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• W2157222015 abstract "We greatly appreciate Dr. Acién's interest in the Task Force's report (1Azziz R. Carmina E. Dewailly D. Diamanti-Kandarakis E. Escobar-Morreale H.F. Futterweit W. et al.The Androgen Excess and PCOS Society Criteria for the Polycystic Ovary Syndrome: The Complete Task Force Report.Fertil Steril. 2009; 91: 456-488Abstract Full Text Full Text PDF PubMed Scopus (1319) Google Scholar). He first suggests that “more stress should have been put on the criteria to define each symptom and analytical data instead of widely analyzing their prevalence.” We fully agree that while much emphasis has been made on arriving at a uniform definition of polycystic ovary syndrome (PCOS), of equal or even greater importance is the need to clearly and accurately define the specific phenotypic features used in the definitions. Although not the aim of our Task Force, we did make an effort to discuss throughout the pitfalls and limitations of each of the diagnostic criteria discussed (e.g., assessment of ovulatory dysfunction, measures of androgen levels, exclusion of related disorders). Further details on these important questions were discussed elsewhere (2Azziz R. Diagnosing the diagnosis: Why we must standardize the defining features of PCOS.Ann Clin Biochem. 2008; 45: 3-5Crossref PubMed Scopus (10) Google Scholar). Second, Dr. Acién notes that the assessment of ovarian morphology by “transabdominal echography is of little utility; therefore, it should be done transvaginally.” Although transvaginal ultrasonography is clearly superior to transabdominal imaging, we should note that not all patients tolerate a vaginal or rectal examination, and are able to tolerate a transabdominal exam. The results of transabdominal sonography greatly depend on the degree of the patient's obesity and are superior for assessment of ovarian size than follicle number. Although it is true that it is preferable that the ultrasound examination is performed by the examining physician, this is not always practical or possible. In fact, the results of the evaluation will primarily depend on the skill of the sonographer, be it a radiologic technician, radiologist, or clinician. Therefore, whereas we agree that transvaginal sonography has a greater value than transabdominal imaging, we cannot agree that the latter is “of little utility.” Likewise, we respectfully disagree that PCOS is a gynecologic pathology. Polycystic ovary syndrome is a life-long reproductive-metabolic disorder, whose impact is felt and should be understood and managed by a broad spectrum of practitioners. Third, the correspondent notes that in his opinion all features of PCOS must be present for the diagnosis to be made (i.e., hirsutism, hyperandrogenemia, oligoanovulation, polycystic ovaries, and alteration of the relation FSH/LH in day 3–4 of the cycle). Surprisingly he feels that need for “the exclusion of other related disorders is even more imperative” when “any of these criteria is missing.” We disagree. Polycystic ovary syndrome clearly has a heterogeneous presentation, and exclusion of related disorders should be made in all patients suspected of the disorder, regardless of their phenotypic presentation. The correspondent is referred to the text of the report for further responses to this statement (1Azziz R. Carmina E. Dewailly D. Diamanti-Kandarakis E. Escobar-Morreale H.F. Futterweit W. et al.The Androgen Excess and PCOS Society Criteria for the Polycystic Ovary Syndrome: The Complete Task Force Report.Fertil Steril. 2009; 91: 456-488Abstract Full Text Full Text PDF PubMed Scopus (1319) Google Scholar). We apologize that we did not include the correspondent's own publication in our task force report. However, we should note that many other reports were not included, particularly if they did not report the prevalence of the features of PCOS being evaluated (e.g., menstrual or ovulatory dysfunction, hirsutism, hyperandrogenemia). Of note, a “total of 527 articles were initially available for this review, although additional studies (cross-references and those published in 2006) were also considered” and only a fraction of these were actually included. We appreciate Dr. Acién's interest in the report. Criteria for the polycystic ovary syndromeFertility and SterilityVol. 92Issue 1PreviewTo the Editor: Full-Text PDF Open Archive" @default.
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• W2157222015 title "Reply of the Authors: Criteria for the polycystic ovary syndrome" @default.
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• W2157222015 doi "https://doi.org/10.1016/j.fertnstert.2009.03.111" @default.
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