Determination of the relationship of mullerian anomalies with polycystic over syndrome phenotype in infertile population

INTRODUCTİON: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with a prevalence of 5-10%. It causes menstrual disorders, infertility, metabolic, cardiovascular diseases and reproductive problems. Rotterdam criteria are the most commonly used criteria for diagnosis. PCOS is characterized by oligo / anovulation, clinical / biochemical hyperadrogenism and polycystic ovarian morphology on ultrasonography. Accordingly, PCOS patients can be classified into 4 different phenotypes: Phenotype 1: Oligo / anovulation + hyperandrogenism + polycystic ovaries, Phenotype 2: Oligo / anovulation + hyperandrogenism, Phenotype 3: Hyperandrogenism + polycystic ovaries, Phenotype 4: Oligo / anovulation + polycystic ovaries. Müllerian duct anomalies cause various problems such as menstrual disorders and infertility. However, these anomalies are mostly detected by incidentally and many minor mullerian anomalies are overlooked. Therefore, the existence of a relationship between oligomenorrhea and mullerian anomaly has not attracted attention for many years. Biochemical factors such as antimullary hormone (AMH) changes may play a role in the etiopathogenesis of both conditions. There are few reports of cases with PCOS in the etiology of mullerian anomalies with anovulation. Therefore, we planned our study to determine whether mullerian anomalies are associated with PCOS phenotype in infertile population admitted to our clinic. MATERİALS AND METHODS: A total of 1000 reproductive age women admitted to Sakarya Training and Research Hospital infertility outpatient clinic between 2016 and 2019 were included in our study. Clinical (ultrasonography, hysterosalfingography, etc.), laboratory, medical history, infertility etiology and duration of the examination files were examined and the aim of this retrospective planned study was to determine the association of mullerian anomalies with PCOS phenotype. RESULTS: Müllerian anomaly was detected in 106 (10.6%) of the patients who underwent further examination for infertility. The frequency of Müllerian anomalies in patients with PCOS was statistically higher than in patients without PCOS. (p = 0.001). However, PCOS was diagnosed in 39 (36.8%) out of 106 patients diagnosed with Müllerian anomaly. In addition, PCOS was diagnosed in 197 (22%) out of 894 patients who were not diagnosed with Müllerian anomaly. Of the 1000 infertile patients, 236 (23.6%) were diagnosed with PCOS. When PCOS phenotypes were examined, phenotype 1 and phenotype 4 were more common, whereas phenotype 3 was less frequent. When we look at the frequency of Müllerian anomalies in PCOS phenotypes, the frequency of Müllerian anomaly in PCOS phenotype 1 group was found to be significantly higher than other phenotypes and non-PCOS group (p <0.001). In 106 patients with a diagnosis of mullerian anomaly, USG was able to diagnose only 41.5% of the patients, and 69.8% of the patients could be diagnosed by MR. However, HSG was diagnosed in 99.1% of the patients. HSG was found to be statistically superior to other imaging methods in the diagnosis of Mullerian anomaly (p <0.001). DİSCUSSİON: In our study, the frequency of Müllerian anomalies was found to be higher in patients with PCOS who were examined for infertility than those without PCOS. In addition, among the PCOS phenotypes, the frequency of Müllerian anomaly was found to be higher in phenotype 1. Because of the anovulation in PCOS patients, ovulation induction is generally initiated, whereas spermiogram and uterine and tubal factors should be evaluated in these infertile couples with PCOS. However, PCOS and Müllerian anomaly should be considered and investigated in cases with unknown etiology. Further studies on PCOS phenotypes and Müllerian anomalies are needed. KEY WORDS: Polycystic ovary syndrome phenotypes, Müllerian anomaly, infertilty