RETROSPECTIVE STUDY ON PREVALENCE OF POLYCYSTIC OVARIES: A COMMON FEATURE IN TRANSVAGINAL SCAN

Vivek Kumar Garg and Manjula Sharma*

ABSTRACT

Polycystic ovary syndrome is a multi-factorial disease. The coexistence of hirsutism, oligo-ovulation, infertility and bilateral enlargement of the ovaries was first reported by Stein and Leventhal in 1935.[1] The term polycystic ovary syndrome (PCOS) was first used in the 1960s and gradually replaced its former name (Stein–Leventhal syndrome). This disease entity is primarily characterized by disrupted ovulation and hyperandrogenism, but the clinical picture can be diversified and symptom intensity can vary. Currently, the sonographic assessment of ovaries is one of the obligatory criteria for the diagnosis of PCOS according to the Rotterdam consensus (2003).[2] Polycystic ovaries (PCO) are described on ultrasound scan as the "presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter, and/or increased ovarian volume (>10 ml)". Polycystic ovarian syndrome (PCOS) or disease (PCOD) is diagnosed when polycystic ovaries are associated with chronic anovulation and clinical and/or biochemical androgen excess (typically featured as oligo-amenorrhoea and hirsutism/acne, respectively). The Rotterdam criteria for diagnosis require any two of the three features. Unilaterality does not affect diagnosis; neither does the location of the cysts in the ovary. PCOS is associated with infertility, as well as obesity, insulin resistance and hyperinsulinemia, leading to impaired glucose tolerance. Environmental factors, such as obesity, seem to exacerbate genetic predispositions. PCOS is a diagnosis of medical interest, as associations with important non-communicable diseases have been made-notably, the metabolic syndrome. This comprises: insulin resistance, obesity, hypertension and dyslipidaemia, which significantly increase the woman's risk of cardiovascular disease.[3] This makes extensive evaluation of PCOS of wider interest, much beyond its role in infertility. Prevalence of polycystic ovaries in western world is approximately 10-26% in reproductive age group women.[4] Polycystic ovary syndrome is the most common endocrine disease in women of child-bearing age. The prevalence ranges from 9% when the NIH (National Institutes of Health) criteria are used to even 18% according to the guidelines of the Rotterdam consensus.[5] This study was aimed at documenting prevalence of polycystic ovary syndrome in women of child bearing age, who had undergone transvaginal ultrasound at Department of Radiodiagnosis in NSCB Zonal Hospital Mandi. Methods: This was a retrospective study of 259 transvaginal ultrasound scans performed at Department of Radiodiagnosis in NSCB Zonal Hospital Mandi. All obstetric ultrasounds were excluded. All scans were performed using a 5.0 MHz transvaginal probe(SIEMENS ACUSON). Probes were properly sheathed with lubricated latex condoms before use. Data were analysed with IBM SPSS Statistics 20 by simple frequencies and means. Results: As per Rotterdam criteria, about 40 patients, a proportion of 16% had polycystic ovaries (Fig. 1). Most of these patients were in the age group of 20-29 years with a mean age of 26+/-5 years. Infertility( 37%) was the most common indication for TVS, followed by oligomenorrhoea(29%). Table 1 shows the indication. About 22 patients had unilateral polycystic ovaries, the rest 18) had bilateral. Using the current features on Rotterdam criteria, at least 12(30%) patients had polycystic ovary syndrome.

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