A 28-year-old woman is evaluated for infeility and amenorrhea. She is obese and has significant facial hair in a male distribution. Laboratory studies reveal an increase in serum LH, as well as in total serum testosterone and in the testosterone metabolite dehydroepiandrosterone sulfate. A pelvic ultrasound examination would probably reveal which of the following findings?

The findings are those of the Polycystic Ovary (Stein-Leventhal) Syndrome, an impoant cause of infeility in young women that is characterized by amenorrhea, infeility, obesity and hirsutism Increased levels of LH and of androgens are often found, and it has been thought that LH may stimulate follicular theca-lutein cells, with consequent hyperproduction of androgens. Hyperinsulinemia may lead to increased ovarian androgen production, which then may lead to increased LH. The syndrome is characterized by multiple small follicular cysts, a markedly thickened ovarian capsule, and coical stromal fibrosis. A mass resembling a bunch of grapes projecting into the vagina is characteristic of sarcoma botryoides. Blood filled cysts on the ovary are termed "chocolate cysts" and are associated with endometriosis, another cause of infeility. Fluid accumulation in the fallopian tubes is termed hydrosalpinx.