Context: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder. The phenotype may differ between patients who exhibit signs of recent ovulation and anovulatory PCOS patients. Objective: Our objective was to study differences in clinical and endocrine characteristics and response to ovulation induction (OI) treatment comparing oligoovulatory and anovulatory PCOS patients. Design and Setting: We conducted a retrospective cohort study at a tertiary hospital. Patients: PCOS patients (n = 1750) presenting with oligo- or amenorrhea were diagnosed according to the Rotterdam 2003 consensus criteria. Arbitrarily, oligoovulatory PCOS was defined by a single random serum progesterone level of 10 nmol/liter or higher. Main Outcome Measures: We evaluated the incidence of oligo- or amenorrhea, menstrual cycle length, serum androgen levels, follicle count, and OI outcome parameters. Results: Anovulatory women (n = 1541 of 1750, 88.1%) were more often amenorrheic (P < 0.001) and presented with a longer cycle duration (P<0.001) compared with oligoovulatory women (n= 209 of 1750, 11.9%). Serum levels of testosterone (P<0.001), the free androgen index (P<0.001), and total follicle count (P < 0.005) were higher in anovulatory compared with oligoovulatory patients. During clomiphene citrate OI, more oligoovulatory women gained regular menstrual cycles (P < 0.05), whereas after second-line treatment with recombinant FSH, more anovulatory women became pregnant (P < 0.05). Conclusions: Oligoovulatory women with PCOS exhibit a milder phenotype of ovarian dysfunction and have a more favorable response to OI treatment using clomiphene citrate compared with anovulatory PCOS patients. However, during second-line treatment with recombinant FSH, anovulatory PCOS patients presented with a higher chance of pregnancy compared with oligoovulatory patients. Copyright

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Burgers, J.A, Lie Fong, S, Louwers, Y.V, Valkenburg, O, de Jong, F.H, Fauser, B.C.J.M, & Laven, J.S.E. (2010). Oligoovulatory and anovulatory cycles in women with polycystic ovary syndrome (PCOS): What's the difference?. Journal of Clinical Endocrinology and Metabolism, 95(12). doi:10.1210/jc.2009-2717