Polycystic ovary syndrome – controversy in the diagnosis

Polycystic ovary syndrome (PCOS) is found in 3 to 6% of women in child-bearing age. At the same time PCOS is the most common cause of infertility. The diagnostic criteria for PCOS include: anovulation or ovulatory disorders, hyperandrogenism and typical polycystic ovary image in ultrasound examination in the absence of other causes of hyperandrogenism. The etiology of the syndrome remains unknown, nevertheless it seems that abnormal regulation of cytochrome P450-17alfa may be the underlying cause. Impaired regulation of abnormal androgen metabolism is closely related to increased level of luteinizing hormone (LH) and hyperinsulinemia. The most common clinical symptoms include: menstrual disorders, hirsutism and acne. Obesity is found in 30 to 60% of PCOS patients. Increased body weight in PCOS patients is often accompanied by more intense clinical symptoms than in not obese PCOS patients with similar biochemical disorders observed. Today the majority of clinical practitioners in the world recognize the Rotterdam criteria published in 2003, nevertheless the recommendations of National Institute of Health in the USA from 1990 are also commonly followed. In 2009 Androgen Excess and PCOS Society published reviewed recommendations for PCOS diagnosis. Despite the fact that there are three different diagnostic recommendations published the interpretation of three basic groups of PCOS symptoms is in many ways controversial. The assessment of hyperandrogenisation is largely subjective and may be done by means of various scoring systems. The measurement of androgen concentration is an issue due to the absence of easily accessible and at the same time precise laboratory methods. Similarly, the assessment of ovulation is not standardized. Evaluating the structure of the ovary in the ultrasound examination is problematic as the methods suggested in the Rotterdam criteria are time-consuming and difficult to apply. As a result different physicians may diagnose PCOS in women with various phenotypes.