This study was funded by Cornell University and fellowship awards from the Saskatchewan Health Research Foundation and Canadian Institutes of Health Research. The authors have no conflict of interests to disclose.

Objective To compare the diagnostic potential of ultrasonographic markers of ovarian morphology, used alone or in combination, to predict PCOS. Design A diagnostic test study using cross-sectional data collected from 2006 to 2011. Setting Academic hospital and clinical research unit. Participants 82 women with PCOS and 60 healthy female volunteers. Interventions None. Main Outcome Measures Follicle number per ovary (FNPO), ovarian volume (OV), follicle number per single cross-section (FNPS), follicle distribution pattern, stromal area, ovarian area, stromal to ovarian area ratio (S:A) and stromal index (SI). Results FNPO best predicted PCOS (R2=67%) with 85% sensitivity and 98% specificity, followed by OV (R2=44%), and FNPS (R2=36%). Neither S:AnorSI had predictive power for PCOS. In combination, FNPO+S:A and FNPO+SI most significantly predicted PCOS (R2=74% vs.73%, respectively). The diagnostic potentials of OV and FNPS were substantially improved when used in combination (OV+FNPO,R2=55%). Conclusions As a single metric, FNPO best predicted PCOS. While the addition of S:Aor SI improved the predictive power of FNPO, gains were marginal suggesting limited use in clinical practice. When image quality precludes a reliable estimation of FNPO, measurements of OV+FNPS provide the next closest level of diagnostic potential.

Lifestyle modifications are recommended as first-line therapy in polycystic ovary syndrome (PCOS). However, usual dietary and physical activity (PA) behaviors of women with PCOS remain uncertain, likely owing to controversy in diagnostic criteria. Our objective was to contrast the usual dietary and PA behaviors of women with PCOS (n = 80) diagnosed by the 2018 International Evidence-based Guideline for the Assessment and Management of PCOS to that of controls (n = 44). Study outcomes were dietary intake, diet quality (Healthy Eating Index-2015), and PA (questionnaire, waist-worn accelerometers). Women with PCOS met the acceptable macronutrient distribution ranges for carbohydrate, fat, and protein, but did not meet the recommended dietary reference intakes for vitamin D (mean (95% confidence interval); 6 (5–7) μg/d), vitamin B9 (275 (252–298) μg/d), total fiber (24 (22–26) g/d), or sodium (4.0 (3.6–4.4) g/d). Women with PCOS also met the US recommendations for PA. No differences were detected in dietary intake, diet quality, or PA levels between groups (p ≥ 0.11). In conclusion, women with and without PCOS have comparable dietary and PA behaviors. A lack of unique targets for dietary or PA interventions supports the position of the new guideline to foster healthy lifestyle recommendations for the management of PCOS.

Abstract Context Osteosarcopenia (loss of skeletal muscle and bone mass and/or function usually associated with aging) shares pathophysiological mechanisms with polycystic ovary syndrome (PCOS). However, the relationship between osteosarcopenia and PCOS remains unclear. Objective We evaluated skeletal muscle index% (SMI%=[appendicular muscle mass/weight {kg}]×100) and bone mineral density (BMD) in PCOS (hyperandrogenism+oligoamenorrhea), and contrasted these musculoskeletal markers against 3 reproductive phenotypes: (1) HA (hyperandrogenism+eumenorrhea); (2) OA (normoandrogenic+oligoamenorrhea) and, (3) controls (normoandrogenic+eumenorrhea). Endocrine predictors of SMI% and BMD were evaluated across the groups. Design, Setting, Participants Multicenter case-control study of 203 women (18–48y) in New York State. Results PCOS group exhibited reduced SMI% (mean [95%CI]; 26.2% [25.1,27.3] vs. 28.8% [27.7,29.8]), lower-extremity SMI% (57.6% [56.7,60.0] vs. 62.5% [60.3,64.6]), and BMD (1.11 [1.08,1.14] vs. 1.17 [1.14,1.20] g/cm2) compared to controls. PCOS group also had decreased upper (0.72 [0.70,0.74] vs. 0.77 [0.75,0.79] g/cm2) and lower (1.13 [1.10,1.16] vs. 1.19 [1.16,1.22] g/cm2) limb BMD compared to HA. Matsuda index was lower in PCOS vs. controls and positively associated with SMI% in all groups (All:P≤0.05). Only controls showed associations between insulin-like-growth-factor-1 (IGF-1) and upper (r=0.84) and lower (r=0.72) limb BMD (All:P<0.01). Unlike in PCOS, IGF binding-protein-2 was associated with SMI% in controls (r=0.45) and HA (r=0.67), and with upper limb BMD (r=0.98) in HA (All:P<0.05). Conclusions Women with PCOS exhibit early signs of osteosarcopenia when compared to controls likely attributed to disrupted insulin function. Understanding the degree of musculoskeletal deterioration in PCOS is critical for implementing targeted interventions that prevent and delay osteosarcopenia in this clinical population.

Context The mechanism of oligo-anovulation in polycystic ovary syndrome (PCOS) is unknown. Objectives To evaluate follicular and endocrine characteristics of anovulatory and sporadic ovulatory cycles in women with PCOS. Design Prospective, longitudinal study. Setting Academic clinical research unit. Participants 26 reproductive-aged women (18-38 years) with PCOS, observed during natural anovulatory (PCOS-Anov; n = 12) and sporadic ovulatory cycles (PCOS-Ov; n = 14), and 12 controls. Interventions Transvaginal ultrasonography and venipuncture were performed every other day for 4 to 6 weeks in women with PCOS or at 1 interovulatory interval in control subjects. Main Outcome Measures Follicle number and diameter (ie, ≥2 mm) were quantified at each visit. Individual growth profiles were assessed for all follicles that grew to ≥7 mm. Blood samples were assayed for follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone. Results Follicular excess, or heightened follicle number versus controls, was observed across anovulatory and sporadic ovulatory cycles in PCOS. In PCOS-Anov, follicles emerged cyclically in some women (6/12; 50%) and continuously in others (6/12; 50%), then grew to a mean maximum diameter of 7.2 mm and regressed within 4.7 days. In PCOS-Ov, follicles mostly emerged cyclically as part of a cohort and dominant follicles showed normal growth to ovulation—albeit mean and maximum luteal progesterone concentrations were significantly lower versus controls. Conclusions Follicle growth and regression were detected on ultrasonography amidst perpetual follicular excess in PCOS. Documentation of continuous follicle recruitment and turnover, the absence of persistence, and altered luteal progesterone following sporadic ovulation, provide formative data on antral follicle development in PCOS.