RESULTS
There was no statistically significant difference in terms of age between PCSO and Control patients, respectively as 31.8 ± 4.4 and 31.9 ± 5. As expected, body mass index (BMI) was found to be higher in PCOS patient than in control (27.2 + 6.2 vs. 23.9 + 4.5, p:0.03). Also, AFC and serum AMH levels were significantly higher in the PCOS group (AFC; 20 (9-20) vs. 12 (9-18) p:0.05, AMH;4.1 ng/ml (2.5-7.2) vs. 2.3 ng/ml (1.6-3.8), p<0.01). There were no statistically significant differences between the PCOS patients and controls in term of serum follicle stimulating hormone (FSH) (5 IU/L (4.2-5.9) vs. 5.4 IU/L (4.4-6.2), p:0.325), Serum luteinizing hormone (LH) (3.8 IU/L (2.8-5.6) vs. 3.4 IU/L (2.6-4.1), p:0.09), free testosterone (2.1 ng/dl (1.3-3.4) vs. 1.9 ng/dl (0.6-4.3), p:0.75), dehydroepiandrosterone sulfate (DHEASO4) (314 mcg/dl (248-408) vs. 225 mcg/dl (141-348) p:0.1), 17OH Progesterone (1.64 ng/ml (1.1-2.2) vs. 0.9 ng/ml (0.8-2.5) p:0.2) , except serum total testosterone levels (0.59 mcg/l + 0.19 vs. 0.4 mcg/l + 0.16, p:0.02).
HSG results are given in Table 1.
When arcuate cavity (Figure II) which is classified as an abnormality in ASRM but a variation of normal in ESGE - ESHRE is accepted as an abnormality, 45.9 % and 73.1 % of the uterine cavities in PCOS and control patients was reported as normal which is statistically significant (Table 1 – Analysis 1). Total uterine cavity abnormality rate (Figure II + III + IV + IV + IV) was statistically significantly higher in PCOS than in Control (54.1 %, 26.9 %)
When the arcuate cavity is considered normal as in the ESGE - ESHRE classification, in terms of uterine cavity abnormalities, the statistically significant difference disappears between PCOS and control patients (11.86 % versus 20.16 %) (Table 1 – Analysis 2)
When Figure III (ESGE - ESHRE U2a / ASRM Va) and Figure IV (ESGE - ESHRE U2b / ASRM Vb) are evaluated together in the same group, there was a significant difference between PCOS and Control groups (10.57 % versus 1.2 %). (Table 1 - Analysis 2)
When these groups were evaluated separately, a statistically significant difference was found in PCOS and Control groups in Figure III (ESGE - ESHRE U2a / ASRM Va) and Figure IV (ESGE - ESHRE U2b / ASRM etc.), respectively (5.1 % versus 0, 3.4 % versus 1.2 %) (Table 1 - Analysis 3).
When the Figure V (ESGE - ESHRE U1a / ASRM VII), which is commonly used as T shape and Figure VI (ESGE - ESHRE Uc? / ASRM Unclassified), named as Y shaped but not classified, are evaluated together in the same group, there were not statistically significant differences between the groups (21. % versus 18.9 %) (Table 1 - Analysis 2). When they were evaluated separately, there were no differences in terms of T shaped cavity between the groups (13.8 % versus 18.3 %) but, the frequency of Y shaped cavity in PCOS patients was found higher than controls (7.4 % versus 0).
When 6 Figures are evaluated separately, the frequency of abnormality is found higher among all groups except T shape (Figure V) in PCOS patients than in controls (Figure II; 22.1 % versus 6.6 %, Figure III; 5.1 % versus 0, Figure IV; 3.4 % versus 1.2 %, Figure V; 7.4 % versus 0) (Table 1, Analysis 3).
Uterine cavity was reported as abnormal in 28 of 51 (54.9 %) PCOS patients according to HSG results, while rest of them (23 of 51, 45.09 %) were normal.
Among PCOS patients with normal and abnormal uterine cavities, there were no statistically significant differences in terms of mean age (32 ± 4.5, 31.6 ± 4.4, p:0.7), mean BMI (26.7 ± 6.6 , 27.9 ± 5.8, p:0.53), Ferriman Gallwey Scores (15 (12-23) vs 19 (9-21), p:0.8), AFC (20 (13-20) vs. 14 (9-20), p:0.1), serum AMH levels (5.2 ng/ml (3.4-11.9) vs. 3.8 ng/ml (2.4-5.9), p:0.09), Serum FSH levels (5 IU/L (3.8-5.9) vs 5.2 IU/L (4.7-5.9), p:0.22), serum LH levels (3.8 IU/L (3-6.3) vs. 3.5 IU/L (2.7-5.3), p:0.6), total testosterone levels (0.53 mcg/L + 0.18 vs. 0.62 mcg/L+ 0.19, p:0.08), free testosterone levels (2.1ng/dl (1-3) vs. 2.2 ng/dl (1.3-4), p:0.44), DHEASO4 levels (322 mcg/dl (254-397) vs. 310 mcg/dl (240-418), p:0.58), 17 OH Progesterone levels (1.3 ng/ml (0.9-2.1) vs. 1.7ng/dl (1.3-2.3), p:0.07) between both groups.
There was no correlation between the serum AMH levels and the presence of uterine cavity abnormalities in all patients (Figure 2) and in PCOS patients as subgroup (Figure 3) (Threshold for uterine normality AMH 3.05, 50 % Sensitivity 53% Specificity, AUC 0.550 with CI (0.438-0.663) , AMH 4.05, 65% Sensitivity %60 Specificity, AUC 0.639 with CI (0.481-0.797), for Figure 1 and 2, respectively.