PCOS Diagnostic Criteria and Hormonal Assessment

This cross‐sectional observational study was carried out in a private infertility clinic. Infertile women aged <40 years who visited our clinic from April 2021 to March 2022 were enrolled. All data used in this study were obtained during routine infertility examinations without any additional interventions. Venous blood samples for assaying the basal serum concentrations of luteinizing hormone (LH), follicle‐stimulating hormone (FSH), estradiol, and testosterone were collected during the first 5 days of spontaneous menstrual cycles or if the United States did not show large follicles (diameter > 9 mm) or a thick endometrium (>6 mm). Testing of blood samples was carried out in our laboratory using an Access 2 immunoassay system (Beckman‐Coulter). The diagnosis of PCOS was based on the criteria of the Japanese Society of Obstetrics and Gynecology (JSOG)‐2007.¹² Briefly, patients who had both oligo‐anovulation and polycystic ovarian morphology (PCOM), and either hyperandrogenemia (total testosterone level > 0.47 ng/dL) or elevated serum LH (>7 mIU/mL) with normal serum FSH (3–8 mIU/mL), were diagnosed as PCOS. Patients with an elevated FSH level (>14 mIU/ml), or who had US‐visible tumorous lesions in a small pelvic cavity (e.g., fibroids, endometrial polyps, ovarian cysts, ovarian endometrioma, or adenomyosis), or had a history of uterine surgery (e.g., myomectomy or cesarean section), were excluded.
Transvaginal ultrasound was performed using an 3D‐US system (Voluson SWIFT; GE Healthcare Ultrasound) with volumetric transvaginal probes (RIC5‐9A‐RS) at the time when endometrial thickness was greater than 6 mm regardless of the day of the cycle. The 3D‐US datasets of each uterus were anonymized, except for each patient's identification number (ID), and stored for later measurements.