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PubMedDate not supplied

[The role of insulin-like growth-factor binding proteins in normal and polycystic ovaries].

The insulin-like growth factor binding proteins are single chain polypeptides, that can bind insulin-like growth factors, but not insulin. They can serve as autocrine or paracrine regulators of the actions of insulin-like growth factor. The human granulosa cells produce insulin-like growth factor-II but not insulin-like growth factor-I, while the human theca cells produce insulin-like growth factor-I and II. Polycystic ovarian syndrome is a disorder which is characterised by hyperandrogenism and anovulation. In polycystic ovarian syndrome there is a disorder of follicular development, with the accumulation of antral follicles within the ovary which fail to respond appropriately to endogenous follicle-stimulating hormone. Significance is given to insulin-like growth factor binding proteins, which have an inhibitory action on follicle-stimulating hormone. No differences were found in the total level of insulin-like growth factor binding proteins follicular profiles between women with polycystic ovarian syndrome and without it. Serum insulin-like growth factor binding protein-I levels are lower in polycystic ovarian syndrome with hyperinsulinaemia, probably as a consequence of insulin-mediated suppression of insulin-like growth factor binding protein-I. Consequently, serum free insulin-like growth factor-I levels are higher. This alteration may cause an excessive thecal androgen production. The alterations in the insulin-like growth factor-insulin-like growth factor binding proteins axis may be one of several mechanisms that help to sustain the steady state of anovulation and follicular dysmaturation that are characteristic of this syndrome.

Female↗
PubMedDate not supplied

A prospective study of infertility due to ovulatory disorders, ovulation induction, and incidence of breast cancer.

BACKGROUND: Anovulation has been hypothesized to decrease the risk of breast cancer. Therefore, infertility attributed to ovulatory disorders and ovulation-induction therapy may influence breast cancer risk. METHODS: We analyzed prospectively collected data from the Nurses' Health Study II, a cohort of 116,671 female registered nurses aged 25 to 42 years at baseline. Information on infertility was assessed every 2 years starting in 1989, ovulation induction was assessed every 2 years from 1993 to 1997, and incident cases of breast cancer were included through 2001. RESULTS: During 1,275,566 person-years of follow-up (1989-2001), 1357 incident cases of invasive breast cancer were diagnosed. Overall, women who reported infertility due to ovulatory disorder had a significantly lower incidence of breast cancer than women who did not report problems conceiving during a 12-month period (covariate-adjusted hazard ratio, 0.75; 95% confidence interval, 0.59-0.96). The incidence of breast cancer was lowest among women with infertility due to ovulatory disorder who received ovulation-induction therapy (covariate-adjusted hazard ratio, 0.60; 95% confidence interval, 0.42-0.85). CONCLUSIONS: Among women who participated in the Nurses' Health Study II, we observed an inverse association between infertility due to ovulatory disorder and breast cancer incidence. We observed the greatest reduction in the incidence of breast cancer for women who reported ovulatory disorder and use of ovulation-induction therapy, but these results should be interpreted with caution because these women may be the most infertile.

Adult↗
PubMed1996

Interstitial laser treatment of the ovary: an experimental study in goats.

BACKGROUND AND OBJECTIVE: Interstitial laser treatment (ILT) of the ovary might be a new surgical approach to restore ovulation with a minimal risk of adhesion formation in patients with chronic hyperandrogenic anovulation who are unresponsive to hormone therapy. The objective was to investigate the feasibility of inducing a lesion limited to the center of the ovary in an animal model. STUDY DESIGN/MATERIALS AND METHODS: ILT was performed in seven goats using Nd:YAG laser in combination with ultrasound monitoring. The extent of direct thermal damage was investigated in two goats, treating both ovaries during a laparotomy at 2, 4, 6, and 8 W, respectively, for 5 min. Adhesion formation was evaluated in five goats 81 days after an unilateral laparoscopic ILT at 1, 2, 4, 6, or 8 W for 5 min. During treatment temperatures on the surface of the ovary were measured. RESULTS: Histology after 1 day showed sharply demarcated necrotic lesions located centrally or subcapsularly at low powers, whereas at higher powers the lesions extended to the surface of the ovary. At low powers no adhesions were observed, whereas higher powers resulted in periovarian adhesions. Temperatures measured on the ovarian surface during treatment ranged between 38 degrees C and 90 degrees C. Ultrasound monitoring of the extent of thermal damage failed due to poor positioning. CONCLUSION: Although this pilot study does not warrent firm conclusions, the results indicate that ILT of the ovary is feasible and that lesions without adhesions can be produced at low powers. The use of ultrasound to monitor the extent of thermal damage in the ovary should be a subject of further evaluation.

Aluminum Silicates↗
PubMed2005

Laparoscopic "drilling" by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome.

BACKGROUND: Problems in inducing ovulation in women with polycystic ovary syndrome (PCOS) and anovulation (failure to ovulate) are well recognised. Surgical ovarian wedge resection was the first established treatment for anovulatory PCOS patients but was largely abandoned due to the risk of post-surgical adhesions and the introduction of medical ovulation induction with clomiphene and gonadotrophins. However patients with PCOS treated with gonadotrophins often have an over-production of follicles and are exposed to the risks of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. Moreover ovulation induction with gonadotrophins, though effective, is an expensive, inconvenient and time-consuming treatment requiring intensive monitoring. Surgical therapy with laparoscopic ovarian "drilling" (LOD) may avoid or reduce the need for gonadotrophins or may facilitate their use. The procedure can be done on an outpatient basis with less trauma and fewer postoperative adhesions. Many uncontrolled observational studies have claimed that ovarian drilling is followed, at least temporarily, by a high rate of spontaneous ovulation and conception, and/or that subsequent medical ovulation induction becomes easier. OBJECTIVES: To determine the effectiveness and safety of laparoscopic ovarian drilling compared with ovulation induction for subfertile women with clomiphene-resistant PCOS. SEARCH STRATEGY: We used the search strategy of the Menstrual Disorders and Subfertility Group. SELECTION CRITERIA: We included randomised controlled trials of subfertile women with clomiphene-resistant PCOS that undertook laparoscopic ovarian drilling in order to induce ovulation. DATA COLLECTION AND ANALYSIS: Fifteen trials were identified and six were included in the review. All trials were assessed for quality criteria. The primary outcomes were live birth, ovulation and pregnancy rates and the secondary outcomes were rates of miscarriage, multiple pregnancy, ovarian hyperstimulation syndrome and cost. MAIN RESULTS: There was no evidence of a difference in live births or ongoing pregnancies between LOD and gonadotrophins and the pooled Odds Ratio (OR) (all studies) was 1.04 (95% CI 0.74, 1.99) and 1.16 (95% CI 0.72, 1.86) respectively. Multiple pregnancy rates were lower with ovarian drilling than with gonadotrophins (1% vs 16%, OR: 0.13, 95% CI: 0.03 to 0.59). There was no evidence of a difference in miscarriage rates between the two groups (OR 0.81, 955% 0.36, 1.86). AUTHORS' CONCLUSIONS: There was no evidence of a difference in the live birth rate and miscarriage rate in women with clomiphene resistant PCOS undergoing LOD compared to gonadotrophin treatment. The reduction in multiple pregnancy rates in women undergoing LOD makes this option attractive. However, there are ongoing concerns about long term effects of LOD on ovarian function.

Anovulation↗
PubMed2006

Endometrial glandular and stromal breakdown, part 1: cytomorphological appearance.

Endometrial carcinoma is the most common invasive neoplasm of the female reproductive tract. Early detection and accurate diagnosis of these lesions and its precursor by endometrial cytology is now accepted in Japan and regarded as an effective primary method of evaluating endometrial pathology (atypical hyperplasia or carcinoma). Careful cytomorphologic evaluation of the abnormal endometrial lesions has made possible an accurate and reproducible microscopic assessment. The current study was conducted to determine the significance of endometrial cytology on disordered endometrium associated with anovulation when compared with endometrial hyperplasia. From January 1998 through April 2004, 144 cases on which histopathological diagnoses were obtained by endometrial curettage after taken direct endometrial sample by Endocyte. The materials comprise 49 cases of normal proliferative endometrium, and 63 cases of endometrial hyperplasia without atypia were prepared as control cases. The cytomorphology was examined involving so-called endometrial glandular and stromal breakdown (EGBD). EGBD cases evidenced significant numbers of stromal cells condensed and formed compact nests with hyperchromatic nuclei and little or no cytoplasm. They were often associated with fragmented clusters of endometrial glands with condensed cluster of stromal cells. Both the fragmented cluster of endometrial glands and condensed cluster of stromal cells are a characteristic cytologic feature of EGBD endometrium on the cyto-architectural diagnosis. The combination of these cellular patterns is highly specific to this abnormal pathological condition in EGBD endometrium. To improve the accuracy of the cytodiagnosis, it is important that the cytology of the EGBD endometrium should be diagnosed negative; as a result, we can achieve successful endometrial cytology with cyto-architectural criteria for the endometrial pathology.

Adult↗
PubMed1996

The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO group II anovulatory infertile women: evidence from a large multicenter study in Spain.

PURPOSE: Our goal was to investigate the safety, effectiveness, and feasibility for the practicing physician of stepwise and low-dose administration of FSH in WHO group II anovulatory infertile women. METHODS: Infertile female patients (n = 234) suffering from WHO group II anovulation, and who failed to became pregnant with clomiphene citrate, were included in a multicenter, prospective, clinical study of treatment with a protocol of chronic low-dose and small incremental rises with urinary purified or highly purified FSH. Follicular development was monitored with ultrasonographic scans. RESULTS: The 234 patients received a total of 534 cycles of treatment, for a mean number of 2.3 treated cycles per patient. hCG was withheld in 65 (12.2%) cyles because of no response and in 28 (5.2%) cycles because of hyperresponse. Of the remaining 441 cycles, 419 (95%) were ovulatory, and in 198 (47.3%) of these cycles a single dominant follicle developed. There were 93 pregnancies (39.7% per patient), for a cycle fecundity rate of 17.4%. Cumulative conception rate after two treated cycles was 33.5%. There were 14 (15%) pairs of twins and 10 (10.8%) spontaneous miscarriages. The prevalence of complications was low with no cases of severe OHSS. Basal LH/FSH ratio was significantly higher in the pregnant group of patients than in nonpregnant women. CONCLUSIONS: Stepwise and chronic low-dose administration of FSH is a safe and effective method for treatment of WHO group II anovulatory infertility, mainly in those patients having high LH/FSH ratios.

Adult↗
PubMed1990

Analysis of the hypothalamic-pituitary-ovary axis in the neonatally-androgenized female rat.

The administration of testosterone propionate (TP) in the female rat at the neonatal age has been used for several yr as a model to study anovulation during adulthood. The present work was designed in order to see whether some neuroendocrine parameters vary with age in this animal model. Hypothalamic LHRH content and LH-FSH anterior pituitary (AP) content and plasma levels were evaluated in samples taken from both neonatally-androgenized and littermate control female rats at different ages (15 to 100 days old). Additionally, we have studied pulsatile LH-FSH released in plasma and in vivo AP response to LHRH in both neonatally-androgenized and control female rats during adulthood. The results indicate that the neonatal TP treatment did not induce any change in hypothalamic LHRH content over development. Neonatally androgenized rats have decreased both LH-FSH AP content and plasma levels at the infantile age (15-day old). LH-FSH AP content remained reduced in samples taken up to the 30th day of age. Plasma LH-FSH levels on the day 30 of age were similar in both groups. TP-treated rats studied on the 100th day of age had: a) an altered pulsatile rhythm of gonadotropin release in plasma due to the decreased LH-FSH trough and average mean values, and to the diminished FSH peak amplitude values, as well as an increased LH:FSH ratio; and b) an impaired in vivo LHRH-induced LH-FSH release.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed2006

Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam's criteria and women whose only clinical signs are oligo/anovulation or hirsutism.

This study was an attempt to determine whether the hormonal and clinical profiles of polycystic ovarian syndrome (PCOS) or non-PCOS cases whose only admission signs were oligo/anovulation or hirsutism. This retrospective study comprised a total number of 118, age-matched, young Turkish women with initial admission signs and symptoms of menstrual disorders (MD) like oligo/anovulation or hirsutism. Of these, 66 cases were diagnosed as PCOS, based on 2003 Rotterdam criteria [presence of two of first three criteria such as oligo- and/or anovulation, signs of clinical hyperandrogenism (HA-c) and/or biochemical signs of hyperandrogenism (HA-b) and polycystic ovaries on ultrasonography after exclusion of specific identifiable disorders]. Fifty-two women were diagnosed as cases of oligo/anovulation or hirsutism before the era of PCOS Rotterdam's consensus criteria. These two PCOS and non-PCOS cases were evaluated in terms of body mass index (BMI), waist-to-hip ratio, serum FSH, LH, estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), androstendione (A) 17 hydroxyprogesterone (17-HP), fasting insulin, C-peptide levels, sex hormone-binding globulin (SHBG) and finally, ultrasonographic ovarian morphology. PCOS cases with unilateral and bilateral polycystic ovarian morphology on ultrasound scan were analyzed based on Rotterdam criteria. No statistically significant difference was detected among two groups, in terms of BMI, waist-to-hip ratio, serum FSH, LH, E2, fasting insulin, C-peptide levels (P > 0.05). However, blood levels of DHEAS, A and 17-HP were higher, whilst SHBG levels were remarkably lower (P = 0.008) in PCOS cases. Among PCOS group, hormonal and clinical characteristics did not differ, irrespective or uni- or bilaterality of ovarian morphology on ultrasonographic scan. Percentages of cases with androgenic alopecia, oily skin/acnea and increased ovarian volume were higher in PCOS group; whereas Ferriman-Gallwey score >/= 8 were similar between two groups. Total but not free testosterone remained high in PCOS group (P < 0.01). In both PCOS and non-PCOS cases, a linear correlation was apparent between BMI and insulin levels (r (s )= 0.69 and 0.32, P < 0.05, respectively). Among PCOS group, MD + HA-b + HA-c (n = 40) was present in 60.6% of subjects, MD + HA-b (n = 12) in 18.2%, and MD + HA-c (n = 14) in 21.2%. The three phenotypes did not differ in mean BMI, waist-to-hip ratio and biochemical characteristics. To conclude, non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.

Adult↗
PubMed1998

Effect of clomiphene citrate on ovulation after treatment withdrawal.

The effect of clomiphene citrate (CC) on ovarian function in cycles subsequent to treatment withdrawal was studied. Thirty two out of 45 patients with anovulation due to polycystic ovarian syndrome (PCOS) and with no other factor affecting fertility who got pregnant were included. All patients received CC to induce ovulation. Pregnancies in CC treated cycles and after treatment were recorded. Twenty pregnancies were achieved during CC treated cycles and 12 in the cycles after it was withdrawn. In the latter group, eight pregnancies were achieved in the cycle following CC therapy, and four in the second subsequent cycle. In relation to pregnancy complications no significant statistical differences were found between the group of patients who became pregnant during the stimulation cycles and in the cycles after CC.

Adult↗
PubMed1977

Dynamic testing of hypothalamic-pituitary function in abnormalities of ovulation.

A review of 26 unusual patients indicates that a combined luteinizing hormone-releasing hormone (LRH)-clomiphene test in conjunction with an estrogen provocation test not only was helpful in identifying underlying pathophysiology of anovulation but also proved useful in the clinical management of the patients. Dynamic testing per se does not establish a diagnosis but, in conjunction with history and other laboratory findings, it does make possible further subdivisions of groups of patients who otherwise appear similar, both clinically and from routine laboratory evaluations. It, therefore, tends to pinpoint a lesion and establish the area in which further tests should be made. It is concluded that the value of such investigations will be more evident as gynecologic endocrinology moves into investigation of the supratentorial control of hypothalamic function and as hypothalamic LRH becomes available as a therapeutic agent.

Amenorrhea↗
PubMed1979

Effects of a superactive luteinizing hormone-releasing factor agonist on gonadotropin and ovarian function during the menstrual cycle.

The effect of a potent luteinizing hormone-releasing factor (LRF) agonist (D-Trp6, Pro9 NEt)-LRF on pituitary gonadotropin release and its concomitant ovarian response was examined in normal women during the early follicular (EFP), late follicular (LFP), and midluteal (MLP) phases. A single subcutaneous injection of 50 micrograms of LRF agonist in subjects during the EFP caused prompt release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to levels comparable to those found during spontaneous midcycle gonadotropin surges, while in LFP subjects gonadotropin levels rose 1 1/2 to 2 times above the levels of midcycle surges. The LH/FSH release in the MLP was almost identical to that found in the EFP. The ovarian response as measured by increasing estradiol levels followed a similar pattern during the 48 hours after injection in all three phases of the cycle. The inappropriate gonadotropin surge induced by LRF agonist in EFP subjects resulted in prolonged follicular phases and anovulation. Three of four subjects in the LFP showed evidence of ovulation in response to the same dose of LRF agonist. The pharmacodynamics of gonadotropin-ovarian responses to this potent LRF agonist reported here should provide an important reference for systemic investigation and rational clinical application.

Adult↗
PubMed1979

Testosterone levels in female partners of infertile couples. Relationship between androgen levels in the woman, the male factor, and the incidence of pregnancy.

Plasma testosterone levels were measured in the female partners of 146 consecutive infertile couples. The incidence of hyperandrogenism in the woman was correlated with ovarian function, incidence of pregnancy, male factor, and response of plasma testosterone levels to prednisone treatment. Over 70 per cent of the patients had pretreatment testosterone levels above 40 ng. per 100 ml. while after a minimum of two months of therapy approximately 80 per cent had levels below 40 ng. per 100 ml. High levels of plasma testosterone were associated with significant prolongation of the follicular phase of the cycle and increased incidence of amenorrhea or anovulation. An over-all pregnancy rate of 50.4 per cent resulted from the treatment. A direct relationship between pregnancy rates and sperm density as well as between pregnancy rates and degree of suppression of plasma testosterone after therapy was observed. These results demonstrate a high incidence of hyperandrogenism in female partners of infertile couples. The effectiveness of glucocorticoid treatment appears to be related to suppression of excessive androgen levels. The data also suggest that infertility is a relative state related to the fertility potential of each member of the couple. Improvement of the fertility potential of either member may result in conception.

Amenorrhea↗
PubMed1981

Postcoital testing in relation to circulating sperm-agglutinating antibodies in women.

Repeated postcoital tests (PCTs) were evaluated in couples with unexplained infertility, in couples with circulating sperm-agglutinating antibodies of the head-to-head (H-H) or tail-to-tail (T-T) type in serum, and in couples without any antibodies. The results were compared with those of PCTs in the conception cycle from women undergoing gonadotropin treatment for anovulation. Only limited differences in the PCT results were noted between couples with sperm-agglutinating antibodies, couples without such antibodies, and fertile couples.

Anovulation↗
PubMed1990

Hypothalamic amenorrhea: clinical perspectives, pathophysiology, and management.

The development of functional hypothalamic amenorrhea reflects an individual's response to environmental stressors and life-style variables. In this disorder there are no detectable anatomic abnormalities with respect to the hypothalamic-pituitary-ovarian-endometrial axis. Current evidence suggests that the common underlying defect is a decrease in the activity of the hypothalamic gonadotropin-releasing hormone pulse generator. Of the neuroendocrine factors that appear to regulate gonadotropin-releasing hormone activity, the opiate and dopamine neuronal systems have been implicated as factors that are responsible in part for the decreased secretion of gonadotropin-releasing hormone. Because of the functional nature of this disorder, reactivation of the hypothalamic-pituitary unit would be expected to take place in most women after accommodation to environmental stressors or modification in life-style. For women with persistent anovulation, treatment with estrogen-replacement therapy should be offered. In those desiring fertility, ovulation induction with pulsatile gonadotropin-releasing hormone would be the most effective modality.

Amenorrhea↗
PubMed1992

Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome?

OBJECTIVE: Our purpose was to determine the prevalence of adrenal hyperandrogenism and insulin resistance in patients with hyperandrogenic chronic anovulation, also called polycystic ovary syndrome, living in the United States, Italy, and Japan. STUDY DESIGN: Seventy-five women with polycystic ovary syndrome, 25 each from the United States, Italy, and Japan, and 10 ovulatory controls were studied. Hirsutism, obesity, and the presence of cystic ovaries were assessed, as were blood levels for estrogen, luteinizing hormone, testosterone, adrenal androgens, and insulin. All patients received an insulin tolerance test to assess insulin resistance. RESULTS: Women from Japan were less obese (p < 0.05) and did not have hirsutism, although the percentage of cystic ovaries (68% to 80%) was comparable. Serum luteinizing hormone, testosterone, and estradiol were similar, but levels of 3 alpha-androstanediol glucuronide, which was elevated in women from the United States and Italy, was normal in women from Japan. The adrenal androgens, dehydroepiandrosterone sulfate and 11 beta-hydroxyandrostenedione were elevated in 48% to 64% of the patients and by a similar percentage in the three groups. Fasting insulin was elevated in all groups, but was significantly higher in women from the United States and Italy compared with women from Japan (p < 0.05). However, insulin resistance as assessed by dissociation constant of insulin tolerance test values was significantly elevated but similar in the three groups and occurred in 68% to 76% of patients. CONCLUSION: In polycystic ovary syndrome, although obesity and hirsutism vary according to dietary, genetic, and environmental factors, the prevalence of adrenal androgen excess and insulin resistance appear to be fairly uniform. These results suggest that these factors may be involved in the pathophysiologic features of the disorder.

Adrenal Gland Diseases↗
PubMed1995

Effect of levonorgestrel-releasing intrauterine device on hormonal profile and menstrual pattern after long-term use.

In the present study 14 women after 6 years' use of levonorgestrel-releasing IUD were investigated for the changes of LH, progesterone (P), estradiol (E2), prolactin (PRL) and serum binding globulin (SHBG) in relation to the levonorgestrel levels throughout a segment of 26-40 days with the aim of comparing the hormonal profiles with those during the first year of use of Lng-IUD. Ultrasound scanning was used to follow the development of follicles along with the RIA measurement of hormones. The results of serum LH, P and E2 showed ovulation in 11 cases with either normal menstrual cycles (5 cases), prolonged or irregular cycles (4 cases) or with amenorrhea for 2-3 years (2 cases). One case showed insufficiency of luteal function and 2 cases showed anovulation but with follicular hyperactivity. Higher percentages of ovulatory cycles (78.5%) were found after 6 years of use. No case of complete suppression of ovulation was found. Anovulatory cycles only constituted 14.3%. Clinically, the development of follicles followed by ultrasound scanning further confirmed the hormonal findings. The persistent enlargement of follicles coincided with high levels of E2. After 6 years of use, the serum levels of levonorgestrel were still maintained at mean levels of 314.26 pmol/L and 470.63 pmol/L in the ovulatory and anovulatory groups, respectively. It is concluded that over two-thirds of the cases have ovulatory cycles after long-term use of Lng-IUD; the contraceptive effect is mainly due to its local action on the endometrium, with much less effect on the ovarian function.

Adult↗
PubMed1985

Endometrial carcinoma in premenopausal women: a clinicopathological study.

A clinicopathological review of 106 cases of premenopausal endometrial carcinoma has confirmed the good prognosis in such patients. Women less than 40 years old were more likely to be nulliparous, over 80 kg in weight, and to present with irregular or heavy and irregular bleeding, than women 40 years or older. Seven patients developed malignancies at other sites. A detailed pathological review of 32 cases revealed poor prognostic features in 30% of patients; corpora lutea were identified in the ovaries of 13 patients. It is suggested that factors other than anovulation are related to the development of endometrial cancer in the over 40 age group.

Adult↗
PubMed2004

A practical approach to the diagnosis of polycystic ovary syndrome.

The diagnosis of polycystic ovary syndrome (PCOS) is primarily achieved through clinical history and physical findings. The principle features are hirsutism or biochemical evidence of excess androgen production and irregular menstrual bleeding caused by the chronic anovulation. Associated findings include insulin resistance with compensatory hyperinsulinemia and obesity. Ultrasound imaging of the ovary has facilitated the diagnosis. It is important to exclude conditions that may mimic PCOS, such as hyperthecosis, congenital adrenal hyperplasia, 21-hydroxylase deficiency, Cushing's syndrome, and androgen-producing neoplasms. These disorders are usually revealed by appropriate laboratory assessment. Screening tests include measurement of serum total testosterone, DHEA sulfate, and 17-hydroxyprogesterone. In addition, in the obese individual, determinations of glucose and insulin levels, as well as a lipid profile, are highly recommended.

17-alpha-Hydroxyprogesterone↗