Oligoovulatory and Anovulatory Cycles in Women with Polycystic Ovary Syndrome (PCOS): What’s the Difference?

摘要

Context: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder. The phenotype may differ between patients who exhibit signs of recent ovulation and anovulatory PCOS patients.Objective: Our objective was to study differences in clinical and endocrine characteristics and response to ovulation induction (OI) treatment comparing oligoovulatory and anovulatory PCOS patients.Design and Setting: We conducted a retrospective cohort study at a tertiary hospital.Patients: PCOS patients (n = 1750) presenting with oligo- or amenorrhea were diagnosed according to the Rotterdam 2003 consensus criteria. Arbitrarily, oligoovulatory PCOS was defined by a single random serum progesterone level of 10 nmol/liter or higher.Main Outcome Measures: We evaluated the incidence of oligo- or amenorrhea, menstrual cycle length, serum androgen levels, follicle count, and OI outcome parameters.Results: Anovulatory women (n = 1541 of 1750, 88.1%) were more often amenorrheic ( P < 0.001) and presented with a longer cycle duration ( P < 0.001) compared with oligoovulatory women (n = 209 of 1750, 11.9%). Serum levels of testosterone ( P < 0.001), the free androgen index ( P < 0.001), and total follicle count ( P < 0.005) were higher in anovulatory compared with oligoovulatory patients. During clomiphene citrate OI, more oligoovulatory women gained regular menstrual cycles ( P < 0.05), whereas after second-line treatment with recombinant FSH, more anovulatory women became pregnant ( P < 0.05).Conclusions: Oligoovulatory women with PCOS exhibit a milder phenotype of ovarian dysfunction and have a more favorable response to OI treatment using clomiphene citrate compared with anovulatory PCOS patients. However, during second-line treatment with recombinant FSH, anovulatory PCOS patients presented with a higher chance of pregnancy compared with oligoovulatory patients.