Clinical Question: Does an ultrasound report of polycystic ovaries mean that a women is likely to be infertile?

Setting: Outpatient (any)

Study Design: Case-control

Synopsis: A polycystic appearance of the ovaries is defined as at least 10 cysts in a single plane, each less than 10 mm in diameter, and with a dense stroma. This polycystic appearance is found in one fourth to one third of women of reproductive age, and may cause them and their physicians to be concerned about subfertility. Polycystic ovary syndrome (PCOS) is defined variably and usually includes menstrual disturbance, obesity, acne, and hirsutism, with or without polycystic ovaries on imaging. In this case-control study, 258 women who met the criteria for polycystic ovaries were compared with 232 women whose ovaries had a normal appearance.

All of the participants had attempted to conceive. In the group with polycystic ovaries, 84 women who had no other signs or symptoms associated with PCOS had a mean time to pregnancy similar to that of women with normal-appearing ovaries. The proportion of subfertile women (those with time to pregnancy of more than 12 months or who did not conceive despite trying for at least 12 months) was 12 percent with none of the above symptoms and increased among women with one to four additional PCOS symptoms to 36, 78, 94, and 100 percent, respectively, regardless of the combination.

Bottom Line: A polycystic appearance of the ovaries on ultrasonography is common in women of reproductive age. Women have normal fertility if they have polycystic ovaries on ultrasound examination and no other characteristics of PCOS, including menstrual disturbance, obesity, acne, and hirsutism. (Level of Evidence: 2b+)