Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society

Dewailly, D.; Lujan, M. E.; Carmina, E.; Cedars, M. I.; Laven, J.; Norman, R. J.; Escobar-Morreale, H. F.

doi:10.1093/humupd/dmt061

Cited by 551Ovarian function and disordersGenetic and Kidney Cyst DiseasesReproductive Biology and Fertility

Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society

Dewailly, D., Lujan, M. E., Carmina, E., Cedars, M. I., Laven, J., Norman, R. J., Escobar-Morreale, H. F.·2014·Human Reproduction Update

DOI 10.1093/humupd/dmt061

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Abstract

BACKGROUND The diagnosis of polycystic ovary syndrome (PCOS) relies on clinical, biological and morphological criteria. With the advent of ultrasonography, follicle excess has become the main aspect of polycystic ovarian morphology (PCOM). Since 2003, most investigators have used a threshold of 12 follicles (measuring 2-9 mm in diameter) per whole ovary, but that now seems obsolete. An increase in ovarian volume (OV) and/or area may also be considered accurate markers of PCOM, yet their utility compared with follicle excess remains unclear. METHODS Published peer-reviewed medical literature about PCOM was searched using PubMed.gov online facilities and was submitted to critical assessment by a panel of experts. Studies reporting antral follicle counts (AFC) or follicle number per ovary (FNPO) using transvaginal ultrasonography in healthy women of reproductive age were also included. Only studies that reported the mean or median AFC or FNPO of follicles measuring 2-9 mm, 2-10 mm or <10 mm in diameter, or visualized all follicles, were included. RESULTS Studies addressing women recruited from the general population and studies comparing control and PCOS populations with appropriate statistics were convergent towards setting the threshold for increased FNPO at ≥25 follicles, in women aged 18-35 years. These studies suggested maintaining the threshold for increased OV at ≥10 ml. Critical analysis of the literature showed that OV had less diagnostic potential for PCOM compared with FNPO. The review did not identify any additional diagnostic advantage for other ultrasound metrics such as specific measurements of ovarian stroma or blood flow. Even though serum concentrations of anti-Müllerian hormone (AMH) showed a diagnostic performance for PCOM that was equal to or better than that of FNPO in some series, the accuracy and reproducibility issues of currently available AMH assays preclude the establishment of a threshold value for its use as a surrogate marker of PCOM. PCOM does not associate with significant consequences for health in the absence of other symptoms of PCOS but, because of the use of inconsistent definitions of PCOM among studies, this question cannot be answered with absolute certainty. CONCLUSIONS The Task Force recommends using FNPO for the definition of PCOM setting the threshold at ≥25, but only when using newer technology that affords maximal resolution of ovarian follicles (i.e. transducer frequency ≥8 MHz). If such technology is not available, we recommend using OV rather than FNPO for the diagnosis of PCOM for routine daily practice but not for research studies that require the precise full characterization of patients. The Task Force recognizes the still unmet need for standardization of the follicle counting technique and the need for regularly updating the thresholds used to define follicle excess, particularly in diverse populations. Serum AMH concentration generated great expectations as a surrogate marker for the follicle excess of PCOM, but full standardization of AMH assays is needed before they can be routinely used for clinical practice and research. Finally, the finding of PCOM in ovulatory women not showing clinical or biochemical androgen excess may be inconsequential, even though some studies suggest that isolated PCOM may represent the milder end of the PCOS spectrum.

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Approximately 50% of girls with persistent oligomenorrhea or abnormal uterine bleeding for 1 year remained oligomenorrheic during an 8-year follow-up period.
“Southam and Richart [71] demonstrated that approximately 50% of girls with persistent oligomenorrhea or abnormal uterine bleeding for 1 year remained oligomenorrheic during an 8-year follow-up period.”
From The Diagnosis of Polycystic Ovary Syndrome during Adolescence (2015) · cites this paper as [71]
Persistence of oligomenorrhea with cycles longer than 45 days, secondary amenorrhea for more than 3 months, or primary amenorrhea in girls with complete pubertal development and adult stature suggests coexisting androgen excess.
“Accordingly, the persistence of oligomenorrhea (menstrual cycles longer than 45 days), secondary amenorrhea (absence of cycles for more than 3 months), or primary amenorrhea in girls with complete pubertal development and adult stature suggests the coexistence of androgen excess [71,78]”
From The Diagnosis of Polycystic Ovary Syndrome during Adolescence (2015) · cites this paper as [71]

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Swanton, A., Story, L., McVeigh, E., & Child, T. J. (2009) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2009.11.017 · Cited by 99 · see citing works
Polycystic ovarian disease: contribution of vaginal endosonography and reassessment of ultrasonic diagnosis
Ardaens, Y., Robert, Y., LEMAITRE, L., Fossati, P., & Dewailly, D. (1991) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54353-2 · Cited by 99 · see citing works
Self-citation
Age-specific nomogram for the decline in antral follicle count throughout the reproductive period
Marca, A. L., Spada, E., Sighinolfi, G., Argento, C., Tirelli, A., Giulini, S., Milani, S., & Volpe, A. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2010.07.1069 · Cited by 96 · see citing works
The interobserver reliability of three‐dimensional power Doppler data acquisition within the female pelvis
Raine‐Fenning, N., Campbell, B. K., Clewes, J. S., Kendall, N. R., & Johnson, I. R. (2004) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.1019 · Cited by 94 · see citing works
Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case–control study
Zhang, H. Y., Guo, C. X., Zhu, F. F., Qu, P. P., Lin, W. J., & Xiong, J. (2013) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-012-2568-z · Cited by 94 · see citing works
Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound
Allemand, M. C., Tummon, I. S., Phy, J. L., Foong, S. C., Dumesic, D. A., & Session, D. R. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.07.1279 · Cited by 88 · see citing works
Accuracy of ultrasound measurements of female pelvic organs
SAXTON, D. W., Farquhar, C. M., Rae, T., Beard, R. W., Anderson, M. C., & Wadsworth, J. (1990) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1990.tb16241.x · Cited by 87 · see citing works
Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome?
Catteau-Jonard, S., Bancquart, J., Poncelet, É., Lefebvre‐Maunoury, C., Robin, G., & Dewailly, D. (2012) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.11202 · Cited by 86 · see citing works
Self-citation
Quantitative analysis of antral follicle number and size: a comparison of two‐dimensional and automated three‐dimensional ultrasound techniques
Deb, S., Campbell, B. K., Clewes, J. S., & Raine‐Fenning, N. J. (2009) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.7505 · Cited by 86 · see citing works
Polycystic Ovarian Morphology in Normal Women Does Not Predict the Development of Polycystic Ovary Syndrome
Murphy, M. K., Hall, J. E., Adams, J. M., Lee, H., & Welt, C. K. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1085 · Cited by 85 · see citing works
The association between circulating levels of antimüllerian hormone and follicle number, androgens, and menstrual cycle characteristics in young women
Kristensen, S. L., Ramlau‐Hansen, C. H., Andersen, C. Y., Ernst, E., Olsen, S. F., Bonde, J. P., Vested, A., & Toft, G. V. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.12.017 · Cited by 81 · see citing works
Differences of the association of anti-Müllerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome
Woo, H., Kim, K. H., Rhee, E., Park, H., & Lee, M. (2012) · Endocrine Journal · doi:10.1507/endocrj.ej12-0055 · Cited by 78 · see citing works
Age-Related Structural and Metabolic Changes in the Pelvic Reproductive End Organs
Well, D., Yang, H., Houseni, M., Iruvuri, S., Alzeair, S., Sansovini, M., Wintering, N., Alavi, A. A., & Torigian, D. A. (2007) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2007.01.004 · Cited by 77 · see citing works
Intraobserver and Interobserver Reproducibility of Ovarian Volume, Antral Follicle Count, and Vascularity Indices Obtained With Transvaginal 3-Dimensional Ultrasonography, Power Doppler Angiography, and the Virtual Organ Computer-Aided Analysis Imaging Pr
Merce, L. T., Gómez, B., Engels, V., Bau, S., & Bajo, J. (2005) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2005.24.9.1279 · Cited by 76 · see citing works
The interobserver reliability of off‐line antral follicle counts made from stored three‐dimensional ultrasound data: a comparative study of different measurement techniques
Jayaprakasan, K., Walker, K. F., Clewes, J. S., Johnson, I. R., & Raine‐Fenning, N. J. (2007) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.3913 · Cited by 75 · see citing works
Ultrasound in polycystic ovary syndrome the measuring of ovarian stroma and relationship with circulating androgens: results of a multicentric study
Fulghesu, A. M., Angioni, S. L., Frau, E., Belosi, C., Apa, R., Mioni, R., Xamin, N., Capobianco, G., Dessole, S., Fruzzetti, F., et al. (2007) · Human Reproduction · doi:10.1093/humrep/dem202 · Cited by 75 · see citing works
Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters
Lam, P. M., Johnson, I. R., & Raine‐Fenning, N. J. (2007) · Human Reproduction · doi:10.1093/humrep/dem218 · Cited by 74 · see citing works
A 20-Year Follow-up of Young Women With Polycystic Ovary Syndrome
Dungan, J. S. (2012) · Yearbook of Obstetrics Gynecology and Women s Health · doi:10.1016/j.yobg.2012.06.193 · Cited by 72 · see citing works
Intracycle variation in number of antral follicles stratified by size and in endocrine markers of ovarian reserve in women with normal ovulatory menstrual cycles
Deb, S., Campbell, B. K., Clewes, J. S., Pincott‐Allen, C., & Raine‐Fenning, N. J. (2012) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.11226 · Cited by 71 · see citing works
Polycystic Ovary-Like Abnormalities (PCO-L) in Women with Functional Hypothalamic Amenorrhea
Robin, G., Gallo, C., Catteau-Jonard, S., Maunoury-Lefebvre, C., Pigny, P., Duhamel, A., & Dewailly, D. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1836 · Cited by 69 · see citing works
Self-citation
Asymptomatic Volunteers with a Polycystic Ovary Are a Functionally Distinct but Heterogeneous Population
Mortensen, M., Ehrmann, D. A., Littlejohn, E., & Rosenfield, R. L. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2771 · Cited by 69 · see citing works
Ultrasound criteria in the diagnosis of polycystic ovary syndrome (PCOS)
Atiomo, W., Pearson, S., Shaw, S. R., Prentice, A. G., & Dubbins, P. A. (2000) · Ultrasound in Medicine & Biology · doi:10.1016/s0301-5629(00)00219-2 · Cited by 68 · see citing works
Comparison of ovarian stromal blood flow between fertile women with normal ovaries and infertile women with polycystic ovary syndrome
Ng, E. H. Y., Chan, C. C. W., Yeung, W. S. B., & Ho, P. C. (2005) · Human Reproduction · doi:10.1093/humrep/deh853 · Cited by 67 · see citing works
Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian drilling
Weerakiet, S., Lertvikool, S., Tingthanatikul, Y., Wansumrith, S., Leelaphiwat, S., & Jultanmas, R. (2007) · Gynecological Endocrinology · doi:10.1080/09513590701485212 · Cited by 67 · see citing works
Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women
Duijkers, I. J. M., & Klipping, C. (2010) · Gynecological Endocrinology · doi:10.3109/09513590903247824 · Cited by 66 · see citing works
Do polycystic-appearing ovaries affect the risk of cardiovascular disease among women with polycystic ovary syndrome?
Loucks, T. L., Talbott, E. O., McHugh-Pemu, K. P., Keelan, M. H., Berga, S. L., & Guzick, D. S. (2000) · Fertility and Sterility · doi:10.1016/s0015-0282(00)00695-6 · Cited by 65 · see citing works
The Pregnancy in Polycystic Ovary Syndrome II study: baseline characteristics and effects of obesity from a multicenter randomized clinical trial
Legro, R. S., Brzyski, R. G., Diamond, M. P., Coutifaris, C., Schlaff, W. D., Alvero, R. J., Casson, P. R., Christman, G. M., Huang, H., Yan, Q., et al. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.08.056 · Cited by 64 · see citing works
Ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome in Chinese women
Chen, Y., Li, L., Chen, X., Zhang, Q., Wang, W., Li, Y., & Yang, D. (2008) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.5393 · Cited by 61 · see citing works
Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women
Duijkers, I. J. M., & Klipping, C. (2009) · Gynecological Endocrinology · doi:10.1080/09513590903247824 · Cited by 60 · see citing works
Two- and Three-Dimensional Sonographic and Color Doppler Techniques for Diagnosis of Polycystic Ovary Syndrome
Battaglia, C., Battaglia, B., Morotti, E., Paradisi, R., Zanetti, I., Meriggiola, M. C., & Venturoli, S. (2012) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2012.31.7.1015 · Cited by 55 · see citing works
Antral follicle count: absence of significant midlife decline
Rosen, M. P., Sternfeld, B., Schuh-Huerta, S. M., Pera, R. A. R., McCulloch, C. E., & Cedars, M. I. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.12.045 · Cited by 54 · see citing works
Self-citation
Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy
Das, M., Shehata, F., Son, W.-Y., Tulandi, T., & Holzer, H. E. G. (2012) · Human Reproduction · doi:10.1093/humrep/des143 · Cited by 54 · see citing works
The Complex Relationship between Hypothalamic Amenorrhea and Polycystic Ovary Syndrome
Wang, J. G., & Løbo, R. A. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1716 · Cited by 54 · see citing works
Polycystic ovary syndrome: relationship between insulin sensitivity ,sex hormone levels and ovarian stromal blood flow
Loverro, G., Vicino, M., Lorusso, F. P., Vimercati, A., Greco, P., & Selvaggi, L. E. (2001) · Gynecological Endocrinology · doi:10.1080/gye.15.2.142.149 · Cited by 52 · see citing works
Predictors of antral follicle count during the reproductive years
Kline, J. K., Kinney, A. M., Kelly, A., Reuss, M. L., & Levin, B. L. (2005) · Human Reproduction · doi:10.1093/humrep/dei048 · Cited by 52 · see citing works
Evaluation of Ovarian Reserve Based on Hormonal Parameters, Ovarian Volume, and Antral Follicle Count in Women with Type 2 Diabetes Mellitus
Işık, S., Özcan, H. N., Özuğuz, U., Tütüncü, Y., Berker, D. S., Alımlı, A. G., Akbaba, G., Karademir, M. A., & Güler, S. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1923 · Cited by 52 · see citing works
The role of serum anti-Müllerian hormone (AMH) in the hormonal diagnosis of polycystic ovary syndrome
Casadei, L., Madrigale, A., Puca, F., Manicuti, C., Emidi, E., Piccione, E., & Dewailly, D. (2013) · Gynecological Endocrinology · doi:10.3109/09513590.2013.777415 · Cited by 51 · see citing works
Self-citation
An evaluation of the inter-observer and intra-observer variability of the ultrasound diagnosis of polycystic ovaries
Amer, S. A. K. S., Li, T. C., Bygrave, C. J., Sprigg, A., Saravelos, H. G., & Cooke, I. D. (2002) · Human Reproduction · doi:10.1093/humrep/17.6.1616 · Cited by 51 · see citing works
Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC
Salama, S., Arbo, E., Lamazou, F., Levailllant, J. M., Frydman, R., & Fanchin, R. R. F. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.12.115 · Cited by 44 · see citing works
Hypothalamic amenorrhea in young women with underlying polycystic ovary syndrome
Sum, M., & Warren, M. P. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.05.063 · Cited by 44 · see citing works
Ultrasound diagnosis of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome is not associated with subfecundity or subfertility
Hassan, M. A. M., & Killick, S. R. (2003) · Fertility and Sterility · doi:10.1016/s0015-0282(03)01010-0 · Cited by 43 · see citing works
Impaired uterine perfusion associated with metabolic disorders in women with polycystic ovary syndrome
Chekir, C., Nakatsuka, M., Kamada, Y., Noguchi, S., Sasaki, A., & Hiramatsu, Y. (2005) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/j.0001-6349.2005.00678.x · Cited by 43 · see citing works
Grid Analysis Improves Reliability in Follicle Counts Made by Ultrasonography in Women With Polycystic Ovary Syndrome
Lujan, M. E., Brooks, E. D., Kepley, A. L., Chizen, D. R., Pierson, R. A., & Peppin, A. K. (2010) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2010.02.008 · Cited by 42 · see citing works
Self-citation
Psychological stress and reproductive aging among pre-menopausal women
Bleil, M. E., Adler, N. E., Pasch, L. A., Sternfeld, B., Gregorich, S. E., Rosen, M. P., & Cedars, M. I. (2012) · Human Reproduction · doi:10.1093/humrep/des214 · Cited by 40 · see citing works
Self-citation
Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries?
Köşüş, N., Köşüş, A., Turhan, N. Ö., & Kamalak, Z. (2010) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2010.10.007 · Cited by 40 · see citing works
Assessment of ultrasonographic features of polycystic ovaries is associated with modest levels of inter-observer agreement
Lujan, M. E., Chizen, D. R., Peppin, A. K., Dhir, A., & Pierson, R. A. (2009) · Journal of Ovarian Research · doi:10.1186/1757-2215-2-6 · Cited by 40 · see citing works
Self-citation
Improving inter-observer variability in the evaluation of ultrasonographic features of polycystic ovaries
Lujan, M. E., Chizen, D. R., Peppin, A. K., Kriegler, S., Leswick, D. A., Bloski, T. G., & Pierson, R. A. (2008) · Reproductive Biology and Endocrinology · doi:10.1186/1477-7827-6-30 · Cited by 35 · see citing works
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Number of Antral Follicles, Ovarian Volume, and Vascular Indices in Asymptomatic Women 20 to 39 Years Old as Assessed by 3-Dimensional Sonography
Jokubkiene, L., Sladkevicius, P., & Valentin, L. (2012) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2012.31.10.1635 · Cited by 34 · see citing works
Relationship between ultrasonography and histopathological changes in polycystic ovarian syndrome
Takahashi, K., Ozaki, T., Okada, M., Uchida, A., & Kitao, M. (1994) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a138432 · Cited by 30 · see citing works
Three‐dimensional ultrasound features of the polycystic ovary in Chinese women
Lam, P. M., Raine‐Fenning, N. J., Cheung, L. P., & Haines, C. J. (2009) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.6442 · Cited by 29 · see citing works
Doppler analysis of uterine perfusion and ovarian stromal blood flow in polycystic ovary syndrome
Adalı, E., Kolusarı, A., Adali, F., Yıldızhan, R., Kurdoğlu, M., & Şahin, H. G. (2009) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2008.12.023 · Cited by 29 · see citing works
Three‐dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome
Sun, L., & Fu, Q. (2007) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2007.02.024 · Cited by 28 · see citing works
Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography
Pascual, M. A., Graupera, B., Hereter, L., Tresserra, F., Rodríguez, I., & Alcázar, J. L. (2008) · Gynecological Endocrinology · doi:10.1080/09513590802308099 · Cited by 27 · see citing works
Transvaginal Ultrasound Appearances of the Ovary in Normal Women and Hirsute Women with Oligomenorrhoea
Fox, R. (1999) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.1999.tb03447.x · Cited by 25 · see citing works
Prospective evaluation of basal stromal Doppler studies in women with good ovarian reserve and infertility undergoing in vitro fertilization–embryo transfer treatment: patients with polycystic ovary syndrome versus ovulatory patients
Younis, J. S., Jadaon, J. E., Haddad, S., Izhaki, I., & Ben‐Ami, M. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.01.007 · Cited by 23 · see citing works
Ultrasound Diagnosis of Polycystic Ovaries
Fox, R., & Hull, M. G. R. (1993) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1993.tb43868.x · Cited by 21 · see citing works
Reliability of automated volumetric measurement of multiple growing follicles in controlled ovarian hyperstimulation
Lamazou, F., Arbo, E., Salama, S., Grynberg, M., Frydman, R., & Fanchin, R. R. F. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2010.01.062 · Cited by 19 · see citing works
Are there differences in ultrasound parameters between Chinese women with polycystic ovaries only and with polycystic ovary syndrome?
Ng, E. H. Y., Chan, C. C. W., & Ho, P. C. (2005) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2005.07.023 · Cited by 19 · see citing works
Influence of oral contraceptive pills on phenotype expression in women with polycystic ovary syndrome
Mulders, A. G. M. G. J., ten Kate-Booij, M., Pal, R., Kruif, M. D., Nekrui, L. C., Oostra, B. A., Fauser, B. C. J. M., & Laven, J. S. E. (2005) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)61687-2 · Cited by 17 · see citing works
Self-citation
The significance of polycystic-appearing ovaries versus normalappearing ovaries in patients with polycystic ovary syndrome
Najmabadi, S., Wilcox, J., Acacio, B., Thornton, M. H., Kolb, B. A., & Paulson, R. J. (1997) · Fertility and Sterility · doi:10.1016/s0015-0282(97)81357-x · Cited by 16 · see citing works
Hyperinsulinemia and uterine perfusion in patients with polycystic ovary syndrome
AJOSSA, S., Guerriero, S., Paoletti, A. M., Orrù, M., & Melis, G. B. (2002) · Ultrasound in Obstetrics and Gynecology · doi:10.1046/j.1469-0705.2002.00790.x · Cited by 9 · see citing works
Changes in the ovarian stromal blood flow in patients treated with laparoscopic salpingostomy for ectopic pregnancy
Keskin, U., Duru, N. K., Ercan, C. M., Dede, M., Yenen, M. C., & Ergün, A. (2013) · Journal of Obstetrics and Gynaecology · doi:10.3109/01443615.2013.769942 · Cited by 3 · see citing works

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The Diagnosis of Polycystic Ovary Syndrome during Adolescence
Witchel, S. F., Oberfield, S., Rosenfield, R. L., Codner, E., Bonny, A., Ibáñez, L., Pena, A., Horikawa, R., Gomez-Lobo, V., Joel, D., et al. (2015) · Hormone Research in Paediatrics · doi:10.1159/000375530 · Cited by 3,113 · see citing works
Polycystic Ovary Syndrome: Definition, Aetiology, Diagnosis and Treatment
Escobar-Morreale, H. F. (2018) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2018.24 · Cited by 2,083 · see citing works
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Polycystic ovary syndrome
Azziz, R., Carmina, E., Chen, Z., Dunaif, A., Laven, J. S. E., Legro, R. S., Lizneva, D., Natterson-Horowtiz, B., Teede, H. J., & Yildiz, B. O. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.57 · Cited by 2,005 · see citing works
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The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited
Rosenfield, R. L., & Ehrmann, D. A. (2016) · Endocrine Reviews · doi:10.1210/er.2015-1104 · Cited by 1,603 · see citing works
Criteria, Prevalence, and Phenotypes of Polycystic Ovary Syndrome
Lizneva, D., Suturina, L., Walker, W., Brakta, S., Gavrilova-Jordan, L., & Azziz, R. (2016) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.05.003 · Cited by 1,358 · see citing works
Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015) · Endocrine Reviews · doi:10.1210/er.2015-1018 · Cited by 1,020 · see citing works
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The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global who guidance
Balen, A. H., Morley, L. C., Misso, M., Franks, S., Legro, R. S., Wijeyaratne, C. N., Stener-Victorin, E., Fauser, B. C. J. M., Norman, R. J., & Teede, H. (2016) · Human Reproduction Update · doi:10.1093/humupd/dmw025 · Cited by 705 · see citing works
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Intraovarian Control of Early Folliculogenesis
Hsueh, A. J. W., Kawamura, K., Cheng, Y., & Fauser, B. C. J. M. (2014) · Endocrine Reviews · doi:10.1210/er.2014-1020 · Cited by 708 · see citing works
Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications
Broer, S. L., Broekmans, F. J., Laven, J. S. E., & Fauser, B. C. J. M. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmu020 · Cited by 691 · see citing works
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The polycystic ovary syndrome: a position statement from the European Society of Endocrinology
Conway, G., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H. F., Franks, S., Gambineri, A., Kelestimur, F., Macut, D., Micic, D., Pasquali, R., et al. (2014) · European Journal of Endocrinology · doi:10.1530/eje-14-0253 · Cited by 676 · see citing works
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Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls
Witchel, S. F., Oberfield, S. E., & Peña, A. S. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2019-00078 · Cited by 653 · see citing works
American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome–part 1
Goodman, N. F., Cobin, R. H., Futterweit, W., Glueck, J. S., Legro, R. S., & Carmina, E. (2015) · Endocrine Practice · doi:10.4158/ep15748.dsc · Cited by 623 · see citing works
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Update on PCOS: consequences, challenges, and guiding treatment
Hoeger, K. M., Dokras, A., & Piltonen, T. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa839 · Cited by 610 · see citing works
Polycystic Ovary Syndrome
McCartney, C. R., & Marshall, J. C. (2016) · New England Journal of Medicine · doi:10.1056/nejmcp1514916 · Cited by 619 · see citing works
Polycystic Ovary Syndrome
Azziz, R. (2018) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002698 · Cited by 573 · see citing works
An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence
Ibáñez, L., Oberfield, S. E., Witchel, S., Auchus, R. J., Chang, R. J., Codner, E., Dabadghao, P., Darendeliler, F., Elbarbary, N. S., Gambineri, A., et al. (2017) · Hormone Research in Paediatrics · doi:10.1159/000479371 · Cited by 463 · see citing works
Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences
Anagnostis, P. G., Tarlatzis, B. C., & Kauffman, R. P. (2017) · Metabolism · doi:10.1016/j.metabol.2017.09.016 · Cited by 428 · see citing works
Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity
Wolf, W. M., Wattick, R. A., Kinkade, O. N., & Olfert, M. D. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15112589 · Cited by 415 · see citing works
Endometrial function in women with polycystic ovary syndrome: a comprehensive review
Palomba, S., Piltonen, T., & Giudice, L. C. (2020) · Human Reproduction Update · doi:10.1093/humupd/dmaa051 · Cited by 385 · see citing works
Current Guidelines for Diagnosing PCOS
Christ, J. P., & Cedars, M. I. (2023) · Diagnostics · doi:10.3390/diagnostics13061113 · Cited by 340 · see citing works
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Poly Cystic Ovarian Syndrome: An Updated Overview
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Self-citation
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
Dewailly, D., Gronier, H., Poncelet, É., Robin, G., Leroy, M., Pigny, P., Duhamel, A., & Catteau-Jonard, S. (2011) · Human Reproduction · doi:10.1093/humrep/der297 · Cited by 483 · see citing works
Self-citation

Authors: Dewailly, D., Lujan, M. E., Carmina, E., Cedars, M. I., Laven, J., Norman, R. J., & Escobar-Morreale, H. F.
Affiliations: Université de Lille (FR)
Cornell University (US)
University of Palermo (IT)
University of California, San Francisco (US)
Erasmus MC (NL)
The University of Adelaide (AU)
Universidad de Alcalá (ES)
Corresponding author: Dewailly, D.
ORCID: Dewailly, D.
Lujan, M. E.
Carmina, E.
Cedars, M. I.
Laven, J.
Norman, R. J.
Escobar-Morreale, H. F.
Venue: Human Reproduction Update
Publisher: Oxford University Press (OUP)
Published: 2013-12-16
Volume: 20
Issue: 3
Pages: 334-352
ISSN: 1355-4786 (ISSN-L)
1460-2369
DOI: 10.1093/humupd/dmt061
OpenAlex: W2150346446
Cited by: 551
References: 131
Citations by year: 2026: 25 · 2025: 47 · 2024: 51 · 2023: 52 · 2022: 53 · 2021: 26 · 2020: 43 · 2019: 56 · 2018: 39 · 2017: 39 · 2016: 47 · 2015: 39 · 2014: 28 · 2013: 1 · 2012: 2
FWCI: 46.29
Type: journal article
Language: en
Open access: closed
Locations: Human Reproduction Update (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (acceptedVersion)
EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Kidney Cyst Diseases
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
Keywords: polycystic ovary syndrome, polycystic ovary morphology, ovarian volume, antral follicle count, transvaginal ultrasound, anti-Müllerian hormone, diagnostic thresholds, ovarian morphology, ovarian stroma, ovarian blood flow, hyperandrogenism, PCOS diagnostic criteria
MeSH terms: Adolescent, Adult, Female, Ovarian Follicle, Humans, Terminology as Topic, Ovary, Polycystic Ovary Syndrome, Reproducibility of Results, Biomarkers, Anti-Mullerian Hormone, Young Adult

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Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society

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