/MS. Acta biomedica scientifica. 2022; 7(6): 92-101. (In Russ.). doi: 10.29413/ABS.2022-7.6.9
Review
For citations:
Lazareva L.M., Atalyan A.V., Danusevich I.N., Nadeliaeva I.G., Belenkaya L.V., Egorova I.Yu., Babaeva N.I., Suturina L.V. Ultrasonographic threshold of ovarian structure in premenopausal women of different ethnicity. Acta Biomedica Scientifica. 2024;9(3):49-68. (In Russ.) https://doi.org/10.29413/ABS.2024-9.3.5