Impact of Updated International Diagnostic Criteria for the Diagnosis of Polycystic Ovary Syndrome

Open AccessPublished:December 21, 2022DOI:
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      To study whether application of the new 2018 guidelines for the diagnosis of Polycystic Ovary Syndrome (PCOS) would decrease the diagnosis of PCOS. Secondarily, to compare the metabolic profiles of women included and excluded in this new definition.


      Retrospective cross-sectional chart review.


      University-affiliated hospital system.


      Women, ages 12-50 with the International Classification of Diseases (ICD) code ‘Polycystic Ovary Syndrome’ in 2017.


      Application of the new 2018 guidelines for the diagnosis of PCOS

      Main Outcome Measures

      The primary outcome was retention of PCOS diagnosis after application of the new 2018 guidelines. Secondary outcomes included comparison of metabolic risk factors. Analysis was performed using Chi-square tests for categorical variables and unpaired T-tests for continuous variables, with a p-value <0.05 determined to be significant.


      Of 258 women with PCOS based on Rotterdam criteria, only 195 (76%) met criteria based on the new 2018 guidelines (p<0.001). Those women who only met Rotterdam criteria (n=63) had significantly lower body mass indexes (BMI) (32.7 vs 35.8, p=0.01), lower total cholesterol levels (151 vs 176 mg/dL, p=0.003), lower triglyceride levels (96 vs 124 mg/dL, p=0.04), lower total (33.2 vs 52.3 ng/dL, p<0.001) and free testosterone levels (4.7 vs 8.3, p<0.001), lower AMH levels (3.1 vs 7.7 ng/mL, p=0.01), and were more likely to be multiparous (50% vs 29%, p=0.01) than women who met 2018 criteria.


      Increasing the minimum antral follicle count to ≥20 antral follicles significantly decreases the number of women with the diagnosis of PCOS. Furthermore, the women that meet the new criteria have more health risks for metabolic syndrome than those who only meet Rotterdam criteria.