Diagnosis of PCOD | Jindal IVF Chandigarh
                      
Umesh N. Jindal
Jindal IVF & Sant Memorial Nursing Home
Chandigarh
 Described first in 1935
 Histology : 
• Twice cross-sectional area
• Same number of primordial follicles 
• Double the  developing and atretic  follicles.
• 50 % thick tunica
• 4 fold greater number of hilar call nests
Insulin PCOS
Resistan Anovulatio
MS ce n
Infertility
Obesit DUB
y
Diabet Cance
es rs
Atheroscler Hirsutis
osis m
Hypertens Acne
ion
CVD Alopecia
Fatty 
liver Sleep Depressio Apnea
n

 Any chronic anovulatory state will lead to a 
polycystic picture provided HPO axis is intact, 
chronpc estrogenism and / or hyper 
androgenism due to any cause will lead to 
PCO. 

 Estradiol fluctuate but remain within normal 
range.
 Increased Estrone peripheral conversion.
 Increased Testosterone         
 Increased Androstenedione   Ovary, LH 
 Increased17-OHP
 Increased DHEA
 Increased DHEA-S Adrenal

Genetic
Gn 
regulation Weight and 
and action energy 
PCOS regulation
Complex 
metabolic 
disorder
Insulin 
secretion and Androgen 
action synthesis 
and 
regulation 
Environmental
 Complex metabolic disorder
 Functional derangement of follicular 
development
 Increased estogens and androgens, LH and 
loss of cyclicity due self propogating feed 
back loop.
 Insulin resistance in 70 %.
 Polygenic inheritance.
Year Proposed  by Androgen Ovarian Ovarian Other 
function morphology cause
1990 NICHD Must Menstrual      - Exclusion
                      
          
disorders
2003 Rotterdam Two of the three Exclusion
ASRM-ESHRE
2006 AE-PCOS Must Either of two Exclusion
Definition Clinical or Oligo- PCO on Cushing’s 
biochemical anovulation ultrasound Tumur etc.
Clinical Hyperandrogenemia
• Hirsuitism
• 60-70%
• More gradual
• Variation with age and ethnicity
• Ferrimen and Gallway score->15 severe
  Early follicular phase(day3-5)
  Oligo/Amenorrhoeic-at random or 3-5 days
  Stromal area/total area ratio and or increased    
      
    stromal echogenesity
The usefullness of 3-D,Doppler or MRI
(Ultrasound assessment of the polycystic ovary-International 
consensus definition-Human reproduction;9:505-13)
Swanson and Co-Workers-1981
•General population-20-33%
 > 12 follicles at 2 - 9 mm in at least 1 ovary
 Volume > 10cc
 If a follicle is >10mm, repeat scan next cycle.
 Transvaginal is preferable
 Does not apply to women on OC pills
 Single ovary-sufficient to diagnose
PCOM (Polycystic Ovarian Morphology)
 Obesity-BMI>25 in 35-50%
 Android appearance
 Waist to hip ratio
 Acanthosis Nigricans-Non specific
 HAIR-AN SYNDROME
 Hyperpigmented velvety patch-nape of the 
neck,axilla,inner thigh and vulva
Gonadotrophins-LH/FSH
Increase in amplitude and frequency of LH
Elevated in 95%
LH increased in 60-70%
?Reliability of a single measurement
Increased LH levels and its treatment-
controversial
Lack on agreement on abnormal result
 2 hr GTT-F-110-125mgm/dl
                  2hr-140-199mgm/dl
With severe stigmata of insulin resistance
and hyperandrogenemia or undergoing
ovulation induction
 Fasting insulin->25microIU/ml
 Fasting G/I ratio of 4.5 or less  
                      (Suggested evaluation in PCOS-ACOG2009)
Tests for metabolic syndrome(Updated adult t/t 
panel lII)
Cholestrol,LDL
HDL150mgm/dl
BP-130/85 
F blood glucose>100mgm/dl
Waist circumference>35 inches
                      (Suggested evaluation in PCOS-ACOG2009)
 Hypergonadotrophic hypogonadism
 Hypogonadotropic hypogonadism
 Non classic congenital adrenal hyperplasia
 Suspected PCOS-1-19%
 Screening-17OHP-500 certain
 ACTH stimulation test-25USP
 17OHP>1000
 CUSHING SYNDROME
24 hour free cortisol and 17 hydroxysteroids
 Adrenal and ovarian tumours
▪  Rapid virilization
▪ Testosterone >200ngm/dl
▪ DHEAS >700ng/dl
▪ Imaging techniques
 ? Hyper prolactinamia
 ?Hypothyroidism
 HISTORY-Menstral disturbances, 
Hyperandrogenism, Infertility, weight gain, 
Galactorrhoea, Symptoms of hypothyroidism, 
Drug intake, Family history
 Examination-BMI, Type of obesity, 
Hypertension, Hirsuitism, Signs of 
virilization, Signs of Cushings disease, 
Galactorrhoea, Acanthosis nigricans, 
Abdominal examination, PV /PR Examination
 Free testosterone
 Total testosterone
 DHEAS
 LH/FSH Ratio
 17OH progesterone
•   Prolactin 
•    TSH
 Test for hyperinsulinemia 
 Test for dyslipidemias
Early diagnosis and intervention is imperative
Rotterdam criteria should be used
 Somatic or Lab Hyperandrogenism
 Oligo-anovulation
 Polycystic Ovarian Morphology
     Exclude
 Non-classical 17-hydroxylase deficiency, adrenal tumor, Cushing’s, 
prolactinemia, thyroid disorders, hypothalamic amenorrhea
Make a diagnosis  of PCOS  before starting treatment
Thank You