Polycystic ovary syndrome (PCOS) attracted great attention from scholars and health practitioners in 1935 when Leventhal and Stein found out that it was common in women who had amenorrhea based on ovarian morphology, fibrotic thickening of the outer cortex and tunica albuginea as well as cystic follicles in multiple numbers although its history dates back to 1844. The incidences of PCOS have been characterized by symptoms and signs that range from obesity to amenorrhea, acne, hirsutism, infertility, hypothyroidism, virilization, corpus luteum, menstrual dysfunction and biphasic BBT among others. There have been numerous researches into this complex matter. This paper is a critical analysis of an article on PCOS, ultrasonography and OHSS written by Battaglia, Nicola, de Aloysio, Zaccaria and Fulvia (2004). The article is titled “Ultrasound evaluation of PCO, PCOS and OHSS.”
Statement of Phenomenon of Interest
The researchers in this study term the concomitant androgen excess and polycystic ovary Syndrome (PCOS) as being quite disrupting and a distress to the female population which they suggest require diagnosis done promptly and treatment given adequately. They are of the opinion that the criteria used in the diagnosis and the definitions given to PCOS have a heterogeneous nature. Battaglia et al. (2004) assert that the pathological state of PCOS and the degree of disease progression are likely to be expounded better by assessing the ovarian morphology through Doppler flow analysis and trans-vaginal ultrasound of both uterine and intra-ovarian arteries. They single out the advances in ultrasonographic examination of ovaries as having had the greatest contribution to PCOS diagnosis. They point out that this is a result of having a concordance rate with histological examination and laparoscopy of a high degree.
It is worth noting that the article begins by justifying the significance of PCO syndrome which they term as being diverse. The significance of PCOS is supported by a review of the literature reports that establish the assertion that PCOS is common among the female population. Specifically, Battaglia et al. (2004) review the reports of studies that were conducted between the 1950s and early 1990s. The reports show that a significant percentage of the patients involved in the studies tested positively for PCOS and their characteristic symptoms and signs. The reports used in the article date back more than ten years from the date the article was published and thus no recent reports were reviewed by the researchers. This is one of the limitations of the article because it is important for any study to review both earlier and recent literatures so as to determine whether the problem under investigation has changed over time. Additionally, not all the reports show the linkage between ultrasound scanning of ovaries in terms of appearance and history of cycle to the claimed evidence of excessive androgen.
The grounded research studies theory in PCOS acknowledge the complexity, developments and conflicts in the issue and hence detailed literature review is recommended since it is not a research being done but rather reports of researches to provide reliable diagnosis and treatment. This is for the purposes of establishing the relevant comprehensive data collection and development of articles so as to be reliable in the field as well as recognize relevant contributions made by others in the same (Chang, Heinedel & Dunaif, 2002).
Purpose of the Article
The main purpose of the article by Battaglia et al. (2004) is to confirm the fact that the analysis process of intra-ovarian arteries using Doppler flow and the use of trans-vaginal ultrasound in assessing ovarian morphology give valid insight into the PCOS pathological state. It also aimed at confirming that Doppler flow and trans-vaginal ultrasound validly determine the degree of disease progression despite all odds of the complexity and heterogeneity as presented by clinical expression. Therefore, to Battaglia et al. (2004), these are useful in effectively preventing and managing OHSS. This research is based on assumptions of a relative commonality of the prevalence of PCOS among women. Battaglia et al. (2004) further assume that there is a correlated linkage between the ultrasound appearances of the ovary, history of menstrual cycle and excessive androgen based on clinical evidence.
The Varying Endocrinology and Definitions of PCOS
In this discussion, Battaglia et al. (2004) manage to recognize the facts that the complexity of PCOS is due to the different views of their origin. These they manage to present from previous studies and the opinions of having genetic transmission supported by the prior studies. However, this does not comprehensively bring out the complexity nature from different opinions as to the origin while the researches used are past and the authors have a contribution in the same thus lowering their credibility (Chang et al., 2002). Battaglia et al. (2004) manage to show the various PCOS clinical manifestations although this is based on a 1963 report which is very ancient and should not be relied on in the 21st century. The heterogeneity in the definitions of PCOS is presented through race in a logical manner although it is not the only factor which influences PCOS.
Battaglia et al. (2004) insist that the heterogeneous nature of the clinical expression and complex nature of patho-physiological interactions are to blame for the PCOS diagnosis problems. However, this is not represented by adequate research. They also observe that laparoscopy, with or without associations with ovarian biopsy, is preferred for the accurate diagnosis of PCOS. However, the support of their observation relies upon reports of a study conducted in 1990 which dates back more than a decade from the year the Battaglia et al.’s article was published.
Ultrasound and the Diagnosis of Polycystic Ovaries
In this respect, Battaglia et al. (2004) ascribe the greatest contributions to PCOS diagnosis as the advances in the examination of ovaries (ultrasonography). They clearly point out that this is due to its relation to histological examination and laparoscopy. They are of the opinion that this method is the best in PCOS diagnosis especially under conditions of menstrual disorders and hyper-androgenism; a claim which is supported by research. The assertions of Battaglia et al. regarding ultrasound examination are however contradicted by their acknowledgement of the diverse nature of histological and anatomical characteristics of PCOS as well as lack of their validity.
Battaglia et al. (2004) comprehensively describe the various approaches for diagnosis of PCOS through ultrasound. They specifically point out the trans-abdominal and trans-vaginal approaches which are preferred on the basis of ultrasound scanning which is recommended for PCOS diagnosis due to closeness to histological parameters. The contradictions on the number of follicles required for PCOS diagnosis is explained while PCOS is categorized into two groups on the basis of follicles distribution namely: the general and peripheral cystic patterns. Battaglia et al. (2004) logically express the role of the ovarian stroma in increasing the sensitivity of PCOS diagnosis which they further expand to confirm the usefulness of Doppler analysis. They further outline the bilateral nature of Doppler and ultrasosnography which makes it useful in PCOS analysis. Its reliability is emphasized by the researchers pointing out that some universal characteristics can be found which limit diagnosis.
Ultrasound and the Variability of PCOS
Battaglia et al. (2004) rely on precedent discussions in their assumptions of obtaining a specific diagnosis from the parameters studied. They specifically challenge their assertion of diagnosis of PCOS using ultrasound since the presence of PCOS by ultrasound does not guarantee positive diagnosis of PCOS thus raising questions as to normal ovarian appearance and form of PCOS. They show that this variability can be linked to hyperandrogenism and ovarian stimulation. Although fatal effects of OHSS which is linked to ovarian hyper stimulation are outlined, the research reveals low prevalence rates. They further emphasize that OHSS is prevalent among women with PCOS and affected by risk factors such as young age, hyperinsulinanemia and a lean body type. Although this explanation is presented logically, the reliance on ultrasonography in examination of OHSS is contradicted by the variability presented.
Battaglia et al. (2004) in their article present logical explanations of their hypothesis but the conclusions are affected by the incomprehensive use of research given that the article is a report. The use of their own prior researches to base their conclusions and form assumptions as well as the use of ancient rather than recent research studies limits the reliability of their article. Further, the complexity of PCOS is not adequately revealed hence other researches are overlooked. Despite these limitations, Battaglia et al. (2004) have represented a logical, clear and understandable paper.
Battaglia, C., Nicola, P., de Aloysio, D., Zaccaria, V., & Fulvia, M. (2004). Ultrasound evaluation of PCO, PCOS, and OHSS. Reproductive Biomedical Online, 9(6), 614-619. Web.
Chang, J., Heinedel, J., & Dunaif, A. (2002). Polycystic Ovary Syndrome. Alabama: Informa Health Care.