diagnosis of polycystic ovary syndrome in case of infertility

8/16/2019 Diagnosis of Polycystic Ovary Syndrome in Case of Infertility

1/17

DIAGNOSIS OF

POLYCYSTIC OVARY

SYNDROME IN CASE

OF INFERTILITY

NURCAHYO TRI UTOMO

1061050012

Medical student in Department of obstetric and gynaecology

Faculty of medicine, Christian university of Indonesia, Jakarta


2/17

PRELUDE

POLYCYSTIC OVARY SYNDROME (PCOS) OR

HYPERANDROGENIC ANOVULATION OR

STEIN-LEVENTHAL SYNDROME IS A SET OF

SYMPTOMS DUE TO ELEVATED MALE

HORMONE IN WOMEN. WOMEN WITH PCOSHAVE ABNORMALITIES IN THE

METABOLISM OF ANDROGENS AND

ESTROGEN AND IN THE CONTROL OF

ANDROGEN PRODUCTION.


3/17

PRELUDE

ACCORDING TO AZZIZ ET AL, 105 MILLION

WOMEN BETWEEN 15 AND 49 YEARS WITH

PCOS, ABOUT 72% TO 82% OF THE CAUSE OF

HYPERANDROGENISM IS A INFERTILE

WOMEN.


4/17

PRELUDE

NIH

• OLIGO-ANOVULATION• BIOCHEMICAL OR CLINICAL HYPERANDROGENISM

THEROTTERDA

M

• PRESENCE OF 2 OUT OF 3 CRITERIA :

• OLIGO-ANOVULATION• BIOCHEMICAL OR CLINICAL HYPERANDROGENISM• POLYCYSTIC OVARIES ON ULTRASOUND

AE-PCOS

•TWO OF THE FOLLOWING CRITERIA WOULD BE NECESSARY :•OLIOGO AND/OR ANOVULATION AND POLYCYSTIC OVARIES ON

ULTRASOUND•CLINICAL OR LABORATORY EVIDENCE OF ANDROGEN EXCESS

THE AMSTERDA

M

• MOST RECENTLY DEFINED PRESENCE OF 2 OUT OF 3 CRITERIA :• MENSTRUAL DISFUNCTION AND/OR POLYCYSTIC OVARY• HYPERANDROGENIA AND/OR HYPERANDROGENISM• THE ULTRASOUND SHOWING A POLYCYSTIC OVARY


5/17

PRELUDE

THE PURPOSE OF THIS PAPER IS TO

DETERMINE HOW THE DIAGNOSIS OF

POLYCYSTIC OVARY SYNDROME IN CASES

OF INFERTILITY SO PHYSICIAN CAN

DETERMINE THE APPROPRIATETREATMENT TO CONSIDER THE BENEFITS

AND DISADVANTAGES OF EACH

CONTAIMENT PROCEDURES THAT EXIST

TODAY.


6/17

DIAGNOSIS POLYCYSTIC OVARY

SYNDROME

BIOPHYSICAL

USG 2D

USG 3D

BIOCHEMISTR Y

ANDROGEN

AMH


7/17

SCI

FROM THE DEPARTMENT OF GYNECOLOGY

AND PATHOPHYSIOLOGY OF HUMAN

REPRODUCTION, UNIVERSITY OF BOLOGNA,

ITALYCOMPARISON BETWEEN 2D AND 3D

TRANSVAGINAL ULTRASOUND ISOVARIAN VOLUME (73%,86%)vs(73%,90%)

SUBCAPSULAR FOLLICLE(73%,80%)vs(77%,80%)OVARIAN STROMA (96%,86%)vs(94%,92%)


8/17

FROM ROYAL UNIVERSITY HOSPITAL WITHIN THE

DEPARTMENT OF OBSTETRICS, GYNECOLOGY AND

REPRODUCTIVE SCIENCES, CANADA

COMPARISON ON TRANSVAGINAL ULTRASOUND

EXAMINATION IS :FNPO (FOLLICLE COUNTS THROUGHOUT THE ENTIRE

OVARY) (81%,94%)

FNPS (FOLLICLE COUNTS IN A SINGLE CROSS SECTION)

(69%,90%)

OV (OVARIAN VOLUME) (81%,84%)


9/17

FROM DEPARTMENT OF ENDOCRINE

GYNECOLOGY AND REPRODUCTIVE MEDICINE,

FACULTY OF MEDICINE OF LILLE, FRANCE

IN THIS STUDY EXAMINED PHYSICALEXAMINATION, SERUM AND ULTRASOUND,

FROM THE THREE OF EXAMINATION WAS NO

SIGNIFICANT DIFFERENCE

BUT FROM SERUM AMH THERE ARE A

SIGNIFICANT DIFFERENCE :CONTROL (19,8 pmol/L)

PCO (33,6 pmol/L)

PCOS(63,3 pmol/L)


10/17

DISCUSSION A PROSPECTIVE COHORT STUDY INCLUDED 382

WOMEN IN RIGSHOS PITALET, COPENHAGEN,

DENMARK BETWEEN 2011-2013 . IN PCOS

BIOCHEMICAL, THERE ARE INCREASED LEVELS OF

FSH AND LH AND INCREASING LEVELS OF LH/FSH

WHILE ALSO ON OVARIAN MORPHOLOGY IN PCOS

THERE IS NUMBER FOLLICLE ANTRUM (AFC) ≥ 12

AND THE OVARIAN VOLUME > 10 ML IN AT LEAST

ONE OVARY WAS THE SAME IN TERMS OF

BIOCHEMICAL AND BIOPHYSICAL


11/17

DISCUSSION A CROSS-SECTIONAL STUDY WITH A SAMPLE OF 463

PCOS CONDUCTED AT FACULTY OF MEDICINE

CERRAHPASA, ISTANBUL, TURKEY STUDIED

BETWEEN JANUARY 2008 TO MAY 2012.

PATIENT WERE EVALUATED FOR GYNECOLOGICALEXAMINATION, ULTRASOUND AND HORMONE.

DIAGNOSIS OF PCOS USING THE ROTTERDAM

CRITERIA.

PATIENTS WITH PCOS SHOWED AN INCREASE OF

LEVELS OF LH AND AMH, OVARIAN VOLUME ANDTHE NUMBER OF ANTRAL FOLLICLES.


12/17

DISCUSSION A PROSPECTIVE COHORT STUDY WITH A SAMPLE OF

4567 WITH THE AGE BETWEEN 16 TO 26 YEARS WHO

PERFOMED AT THE FACULTY OF MEDICINE,

UNIVERSITY OF OULU, FINLAND.

IN THIS STUDY WANTED TO KNOW THEREALATIONSHIP BETWEEN MENSTRUAL

IRREGULARITIES AND INCREASED ANDROGEN

LEVELS.

SWELLAM ET AL FOUND SERUM AMH COULD BE

USED AS A MAKER IN THE DIFFERENTIALDIAGNOSIS IN PATIENTS WITH PCOS AND THERE

ARE POSITIVE RELATIONSHIP BETWEEN ANTRAL

FOLLICLE AND AMH


13/17

DISCUSSION ANOTHER STUDY BY THE OBSERVATIONAL STUDY

CROSS SECTIONAL USING 49 WOMEN IN THE FACULTY

OF MEDICINE, UNIVERSITY OF SASKATCHEWAN,

CANADA, WITH AGE OF PATIENTS 19 TO 36 YEARS .

IN TERMS OF THE EXAMINATION OF TRANSVAGINAL

ULTRASONOGRAPHY WERE ASSESSED IS AFC, OV, OA,SA, S/A, AND FDP.

THE CORE OF THE STUDY IS AFC ASSOCIATED

POSITIVELY WITH TT, ANDROSTENEDIONE, AND

LH:FSH. SI POSITIVELY ASSOCIATED WITH MARKERS OF

ANDROGEN AND LH:FSH IS PREDICTED TO INCREASEIN SIZE OF THE FOLLICLES ≤ 4 MM.

THE CONCLUSION IS AFC IS A REFLECTION OF THE

SEVERITY ABNORMALITIES REPRODUCTIVE IN PCOS


14/17

DISCUSSION OTHER COMPARATIVE STUDY IS AN

OBSERVATIONAL STUDY DESIGN CROSS SECTIONAL

STUDY WITH A SAMPLE OF 438 WOMEN ATTENDING

FERTILITY CLINICS BETWEEN SEPTEMBER 2012

UNTIL SEPTEMBER 2013, THE STUDY WAS

CONDUCTED AT THE CENTRE FOR FERTILITY

HOMERTON HOMERTON UNIVERSITY HOSPITAL,

LONDON, ENGLAND.

IN THIS STUDY, THERE ARE SEVERAL CHECKS ARE

PERFORMED AND COMPARED OF SERUM AMH, AFC

AMOUNT, SERUM FSH, LH SERUM, AGE, AND BMI.

THE CONCLUSIONS IS COMPARABLE TO THE

INCREASE IN AFC AND AMH INCREASE IN LH, THE

RATIO OF AMH / AFC IN WOMEN WITH PCOS HAVE

INCREASED


15/17

DISCUSSION OTHER COMPARATIVE STUDIES ARE DESIGNED

COHORT STUDY WITH A SAMPLE OF 121 WOMEN

CONDUCTED AT 3 HOSPITALS IN COPENHAGEN WITH

109 WOMEN DO PELVIC MRI AND ULTRASOUND, 11

WOMEN ONLY ULTRASOUND EXAMINATION AND ONE

WOMAN ONLY MRI EXAMINATION. SERUM AMH REFLECTED IN THE CATEGORY OF SMALL

FOLLICLES (2-3 MM) AND FOLLICLE MODERATE (4-6

MM) BUT NOT IN THE LARGE FOLLICLES (≥7 MM).

SO THE CONCLUSION FROM THIS RESEARCH IS PCOM

CORRELATION BETWEEN SERUM AMH LEVELS WEREINCREASED WITH THE NUMBER OF FOLLICLES > 12

AND THE SIZE OF THE FOLLICLES IN SMALL (2-3 MM)

AND MEDIUM (4-6 MM) IS ASSOCIATED.


16/17

CONCLUSION

AFC INCREASE PROPORTIONAL TO THE

INCREASE IN AMH AND LH, THE RATIO OF

AMH / AFC IN WOMEN WITH PCOS HAVE

INCREASED

AFC IS ASSOCIATED POSITIVELY WITH

TOTAL TESTOSTERONE,

ANDROSTENEDIONE, AND LH: FSH. SI

POSITIVELY ASSOCIATED WITH MARKERS

OF ANDROGEN AND LH: FSH, ALTHOUGH S / A NEGATIVE ASSOCIATED WITH THIS

VARIABLE. THE AFC IS A REFLECTION OF

THE SEVERITY OF ABNORMALITIES OF THE

REPRODUCTIVE FUNCTION IN PCOS.


17/17

THANK YOU

diagnosis of polycystic ovary syndrome in case of infertility

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