Long-term follow-up of patients with polycystic ovary syndrome after laparoscopic ovarian drilling: endocrine and ultrasonographic outcomes.

BACKGROUND: There is considerable controversy as to how long the beneficial effects of laparoscopic ovarian drilling (LOD) last. This follow-up study was undertaken to investigate the long-term effects of LOD. METHODS: The study included 116 anovulatory women with polycystic ovary syndrome (PCOS) who underwent LOD between 1991 and 1999 (study group) and 34 anovulatory PCOS women diagnosed during the same period, who had not undergone LOD (comparison group). The hospital records were reviewed and most patients attended for a transvaginal ultrasound scan and blood sampling to measure the serum concentrations of LH, FSH, testosterone, androstenedione and sex hormone-binding globulin. The results before and at different intervals, short- (<1 year), medium- (1-3 years) and long-term (4-9 years), after LOD were compared. RESULTS: The LH:FSH ratio, mean serum concentrations of LH and testosterone and free androgen index decreased significantly after LOD and remained low during the medium- and long-term follow-up periods. The mean ovarian volume decreased significantly (P < 0.05) from 11 ml before LOD to 8.5 ml at medium-term and remained low (8.4 ml) at long-term follow-up. CONCLUSION: The beneficial endocrinological and morphological effects of LOD appear to be sustained for up to 9 years in most patients with PCOS.

An evaluation of the inter-observer and intra-observer variability of the ultrasound diagnosis of polycystic ovaries.

BACKGROUND: This prospective observational study was undertaken to evaluate the reliability and consistency of ultrasound diagnosis of polycystic ovarian syndrome (PCOS). METHODS: Eighteen women with clinical and biochemical features suggestive of PCOS and nine normal control women underwent transvaginal ultrasound scan by a single ultrasonographer. The 27 ovarian scans were video-recorded and the recordings were later edited and arranged randomly so that each record appeared twice at random on the tape producing a total of 54 ovarian scans. Four experienced observers independently reviewed the recordings. The observers scored each case as follows: normal, possible polycystic ovary (PCO) and definite PCO. RESULTS: The mean intra-observer agreement was 69.4% (kappa = 0.54) and the mean inter-observer agreement was 51% (kappa = 0.28). CONCLUSION: The results suggest that the currently used ultrasonographic criteria for the diagnosis of polycystic ovaries do have significant intra-observer and inter-observer variability and as such must be considered subjective. Transvaginal ultrasonography alone may not therefore be a reliable method of diagnosing or excluding PCOS.