Remission of polycystic ovary syndrome based on the recovery of ovarian morphology identified by three-dimensional ultrasonography: a retrospective study.

BACKGROUND

Polycystic ovary syndrome (PCOS) is a prevalent chronic disease, yet the concept of PCOS remission and its predictors remain poorly understood.

OBJECTIVES

This study investigated PCOS remission rates via three-dimensional (3D) ultrasonography assessment of ovarian morphological normalization.

METHODS

This retrospective study included 1379 reproductive-aged PCOS women from Shanghai Tenth People's Hospital (Aug. 2019-Dec. 2025). After medication initiation, anthropometric, biochemical, and reproductive data (both baseline and post-treatment) were collected quarterly, while 3D ultrasonography was used to evaluate polycystic morphology during follow-up.

RESULTS

Among the 468 eligible participants, 55 (11.75%) achieved clinical remission of PCOS, defined as restoration of regular menses, normalization of serum testosterone levels, and recovery of normal ovarian morphology. The mean time to remission was 12.76 ± 11.77 months. Patients in the clinical remission group were frequently prescribed insulin-sensitizing and weight-loss agents, including metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose linked transporter 2 inhibitors (SGLT-2is), and thiazolidinediones (TZDs). Following treatment, the remission group exhibited significant increases in menstrual cycle frequency and estradiol (E2), together with significant reductions in body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GT), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), uric acid (UA), total testosterone (TT), androstenedione, and anti-Müllerian hormone (AMH) compared with baseline. Significant decreases in bilateral ovarian volume and follicle number were also observed. After adjustment for multiple confounding factors, multivariate Cox proportional hazards regression revealed that BMI, ALT, and LDL-c retained strong independent predictive value for PCOS remission.

CONCLUSION

Our study demonstrated that 11.75% of women with PCOS achieved complete clinical remission following targeted metabolic pharmacotherapy, as evidenced by restored ovarian morphology, normalized testosterone concentrations, and regular menstrual cycles.

CLINICAL TRIAL REGISTRATION: http://www.chictr.org.cn, identifier: NCT05063383.