After discussion, the expert meeting unanimously agreed to recommend the criteria recommended by the 2003 European Society for Human Reproduction and Embryology and American Society for Reproductive Medicine (ESHRE/ASRM) expert meeting in Rotterdam to be used in China at this stage, and to consider whether to amend the diagnostic criteria after the preliminary results of epidemiological surveys and related studies in China are available.
I. Diagnostic criteria for PCOS
(1) Sporadic ovulation or anovulation;
(2) Clinical manifestations of hyperandrogenism and/or hyperandrogenemia;
(3) polycystic ovarian changes: ≥12 follicles of 2-9 mm in diameter in one or both ovaries and/or ovarian volume ≥10 ml;
(4) Two of the above three criteria should be met and other causes of hyperandrogenism should be excluded: congenital adrenocortical hyperplasia, Cushing’s syndrome, androgen-secreting tumors, etc.
II. Judgment of criteria
(1) Sporadic ovulation or anovulation.
1, Judgment criteria: two years after menarche cannot establish regular menstruation; amenorrhea (menopause more than 3 previous menstrual cycles or menstrual cycle ≥ 6 months); sporadic menstruation ≥ 35 days and ≥ 3 months per year without ovulation (WHO class II anovulation) is in line with this article;
2. Regular menstruation cannot be used as evidence of ovulation;
3. Basal body temperature (BBT), ultrasound monitoring of ovulation, progesterone measurement in the second half of menstruation, etc. can be used to determine whether ovulation is occurring;
4. Normal follicle stimulating hormone (FSH) and estrogen (E2) levels are used to exclude hypogonadotropic hypogonadism and premature ovarian failure.
(2) Clinical manifestations of hyperandrogenism: acne and hirsutism
1. Characteristics of hyperandrogenic acne: Recurrent acne, often located on the forehead, cheeks, nose and lower jaw;
(2) Features of hyperandrogenic hirsutism: coarse and hard hairs appear on the upper lip, jaw, around the areola, and the midline of the lower abdomen.
(3) Biochemical indexes of hyperandrogenism: total testosterone, free testosterone index (FAI) = total testosterone/SHBG concentration × 100) or free testosterone is higher than the laboratory reference normal value;
(4) PCO diagnostic criteria: ≥ 12 follicles of 2-9 mm diameter in one or both ovaries and/or ovarian volume ≥ 10 ml.
[PCO measurement methods].
1.Vaginal ultrasound is more accurate;
2.Early follicular phase (regular menstruation) or without dominant follicle state;
3.Ovarian volume calculation: 0.5×length×width×thickness (ml);
4, Follicle number measurement should include transverse and longitudinal scans;
5. Follicle diameter <10 mm: average of transverse and longitudinal diameters.
Third, the exclusion criteria for the diagnosis of PCOS, the exclusion criteria are necessary for the diagnosis of PCOS.
(1) If elevated prolactin levels are evident, pituitary tumors should be excluded. 20-35% of patients with PCOS have mildly elevated prolactin;
(2) If hyperandrogenemia or obvious clinical manifestations of hyperandrogenism are present, atypical adrenocortical hyperplasia (NCAH) (due to 21-hydroxylase deficiency and measurement of 17-hydroxyprogesterone levels), Cushing’s syndrome, and androgen-secreting ovarian tumors should be excluded.
IV. Comorbidities of PCOS.
Polycystic ovary syndrome is often associated with obesity, metabolic syndrome and insulin resistance. The diagnostic criteria of obesity are shown in Annex II, central obesity in Annex III, metabolic syndrome in Annex IV and insulin resistance in Annex V.