A 26-year-old woman presents with oligomenorrhea since menarche, hirsutism (Ferriman-Gallwey score 14), and acne. Transvaginal ultrasound shows 18 follicles (2-9 mm) per ovary. Serum testosterone is elevated and prolactin, TSH are normal. According to the Rotterdam 2003 criteria, which additional finding is required to confirm a diagnosis of polycystic ovary syndrome (PCOS)?

• A Elevated LH:FSH ratio greater than 2:1
• B Anti-Mullerian hormone level greater than 5 ng/mL
• C Fasting insulin resistance (HOMA-IR > 2.5)
• D Oligo-anovulation or anovulation ✓

Explanation

The Rotterdam 2003 criteria require two of three features: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. This patient already has hyperandrogenism and polycystic morphology, so oligo-anovulation completes the diagnosis. LH:FSH ratio, insulin resistance, and AMH are supportive but not diagnostic criteria. (Adamsson and Watts, Williams Gynecology; Rotterdam ESHRE/ASRM consensus).

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.