Digit ratios do not serve as anatomical evidence of prenatal androgen exposure in clinical phenotypes of polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is heterogeneous in its clinical presentation and four major phenotypes have been identified. The precise etiology of PCOS is unknown; however, variable exposure to prenatal androgens may be responsible for the spectrum of endocrine and metabolic disturbances characteristic of this syndrome. Since prenatal testosterone exposure is known to decrease the ratio of the second to fourth finger lengths (2D:4D), we characterized the left and right hand 2D:4D in women with clinical variants of PCOS. We hypothesized that if prenatal androgens were involved in the development of the phenotypic spectrum of PCOS, then lower 2D:4D would be differentially expressed among clinical variants of the syndrome. METHODS: Digit ratios were determined in 98 women diagnosed with PCOS by the 2003 international consensus guidelines and in 51 women with regular menstrual cycles, no clinical or biochemical signs of hyperandrogenism and normal ovarian morphology. Women with PCOS were categorized into four clinical phenotypes (i.e. Frank, Non-PCO, Ovulatory and Mild) and 2D:4D among groups were compared by Tukey-Kramer multiple comparisons tests. RESULTS: Left (P = 0.77) and right (P = 0.68) hand 2D:4D were similar among the four clinical phenotypes and no phenotype of PCOS demonstrated a 2D:4D that differed from controls (Left Hand, P = 0.44 and Right Hand, P = 0.75). CONCLUSIONS: Women with PCOS do not demonstrate finger length patterns that are consistent with increased prenatal androgen exposure. These findings do not preclude a role for prenatal androgens in the development of PCOS; however, low 2D:4D are not a characteristic of PCOS.

Digit ratios (2D:4D) determined by computer-assisted analysis are more reliable than those using physical measurements, photocopies, and printed scans.

Prenatal androgens influence the second to fourth digit ratio (2D:4D) of hands with men having lower ratios than women. Numerous methods are used to assess 2D:4D including, physical measurements with calipers, and measurements made from photocopies, scanned images, digital photographs, radiographs, and scaled tubes. Although each method appears relatively reliable, agreement upon a gold standard is necessary to better explore the putative effects of prenatal androgens. Our objective was to assess the level of intra and interobserver reliability when evaluating 2D:4D using four techniques: (1) physical measurements, (2) photocopies, (3) printed scanned images, and (4) computer-assisted image analysis. Physical measurements, photocopies, and printed scanned images were measured with Vernier calipers. Scanned images were also measured with computer-based calipers. Measurements were made in 30 men and 30 women at two different time points, by three experienced observers. Intraclass correlation coefficients were used to assess the level of reliability. Intraobserver reliability was best for computer-assisted (0.957), followed by photocopies (0.939), physical measurements (0.925), and printed scans (0.842; P = 0.015). Interobserver reliability was also greatest for computer-assisted (0.892), followed by photocopies (0.858), physical measurements (0.795), and printed scans (0.761; P = 0.001). Mean 2D:4D from physical measurements were higher than all other techniques (P < 0.0001). Digit ratios determined from computer-assisted, physical measurements, and printed scans were more reliable in men than women (P = 0.009, P = 0.017, and P = 0.012, respectively). In summary, 2D:4D determined from computer-assisted analysis yielded the most accurate and consistent measurements among observers. Investigations of 2D:4D should use computer-assisted measurements over alternate methods whenever possible.

Improving inter-observer variability in the evaluation of ultrasonographic features of polycystic ovaries.

BACKGROUND: We recently reported poor inter-observer agreement in identifying and quantifying individual ultrasonographic features of polycystic ovaries. Our objective was to determine the effect of a training workshop on reducing inter-observer variation in the ultrasonographic evaluation of polycystic ovaries. METHODS: Transvaginal ultrasound recordings from thirty women with polycystic ovary syndrome (PCOS) were evaluated by three radiologists and three reproductive endocrinologists both before and after an ultrasound workshop. The following endpoints were assessed: 1) follicle number per ovary (FNPO), 2) follicle number per single cross-section (FNPS), 3) largest follicle diameter, 4) ovarian volume, 5) follicle distribution pattern and 6) presence of a corpus luteum (CL). Lin's concordance correlation coefficients (rho) and kappa statistics for multiple raters (kappa) were used to assess level of inter-observer agreement (>0.80 good, 0.60 - 0.80 moderate/fair, <0.60 poor). RESULTS: Following the workshop, inter-observer agreement improved for the evaluation of FNPS (rho = 0.70, delta rho = +0.11), largest follicle diameter (rho = 0.77, delta rho = +0.10), ovarian volume (rho = 0.84, delta rho = +0.12), follicle distribution pattern (kappa = 0.80, delta kappa = +0.21) and presence of a CL (kappa = 0.87, delta kappa = +0.05). No improvement was evident for FNPO (rho = 0.54, delta rho = -0.01). Both radiologists and reproductive endocrinologists demonstrated improvement in scores (p < 0.001). CONCLUSION: Reliability in evaluating ultrasonographic features of polycystic ovaries can be significantly improved following participation in a training workshop. If ultrasonographic evidence of polycystic ovaries is to be used as an objective measure in the diagnosis of PCOS, then standardized training modules should be implemented to unify the approach to evaluating polycystic ovarian morphology.