The Prevalence of Polycystic Ovaries in Women With Infertility

摘要

Many women with hirsutism or a history of multiple miscarriages are found to have polycystic ovaries, but the functional relevance of this finding in ovulating women who present with infertility is uncertain. This study used ultrasonography to determine the prevalence of polycystic ovaries in 289 infertile women. The group included 98 anovulatory women, 52 with tubal disease, 76 couples with sperm dysfunction, and 63 with unexplained infertility. Cycle monitoring included serial ultrasound scans and timed hormone estimates to clarify the structure and function of the ovaries. Scans were made at 3- to 4-day intervals starting on cycle day 8. Serum levels of gonadotropins and testosterone were determined when ovulation was confirmed and during the midluteal phase of a subsequent cycle. Sixty-seven women who considered themselves normal and who had conceived spontaneously served as a control group.Polycystic ovaries were diagnosed in 83 percent of anovulatory women, whose day-8 LH levels were significantly higher than those of control women. No hormonal abnormalities were evident in anovulatory women with normal ovarian morphologic structure. The prevalence of polycystic ovaries in women whose partners had abnormal semen was 53 percent. Half of the 52 women with tubal disease were diagnosed as having polycystic ovaries, and these women also had significantly elevated day-8 testosterone levels. Among the 63 women with unexplained infertility were 28 (44 percent) with polycystic ovaries. Six of the latter women but none of those with normal ovaries were hirsute. Polycystic ovaries were documented in 14 of 34 women with primary infertility and in 14 of 29 with secondary infertility. Polycystic ovaries were also detected in 28 percent of control women. The prevalence of polycystic ovaries was significantly elevated in anovulatory women, those whose partners had dysfunctional sperm, and those with tubal disease as compared with the control group.These findings suggest that in ovulatory women with tubal disease or a partner with dysfunctional sperm who are diagnosed with polycystic ovaries, some unidentified factor related to polycystic ovaries, possibly having to do with hyperandrogenemia, contributes to subfertility.Hum Reprod 1999;14:2720–2723