Women with polycystic ovary syndrome have agreement in inter-ovarian follicle number in the diagnosis of polycystic ovary
Keywords:
Polycystic ovary syndrome, Polycystic ovary, Polycystic ovary morphology, Ovarian volume, Follicle number per ovary, Rotterdam criteria, Polyendocrine metatbolic ovarian syndromeAbstract
Background: Polycystic ovary (PCO) is diagnosed by meeting either the ovarian volume (OV) or follicle number per ovary (FNPO) criterion in any ovary. However, scanning a single ovary may detect fewer PCO.
Aim: To compare OV and FNPO and assess their agreement in patients with polycystic ovary syndrome (PCOS).
Methods: This cross-sectional study included 100 women with newly diagnosed PCOS (ages 15–39 years) based on the revised 2003 Rotterdam criteria. In addition to clinical, hormonal, and biochemical data, ovarian ultrasonography (trans-abdominal/trans-vaginal: 60/40) was performed during the follicular phase of the menstrual cycle to measure OV and FNPO by an expert sonologist. Any OV >10 mL or FNPO ≥12 of 2-9 mm was considered PCO.
Results: OV and FNPO were similar between the ovaries. PCO was significantly associated with higher total testosterone in both ovaries. The OV (ρ=0.5) and FNPO (ρ=0.7) between the ovaries correlated better than within the ovary. The Agreement between the ovaries and among the criteria was minimal to weak (κ=0.2-0.4). The FNPO criteria (κ=0.6) demonstrated clinically significant inter-ovarian agreement, which further improved when assessed with transvaginal sonography (κ =0.8).
Conclusions: When pathology is present in one ovary, reporting the FNPO for the unaffected ovary may be acceptable for diagnosing PCO, especially when assessed transvaginally.
[J Assoc Clin Endocrinol Diabetol Bangladesh, July 2026; 5 (2): e90272]
392
113
References
1. Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T 2013;38(6):336-55.
2. Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935;29(2):181-91.
DOI: https://doi.org/10.1016/S0002-9378(15)30642-6
3. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 2023;189(2):G43-G64.
DOI: https://doi.org/10.1093/ejendo/lvad096
4. Rao P, Bhide P. Controversies in the diagnosis of polycystic ovary syndrome. Ther Adv Reprod Health 2020;14:2633494120913032.
DOI: https://doi.org/10.1177/2633494120913032
5. Aljahdali GL, Alkhaldi FA, Almujarri SF, Alsadhan HF, Yaqoub AS, Alsahabi JA, et al. Live birth rate comparison between single vs. double ovary women with assisted reproduction: A single tertiary center study. Cureus 2021;13(5):e14876.
DOI: https://doi.org/10.7759/cureus.14876
6. Deb S, Kannamannadiar J, Campbell BK, Clewes JS, Raine-Fenning NJ. The interovarian variation in three-dimensional ultrasound markers of ovarian reserve in women undergoing baseline investigation for subfertility. Fertil Steril 2011;95(2):667-72.
DOI: https://doi.org/10.1016/j.fertnstert.2010.09.031
7. Köninger A, Koch L, Edimiris P, Nießen S, Kasimir-Bauer S, Kimmig R, et al. Intraindividual right-left comparison of sonographic features in polycystic ovary syndrome (PCOS) diagnosis. Eur J Obstet Gynecol Reprod Biol 2014;181:124-29.
DOI: https://doi.org/10.1016/j.ejogrb.2014.07.029
8. Jarrett BY, Vanden Brink H, Brooks ED, Hoeger KM, Spandorfer SD, Pierson RA, et al. Impact of right-left differences in ovarian morphology on the ultrasound diagnosis of polycystic ovary syndrome. Fertil Steril 2019;112(5):939-46.
DOI: https://doi.org/10.1016/j.fertnstert.2019.06.016
9. Chun S. Inter-ovarian differences in ultrasound markers of ovarian size in women with polycystic ovary syndrome. Clin Exp Reprod Med 2019;46(4):197-201.
DOI: https://doi.org/10.5653/cerm.2019.00374
10. Sendur SN, Yildiz BO. Influence of ethnicity on different aspects of polycystic ovary syndrome: A systematic review. Reprod Biomed Online 2021;42(4):799-818.
DOI: https://doi.org/10.1016/j.rbmo.2020.12.006
11. Madadizadeh F, Bahariniya S. A tutorial on sample size calculation for inter-rater and intra-rater agreement studies. Indian J Psychol Med 2026;48(4):449-53.
DOI: https://doi.org/10.1177/02537176261422290
12. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19(1):41-47.
DOI: https://doi.org/10.1093/humrep/deh098
13. Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, et al. Epidemiology, diagnosis and management of hirsutism: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2012;18(2):146-70.
DOI: https://doi.org/10.1093/humupd/dmr042
14. Braunstein GD, Reitz RE, Buch A, Schnell D, Caulfield MP. Testosterone reference ranges in normally cycling healthy premenopausal women. J Sex Med 2011;8(10):2924-34.
DOI: https://doi.org/10.1111/j.1743-6109.2011.02380.x
15. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22(3):276-82.
DOI: https://doi.org/10.11613/BM.2012.031
16. Kelsey TW, Dodwell SK, Wilkinson AG, Greve T, Andersen CY, Anderson RA, et al. Ovarian volume throughout life: A validated normative model. PLoS One 2013;8(9):e71465.
DOI: https://doi.org/10.1371/journal.pone.0071465
17. Moro F, Scavello I, Maseroli E, Rastrelli G, Baima Poma C, Bonin C, et al. The physiological sonographic features of the ovary in healthy subjects: A joint systematic review and meta-analysis by the Italian Society of Gynecology and Obstetrics (SIGO) and the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2023;46(3):439-56.
DOI: https://doi.org/10.1007/s40618-022-01939-8
18. Balen AH, Laven JSE, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: International consensus definitions. Hum Reprod Update 2003;9(6):505-14.
DOI: https://doi.org/10.1093/humupd/dmg044
19. Ahmed S, Pahwa S, Das CJ, Mir FA, Nisar S, Jehangir M, et al. Comparative evaluation of sonographic ovarian morphology of Indian women with polycystic ovary syndrome versus those of normal women. Indian J Endocrinol Metab 2014;18(2):180-84.
DOI: https://doi.org/10.4103/2230-8210.129108
20. Atiomo WU, Pearson S, Shaw S, Prentice A, Dubbins P. Ultrasound criteria in the diagnosis of polycystic ovary syndrome (PCOS). Ultrasound Med Biol 2000;26(6):977-80.
DOI: https://doi.org/10.1016/S0301-5629(00)00219-2
21. Antonio L, Pauwels S, Laurent MR, Vanschoubroeck D, Jans I, Billen J, et al. Free testosterone reflects metabolic as well as ovarian disturbances in subfertile oligomenorrheic women. Int J Endocrinol 2018;2018:7956951.
DOI: https://doi.org/10.1155/2018/7956951
22. Hahn S, Bering van Halteren W, Roesler S, Schmidt M, Kimmig R, Tan S, et al. The combination of increased ovarian volume and follicle number is associated with more severe hyperandrogenism in German women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2006;114(4):175-81.
DOI: https://doi.org/10.1055/s-2006-924063
23. Rosenfield RL. The polycystic ovary morphology-polycystic ovary syndrome spectrum. J Pediatr Adolesc Gynecol 2015;28(6):412-19.
DOI: https://doi.org/10.1016/j.jpag.2014.07.016
24. Pea J, Bryan J, Wan C, Oldfield AL, Ganga K, Carter FE, et al. Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: a systematic review and diagnostic meta-analysis. Hum Reprod Update 2024;30(1):109-30.
DOI: https://doi.org/10.1093/humupd/dmad027
25. Afrine S, Haque JA, Morshed MS, Banu H, Hossain A, Hasanat MA. Ovarian volume is more closely related to the different manifestations of polycystic ovary syndrome than follicle number per ovary. Clin Exp Reprod Med 2023;50(3):200-05.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Shazia Afrine, Md Shahed-Morshed, Hurjahan Banu, Jasmine Ara Haque, Muhammad Abul Hasanat
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles in the JACEDB are licensed under a Creative Commons CC BY-NC License Attribution-Noncommercial 4.0 International (CC BY-NC 4.0). This license permits Share— copy and redistribute the material in any medium or format, Adapt — remix, transform, and build upon the material.
