Ultrasound in PCOS: What Patients Need to Know
Dr. Prof (Col) Pankaj Talwar, VSM, MD, PhD
Medical Council Registration Number: HMC-HN 16822
Polycystic Ovarian Syndrome (PCOS) is a complex hormonal condition, and Ultrasound remains one of the cornerstone criteria for its diagnosis. At Talwar Fertility & Child Health Centre, we use high-sensitivity Transvaginal Sonography (TVS) to identify polycystic ovaries in approximately 75% of women who present with clinical symptoms of PCOS.
What are Antral Follicles?
Antral follicles are small, fluid-filled sacs in the ovary (measuring 2-9 mm) that contain immature eggs. In a normal menstrual cycle, these follicles grow over 10-12 days until one “dominant” follicle is selected to release an egg. However, in PCOS, this selection process is often disrupted.
Diagnostic Ultrasound Criteria for PCOS
Medical guidelines for PCOS have evolved to become more precise. Here are the key ultrasound markers we look for:
- Antral Follicle Count (AFC): Traditionally, an AFC of more than 12 follicles (sized 2-9mm) in one or both ovaries was the standard. These follicles are often arranged peripherally (like a “string of pearls”) or diffusely within a dense ovarian stroma.
- Ovarian Volume: An ovarian volume greater than 10 cm³ (in the absence of a dominant follicle or cyst) is a strong indicator of PCOS.
- Updated Guidelines: Recent international guidelines (Human Reproduction Update) now suggest that an AFC > 25 in one or both ovaries is a more accurate ultrasound criterion for PCOS diagnosis.
Why Accuracy Matters
Identifying the exact nature of polycystic ovaries helps in tailoring fertility treatments. Whether it is ovulation induction or managing insulin resistance, a clear ultrasound mapping of the ovarian stroma and follicle distribution allows us to predict how your body will respond to medication.
- • Gardner’s Text Book of ART, 5th Edition (Pg 676)
- • Clinical Endocrinology 1991
- • Human Reproduction Update 2014; 20(3): 334-52
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