title: Oligoovulatory and anovulatory cycles in women with polycystic ovary syndrome (PCOS): what's the difference?
abstract: BACKGROUND
  Polycystic ovary syndrome (PCOS) is a heterogeneous disorder. The phenotype may differ between patients who exhibit signs of recent ovulation and anovulatory PCOS patients.
  
  
  OBJECTIVE
  Our objective was to study differences in clinical and endocrine characteristics and response to ovulation induction (OI) treatment comparing oligoovulatory and anovulatory PCOS patients.
  
  
  METHODS
  We conducted a retrospective cohort study at a tertiary hospital.
  
  
  METHODS
  PCOS patients (n=1750) presenting with oligo- or amenorrhea were diagnosed according to the Rotterdam 2003 consensus criteria. Arbitrarily, oligoovulatory PCOS was defined by a single random serum progesterone level of 10 nmol/liter or higher.
  
  
  METHODS
  We evaluated the incidence of oligo- or amenorrhea, menstrual cycle length, serum androgen levels, follicle count, and OI outcome parameters.
  
  
  RESULTS
  Anovulatory women (n=1541 of 1750, 88.1%) were more often amenorrheic (P<0.001) and presented with a longer cycle duration (P<0.001) compared with oligoovulatory women (n=209 of 1750, 11.9%). Serum levels of testosterone (P<0.001), the free androgen index (P<0.001), and total follicle count (P<0.005) were higher in anovulatory compared with oligoovulatory patients. During clomiphene citrate OI, more oligoovulatory women gained regular menstrual cycles (P<0.05), whereas after second-line treatment with recombinant FSH, more anovulatory women became pregnant (P<0.05).
  
  
  CONCLUSIONS
  Oligoovulatory women with PCOS exhibit a milder phenotype of ovarian dysfunction and have a more favorable response to OI treatment using clomiphene citrate compared with anovulatory PCOS patients. However, during second-line treatment with recombinant FSH, anovulatory PCOS patients presented with a higher chance of pregnancy compared with oligoovulatory patients.
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Janneke A
authors.initials: JA
authors.lastname: Burgers
authors.forename: Sharon Lie
authors.initials: SL
authors.lastname: Fong
authors.forename: Yvonne V
authors.initials: YV
authors.lastname: Louwers
authors.forename: Olivier
authors.initials: O
authors.lastname: Valkenburg
authors.forename: Frank H
authors.initials: FH
authors.lastname: de Jong
authors.forename: Bart C J M
authors.initials: BC
authors.lastname: Fauser
authors.forename: Joop S E
authors.initials: JS
authors.lastname: Laven
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000503:physiopathology; D000728:Androgens / Q000097:blood; D000858:Anovulation / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology*; D002996:Clomiphene / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods; D034445:Ovulation Inhibition / Q000502:physiology*; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000728:Androgens; D005300:Fertility Agents, Female; D011994:Recombinant Proteins; D002996:Clomiphene; D005640:Follicle Stimulating Hormone