Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

Background@#During robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position, aeration loss leads to perioperative atelectasis. Recently developed ventilator mode pressure-controlled ventilation volume-guaranteed (PCV-VG) mode could provide adequate ventilation with lower inspiratory pressure compared to volume-controlled ventilation (VCV); we hypothesized that PCV-VG mode may be beneficial in reducing perioperative atelectasis via low tidal volume (VT ) of 6 mL/kg ventilation during robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position. We applied lung ultrasound score (LUS) for detecting perioperative atelectasis. We aimed to compare perioperative atelectasis between VCV and PCV-VG with a low VT of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position using LUS. @*Methods@#Patients scheduled for robotic gynecologic surgery were randomly allocated to the VCV (n = 41) or PCV-VG group (n = 41). LUS, ventilatory, and hemodynamic parameters were evaluated at T1 (before induction), T2 (10 minutes after induction in the supine position), T3 (10 minutes after desufflation of CO2 in the supine position), and T4 (30 minutes after emergence from anesthesia in the recovery room). @*Results@#Eighty patients (40 with PCV-VG and 40 with VCV) were included. Demographic data showed no significant differences between the groups. The total LUS has changed from baseline to T4, 0.63 (95% confidence interval [CI], 0.32, 0.94) to 1.77 (95% CI, 1.42, 2.21) in the VCV group and 0.86 (95% CI, 0.56, 1.16) to 1.43 (95% CI, 1.08, 1.78) in the PCV-VG group (P = 0.170). In both groups, total LUS increased significantly compared to the baseline values. @*Conclusion@#Using a low VT of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position, our study showed no evidence that PCV-VG ventilation was superior to VCV in terms of perioperative atelectasis.

Assessment of different NEoplasias in the adneXa model for differentiation of benign and malignant adnexal masses in Korean women

Objective@#Ultrasonographic differential diagnosis of ovarian tumors is important for appropriate management. We conducted study to compare the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with a subjective assessment (SA) in differentiating between benign and malignant adnexal masses in Korean women. @*Methods@#A total of 353 patients who underwent adnexal surgery with abnormal pelvic ultrasonographic findings from August 2016 to August 2017 were included in study. The presumptive diagnosis of adnexal malignancy was determined by both SA and the ADNEX model to be >10% calculated risk of malignancy. The area under the curve (AUC) comparison between the SA and ADNEX models was performed using DeLong’s method. @*Results@#340 patients with benign tumors and 13 with malignant adnexal tumors among 292 (82.72%) premenopausal and 61 (17.28%) postmenopausal women were included. The AUCs of SA and the ADNEX model for discrimination between benign and malignant tumors were 0.79 and 0.92, respectively (P=0.10). The sensitivity and specificity of SA and the ADNEX model were 83.5% and 97.0%, and 90.0% and 82.0%, respectively. Comparison of the ADNEX model regarding menopausal status revealed that the predictability was not different. The AUCs of SA and the ADNEX model in premenopausal women were 0.74 and 0.89, respectively (P=0.12). The AUCs of SA and the ADNEX model in postmenopausal women were 0.86 and 0.94, respectively (P=0.60). @*Conclusion@#The ADNEX model offers excellent discrimination between benign and malignant ovarian tumors with similar sensitivity and specificity to SA in both premenopausal and postmenopausal Korean women.

Assessment of different NEoplasias in the adneXa model for differentiation of benign and malignant adnexal masses in Korean women

Objective@#Ultrasonographic differential diagnosis of ovarian tumors is important for appropriate management. We conducted study to compare the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with a subjective assessment (SA) in differentiating between benign and malignant adnexal masses in Korean women. @*Methods@#A total of 353 patients who underwent adnexal surgery with abnormal pelvic ultrasonographic findings from August 2016 to August 2017 were included in study. The presumptive diagnosis of adnexal malignancy was determined by both SA and the ADNEX model to be >10% calculated risk of malignancy. The area under the curve (AUC) comparison between the SA and ADNEX models was performed using DeLong’s method. @*Results@#340 patients with benign tumors and 13 with malignant adnexal tumors among 292 (82.72%) premenopausal and 61 (17.28%) postmenopausal women were included. The AUCs of SA and the ADNEX model for discrimination between benign and malignant tumors were 0.79 and 0.92, respectively (P=0.10). The sensitivity and specificity of SA and the ADNEX model were 83.5% and 97.0%, and 90.0% and 82.0%, respectively. Comparison of the ADNEX model regarding menopausal status revealed that the predictability was not different. The AUCs of SA and the ADNEX model in premenopausal women were 0.74 and 0.89, respectively (P=0.12). The AUCs of SA and the ADNEX model in postmenopausal women were 0.86 and 0.94, respectively (P=0.60). @*Conclusion@#The ADNEX model offers excellent discrimination between benign and malignant ovarian tumors with similar sensitivity and specificity to SA in both premenopausal and postmenopausal Korean women.

The Association of Ovarian Reserve with Exposure to Bisphenol A and Phthalate in Reproductive-aged Women

Background@#Exposure to endocrine disrupting chemicals (EDCs) that influence the hormonal and homeostatic systems is known to be associated with gynecologic health risks in many countries. In this study, we evaluated exposure to EDCs associated with diminished ovarian reserve (DOR) and gynecologic health risks. @*Methods@#This cross-sectional study was performed from September 2014 to November 2014 and included 307 Korean reproductive-aged women. Anthropometric measurements, laboratory tests with urine and blood sampling and pelvic ultrasound examinations were performed. @*Results@#Urinary bisphenol A (BLA) level was significantly higher in the DOR group with antiMüllerian hormone lower than 25 percentile (1.89 ± 2.17 ug/g and 1.58 ± 1.08 ug/g, P < 0.05).Urinary mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate and mono-N-butyl phthalate, and substrates of phthalate were evaluated and no significant difference was observed between the DOR group and non-DOR group. Logistic regression analysis suggested an increase in infertility in high BPA exposure group and the odds ratio (OR, 4.248) was statistically significant after adjustment for age, birth control pills, and the age of menarche, parity, and waist circumference. High phthalate exposure was associated with endometrial polyp after adjustment (OR, 2.742). @*Conclusion@#BPA exposure might be associated with DOR and infertility. Meanwhile, endometrial polyp is increased in women with high phthalate exposure. Therefore, the risk of exposures to EDCs for reproduction should be a matter of concern in reproductive-aged women.

Controlled ovarian hyperstimulation for fertility preservation in women with breast cancer: Practical issues / 대한생식의학회지

In Korean women, a westernized lifestyle is associated with an increased risk of breast cancer. Fertility preservation has become an increasingly important issue for women with breast cancer, in accordance with substantial improvements in survival rate after cancer treatment. The methods of controlled ovarian hyperstimulation (COH) for fertility preservation in breast cancer patients have been modified to include aromatase inhibitors to reduce the potential harm associated with increased estradiol levels. Random-start COH and dual ovarian stimulation are feasible options to reduce the total duration of fertility preservation treatment and to efficiently collect oocytes or embryos. Using a gonadotropin-releasing hormone agonist as a trigger may improve cycle outcomes in breast cancer patients undergoing COH for fertility preservation. In young breast cancer patients with BRCA mutations, especially BRCA1 mutations, the possibility of diminished ovarian reserve may be considered, although further studies are necessary. Herein, we review the current literature on the practical issues surrounding COH for fertility preservation in women with breast cancer.

Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor

Objective@#This study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to select the optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinical experience, for the preservation of fertility. @*Methods@#Ninety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoing MRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative or postoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductive outcome was investigated when the patient wished to conceive. @*Results@#The mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameter of myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1–27), and the total weight of resected myomas was 293.11±281.13 (range, 30–1,260) g. Myomas with high signal intensity on MRI required less time for resection. MS robotic myomectomy was performed for an increased number and total diameter of a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patients who wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10 patients underwent an uneventful cesarean section. @*Conclusion@#SS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, the optimal surgical technique should be selected based on preoperative MRI findings to predict an effective surgical process and the successful preservation of fertility.

Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor

Objective@#This study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to select the optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinical experience, for the preservation of fertility. @*Methods@#Ninety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoing MRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative or postoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductive outcome was investigated when the patient wished to conceive. @*Results@#The mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameter of myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1–27), and the total weight of resected myomas was 293.11±281.13 (range, 30–1,260) g. Myomas with high signal intensity on MRI required less time for resection. MS robotic myomectomy was performed for an increased number and total diameter of a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patients who wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10 patients underwent an uneventful cesarean section. @*Conclusion@#SS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, the optimal surgical technique should be selected based on preoperative MRI findings to predict an effective surgical process and the successful preservation of fertility.

Association between cadmium and anti-Mullerian hormone in premenopausal women at particular ages

BACKGROUND: Anti-Mullerian hormone (AMH) in women is secreted by granulosa cells of antral follicles. AMH appears to be a very stable marker for ovarian function. It may be used to diagnosis cases of premature ovarian failure, polycystic ovary syndrome (PCOS), and ovarian tumors. It has been suggested that cadmium exposure can reduce female fecundity. The purpose of this study was to investigate whether environmental exposure to cadmium was associated with alterations in AMH with regards to age. METHODS: In a cross-sectional study, the data of premenopausal women living in Seoul, ranging from 30 to 45 of age was collected. The study included a total of 283 women who completed serum AMH and whole blood cadmium assessments. Linear regression analyses were used in order to examine the association between cadmium and AMH. Given that age was the strongest confounder in both cadmium and AMH concentrations, we stratified subjects by 5 years old and analyzed their data. RESULTS: Geometric mean concentrations of blood cadmium and AMH were 0.97 μg/L and 3.02 ng/ml, respectively. Total association between cadmium and AMH was statistically significant (adjusted coefficient = − 0.34 (0.15), p = 0.02). After stratification, the only age group with a negative association between cadmium and AMH were the women raging between 30 and 35 years (adjusted coefficient = − 0.43 (0.18), p = 0.01). CONCLUSIONS: The results of this study suggest that environmental exposure to cadmium may alter the AMH level of premenopausal women, depending on their age group.

Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma

OBJECTIVE: Endometriosis is a common and recurring gynecologic disease which have afflicting females of reproductive age. We investigated the efficacy of long-term, post-operative use of dienogest for ovarian endometrioma. METHODS: We studied 203 patients who had undergone laparoscopic or robotic surgery for ovarian endometrioma, and were administrated dienogest 2 mg/day beginning in July of 2013, and continuing. We evaluated side effects of dienogest and ultrasonography was performed every 6 months to detect potential recurrence of endometrioma (2 cm) in these post-surgical patients. RESULTS: The follow-up observation periods were 30.2±20.9 months from surgery. The mean age was 34.1±7.2 years old. The mean diameter of pre-operative endometrioma was 5.6±3.0 cm2. One hundred eighty-two (89.7%) women received dienogest continuously for 12.0±7.1 months. Of the subjects, 21 (10.3%) patients discontinued dienogest at 2.4±1.0 months. The most common side effect when dienogest was discontinued was abnormal uterine bleeding. The occurrence rate of vaginal bleeding was 15.8%, a number which did not differ significantly in patients with/without post-operative gonadotropin releasing hormone agonist administration. The other side effects were gastrointestinal trouble including constipation, acne, headache, depression, hot flush, weight gain, and edema. However, no serious adverse events or side effects were documented and recurrent endometriomas were diagnosed in 3 patients (1.5%). CONCLUSION: The data indicates that dienogest was both tolerable and safe for long-term use as prophylaxis in an effort to obviate the recurrence of ovarian endometrioma post-operatively, as well as potential need for surgical re-intervention.

Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis

OBJECTIVE: Adenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women. METHODS: We used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method. RESULTS: A total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis. CONCLUSION: We must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.

Blood cadmium and volume of uterine fibroids in premenopausal women

BACKGROUND: A number of studies have found associations between heavy metals and uterine fibroids, but the results are inconsistent. Here, we conducted this research to demonstrate the relationships between blood heavy metal concentrations and uterine fibroid volume as well as the rate of uterine fibroid presence. METHODS: In a cross-sectional study, we collected data from 308 premenopausal women aged 30–49 years in Seoul; uterine fibroids are ascertained by past history of myomectomy and pelvic ultrasonography. In the analytic phase, we first analyzed the presence of the fibroids and the concentrations of heavy metals via logistic regression. In subgroup analysis, we used simple and multiple linear regression analyses to examine the associations between heavy metals and uterine fibroid volume. RESULTS: There was no connection between the heavy metal concentrations and the presence of uterine fibroids, but the odds of women having fibroids were higher with three particular metals. In subgroup analysis, the association between blood cadmium concentrations and uterine fibroid volume was statistically significant (adjusted beta coefficient = 2.22, 95% confidential interval: 0.06–4.37). In contrast, blood mercury and lead concentrations were not significantly associated with uterine fibroid volume. CONCLUSIONS: Our findings are the first that we know to report the association of blood cadmium concentrations with the volume of uterine fibroids. We expect that our findings will be used as evidence for supporting policies to improve premenopausal Korean women's health.

A Rare Case of Intra-Endometrial Leiomyoma of Uterus Simulating Degenerated Submucosal Leiomyoma Accompanied by a Large Sertoli-Leydig Cell Tumor

A 50-year-old peri-menopausal woman presented with hard palpable mass on her lower abdomen and anemia from heavy menstrual bleeding. Ultrasonography showed a 13x12 cm sized hypoechoic solid mass in pelvis and a 2.5x2 cm hypoechoic cystic mass in uterine endometrium. Abdomino-pelvic computed tomography revealed a hypodense pelvic mass without enhancement, suggesting a leiomyoma of intraligamentary type or sex cord tumor of right ovary with submucosal myoma of uterus. Laparoscopy revealed a large Sertoli-Leydig cell tumor of right ovary with a very rare entity of intra-endometrial uterine leiomyoma accompanied by adenomyosis. The final diagnosis of ovarian sex-cord tumor (Sertoli-Leydig cell), stage Ia with intra-endometrial leiomyoma with adenomyosis, was made. Considering the large size of the tumor and poorly differentiated nature, 6 cycles of chemotherapy with Taxol and Carboplatin regimen were administered. There is neither evidence of major complications nor recurrence during 20 months' follow-up.

Added Value of Using a CT Coronal Reformation to Diagnose Adnexal Torsion

OBJECTIVE: To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. MATERIALS AND METHODS: This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. RESULTS: Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). CONCLUSION: Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.

Triglyceride Is a Useful Surrogate Marker for Insulin Resistance in Korean Women with Polycystic Ovary Syndrome

PURPOSE: To evaluate lipid profiles and liver enzymes as surrogate markers used for recognizing insulin resistance in Korean women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: 458 women with PCOS were divided into two groups: non-obese with a body mass index (BMI) or =25.0 kg/m2. Anthropometric measures and blood sampling for hormone assay, liver enzymes, lipid profiles and 75 g oral glucose tolerance test were performed. Insulin resistance was defined as homeostasis model assessment of insulin resistance (HOMA-IR)> or =2.5. Areas under the receiver operating characteristic (ROC) curves were used to compare the power of serum markers. Multiple linear regression analysis was used to evaluate the contribution of each confounding factor for HOMA-IR. RESULTS: In non-obese and obese groups, the ROC curve analyses demonstrated that the best marker for insulin resistance was triglyceride (TG), with the areas under the ROC curve of 0.617 and 0.837, respectively. Low-density lipoprotein cholesterol (LDL-C) was the significant marker for insulin resistance with areas under the ROC curve of 0.698 in obese group, but not significant in non-obese group. TG and LDL-C were significantly associated with HOMA-IR in both non-obese and obese PCOS women by multiple linear regression analysis. The optimal cut-off points of TG> or =68.5 was a marker for predicting insulin resistance in non-obese PCOS patients and TG> or =100.5 in obese group. CONCLUSION: TG can be used as a useful marker for insulin resistance in Korean women with PCOS, especially for obese patients.

Serum Anti-Mullerian Hormone Levels before Surgery in Patients with Ovarian Endometriomas Compared to Other Benign Ovarian Cysts

OBJECTIVES: To evaluate preoperative anti-Mullerian hormone (AMH) levels in women with endometrioma or other benign ovarian cysts and differences of AMH changes according to various characteristics. METHODS: Ninety-seven patients aged 20 to 39 years who underwent surgery for benign ovarian cyst were enrolled retrospectively. Of these, 65 patients were diagnosed as endometriomas, and 32 had other benign cysts. Serum AMH, mean, maximum, and total diameter of ovarian cysts were measured. The AMH levels were compared according to pathology (endometrioma vs. other benign cyst), size of ovarian cyst, age-matched AMH quartile percentile and characteristics of endometrioma. RESULTS: Preoperative serum AMH level was significantly lower in endometrioma group than other benign cyst group (4.12 +/- 2.42 ng/mL vs. 6.02 +/- 2.29 ng/mL, P or = 75 percentile in endometrioma group (24.6% vs. 50.0%, P = 0.035). Among 4 subgroups of endometrioma, patients with AMH level > or = 75 percentile were significantly decreased in multiple bilateral endometrioma group. Mean and total diameter of cysts were negatively correlated with preoperative serum AMH level in other benign cyst group. CONCLUSION: We suggest that preoperative AMH level measurement might be considered in women with endometrioma, especially in 30 to 39 years old, multiple bilateral type, or big-sized other benign ovarian cyst to assess the diminished ovarian reserve.

Diagnostic Usefulness of Transrectal Ultrasound Compared with Transvaginal Ultrasound Assessment in Young Korean Women with Polycystic Ovary Syndrome

OBJECTIVES: To determine the diagnostic performance of transrectal ultrasound in virgin patients with polycystic ovary syndrome (PCOS) by receiver operating characteristic (ROC) curve analysis, compared with conventional transvaginal ultrasound assessment. METHODS: Ultrasound examinations were performed in 963 Korean women, with transvaginal transducers in 677 women and transrectal transducers in 286 women at Ewha Womans University Mokdong Hospital. Transvaginal ultrasound examinations were performed in 494 normal control women and 183 PCOS patients according to National Institutes of Health (NIH) PCOS diagnostic criteria. In virgin patients, transrectal ultrasound examinations were performed in 141 normal control women and 145 PCOS patients. ROC curves were calculated for ovarian volume and follicle number. RESULTS: By transvaginal ultrasound examination, the ovarian volume showed an area under the ROC curve (AURC) of 0.838. An ovarian volume decision threshold > 7 cm3 had a sensitivity of 73.0% and a specificity of 84.2% for the diagnosis of PCOS. The follicle number showed an AURC of 0.886. A follicle number decision threshold > or = 9 had a sensitivity of 78.6% and a specificity of 87.2% for the diagnosis of PCOS. By transrectal ultrasound examination, the ovarian volume and the follicle number showed AURCs of 0.815 as same thresholds with a sensitivity of 67.2% and 66.4%, respectively and a specificity of 86.8% each. Ovarian volume and follicle number by transvaginal and transrectal ultrasound assessment had a high diagnostic power for PCOS screening. CONCLUSION: Transrectal ultrasound assessment is as effective as conventional transvaginal ultrasound for the detection of PCOS in virgin patients.

Clinical and Biochemical Profiles according to Homeostasis Model Assessment-insulin Resistance (HOMA-IR) in Korean Women with Polycystic Ovary Syndrome

OBJECTIVES: The aim of this study was to investigate the clinical and biochemical profiles according to homeostasis model assessment of insulin resistance (HOMA-IR) in Korean polycystic ovary syndrome (PCOS) patients. METHODS: In 458 PCOS patients diagnosed by the Rotterdam European Society for Human Reproduction and Embryology (ESHRE) criteria, measurements of somatometry, blood test of hormones, glucose metabolic and lipid profiles, and transvaginal or transrectal ultrasonogram were carried out. HOMA-IR was then calculated and compared with the clinical and biochemical profiles related to PCOS. The patients were divided into 4 groups by quartiles of HOMA-IR. RESULTS: The mean level of HOMA-IR was 2.18 +/- 1.73. Among the four groups separated according to HOMA-IR, body weight, body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, lipid accumulation product (LAP) index, high-sensitivity C-reactive protein (hs-CRP), Apoprotein B, free testosterone, and sex hormone binding globulin (SHBG) were found to be significantly different. TG, LAP index, glucose metabolic profiles, and hs-CRP were positively correlated with HOMA-IR after adjustment for BMI. CONCLUSION: Our results suggest that the clinical and biochemical profiles which are applicable as cardiovascular risk factors are highly correlated with HOMA-IR in Korean women with PCOS.