ULTRASONOGRAPHIC APPEARANCE OF POLYCYSTIC OVARIES IS ASSOCIATED WITH EXAGGERATED OVARIAN ANDROGEN AND ESTRADIOL RESPONSES TO GONADOTROPIN-RELEASING-HORMONE AGONIST IN WOMEN UNDERGOING ASSISTED REPRODUCTION TREATMENT

While no single biochemical test is diagnostic of polycystic ovary syn drome (PCOS), most patients show a characteristic ovarian ultrasonogra phic appearance, It has been proposed that a dysfunction of cytochrome P-450c17 alpha in PCOS leads to an increased 17-hydroxyprogesterone ( 17-OHP) response to a gonadotrophin-releasing hormone (GnRH) agonist-i nduced gonadotrophin rise, We postulated that this abnormality of ster oid metabolism might influence the ovarian response during assisted re production treatment, We investigated 106 patients undergoing a short 'boost' stimulation regimen for assisted reproduction treatment, inclu ding in-vitro fertilization and gamete intra-Fallopian transfers, The ovarian ultrasound pattern was correlated with serum testosterone, 17- OHP, androstenedione and oestradiol responses, and with the clinical o utcome, Polycystic ovaries, defined ultrasonographically as the presen ce of 310 follicles between 2 and 10 mm diameter in either ovary, were found in 48% of the whole study population, Dexamethasone was given t o suppress adrenal androgen secretion, Functional ovarian hyperandroge nism (FOH) was defined as serum testosterone >0.5 nmol/l after dexamet hasone. There was a significantly (P < 0.001) higher prevalence of FOH in patients with polycystic ovaries (23%) compared with normal ovarie s (7%). Patients with polycystic ovaries had approximately double the 17-OHP, androstenedione and oestradiol responses to a GnRH agonist as patients with non-polycystic ovaries, Exaggerated 17-OHP and oestradio l responses to GnRH agonist were found in 89% of patients with clinica lly diagnosed PCOS, The number of oocytes retrieved was positively cor related (r = 0.51, P < 0.001) with the oestradiol responses in all pat ients, Although there was no difference in the total amount of follicl e stimulating hormone (FSH) used between the patients with polycystic and normal ovaries, the median peak oestradiol concentration was 1.6 t imes and the oocyte yield 2.3 times greater in patients with polycysti c ovaries, The overall pregnancy rate per transfer was 32% and did not differ between patients with or without polycystic ovaries and FOH. N o pregnancies occurred when the baseline FSH concentration was >10 IU/ l. We conclude that the ultrasonographic changes characteristic of pol ycystic ovaries should be sought in all women undergoing assisted repr oduction treatment.