Lifestyle modifications are recommended as first-line therapy in polycystic ovary syndrome (PCOS). However, usual dietary and physical activity (PA) behaviors of women with PCOS remain uncertain, likely owing to controversy in diagnostic criteria. Our objective was to contrast the usual dietary and PA behaviors of women with PCOS (n = 80) diagnosed by the 2018 International Evidence-based Guideline for the Assessment and Management of PCOS to that of controls (n = 44). Study outcomes were dietary intake, diet quality (Healthy Eating Index-2015), and PA (questionnaire, waist-worn accelerometers). Women with PCOS met the acceptable macronutrient distribution ranges for carbohydrate, fat, and protein, but did not meet the recommended dietary reference intakes for vitamin D (mean (95% confidence interval); 6 (5–7) μg/d), vitamin B9 (275 (252–298) μg/d), total fiber (24 (22–26) g/d), or sodium (4.0 (3.6–4.4) g/d). Women with PCOS also met the US recommendations for PA. No differences were detected in dietary intake, diet quality, or PA levels between groups (p ≥ 0.11). In conclusion, women with and without PCOS have comparable dietary and PA behaviors. A lack of unique targets for dietary or PA interventions supports the position of the new guideline to foster healthy lifestyle recommendations for the management of PCOS.

The relationship between diet quality and ovarian morphology has biological plausibility yet remains unclear and was therefore evaluated. In a multicenter cross-sectional analysis, four dietary patterns were scored for 111 consecutive reproductive-aged women (18–45 years) using (1) Healthy Eating Index (HEI-2015); (2) alternative HEI-2010; (3) alternate Mediterranean Diet (aMED); (4) and Dietary Approaches to Stop Hypertension (DASH) indices. Ovarian volume (OV) and follicle number per ovary (FNPO) were evaluated on transvaginal ultrasonography. Relationships between dietary and ovarian morphology indices were evaluated by linear regression and mediation analyses. Associations between aMED and DASH scores and OV/FNPO were completely mediated by obesity, insulin resistance, and hyperandrogenism (All: p < 0.05), unlike direct associations (All: p ≥ 0.89). Namely, a 1-standard deviation [SD] increase in aMED score was associated with decreases in OV (0.09 SD; 0.4 mL) through reducing waist circumference. Likewise, a 1 SD increase in aMED and DASH score was associated with decreases in OV (0.07 SD; 0.3 mL) by reducing glucose response to a 75 g glucose tolerance test. A 1 SD increase in DASH score was associated with decreased FNPO (0.07 SD; 2 follicles) by reducing free androgen index (All: p < 0.05). Adherence to aMED and DASH eating plans was indirectly associated with significant improvements in ovarian form, providing novel mechanistic insights for future interventions about contributions of diet quality on ovarian function.

Context: The mechanism of oligo-anovulation in polycystic ovary syndrome (PCOS) is unknown. Objectives: To evaluate follicular and endocrine characteristics of anovulatory and sporadic ovulatory cycles in women with PCOS. Design: Prospective, longitudinal study. Setting: Academic clinical research unit. Participants: 26 reproductive-aged women (18-38 years) with PCOS, observed during natural anovulatory (PCOS-Anov; n = 12) and sporadic ovulatory cycles (PCOS-Ov; n = 14), and 12 controls. Interventions: Transvaginal ultrasonography and venipuncture were performed every other day for 4 to 6 weeks in women with PCOS or at 1 interovulatory interval in control subjects. Main Outcome Measures: Follicle number and diameter (ie, ≥2 mm) were quantified at each visit. Individual growth profiles were assessed for all follicles that grew to ≥7 mm. Blood samples were assayed for follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone. Results: Follicular excess, or heightened follicle number versus controls, was observed across anovulatory and sporadic ovulatory cycles in PCOS. In PCOS-Anov, follicles emerged cyclically in some women (6/12; 50%) and continuously in others (6/12; 50%), then grew to a mean maximum diameter of 7.2 mm and regressed within 4.7 days. In PCOS-Ov, follicles mostly emerged cyclically as part of a cohort and dominant follicles showed normal growth to ovulation—albeit mean and maximum luteal progesterone concentrations were significantly lower versus controls. Conclusions: Follicle growth and regression were detected on ultrasonography amidst perpetual follicular excess in PCOS. Documentation of continuous follicle recruitment and turnover, the absence of persistence, and altered luteal progesterone following sporadic ovulation, provide formative data on antral follicle development in PCOS.

Objective Changes in antral follicle count, hormone production, and menstrual cyclicity as women age are well documented. However, age-related changes in ovarian follicular wave dynamics in women are not understood. The objective of this study was to test the hypothesis that major follicular wave dynamics (ie, those in which a dominant follicle develops) differ in women with age. Methods A prospective, cross-sectional, observational study was conducted in 58 women of mid-reproductive age (MRA; 18-35 y; n = 27), late reproductive age (LRA; 36-44 y; n = 10), and advanced reproductive age (ARA; 45-55 y; n = 21). The number and diameters of all follicles ≥ 2 mm were quantified ultrasonographically every 2 to 3 days for one complete interovulatory interval (IOI). Only ovulatory cycles were evaluated. Antral follicle count and major follicular wave dynamics during the IOI were compared among age groups using SPSS version 19.0 (α = 0.05). Results One (36/58, 62%) or two (22/58, 38%) major follicular waves were observed during the IOI in all women evaluated. The prevalence of follicular-phase dominant follicles (FPDFs) and luteal-phase dominant follicles (LPDFs) was not different among the MRA, LRA, and ARA groups (FPDFs: 27/27 [100%], 10/10 [100%], and 20/21 [95%], respectively; LPDFs: 10/17 [37%], 3/10 [30%], and 10/21 [48%], respectively; P > 0.050). All FPDFs were ovulatory. One LPDF ovulated during menses in the ARA group; all other LPDFs in the MRA, LRA, and ARA groups were anovulatory. On average, LPDFs emerged earlier relative to ovulation (days −6, −2, and −2; P = 0.049), grew longer (11, 3, and 6 d; P = 0.005), and developed to a larger diameter (24, 11, and 11 mm; P = 0.032) in the ARA group versus the MRA and LRA groups. In follicular-phase major waves, there was a tendency for a greater prevalence of polyovulation as women aged (ARA 3/21 [14%] vs MRA 0/27 [0%]; P = 0.070). Conclusions One or two major follicular waves develop during the IOI, irrespective of age. The prevalence of LPDFs (range, 30%-50%) and FPDFs (range, 95%-100%) during the IOI does not differ with age. However, the growth dynamics of major waves change as women age. On average, LPDFs emerge earlier, grow for a longer period, and grow to a larger diameter in ovulatory women of advanced versus mid or late reproductive age. There is a greater tendency for polyovulation in the follicular-phase major wave as women age.