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Dewailly D.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Hieronimus S.,Nice University Hospital Center | Mirakian P.,Clinique de Monplaisir | Hugues J.-N.,Unite de medecine de la reproduction
Annales d'Endocrinologie | Year: 2010

1. The Rotterdam classification should be used to define PCOS in the event of: menstrual cycle anomalies; amenorrhoea, oligomenorrhoea or long cycles, clinical and/or biochemical hyperandrogenism and ultrasound appearance of polycystic ovaries. 2. The presence of two of these three criteria is sufficient once all other diagnoses have been ruled out. 3. Diagnosis of hirsutism should not be based on the Ferriman-Gallway score. 4. The ultrasound definition of PCOS contains precise criteria that must be included in the report: presence of at least 12 follicles in each ovary measuring 2-9 mm in diameter, and/or increase in ovary size > 10 ml. 5. Screening for elevated plasma LH no longer necessary. Testing for GnRH serves no purpose. 6. Routine screening for metabolic abnormalities should be carried out systematically based on weight, height and BMI, waist circumference, blood pressure and laboratory parameters: plasma glucose, triglycerides, HDL cholesterol. 7. In the case of obesity (BMI > 30 kg/m2), oral glucose tolerance testing (OGTT) is recommended where fasting serum glucose is normal. 8. Clomiphene citrate (CC) remains the first-line therapy for ovulation induction. In patients with BMI > 30, it should be preceded by improvement of metabolic status through appropriate lifestyle modifications. © 2009 Elsevier Masson SAS. All rights reserved. Source


Casadei L.,University of Rome Tor Vergata | Madrigale A.,University of Rome Tor Vergata | Puca F.,University of Rome Tor Vergata | Manicuti C.,University of Rome Tor Vergata | And 3 more authors.
Gynecological Endocrinology | Year: 2013

Background: The study was performed to validate the threshold for anti-Müllerian hormone (AMH) that suggests the presence of polycystic ovaries in women with polycystic ovary syndrome (PCOS). Methods: This prospective observational study included 59 infertile women: (A) 22 PCOS with hyperandrogenism (HA) and oligo-anovulation, (B) 15 suspected PCOS with either HA or oligo-anovulation and (C) 22 asymptomatic control women. The diagnosis of PCOS was made according to the NIH classification. Results: For serum AMH and follicle number, respectively, the areas under the receiver operating characteristic curve (A versus C) were 0.97 and 0.93. The best compromise between specificity (95% and 91%) and sensitivity (95% and 82%) was obtained with threshold values of 33pmol/l and 13 follicles, respectively. Using a serum AMH>33pmol/l as a surrogate for either HA or oligo-anovulation in group B would lead to the diagnosis of PCOS in seven (46.6%) patients from this group. Conclusions: Our data confirms that the AMH assay has a high diagnostic potential, providing that an appropriate threshold is used. AMH measurement may be included as an ultimate diagnostic criterion for the diagnosis of PCOS when either HA or anovulation is missing and/or when no reliable antral follicle count can be obtained. © 2013 Informa UK Ltd. Source


Dewailly D.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Gronier H.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Poncelet E.,Service de radiologie | Robin G.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | And 4 more authors.
Human Reproduction | Year: 2011

Background Polycystic ovarian morphology (PCOM) at ultrasound is currently used in the diagnosis of polycystic ovary syndrome (PCOS). We hypothesized that the previously proposed threshold value of 12 as an excessive number of follicles per ovary (FN) is no longer appropriate because of current technological developments. In this study, we have revisited the thresholds for FN and for the serum Anti-Mllerian hormone (AMH) level (a possible surrogate for FN) for the definition of PCOM. Methods Clinical, hormonal and ultrasound data were consecutively recorded in 240 patients referred to our department between 2008 and 2010 for exploration of hyperandrogenism (HA), menstrual disorders and/or infertility. Results According to only their symptoms, patients were grouped as: non-PCOS without HA and with ovulatory cycles (group 1, n = 105), presumption of PCOS with only HA or only oligo-anovulation (group 2, n = 73) and PCOS with HA and oligo-anovulation (group 3, n = 62). By cluster analysis using androgens, LH, FSH, AMH, FN and ovarian volume, group 1 appeared to be constituted of two homogeneous clusters, most likely a non-PCOM non-PCOS subgroup (n = 66) and a PCOM, non-PCOS (i.e. asymptomatic) subgroup (n = 39). Receiver operating characteristic curve analysis was applied to distinguish the non-PCOM non-PCO members of group 1 and to group 3. For FN and serum AMH respectively, the areas under the curve were 0.949 and 0.973 and the best compromise between sensitivity (81 and 92) and specificity (92 and 97) was obtained with a threshold values of 19 follicles and 35 pmol/l (5 ng/ml). Conclusions For the definition of PCOM, the former threshold of >12 for FN is no longer valid. A serum AMH >35 pmol/l (or >5 ng/ml) appears to be more sensitive and specific than a FN >19 and should be therefore included in the current diagnostic classifications for PCOS. © 2011 The Author. Source


Peigne M.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Robin G.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Lernout M.,Service Imagerie de la Femme | Dewailly D.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Lefebvre-Maunoury C.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2011

Mimicking numerous pathologies, ovarian ectopic pregnancy is difficult to diagnose, especially after controlled ovarian hyperstimulation and oocyte pick-up for In Vitro Fertilization (IVF). We report the case of a 28-year old patient admitted for a suspected heterotopic ovarian pregnancy following IVF. Additional imaging examination led us to conclude that the ovarian anomaly was a decidualized endometrioma. Usually taken for a malignant ovarian tumour, decidualized endometrioma is, for the first time, described here as a rare differential diagnosis of ectopic ovarian pregnancy. Source


Dumont A.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Dewailly D.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Plouvier P.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Catteau-Jonard S.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction | Robin G.,Service de Gynecologie Endocrinienne et de Medecine de la Reproduction
Gynecological Endocrinology | Year: 2016

Context: Ovulation induction in patients having both functional hypothalamic amenorrhea (FHA) and polycystic ovarian morphology (PCOM) has been less studied in the literature. As results remain contradictory, no recommendations have yet been established. Objective: To compare pulsatile GnRH therapy versus gonadotropins for ovulation induction in “FHA-PCOM” patients and to determine if one treatment strikes as superior to the other. Methods: A 12-year retrospective study, comparing 55 “FHA-PCOM” patients, treated either with GnRH therapy (38 patients, 93 cycles) or with gonadotropins (17 patients, 53 cycles). Results: Both groups were similar, defined by low serum LH and E2 levels, low BMI, excessive follicle number per ovary and/or high serum AMH level. Ovulation rates were significantly lower with gonadotropins (56.6% versus 78.6%, p = 0.005), with more cancellation and ovarian hyper-responses (14% versus 34% per initiated cycle, p < 0.005). Pregnancy rates were significantly higher with GnRH therapy, whether per initiated cycle (26.9% versus 7.6%, p = 0.005) or per patient (65.8% versus 23.5%, p = 0.007). Conclusion: In our study, GnRH therapy was more successful and safer than gonadotropins, for ovulation induction in “FHA-PCOM” patients. If results were confirmed by prospective studies, it could become a first-line treatment for this population, just as it is for FHA women without PCOM. © 2016 Informa UK Limited, trading as Taylor & Francis Group. Source

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