*Geek Box: The PCOS Diagnostic Evolution

*Geek Box: The PCOS Diagnostic Evolution

What is colloquially known as the “Rotterdam criteria” reflects the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine [ESHRE/ASRM] report from 2003, and included:

• A) High androgens, clinical oligo/anovulation [i.e., irregular/infrequent (oligo) or absence of (ano) menstrual cycles], and polycystic ovaries on ultrasound.
• B) High androgens with clinical oligo/anovulation.
• C) High androgens with polycystic ovaries present on ultrasound, but with ovulatory cycles.
• D) Clinical anovulation with polycystic ovaries on ultrasound, but without high androgens.

This expanded the initial diagnostic criteria set out in 1990 by the National Institute of Health [NIH], which included:

1. High androgens.
2. Oligo/anovulation.
3. Exclusion of known disorders.

Compared to the 1990 NIH criteria, what the Rotterdam criteria in effect added was two new PCOS phenotypes: one defined by women with ovulatory cycles but showing polycystic ovaries combined with elevated androgens, and the other defined by women with oligo/anovulatory cycles and polycystic ovaries but without elevated androgens.

Some have argued that the introduction of these additional phenotypes was premature. Others have argued that the complexity of PCOS requires a more expansive diagnostic criterion. The heterogeneity of PCOS presentations arguably lends more weight to the latter argument.