title: Raising threshold for diagnosis of polycystic ovary syndrome excludes population of patients with metabolic risk.
abstract: OBJECTIVE
  To characterize the population of patients excluded from a diagnosis of polycystic ovary syndrome (PCOS) when follicle number criteria are increased to 25 per ovary as suggested by the Androgen Excess and Polycystic Ovary Syndrome Society's recent task force.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Tertiary academic center.
  
  
  METHODS
  A total of 259 women with PCOS according to Rotterdam criteria who were systematically examined from 2007 to 2015, with 1,100 ovulatory women participating in the Ovarian Aging (OVA) Study as controls.
  
  
  METHODS
  Anthropometric measurements, serum testing, ultrasonic imaging, and comprehensive dermatologic exams.
  
  
  METHODS
  Body mass index (BMI), waist to hip ratio (WHR), serum cholesterol, fasting glucose and insulin, follicle count per ovary, biochemical hyperandrogenemia, and hirsutism.
  
  
  RESULTS
  Forty-seven of 259 women meeting the Rotterdam criteria (18.1%) were excluded from a diagnosis of PCOS when the follicle number criteria was increased to 25. These women had clinical evidence of hyperandrogenism (68.1%) and biochemical hyperandrogenemia (44.7%), although fewer reported oligoanovulation (26.8%). The excluded women had elevated total cholesterol, fasting insulin, and homeostatic model of insulin resistance (HOMA-IR) when compared with controls despite controlling for age and BMI.
  
  
  CONCLUSIONS
  The women excluded from the PCOS diagnosis by raising the threshold of follicle number per ovary to ≥25 continue to show evidence of metabolic risk.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, California. Electronic address: molly.quinn@ucsf.edu.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Quinn
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Chia-Ning
authors.initials: CN
authors.lastname: Kao
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Asima
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Lenhart
authors.affiliation: Department of Dermatology, School of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Kanade
authors.initials: K
authors.lastname: Shinkai
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Huddleston
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D006080:Ovarian Follicle / Q000000981:diagnostic imaging*; D010053:Ovary / Q000000981:diagnostic imaging*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D002784:Cholesterol
keywords: Follicle number; PCOS; insulin resistance; metabolic risk