Impact of revised antral follicle count threshold on PCOS diagnosis: A comparative clinical study

Objective To evaluate the clinical impact of the revised antral follicle count (AFC) threshold on polycystic ovary syndrome (PCOS) diagnosis. Methods A retrospective cross-sectional observational study including women diagnosed using the Rotterdam criteria, stratified by AFC: 12–19 (low AFC) and ≥20 (high AFC). Clinical, metabolic, and hormonal parameters were compared against controls and amongst low and high AFC group. Results Of 336 PCOS women, 208 (62%) had an AFC between 12 and 19 and would not meet the revised ≥20 follicle threshold for the diagnosis of polycystic morphology. These women had worse metabolic and androgenic profiles than controls, and were similar to the high AFC group. Conclusion Excluding low AFC women may misclassify patients who require clinical care.