The history of ESHRE/ASRM sponsored PCOS consensus workshops
The history of ESHRE/ASRM sponsored PCOS consensus workshops
The history of ESHRE/ASRM sponsored PCOS consensus workshops
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<strong>The</strong> <strong>history</strong> <strong>of</strong><strong>ESHRE</strong>/<strong>ASRM</strong> <strong>sponsored</strong><strong>PCOS</strong> <strong>consensus</strong> <strong>workshops</strong>(Tarlatzis/Fauser)IIIIIIDiagnosis (2003, Rotterdam)Infertility treatment (2007, <strong>The</strong>ssaloniki)Women’s Health (2010, Amsterdam)Sponsored by unconditionalgrants from Organon/SP/MSD
Morphology syndrome endocrinology ultrasound metabolic1935 1963 1980 1988 1990Yen,JCEM 80LHFranks,1987SteinLeventh hal19639 casesldzieher,ces, 1079rod & Gol7 referencAxelr(187AD0T ng g/mlDHEAFSHLoboJCEM 83DHE EAS1Dunaif200 Obese LeanJCEM 8310030 60 9030 60 90 120Minutes
<strong>PCOS</strong> diagnosis- 1990 NIH criteria -Hyperandrogenemia<strong>PCOS</strong>Chronicanovulation
Applied criteria for <strong>PCOS</strong>diagnosis in the literatureElevated LH Yen, SchoemakerElevated androgens Lobo, Barbieri, NIHUltrasoundLH + USConway, RismaAndrogens + US Fauser, NormanLH + Androgens Shelly, ArdeansLH + Andr + US Eden, PacheInsulin resistanceNestler, DunaifJacobs, Franks, Balen(Summary literature 1990-2002)
Rotterdam, Hotel New York- <strong>history</strong> meets today
1<strong>PCOS</strong>Hyperandrogenemia2 out <strong>of</strong> 3PCOOligo/anovulationl (WHO 2 type)
<strong>PCOS</strong> as a complex genetic conditionMonogenic disorders(mendelian)autosomal or X-linkedComplex, polygenicconditionMulti-gene/environmentinteractionGene ADiseaseGene AGene BDisease• environmental factors• genetic influence(mutation)ti (polymorphism, SNPs)
<strong>PCOS</strong>changing paradigmsReproductive disordersMetabolic disease15 yrs 60 yrsmenstrual disordershyperandrogenemiainfertilityPregn complic.type 2 diabetescardiovasc diseaseMulti-disciplinary approaches
<strong>PCOS</strong>- hyperandrogenemiaClinical: i l Biochemical:AcneTestosteroneHirsutismtotal t or free (unbound)Free androgen index(T x 100 / SHBG)AndrostenedioneOther androgens (DHEAS)combination
<strong>The</strong> issuesTransabdominal versus transvaginalFew controlled studiesOvarian volumeFollicle number / sizeOvarian stromaConclusions> 12 follicles (2-9 mm)> 10 cm 3
Oligo-, anovulationAmenorrheaOligomenorrhea (anovulation)Oligomenorrhea (ovulation)Normal cycle(subtle abnormalities)Regular cyle
Diagnostic tests and theidentification <strong>of</strong> diseaseDisease+ -Diagnostic + +/+ +/-Falspositive(specificity)Test - -/+ -/-Falsnegative(sensitivity)
Diagnostic <strong>PCOS</strong> criteriarecommendations by various expert groupsNIHRott ConsAES(1990)(2003)(2006)Hyperandrogenism+ + +Oligo/amenorrhea + + +PCO (US)+ +
BJOG 2006= 85% <strong>of</strong> WHO 2= 55% <strong>of</strong> WHO 2WHO 2, n=827
BackgroundDesignResultsConclusionPrevalence estimate <strong>PCOS</strong> in communityaccording to NIH, Rotterdam, AES criteriaRetrospective cohort study728 women (born 1973-1975), single hospitalEstimate prevalence;8.7 NIH11.9 Rotterdam10.2 AESRotterdam and AES prevalence estimatedup twice compared to NIH
<strong>PCOS</strong> diagnosis- inclusive or exclusiveRisks associated with over- or underdiagnosisFor the patient? (“to known what’s wrong”)TreatmentFuture health risk assessmentHealth insurance coverageFamily studies (genetics)
<strong>PCOS</strong> diagnosisInclusiveExclusive
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