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Hum. Reprod. Advance Access originally published online on December 17, 2008
Human Reproduction 2009 24(3):710-717; doi:10.1093/humrep/den433
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria

A.J. Goverde1,3, A.J.B. van Koert1, M.J. Eijkemans1, E.A.H. Knauff1, H.E. Westerveld2, B.C.J.M. Fauser1 and F.J. Broekmans1

1 Department of Reproductive Medicine and Gynaecology, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands 2 Department of Internal Medicine, University Medical Centre, Utrecht, The Netherlands

3 Correspondence address. E-mail: a.j.goverde{at}umcutrecht.nl

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with metabolic abnormalities. It is debated whether all women with PCOS should be screened for metabolic abnormalities as these may vary with PCOS phenotype, age and ethnicity. The aims of this study were to assess the prevalence of metabolic abnormalities in Dutch anovulatory PCOS women and to define criteria for metabolic screening.

METHODS: Anovulatory patients, diagnosed with PCOS according to the Rotterdam consensus criteria, underwent metabolic screening. Through stepwise multivariate analysis patient characteristics associated with metabolic syndrome (MetS) and insulin resistance (IR) were evaluated for their use as selection parameters for metabolic screening.

RESULTS: Overall, prevalence of MetS and IR was 15.9% (n = 25) and 14% (n = 22), respectively, in 157 PCOS women (age 29.0 ± 4.8 years, BMI 26.1 ± 6.7 kg/m2). Anovulatory hyperandrogenic women (with or without polycystic ovaries) had more often MetS and IR (with, 20.8 and 19.8%; without, 100 and 40%, respectively) than non-hyperandrogenic PCOS women (0 and 1.8%; P < 0.001). Waist circumference >83.5 cm along with increased free androgen index (FAI) had the most powerful association with the presence of MetS and IR (area under the receiver operating characteristic curve 0.912) and offered a reduction in the necessity of screening for metabolic derailments of about 50%.

CONCLUSIONS: The hyperandrogenic PCOS phenotypes are highly linked to the presence of MetS and IR in Dutch PCOS women. Waist circumference combined with FAI was identified as an efficient combination test to select those PCOS women who should be screened for the presence of MetS and/or IR.

Key words: insulin resistance/metabolic syndrome/polycystic ovary syndrome/Rotterdam criteria/waist circumference

Submitted on June 23, 2008; resubmitted on October 19, 2008; accepted on November 3, 2008.


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