Prevalence and Ultrasound Presentations of Polycystic Ovarian Syndrome in Black African Women Presenting with Infertility: A Case of Women in Referral Health Institutions in Bulawayo, Zimbabwe

Introduction: Polycystic ovarian syndrome (PCOS) is an endocrine abnormal condition in women of childbearing age with associated health risks, infertility, diabetes mellitus, endometrial hyperplasia and cardiovascular complications. Ultrasound imaging reporting incidences of PCOS requires continued exploration and updating as the disease profiles tend to continuously evolve due to fluctuating environmental factors, heterogenous population migration as seen in Bulawayo, Zimbabwe and other parts of the world. There are no known past or recent studies that have described ultrasound imaging of PCOS incidences and the prevalence of PCOS in Bulawayo. This study sought to determine the association between factors contributing to prevalence of PCOS and their association with ultrasound presentations in women with infertility in Bulawayo, Zimbabwe aimed at improving diagnostics algorithms of the disease.

Materials and Methods: Equal invitations to participate in the study were issued at hospital-based study centres. A cross-sectional survey was conducted. Informed and consenting participants from Mpilo Central Hospital, United Bulawayo Hospital and Imagegate Diagnostics Centre, who were presenting with menstrual irregularities, acne, hirsutism and infertility, were recruited. Participants age ranged from 15-45 years. All participants had their demographics collected using questionnaires. Body mass index, waist-hip ration, clinical presentations and pelvic transabdominal ultrasound scan survey were determined.

Results: Participants were grouped into age groups 15-24 years, 25-34 years, 35-44 years. Polycystic ovaries presented as 10 or more 2-9 mm ovarian follicles with mean ovarian volume ≥ 10 cm3. In establishing the diagnosis of polycystic ovaries, the criterion of 10 or more 2-9 mm ovarian follicles were found to have the highest representation in the 25-34-year age group. The study showed 30.4% of the clients had polycystic ovaries while 46.4% showed other pelvic pathology and the rest, 23.2% had normal pelvis scan results. The prevalence of polycystic ovaries was significantly higher in 25-34 year age sub-group. Acne and hirsutism were significantly associated with positive ultrasound imaging results for PCOS.

Conclusion: The study updated information on PCOS as seen on ultrasound in women in Bulawayo. All women of childbearing age presenting with infertility and clinical signs of hyperandrogenaemia (e.g. hirsutism, acne) should be screened for polycystic ovaries as part of a women wellness program. Furthermore, it is recommended that sonologists and sonographers be aware of the ultrasound criteria for polycystic ovarian syndrome in women of child-bearing age.