Presentation
Investigation of primary infertility
Patient Data
Selected images from a transvaginal pelvic ultrasound examination demonstrate multiple antral follicles (measuring 2-9 mm) within each ovary - with a follicle count of 34 on the left and 44 on the right. There is no dominant follicle, corpus luteum, or other mass within either ovary.
Case Discussion
A follicle count of > 20 in at least one ovary is consistent with polycystic ovarian morphology (PCOM). This does not equate to a diagnosis of polycystic ovarian syndrome (PCOS), which requires any two of three diagnostic criteria to be present:
clinical features of hyperandrogenism (irregular cycles, hirsutism, female pattern hairloss, acne)
biochemical hyperandrogenism
PCOM on ultrasound or elevated AMH
Note that other descriptive features that are often seen with polycystic ovaries are demonstrated here, such as the "string of pearls" sign of peripheral distribution and the central hyperechoic stroma. These features no longer contribute to the formal definition of PCOM, but nonetheless add to the radiologist's gestalt recognition of the condition.
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