The ESHRE/ASRM consensus on polycystic ovary syndrome (PCOS) – an extended critical analysis

Abstract

The 'ESHRE/ASRM consensus on diagnosis, nomenclature and long-term health risks of polycystic ovarian syndrome (PCOS)' (conference in Rotterdam, Netherlands, March, 2003), which was criticized shortly after its oral presentation in 2003, is still being debated following its publication in 2004. Therefore, an extended, intensive analysis of all parameters and their combinations has been performed, differentiating between inclusion and exclusion criteria. By doing this, the profound significance of the endocrinological part of the syndrome is highlighted. The nomenclature, semantic meaning of terms, definitions, structural balancing, specificity, practicability, flexibility, limitations and reproducibility for both individualization, as well as grouping from the clinical and scientific perspective, have been examined in detail. This analysis supports previous critical comments, and reaches the conclusion that the recommendations of the consensus lack accuracy and specificity, a weakness that results in the risk of overdiagnosis and in a lack of reproducibility. Altogether, they fail to fulfil the criteria of universal guidelines on several levels. Instead, a profound paradigm shift is demanded, from an inconsistent perception to a more systematic, balanced and comprehensive view. A short indication on an alternative sweeping concept of a strictly defined, therapy-targeted classification and diagnostic procedure of female functional androgenization is presented.

Pathogenesis of infertility and recurrent pregnancy loss in thyroid autoimmunity

“…These findings are in accordance with previous prospective works reporting 2e3 fold increase in the rate of preterm deliveries in thyroid antibodypositive women compared to control [13,15,16]. Higher titers of thyroid antibodies were also found in women with polycystic ovaries and endometrisosis (see below, Section 5), two frequent causes of infertility [17,18]. Both retrospective and prospective data support higher rate of approximately 3 fold of aTPO antibodies in women with polycystic ovaries [19,20] that are also likely to correlate with response to fertility treatment regimens with metformine and clomiphene citrate [20].…”

Improved implantation and ongoing pregnancy rates after single-embryo transfer with an optimized protocol for in vitro oocyte maturation in women with polycystic ovaries and polycystic ovary syndrome

“…All women included in this study had PCO confirmed by ultrasound assessment or were diagnosed with PCOS using the Rotterdam ESHRE/ASRM classification (32,33). Women were excluded if they were R42 years of age or had a body mass index of R35.…”

Adipositas und Fertilität der Frau aus gynäkologischer Sicht

“…Eine umfassende Metaanalyse [23] lieferte Hinweise dafür, dass bei Kinderwunschpatientinnen eine begleitende Metformintherapie wahrscheinlich nur bei Vorliegen einer Clomifenresistenz von Nutzen ist, wie schon in der früheren Metaanalyse von 2003 beschrieben. Die den Studien zugrunde liegende, enorme Heterogenität des "PCOS", die sich aus dem mangelhaften Definitionsniveau ergibt [7,20], mag eine Ursache dafür sein, dass die Ergebnisse nicht eindeutiger ausgefallen sind.…”