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Martina Kollmann, Wellington P. Martins, Nick Raine-Fenning, Terms and thresholds for the ultrasound evaluation of the ovaries in women with hyperandrogenic anovulation, Human Reproduction Update, Volume 20, Issue 3, May/June 2014, Pages 463–464, https://doi.org/10.1093/humupd/dmu005
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Dear Sir,
We enjoyed reading the insightful and informative article by Dewailly et al. (2014) and want to congratulate them for considering and clarifying one of the most contentious subjects in reproductive medicine. Their results are of great value and elegantly demonstrate the need to update the current diagnostic criteria used to describe and define polycystic ovarian syndrome (PCOS). These findings will hopefully lead to a revision of the present criteria and some long overdue changes. Their recommendation to use ≥25 follicles per ovary as suspicion of hyperandrogenemia (HA) should be adopted promptly as it is clear that the former threshold of 12 follicles is obsolete due to the improvement in the resolution of ultrasound achieved through both software and hardware developments (Lujan et al., 2013).
We would, however, like to raise one other issue and one that we passionately believe is no less important than the question of diagnostic criteria and thresholds: the misnomer given to the associated health condition. Whatever the final threshold agreed the ovaries that many sonographers recognize so easily, know so well and are all trying to describe do not contain ‘cysts’ but rather multiple follicles which are arrested in their development: the term ‘polycystic’ is without question misleading. Many women, and indeed some healthcare practitioners, are confused by a diagnosis of ‘polycystic ovaries’: some patients even ask whether there is a need for surgery to physically remove these ‘cysts’ and many of them return for a new ultrasound after the intervention to evaluate whether the cysts had disappeared or not. The ovarian appearance would be better described as ‘multifollicular’, as the only difference is an increase in the number of antral follicles. And PCOS would be better termed ‘hyperandrogenic anovulation’, as this better describes what it is: an endocrine disorder with reproductive features. This term is much more easily explained and understood, causing less harm.
