Can Ultrasound Diagnose Polycystic Ovary Syndrome?

Can ultrasound detect polycystic ovary syndrome (PCOS)?

I have been experiencing irregular menstrual cycles for nine years.
My first period started at age nineteen and was very regular, even coming without any stimulation.
In the past three years, my condition has improved to about once every two months, but it is still quite difficult to predict.
Based on my basal body temperature, I have only had one or two instances of high and low temperatures in the past six months; otherwise, my temperatures have been fluctuating.
Since I really want to get pregnant, I consulted a gynecologist.
The doctor performed an abdominal ultrasound and noted a slight retroversion of the uterus, but since I do not have symptoms like acne or hirsutism, the doctor said I do not seem to have polycystic ovary syndrome (PCOS).
They prescribed Clomid, one tablet a day, for me to try, but it seems to have no effect; my high temperature phase still hasn't occurred, and my period is also late (38 days).
Not giving up, I consulted another doctor, who performed a transvaginal ultrasound and found several follicles (about six) clustered in one corner of the ovary, resembling a honeycomb structure, and diagnosed me with PCOS, stating that I would need to take ovulation induction injections.
A friend mentioned that having only a few follicles does not necessarily indicate PCOS, as there should be at least a dozen follicles on each side to meet the criteria.
Could it be that my symptoms do not indicate PCOS? Also, why am I not responding to the ovulation medication? Is the dosage too low? Should I try the ovulation medication for a longer period, or should I follow the doctor's advice and go directly for the ovulation injections?

garland, 20~29 year old female. Ask Date: 2005/07/05

Dr. Wei Fumao reply Obstetrics and Gynecology

This condition is more complex and difficult to explain.
Please do not visit a clinic; instead, go to a medical center for infertility outpatient treatment or consult a private hospital capable of performing in vitro fertilization.

Reply Date: 2005/07/05

More Info

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects many women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, signs of hyperandrogenism (such as acne or excessive hair growth), and polycystic ovaries as seen on ultrasound. However, diagnosing PCOS is not solely reliant on ultrasound findings; it requires a comprehensive evaluation that includes clinical symptoms, hormonal assessments, and imaging studies.

In your case, you have experienced irregular menstrual cycles for an extended period, which is a common symptom of PCOS. The fact that your cycles have improved somewhat over the last three years, but still remain unpredictable, is also noteworthy. The ultrasound findings you described, where a few follicles were observed in one area of the ovary, do suggest the possibility of polycystic ovaries. However, the diagnosis of PCOS typically requires the presence of multiple follicles (usually more than 12) distributed throughout the ovaries, along with other clinical signs.

It is important to note that the absence of symptoms such as acne or hirsutism does not rule out PCOS. Many women with PCOS may not exhibit all the classic symptoms, and the syndrome can present differently in each individual. Additionally, hormonal imbalances can exist without overt symptoms. The hormonal tests you underwent, including LH and FSH levels, are also crucial in the diagnostic process. A high LH to FSH ratio is often indicative of PCOS, but it is not definitive on its own.

Regarding your response to Clomid (clomiphene citrate), it is not uncommon for some women with PCOS to have a variable response to ovulation induction medications. Factors such as the dosage of Clomid, the duration of treatment, and individual hormonal profiles can influence its effectiveness. If you have not responded to Clomid after a reasonable trial, it may be worth discussing alternative treatment options with your healthcare provider. This could include increasing the dosage of Clomid, switching to another medication, or considering injectable ovulation induction agents, such as gonadotropins, which may be more effective for some women with PCOS.

Your concern about whether your symptoms indicate that you do not have PCOS is valid. It is essential to have a thorough discussion with your healthcare provider about your symptoms, ultrasound findings, and treatment options. If you feel uncertain about your diagnosis or treatment plan, seeking a second opinion from a reproductive endocrinologist or a specialist in infertility may provide additional insights and options.

In summary, while ultrasound is a valuable tool in diagnosing PCOS, it is not the sole determinant. A comprehensive evaluation that includes clinical history, hormonal testing, and imaging is necessary for an accurate diagnosis. If you have concerns about your treatment or diagnosis, do not hesitate to seek further evaluation and discuss your options with a qualified healthcare provider.

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