**3. Diagnosis**

There are several diagnostic criteria for PCOS such as NIH 1990/2012, ESHRE/ASRM 2003 (Rotterdam), or AE-PCOS 2006. Diagnosis of PCOS should take into consideration the history, clinical manifestations, ultrasound imaging results, and serum examination results.

AMH in women with PCOS is higher than in healthy women, which probably reflects the number of small follicles observed on the ultrasounds of polycystic ovaries [45]. Studies have reported that 97% of women with AMH >10 ng/mL had PCOS and this correlated positively with LH, total testosterone, and DHEA [45, 46]. Besides, serum AMH revealed high predictive ability for the presence of OA or amenorrhea [45, 46]. Recently, serum AMH is proving to be a better tool to understand ovarian function and follicular count; however, the clinical use of

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Management of PCOS is limited to improve clinical manifestations, since the real etiology of the disorder is unclear [47]. While multiple cardiovascular risk factors such as obesity, dyslipidemia, hypertension, and DM are prevalent in PCOS, current therapeutic management of PCOS usually focuses firstly on the treatment of metabolic disturbances (anovulation, menstrual irregularity, and hirsutism) and secondly on the control of reproductive hormones or insulin levels [48]. Lifestyle modifications including increased exercise, dietary changes, and weight loss are appropriate first-line interventions for many women with PCOS [49]. Diet therapy for patients with PCOS includes the design of low-calorie diets to achieve weight loss or preserve a healthy weight, restrict the intake of simple sugars, and increase the consumption of foods with a low glycemic index and refined carbohydrates, a decrease in the consumption of trans and saturated fatty acids, and awareness of possible deficiencies such as omega-3, vitamin D, and chromium [50]. One systematic review and meta-analysis demonstrated that moderate physical activity mostly 12 or 24 weeks would improve ovulation, decreased IR (9–30%), and weight loss (4.5–10%) [51]. The AE-PCOS guidelines suggested a target of caloric, diet, and body weight control in PCOS women with more restrictions if

dyslipidemia occurred [52–54]. The detailed information is listed in **Table 2** [52–54].

Reduction of fat Decrease total fat (less than 30% total caloric intake) and

Favor foods intake Increase fiber, vegetables, fruit, cereals, wholegrain breads,

saturated fat (less than 10% total caloric intake)

monounsaturated and polyunsaturated fat intake

Limitation of calories Decrease current diet 500–1000 kcal/day

**Suggestions if dyslipidemia Expect reduction in LDL-C (%)**

**Table 2.** Nutritional recommendations for PCOS women from the AE-PCOS society.

serum assays for AMH still poses some technical problems [33, 44].

**4. Conventional management and limitations**

**Nutrition recommendations Methods**

Reduce body weight by 7–10% 5–8% Decrease saturated fat to 7% total energy 8–10% Decrease dietary cholesterol to <200 mg daily 3–5% Decrease transfat to 1% total energy 2% Increase 2 g of plant stanols daily 6-–0% Add 5–10 g viscous fiber daily 3–5%
