Impact of updated international diagnostic criteria for diagnosis of polycystic ovary syndrome (PCOS) among Asian-Indian women-a cross-sectional study.

OBJECTIVE

To study the impact of updated international diagnostic criteria for follicle number per ovary (FNPO) on diagnosis of polycystic ovary syndrome (PCOS) and phenotype classification among Asian-Indian women. Also, to compare the low FNPO and high FNPO groups in terms of clinical, anthropometric, endocrine, and metabolic parameters.

METHODS

This was a cross-sectional study conducted at a tertiary care referral center. Women aged 21-38 years with a diagnosis of PCOS according to the 2003 Rotterdam criteria were included and were divided according to follicle number per ovary (FNPO) into low FNPO (12-19) and high FNPO (≥20) groups.

RESULTS

A total of 342 women with a diagnosis of PCOS were included for analysis. Changing the FNPO threshold to 20 or more led to reclassification of 18.49% (27/146) of women from PCOS phenotype A into phenotype B and excluded 37.75% (74/196) of women from diagnosis of PCOS (phenotypes C and D) to single criterion phenotypes. Although the high FNPO group had a significantly higher number of participants with prolonged cycle length, higher luteinizing hormone/follicle-stimulating hormone ratio, higher modified Ferriman-Gallwey score and higher serum anti-Müllerian hormone levels, both groups had comparable anthropometric and metabolic parameters and comparable prevalence of metabolic syndrome. After excluding phenotype A (where diagnosis of PCOS is otherwise not affected by FNPO), the cohort of phenotypes C and D was divided into the low and high FNPO groups and both groups had comparable anthropometric and metabolic parameters and comparable incidence of metabolic syndrome.

CONCLUSION

Increasing the FNPO cut-off of polycystic ovarian morphology excludes a significant number of women from the diagnosis of PCOS despite having comparable anthropometric and metabolic parameters. Robust data are required from different ethnic populations before the new cut-off for polycystic ovarian morphology is accepted or refuted, especially in populations with a higher prevalence of non-hyperandrogenic PCOS phenotypes.