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Diagnosis of PCOS: 3998 Chinese casesDiagnosis of PCOS: 3998 Chinese cases
NIH, Rotterdam criteria or AESNIH, Rotterdam criteria or AES ？？
Zi-Jiang Chen M.D., Ph.D
Center for Reproductive Medicine
Jinan, China
OutlineOutline
History of diagnostic criteria1
Clinical study of Chinese PCOS2
Conclusion3
The history of the criteriaThe history of the criteria
2006AES
2003 Rotterdam
1990 NIH
1935 S -L
PCOS
The history of the criteriaThe history of the criteria
oligo-/anovulation (AO), hyperandrogenism(HA) and polycystic ovaries (PCO)
ROTTERDAMAO+PCO
AESHA+ PCO
NIHAO+HA
Comments on the criteriaComments on the criteria
NIH
Rotterdam
AES
Which is more proper ?
Aim: to have a profound understanding of the features of
Chinese PCOS
Time: 2006-
Cases: 3998 PCOS patients from China (13 infertility
centers involved)
Screen criteria: Rotterdam criteria, then subgrouped by
AES and NIH criteria respectively
Clinical study of Chinese PCOS
The clinical phenotypesThe clinical phenotypes
3998 patients (Rotterdam criteria)
2798 (70%) cases diagnosed by AES （ 51.53% ）
2715 (67.9%) cases diagnosed by NIH
The clinical characters (Rotterdam criteria) :
PCOS from clinical patients PCOS from epidemiological study
mentrual dysfunction 97.0 ％ 89.4%
polycystic ovaries 94.0% 72.94%
hyperandrogenism 70.0% 57.65%
hirsutism 16.5% 1.18%
acne 18.1% 38.82%
Constituent ratio of different phenotypes --- Unpulblished
The endocrine of AES and non-AES groupThe endocrine of AES and non-AES group ((xx±±ss))
AES group non-AES group
t p
Age 28.54±3.61 29.11±3.78 -3.872 ＜ 0.01**
BMI 24.97±4.09 24.85±4.15 0.729 0.466
FSH 6.81±1.82 6.51±1.76 4.252 ＜ 0.01**
LH 11.43±6.46 9.27±5.50 9.374 ＜ 0.01**
LH/FSH 1.74±1.05 1.48±0.91 6.874 ＜ 0.01**
E2 55.31±43.25 47.68±43.20 4.428 ＜ 0.01**
PRL 18.82±10.30 18.66±10.00 0.407 0.684
--- Unpublished
Metabolic features of AES and non-AES groupMetabolic features of AES and non-AES groupAES group Non AES group t p
Waistline 83.97±10.82 83.53±10.70 1.031 0.303
W/H 0.864±0.062 0.858±0.058 2.014 0.044*
CHO 4.66±0.93 4.62±0.94 1.097 0.273
TG 1.26±0.92 1.34±1.12 -1.716 0.086
HDL 1.24±2.21 1.28±0.69 -0.399 0.690
LDL 2.56±2.69 2.51±0.81 0.536 0.592
FG 5.10±0.93 5.15±1.06 -1.338 0.181
G30 8.69±2.70 8.58±3.30 0.969 0.333
G60 8.59±4.01 8.35±3.61 1.535 0.125
G120 6.91±2.87 6.75±2.63 1.387 0.166
G180 5.11±2.08 5.01±1.76 1.235 0.186
F INS 10.66±7.88 10.43±7.23 0.766 0.444
INS30 73.88±49.79 69.49±47.61 2.237 0.025*
INS60 87.14±64.08 81.17±60.34 2.432 0.015*
INS120 69.24±60.89 61.97±55.65 3.191 0.001**
INS180 26.59±32.56 23.70±32.56 2.216 0.027*
Diseases AESgroup
non-AESgroup
X2 p
Hypertension 10.6％ 11.4％ 0.374 0.541
Insulin resistance（ HOMA）
15.2％ 15.8％ 0.208 0.649
Obesity 46.0％ 45.2％ 0.151 0.697
Clinical study of Chinese PCOS
--- Unpublished
Family history of AES and non-AES groupFamily history of AES and non-AES group
Family history AESgroup
non-AESgroup
X2 p
Hypertension 29.8％ 29.4％ 0.369 0.543
Diabetes 11.5％ 8.5％ 6.052 0.014*
Cerebrovascular disease
4.9％ 4.5％ 0.201 0.654
Cardiovascular disease
9.4％ 8.8％ 0.276 0.599
--- Unpublished
Endocrine of NIH group and non-NIH groupEndocrine of NIH group and non-NIH group
NIH group non-NIHgroup
t p
Age 28.55±3.64 29.04±3.72 -3.465 ＜ 0.01**
BMI 24.94±4.09 24.93±4.16 0.041 0.967
FSH 6.81±1.83 6.53±1.75 4.090 ＜ 0.01**
LH 11.58±6.46 9.16±5.48 10.696 ＜ 0.01**
LH/FSH 1.76±1.06 1.46±0.91 68.225 ＜ 0.01**
E2 55.67±43.83 47.65±41.98 4.774 ＜ 0.01**
T 77.48±20.52 46.19±15.88 46.460 ＜ 0.01**
PRL 18.79±10.34 18.75±9.94 0.097 0.922
Clinical study of Chinese PCOSClinical study of Chinese PCOS
--- Unpublished
NIH group non-NIH group t p
Waistline 83.89±10.74 83.72±10.89 0.420 0.675
W/H 0.864±0.060 0.859±0.063 2.124 0.034*
CHO 4.66±0.92 4.62±0.95 1.159 0.247
TG 1.26±0.91 1.33±1.11 -1.684 0.092
HDL 1.24±2.25 1.28±0.67 -0.369 0.712
LDL 2.57±2.74 2.50±0.82 0.624 0.533
BG0 5.10±0.92 5.15±1.67 -1.381 0.168
BG30 8.68±2.72 8.61±3.22 0.580 0.562
BG60 8.58±4.05 8.40±3.56 1.193 0.233
BG120 6.91±2.88 6.77±2.62 1.288 0.198
BG180 5.10±2.09 5.02±1.77 1.156 0.248
INS0 10.67±7.98 10.40±7.08 0.972 0.331
INS30 74.06±50.06 69.51±47.23 2.420 0.016*
INS60 87.21±64.37 81.51±60.08 2.379 0.017*
INS120 69.56±61.21 62.03±55.37 3.386 0.001**
INS180 26.91±33.06 23.27±31.48 2.916 0.004**
The difference was still statistical significant after excluding the effect of age. (P=0.044)
Metabolism results of NIH and non-NIH groupMetabolism results of NIH and non-NIH group
Diseases NIHgroup
non-NIHgroup
X2 p
Hypertension 10.5％ 11.5％ 0.611 0.434
Insulin resistance（ HOMA）
15.3％ 15.5％ 0.028 0.868
Obesity 45.8％ 45.8％ 0.000 0.983
No difference was found between groups about their medical history.
Clinical study of Chinese PCOSClinical study of Chinese PCOS
--- Unpublished
Family history of NIH and non-NIH groupFamily history of NIH and non-NIH group
Family history NIHgroup
non-NIHgroup
X2 p
Hypertension 30.5％ 28.1％ 1.892 0.169
Diabetes 11.6％ 8.7％ 6.239 0.012*
Cerebrovascular disease
4.7％ 4.9％ 0.044 0.834
Cardiovascular disease
9.5％ 8.6％ 0.703 0.402
Clinical study of Chinese PCOSClinical study of Chinese PCOS
--- Unpublished
In AES group and NIH group:
Patients are younger,
Besides higher T, higher FSH and LH level.
LH/FSH ratio is also higher significantly
Similar in both groups:
Insulin levels are higher than that of non- groups
Prevalence of Diabetes family history is significantly higher
More risk of long-term complications
Clinical study of Chinese PCOSClinical study of Chinese PCOS
The increased level of FSH and hypersensitivity
caused by hyperandrogenism can promote the
development of mutiple pre-antral follicles. This
may be the reason of the morphological change in
PCOS.
Elevated LH level will stimulate the production of
androgen and form the vicious cycle which will
aggravate the ovulatory dysfunction.
Sarma HN. 2005
DiscussionDiscussion
A strong association between hyperandrogenism and
metabolic syndrome, independent of obesity and insulin
resistance. Hyperandrogenism is the independent risk factor
of CVD
NIH PCOS is associated with a more adverse metabolic profile. The prevalence of obesity and insulin resistance is higher in NIH group. The risk of CVD and DM was increased.
Coviello AD 2006, Legro 2006, Shaw LJ 2008,
Cussons 2008, Moran L 2009 Goverde AJ, 2009
DiscussionDiscussion
Our present results: both NIH and AES PCOS are associated with a more adverse metabolic profile. The insulin level are higher than that of non- groups, the insulin sensitivity was impaired in these subgroups. Prevalence of Diabetes family history is significantly higher.
PCOS without polycystic ovaries (non-PCO ) had higher
cholesterol and low-density lipoprotein, had a higher
incidence of developing long-term complications.
ZJ Chen, et al. 2008
DiscussionDiscussion
IR Anovulation
Hyperinsulinemia
IGFBP-1 Free IGF-1
Hypersensitivity to FSH
Androgenexcess
DiscussionDiscussion
Androgen excess plays an important role in the
pathophysiological process and has crucial significance ，but in clinic, how to determine androgen excess ?
Serum total Testosterone level in PCOS in different ethnicitiesSerum total Testosterone level in PCOS in different ethnicities
Studies ethnicity nT PCOS
% increased over
Ctl mean T
Chang et al., 2005 USA mixed 316 90.02%
Hahn et al., 2005 German 200 81.00%
Legro et al., 2006 USA Caucasian 626 60.80%
Diamanti 2007 Greek 634 103.22%
T Iwasa, 2007 Japanese 49 86±48.00 ng/dl 29.4%
D.Y ang 2008S.Chinese
6613.20±0.30 nmol/l
88.22%
Liou, et al 2008 Chinese TW 613 3.0±1.4nmol/l 57.88%
ZJ Chen, 2010 Chinese 315567.01±24.10 ng/dl
51.9%
Orio et al., 2010 Italians 100 2.6±0.3nmol/l 100.00%
M ASUNCIO´ N, 2010 Spainish 9 1.7 ±0.9 nmol/l 70%
ConclusionsConclusions
NIH and AES criteria are stricter than Rotterdam
criteria.1
2
3
In clinic, which is more practical for PCOS diagnosis?
4 We still need more evidence and studies in the future …
2
Which is more proper for Chinese patients with PCOS: AO +
HA /+PCO ? (mentrual dysfunction should be necessary
condition?)
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