Archives of Gynecology and Obstetrics (2018) 297:1037–1042
GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE
Prevalence, clinical characteristics, and reproductive outcomes
of polycystic ovary syndrome in older women referred for tertiary
· Justin Tan
· Weon‑Young Son
· Michael‑Haim Dahan
Received: 23 August 2017 / Accepted: 22 December 2017 / Published online: 30 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Objective Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women. The
clinical symptoms of PCOS vary with female age, as older women tend to have lower hyperandrogenic symptoms and many
regain regular cycles. In this study, we aimed to estimate the prevalence of PCOS among older women referred for fertility
care, describe their clinical characteristics, and compare their reproductive outcomes to those of matched control group.
Methods A retrospective study conducted at a single reproductive center. All women aged ≥ 40, who were referred for
in-vitro fertilization (IVF), between the years 2011–2015 were screened for possible inclusion. The PCOS diagnosis (was)
made based on the Rotterdam criteria. The reproductive outcomes of the PCOS group were compared to those of matched
control with tubal infertility.
Results During the study period, 1427 women, aged 40 years and over, underwent a total of 2124 IVF cycles. Of these, 72
(5%) women were diagnosed with PCOS. In 69 (95.6%), the PCOS diagnosis was made by a combination of polycystic ovary
morphology (PCOM) and anovulation. Compared to women with tubal factor infertility, women with PCOS needed lower
doses of gonadotropins, had higher number of retrieved oocytes (16.6 vs. 10.4) and higher number of cycles with embryo
cryopreservation (47 vs. 22.9%). This resulted in higher cumulative live birth in the PCOS group (26.3 vs. 15.2%, p = 0.04).
Conclusion PCOS comprised 5% of the infertility diagnosis in women aged ≥ 40; PCOM and anovulation were the most
prominent features. The higher oocyte number resulted in improved cumulative live birth rate.
Keywords Advanced maternal age · Polycystic ovary syndrome · Oocytes · Cumulative live birth rate · In-vitro fertilization
Polycystic ovary syndrome (PCOS) is the most common
endocrine disorder in reproductive age women. The preva-
lence of the syndrome varies; depending on the population
screened for the disorder. PCOS is estimated to aﬀect 6–8%
of the general reproductive age population . However, this
ﬁgure increases to 18% in the infertile female population
. Furthermore, it is estimated that 90% of all anovulation
disorders are caused by PCOS .
The heterogenic clinical and metabolic features of PCOS,
and the ambiguity of its pathophysiology, have led to the
need to establish consensus criteria to diagnose the syn-
drome. Currently, there are three classiﬁcation systems in
use: The National Institute of Health (NIH) criteria , the
Rotterdam criteria , and the Androgen excess and PCOS
society criteria .
The presence of three diﬀerent classiﬁcation systems
demonstrates the wide disagreement between clinicians on
how to diagnose PCOS. However, the Rotterdam criteria,
proposed in 2003, are currently the most widely used to
diagnose PCOS among reproductive endocrinologist . To
make a diagnosis based on the Rotterdam criteria, two out of
the following three criteria should be present: 1-oligo and/
or anovulation, 2-clinical and/or chemical signs of hyperan-
drogenism, and 3-polycystic ovary morphology (PCOM) .
* Samer Tannus
Division of Reproductive Endocrinology and Infertility,
Department of Obstetrics and Gynecology, McGill
University Health Centre (MUHC) Reproductive Centre,
888, Blvd. de Maisonneuve East, suite 200, Montreal,
QC H2L 4S8, Canada
Department of Obstetrics and Gynecology, University
of British Columbia, Vancouver, British Columbia, Canada