{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:44:07Z","timestamp":1793112247297,"version":"4.5.0"},"reference-count":98,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HD093748"],"award-info":[{"award-number":["R01HD093748"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Polycystic ovary morphology (PCOM) on ultrasonography is considered as a cardinal feature of polycystic ovarian syndrome (PCOS). Its relevance as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVE AND RATIONALE<\/jats:title>\n                  <jats:p>The aim of this systematic review and diagnostic meta-analysis was to assess the diagnostic accuracy of various ultrasonographic features of ovarian morphology in the diagnosis of PCOS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SEARCH METHODS<\/jats:title>\n                  <jats:p>Relevant studies published from 1 January 1990 to 12 June 2023 were identified by a systematic search in PubMed, Web of Science, Scopus, CINAHL, and CENTRAL. Studies that generated diagnostic accuracy measures (e.g. proposed thresholds, sensitivity, specificity) for PCOS using the following ultrasonographic markers met criteria for inclusion: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Studies on pregnant or post-menopausal women were excluded. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. Diagnostic meta-analysis was conducted using a bivariate model of pooled sensitivity and specificity, and visualized using forest plots and summary receiver-operating characteristic (SROC) curves.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OUTCOMES<\/jats:title>\n                  <jats:p>From a total of 2197 records initially identified, 31 studies were included. Data from five and two studies were excluded from the meta-analysis due to duplicate study populations or limited data for the index test, leaving 24 studies. Pooled results of 20 adult studies consisted of 3883 control participants and 3859 individuals with PCOS. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81\u201387%; specificity: 91%, CI: 86\u201394%; AUC: 0.905) in adult women. OV and FNPS had similar pooled sensitivities (OV: 81%, CI: 76\u201386%; FNPS: 81%, CI: 70\u201389%) but inferior pooled specificities (OV: 81%, CI: 75\u201386%; FNPS: 83%, CI: 75\u201388%) and AUCs (OV: 0.856; FNPS: 0.870) compared to FNPO. Pooled results from four adolescent studies consisting of 210 control participants and 268 girls with PCOS suggested that OV may be a robust ultrasonographic marker for PCOS diagnosis albeit the current evidence remains limited. The majority of the studies had high risk of bias for the patient selection (e.g. lack of randomized\/consecutive patient selection) and index test (e.g. lack of pre-proposed thresholds for comparison) domains across all ultrasonographic markers. As such, diagnostic meta-analysis was unable to determine the most accurate cutoff for ultrasonographic markers to diagnose PCOS. Subgroup analysis suggested that stratification based on previously proposed diagnostic thresholds, age, BMI, or technology did not account for the heterogeneity in diagnostic accuracy observed across the studies. Studies that diagnosed PCOS using the Rotterdam criteria had improved sensitivity for FNPO. Studies from North America had lower diagnostic accuracy when compared to Asian studies (FNPO: sensitivity) and European studies (OV: specificity, diagnostic odds ratio and positive likelihood ratio). Geographic differences in diagnostic accuracy may potentially be due to differences in age, BMI, and diagnostic criteria of the PCOS group across regions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATIONS<\/jats:title>\n                  <jats:p>This diagnostic meta-analysis supports the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS in adult women. OV and FNPS provide alternatives if total antral follicle counts cannot be accurately obtained. Our findings support the potential for ultrasonographic evidence of PCOM in adolescents as more data becomes available. Subgroup analysis suggests the need to investigate any relative contributions of geographical differences on PCOS phenotypes. These findings may provide the basis for the development of strategies and best practices toward a standardized definition of PCOM and a more accurate ultrasonographic evaluation of PCOS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/humupd\/dmad027","type":"journal-article","created":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T08:32:05Z","timestamp":1696667525000},"page":"109-130","source":"Crossref","is-referenced-by-count":51,"title":["Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: a systematic review and diagnostic meta-analysis"],"prefix":"10.1093","volume":"30","author":[{"given":"Jeffrey","family":"Pea","sequence":"first","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jahnay","family":"Bryan","sequence":"additional","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Wan","sequence":"additional","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4511-3514","authenticated-orcid":false,"given":"Alexis L","family":"Oldfield","sequence":"additional","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Ganga","sequence":"additional","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith E","family":"Carter","sequence":"additional","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M","family":"Johnson","sequence":"additional","affiliation":[{"name":"Cornell Statistical Consulting Unit, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7203-5814","authenticated-orcid":false,"given":"Marla E","family":"Lujan","sequence":"additional","affiliation":[{"name":"Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University , Ithaca, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,6]]},"reference":[{"key":"2024010305592670200_dmad027-B1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.fertnstert.2017.11.012","article-title":"Differential rate in decline in ovarian reserve markers in women with polycystic ovary syndrome compared with control subjects: results of a longitudinal study","volume":"109","author":"Ahmad","year":"2018","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B2","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.fertnstert.2018.11.044","article-title":"Improved diagnostic performance for the diagnosis of polycystic ovary syndrome using age-stratified criteria","volume":"111","author":"Ahmad","year":"2019","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B3","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.fertnstert.2005.07.1279","article-title":"Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound","volume":"85","author":"Allemand","year":"2006","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B4","doi-asserted-by":"crossref","first-page":"4961","DOI":"10.1210\/jc.2009-0839","article-title":"Criteria for polycystic ovarian morphology in polycystic ovary syndrome as a function of age","volume":"94","author":"Alsamarai","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"2024010305592670200_dmad027-B5","doi-asserted-by":"crossref","first-page":"16057","DOI":"10.1038\/nrdp.2016.57","article-title":"Polycystic ovary syndrome","volume":"2","author":"Azziz","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2024010305592670200_dmad027-B6","doi-asserted-by":"crossref","first-page":"4237","DOI":"10.1210\/jc.2006-0178","article-title":"Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline","volume":"91","author":"Azziz","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"2024010305592670200_dmad027-B7","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1093\/humupd\/dmg044","article-title":"Ultrasound assessment of the polycystic ovary: international consensus definitions","volume":"9","author":"Balen","year":"2003","journal-title":"Hum Reprod Update"},{"key":"2024010305592670200_dmad027-B8","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.7863\/jum.2012.31.7.1015","article-title":"Two- and three-dimensional sonographic and color doppler techniques for diagnosis of polycystic ovary syndrome: the stromal\/ovarian volume ratio as a new diagnostic criterion","volume":"31","author":"Battaglia","year":"2012","journal-title":"J Ultrasound Med"},{"key":"2024010305592670200_dmad027-B9","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ejogrb.2014.05.006","article-title":"The combination of ovarian volume and outline has better diagnostic accuracy than prostate-specific antigen (PSA) concentrations in women with polycystic ovarian syndrome (PCOs)","volume":"179","author":"Bili","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2024010305592670200_dmad027-B10","doi-asserted-by":"crossref","first-page":"287","DOI":"10.4158\/EP15903.OR","article-title":"AMH measurement versus ovarian ultrasound in the diagnosis of polycystic ovary syndrome in different phenotypes","volume":"22","author":"Carmina","year":"2016","journal-title":"Endocr Pract"},{"key":"2024010305592670200_dmad027-B11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.fertnstert.2004.12.061","article-title":"Ovarian size and blood flow in women with polycystic ovary syndrome and their correlations with endocrine parameters","volume":"84","author":"Carmina","year":"2005","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B12","doi-asserted-by":"crossref","first-page":"189.e1\u2013189","DOI":"10.1016\/j.ajog.2017.04.007","article-title":"Racial and ethnic differences in the prevalence of metabolic syndrome and its components of metabolic syndrome in women with polycystic ovary syndrome: a regional cross-sectional study","volume":"217","author":"Chan","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B13","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1002\/uog.5393","article-title":"Ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome in Chinese women","volume":"32","author":"Chen","year":"2008","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B14","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jpag.2008.01.081","article-title":"The role of ovarian volume as a diagnostic criterion for Chinese adolescents with polycystic ovary syndrome","volume":"21","author":"Chen","year":"2008","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"2024010305592670200_dmad027-B15","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.fertnstert.2014.12.094","article-title":"Ultrasound features of polycystic ovaries relate to degree of reproductive and metabolic disturbance in polycystic ovary syndrome","volume":"103","author":"Christ","year":"2015","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B16","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.fertnstert.2013.10.001","article-title":"Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome","volume":"101","author":"Christ","year":"2014","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B17","doi-asserted-by":"crossref","first-page":"118","DOI":"10.5152\/dir.2014.14094","article-title":"Contribution of real-time elastography in diagnosis of polycystic ovary syndrome","volume":"21","author":"\u00c7iraci","year":"2015","journal-title":"Diagn Interv Radiol"},{"key":"2024010305592670200_dmad027-B18","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1177\/1933719114522525","article-title":"Prevalence of polycystic ovary syndrome phenotypes using updated criteria for polycystic ovarian morphology: an assessment of over 100 consecutive women self-reporting features of polycystic ovary syndrome","volume":"21","author":"Clark","year":"2014","journal-title":"Reprod Sci"},{"key":"2024010305592670200_dmad027-B19","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ejogrb.2013.06.013","article-title":"Evaluation of ovarian function in 35\u201340-year-old women with polycystic ovary syndrome","volume":"170","author":"de Guevara","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2024010305592670200_dmad027-B20","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/uog.6310","article-title":"Intraobserver and interobserver reliability of automated antral follicle counts made using three-dimensional ultrasound and SonoAVC","volume":"33","author":"Deb","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B21","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.jclinepi.2005.01.016","article-title":"The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed","volume":"58","author":"Deeks","year":"2005","journal-title":"J Clin Epidemiol"},{"key":"2024010305592670200_dmad027-B22","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1093\/humrep\/deu242","article-title":"Using cluster analysis to identify a homogeneous subpopulation of women with polycystic ovarian morphology in a population of non-hyperandrogenic women with regular menstrual cycles","volume":"29","author":"Dewailly","year":"2014","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B23","doi-asserted-by":"crossref","first-page":"3123","DOI":"10.1093\/humrep\/der297","article-title":"Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries","volume":"26","author":"Dewailly","year":"2011","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B24","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1093\/humupd\/dmt061","article-title":"Definition and significance of polycystic ovarian morphology: a task force report from the androgen excess and polycystic ovary syndrome society","volume":"20","author":"Dewailly","year":"2014","journal-title":"Hum Reprod Update"},{"key":"2024010305592670200_dmad027-B25","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00774-010-0211-2","article-title":"Serum concentrations of carboxylated osteocalcin are increased and associated with several components of the polycystic ovarian syndrome","volume":"29","author":"Diamanti-Kandarakis","year":"2011","journal-title":"J Bone Miner Metab"},{"key":"2024010305592670200_dmad027-B26","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/j.1365-2265.2007.02954.x","article-title":"Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS","volume":"67","author":"Diamanti-Kandarakis","year":"2007","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2024010305592670200_dmad027-B27","author":"Doebler","year":"2020"},{"key":"2024010305592670200_dmad027-B60298182","doi-asserted-by":"crossref","first-page":"158","DOI":"10.11152\/mu-1849","article-title":"Is shear wave elastography relevant in the diagnosis of polycystic ovarian syndrome?","volume":"21","author":"Ertekin","year":"2019","journal-title":"Med Ultrason"},{"key":"2024010305592670200_dmad027-B28","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/S0015-0282(01)01919-7","article-title":"A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: ovarian stroma\/total area ratio","volume":"76","author":"Fulghesu","year":"2001","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B29","doi-asserted-by":"crossref","first-page":"915245","DOI":"10.3389\/fendo.2022.915245","article-title":"Application of a new ultrasound criterion for the diagnosis of polycystic ovary syndrome","volume":"13","author":"Gim\u00e9nez-Peralta","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2024010305592670200_dmad027-B30","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1111\/j.1365-2265.2010.03873.x","article-title":"Ethnic differences in Rotterdam criteria and metabolic risk factors in a multiethnic group of women with PCOS studied in Denmark","volume":"73","author":"Glintborg","year":"2010","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2024010305592670200_dmad027-B31","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1055\/s-0032-1304608","article-title":"Age associated differences in prevalence of individual Rotterdam criteria and metabolic risk factors during reproductive age in 446 Caucasian women with polycystic ovary syndrome","volume":"44","author":"Glintborg","year":"2012","journal-title":"Horm Metab Res"},{"key":"2024010305592670200_dmad027-B32","doi-asserted-by":"crossref","first-page":"25","DOI":"10.6118\/jmm.2017.23.1.25","article-title":"Ovarian volume in Korean women with polycystic ovary syndrome and its related factors","volume":"23","author":"Han","year":"2017","journal-title":"J Menopausal Med"},{"key":"2024010305592670200_dmad027-B33","author":"Harrell","year":"2021"},{"key":"2024010305592670200_dmad027-B34","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins"},{"key":"2024010305592670200_dmad027-B35","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1093\/humrep\/den482","article-title":"Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve","volume":"24","author":"Hudecova","year":"2009","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B36","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.3390\/jcm10102101","article-title":"The effect of ageing on clinical, hormonal and sonographic features associated with PCOS\u2014a long-term follow-up study","volume":"10","author":"Jacewicz-\u015awi\u0119cka","year":"2021","journal-title":"J Clin Med"},{"key":"2024010305592670200_dmad027-B37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v038.i08","article-title":"Multi-state models for panel data: the msm package for R","volume":"38","author":"Jackson","year":"2011","journal-title":"J Stat Soft"},{"key":"2024010305592670200_dmad027-B38","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.fertnstert.2019.06.016","article-title":"Impact of right\u2013left differences in ovarian morphology on the ultrasound diagnosis of polycystic ovary syndrome","volume":"112","author":"Jarrett","year":"2019","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B39","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1002\/uog.5301","article-title":"Three-dimensional ultrasound improves the interobserver reliability of antral follicle counts and facilitates increased clinical work flow","volume":"31","author":"Jayaprakasan","year":"2008","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B40","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.fertnstert.2012.05.042","article-title":"Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women","volume":"98","author":"Jayaprakasan","year":"2012","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B41","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/uog.3913","article-title":"The interobserver reliability of off-line antral follicle counts made from stored three-dimensional ultrasound data: a comparative study of different measurement techniques","volume":"29","author":"Jayaprakasan","year":"2007","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B42","doi-asserted-by":"crossref","first-page":"4965","DOI":"10.1210\/jc.2010-0202","article-title":"The polycystic ovary post-Rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance","volume":"95","author":"Johnstone","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"2024010305592670200_dmad027-B43","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/humrep\/dei159","article-title":"Revisiting the ovarian volume as a diagnostic criterion for polycystic ovaries","volume":"20","author":"Jonard","year":"2005","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B44","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1093\/humrep\/deg115","article-title":"Ultrasound examination of polycystic ovaries: is it worth counting the follicles?","volume":"18","author":"Jonard","year":"2003","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B45","first-page":"146","article-title":"2D and 3D trans-vaginal sonography to determine cut-offs for ovarian volume and follicle number per ovary for diagnosis of polycystic ovary syndrome in Indian women","volume":"19","author":"Kar","year":"2018","journal-title":"J Reprod Infertil"},{"key":"2024010305592670200_dmad027-B46","doi-asserted-by":"crossref","first-page":"670e.e1","DOI":"10.1016\/j.ajog.2008.01.037","article-title":"Endocrine and metabolic differences among phenotypic expressions of polycystic ovary syndrome according to the 2003 Rotterdam consensus criteria","volume":"198","author":"Kauffman","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B47","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.3390\/nu12071953","article-title":"Obesity, insulin resistance, and hyperandrogenism mediate the link between poor diet quality and ovarian dysmorphology in reproductive-aged women","volume":"12","author":"Kazemi","year":"2020","journal-title":"Nutrients"},{"key":"2024010305592670200_dmad027-B48","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.fertnstert.2022.01.014","article-title":"Changes in individual polycystic ovary syndrome phenotypical characteristics over time: a long-term follow-up study","volume":"117","author":"van Keizerswaard","year":"2022","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B49","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.3390\/jcm9061831","article-title":"The relevant hormonal levels and diagnostic features of polycystic ovary syndrome in adolescents","volume":"9","author":"Khashchenko","year":"2020","journal-title":"J Clin Med"},{"key":"2024010305592670200_dmad027-B50","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.fertnstert.2017.07.005","article-title":"Polycystic ovary morphology: age-based ultrasound criteria","volume":"108","author":"Kim","year":"2017","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B51","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s00404-014-3317-2","article-title":"Anti-Mullerian hormone: an indicator for the severity of polycystic ovarian syndrome","volume":"290","author":"K\u00f6ninger","year":"2014","journal-title":"Arch Gynecol Obstet"},{"key":"2024010305592670200_dmad027-B52","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.3892\/etm.2011.327","article-title":"Relationship of ovarian volume with mean platelet volume and lipid profile in patients with polycystic ovary syndrome","volume":"2","author":"K\u00f6\u015f\u00fc\u015f","year":"2011","journal-title":"Exp Ther Med"},{"key":"2024010305592670200_dmad027-B53","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ejogrb.2010.10.007","article-title":"Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries?","volume":"154","author":"K\u00f6\u015f\u00fc\u015f","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2024010305592670200_dmad027-B54","doi-asserted-by":"crossref","first-page":"3117","DOI":"10.1093\/humrep\/deq273","article-title":"A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed?","volume":"25","author":"Kristensen","year":"2010","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B55","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2147\/IJWH.S329082","article-title":"A cross-sectional study on potential ovarian volume and related factors in women with polycystic ovary syndrome from infertile couples","volume":"13","author":"Le","year":"2021","journal-title":"Int J Womens Health"},{"key":"2024010305592670200_dmad027-B56","doi-asserted-by":"crossref","first-page":"149","DOI":"10.6118\/jmm.2015.21.3.149","article-title":"Diagnostic usefulness of transrectal ultrasound compared with transvaginal ultrasound assessment in young Korean women with polycystic ovary syndrome","volume":"21","author":"Lee","year":"2015","journal-title":"J Menopausal Med"},{"key":"2024010305592670200_dmad027-B57","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1093\/humrep\/dex226","article-title":"Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: redefining threshold levels for follicle count and serum anti-M\u00fcllerian hormone using cluster analysis","volume":"32","author":"Lie Fong","year":"2017","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B58","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.ultrasmedbio.2010.02.008","article-title":"Grid analysis improves reliability in follicle counts made by ultrasonography in women with polycystic ovary syndrome","volume":"36","author":"Lujan","year":"2010","journal-title":"Ultrasound Med Biol"},{"key":"2024010305592670200_dmad027-B59","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1757-2215-2-6","article-title":"Assessment of ultrasonographic features of polycystic ovaries is associated with modest levels of inter-observer agreement","volume":"2","author":"Lujan","year":"2009","journal-title":"J Ovarian Res"},{"key":"2024010305592670200_dmad027-B60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7827-6-30","article-title":"Improving inter-observer variability in the evaluation of ultrasonographic features of polycystic ovaries","volume":"6","author":"Lujan","year":"2008","journal-title":"Reprod Biol Endocrinol"},{"key":"2024010305592670200_dmad027-B61","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1093\/humrep\/det062","article-title":"Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume","volume":"28","author":"Lujan","year":"2013","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B62","volume-title":"Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy","author":"Macaskill","year":"2010"},{"key":"2024010305592670200_dmad027-B63","doi-asserted-by":"crossref","first-page":"5321","DOI":"10.1210\/jc.2004-0643","article-title":"Stockpiling of transitional and classic primary follicles in ovaries of women with polycystic ovary syndrome","volume":"89","author":"Maciel","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"2024010305592670200_dmad027-B64","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s00404-012-2528-7","article-title":"Does obesity compromise ovarian reserve markers? A clinician\u2019s perspective","volume":"287","author":"Malhotra","year":"2013","journal-title":"Arch Gynecol Obstet"},{"key":"2024010305592670200_dmad027-B65","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jama.2017.19163","article-title":"Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement","volume":"319","author":"McInnes","year":"2018","journal-title":"JAMA"},{"key":"2024010305592670200_dmad027-B66","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.7863\/jum.2005.24.9.1279","article-title":"Intraobserver and interobserver reproducibility of ovarian volume, antral follicle count, and vascularity indices obtained with transvaginal 3-dimensional ultrasonography, power doppler angiography, and the virtual organ computer-aided analysis imaging program","volume":"24","author":"Merc\u00e9","year":"2005","journal-title":"J Ultrasound Med"},{"key":"2024010305592670200_dmad027-B67","first-page":"1","article-title":"Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis","volume":"25","author":"Moslehi","year":"2018","journal-title":"Menopause"},{"key":"2024010305592670200_dmad027-B68","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/uog.14684","article-title":"Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention","volume":"45","author":"Nastri","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B69","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-021-01277-6","article-title":"Effect of body mass index (BMI) on phenotypic features of polycystic ovary syndrome (PCOS) in Singapore women: a prospective cross-sectional study","volume":"21","author":"Neubronner","year":"2021","journal-title":"BMC Women\u2019s Health"},{"key":"2024010305592670200_dmad027-B70","first-page":"1","article-title":"Comparison of stromal thickness and doppler findings in polycystic ovary syndrome and healthy women with ultrasonographic evidence of polycystic ovaries? A cross-sectional study","volume":"42","author":"\u00d6zay","year":"2022","journal-title":"J Obstet Gynaecol"},{"key":"2024010305592670200_dmad027-B71","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.fertnstert.2019.12.012","article-title":"Adjusting antimullerian hormone levels for age and body mass index improves detection of polycystic ovary syndrome","volume":"113","author":"Palomaki","year":"2020","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B72","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12916-020-01516-x","article-title":"Adolescent polycystic ovary syndrome according to the international evidence-based guideline","volume":"18","author":"Pe\u00f1a","year":"2020","journal-title":"BMC Med"},{"key":"2024010305592670200_dmad027-B73","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1093\/humrep\/dey017","article-title":"The numbers of 2-5 and 6-9 mm ovarian follicles are inversely correlated in both normal women and in polycystic ovary syndrome patients: what is the missing link?","volume":"33","author":"Peign\u00e9","year":"2018","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B74","author":"R Core Team","year":"2020"},{"key":"2024010305592670200_dmad027-B75","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.jclinepi.2005.02.022","article-title":"Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews","volume":"58","author":"Reitsma","year":"2005","journal-title":"J Clin Epidemiol"},{"key":"2024010305592670200_dmad027-B76","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.fertnstert.2011.10.031","article-title":"A characterization of the relationship of ovarian reserve markers with age","volume":"97","author":"Rosen","year":"2012","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B77","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1111\/cen.12441","article-title":"Luteal phase dynamics of follicle-stimulating and luteinizing hormones in obese and normal weight women","volume":"81","author":"Roth","year":"2014","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2024010305592670200_dmad027-B78","author":"Rstudio Team","year":"2020"},{"key":"2024010305592670200_dmad027-B79","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S0002-9378(15)30642-6","article-title":"Amenorrhea associated with bilateral polycystic ovaries","volume":"46","author":"Stein","year":"1935","journal-title":"Am J Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B80","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/humrep\/dey256","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"33","author":"Teede","year":"2018","journal-title":"Hum Reprod"},{"key":"2024010305592670200_dmad027-B81","author":"Teede","year":"2018"},{"key":"2024010305592670200_dmad027-B82","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.fertnstert.2003.10.004","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome","volume":"81","author":"The Rotterdam ESHRE\/ASRM-Sponsored PCOS Consensus Workshop Group","year":"2004","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B83","doi-asserted-by":"crossref","first-page":"374","DOI":"10.3390\/diagnostics13030374","article-title":"Diagnostic performance of ovarian morphology on ultrasonography across anovulatory conditions\u2014impact of body mass index","volume":"13","author":"Vanden Brink","year":"2023","journal-title":"Diagnostics"},{"key":"2024010305592670200_dmad027-B84","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.fertnstert.2020.09.006","article-title":"A comparison of two- and three-dimensional ultrasonographic methods for evaluation of ovarian follicle counts and classification of polycystic ovarian morphology","volume":"115","author":"Vanden Brink","year":"2021","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B85","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J Stat Soft"},{"key":"2024010305592670200_dmad027-B86","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1365-2265.2012.04475.x","article-title":"Ovarian volume and gluco-insulinaemic markers in the diagnosis of PCOS during adolescence","volume":"78","author":"Villa","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2024010305592670200_dmad027-B87","doi-asserted-by":"crossref","first-page":"625","DOI":"10.3109\/09513590.2015.1025380","article-title":"Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents","volume":"31","author":"Villarroel","year":"2015","journal-title":"Gynecol Endocrinol"},{"key":"2024010305592670200_dmad027-B88","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2024010305592670200_dmad027-B89","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.fertnstert.2013.03.010","article-title":"Phenotypic comparison of Caucasian and Asian women with polycystic ovary syndrome: a cross-sectional study","volume":"100","author":"Wang","year":"2013","journal-title":"Fertil Steril"},{"key":"2024010305592670200_dmad027-B90","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S0140-6736(03)14410-8","article-title":"Formation and early development of follicles in the polycystic ovary","volume":"362","author":"Webber","year":"2003","journal-title":"Lancet"},{"key":"2024010305592670200_dmad027-B91","doi-asserted-by":"crossref","first-page":"4361","DOI":"10.1210\/jc.2006-1191","article-title":"Defining constant versus variable phenotypic features of women with polycystic ovary syndrome using different ethnic groups and populations","volume":"91","author":"Welt","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"2024010305592670200_dmad027-B92","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med"},{"key":"2024010305592670200_dmad027-B93","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-24277-4","volume-title":"ggplot2: Elegant Graphics for Data Analysis","author":"Wickham","year":"2016"},{"key":"2024010305592670200_dmad027-B94","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.rbmo.2013.06.016","article-title":"Age-related normogram for antral follicle count in women with polycystic ovary syndrome","volume":"27","author":"Wiser","year":"2013","journal-title":"Reprod Biomed Online"},{"key":"2024010305592670200_dmad027-B95","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.tjog.2018.06.004","article-title":"Accuracy of anti-M\u00fcllerian hormone and total follicles count to diagnose polycystic ovary syndrome in reproductive women","volume":"57","author":"Wongwananuruk","year":"2018","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2024010305592670200_dmad027-B96","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.7326\/M21-2234","article-title":"QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies","volume":"174","author":"Yang","year":"2021","journal-title":"Ann Intern Med"},{"key":"2024010305592670200_dmad027-B97","volume-title":"Polycystic Ovary Syndrome","author":"Zawadski"}],"container-title":["Human Reproduction Update"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/humupd\/article-pdf\/30\/1\/109\/54876997\/dmad027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/humupd\/article-pdf\/30\/1\/109\/54876997\/dmad027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T06:00:21Z","timestamp":1704261621000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/humupd\/article\/30\/1\/109\/7296031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,6]]},"references-count":98,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,10,6]]},"published-print":{"date-parts":[[2024,1,3]]}},"URL":"https:\/\/doi.org\/10.1093\/humupd\/dmad027","relation":{},"ISSN":["1355-4786","1460-2369"],"issn-type":[{"value":"1355-4786","type":"print"},{"value":"1460-2369","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,1]]},"published":{"date-parts":[[2023,10,6]]}}}