Ovarian volume as an independent marker for metabolic dysfunction in women with suspected androgen excess

Objective: To determine whether ovarian volume (OV) alone is an independent marker for metabolic dysfunction in women with suspected androgen excess. Design: Retrospective cohort study. Setting: Tertiary academic reproductive endocrinology clinic. Patient(s): Women aged >= 21 years recruited/referred for symptoms related to androgen excess. Intervention(s): Transvaginal ovarian ultrasound, physical and medical evaluation, 2-hour 75-g oral glucose tolerance test (oGTT), and blood sampling. Main Outcome Measure(s): Prevalence of hyperandrogenism and metabolic dysfunction. Result(s): This study included 666 women, of whom 412 (61.9%) and 254 had OVs of > 10 and <= 10 mL, respectively. An OV of > 10 mL was associated with a higher prevalence of hirsutism (65.1% vs. 51.5%) than an OV of <= 10 mL. Polycystic ovary syndrome by the National Institutes of Health 1990 criteria was found in 67.3% and 51.4% of women with OVs of > 10 and <= 10 mL, respectively. Metabolic parameters, including body mass index, waist circumference, and 1-hour insulin levels during the oGTT (odds ratio, 1.98; 95% confidence interval, 1.18-3.31), were significantly higher in women with an OV of > 10 mL than in those with an OV of <= 10 mL. An OV of <= 10 mL had a 76.3% negative predictive value for hyperinsulinemia at 1 hour. Conclusion(s): In women with suspected androgen excess, an OV of > 10 mL in at least 1 ovary is not associated with metabolic syndrome but is associated with younger age; an increased body mass index and waist circumference; a higher prevalence of hirsutism, oligoovulation, and polycystic ovary syndrome; and a higher 60-minute insulin level during the oGTT. Overall, an increased OV appears to be a good marker for hyperinsulinemia and hyperandrogenism in women suspected of having an androgen excess disorder. (Fertil Steril Rep (R) 2022;3:366-71. (c) 2022 by American Society for Reproductive Medicine.)