Recombinant FSH is superior to CC for enabling multifollicular development in OS/IUI cycles of unexplained and male subfertile couples. Although this finding did not lead to a statistically significant superiority of rFSH in terms of clinical outcomes, the presence of relative increase by 62.5% in OPR with rFSH may be regarded as a clinically significant trend.

Cyproterone acetate containing OCs seem to be more effective to treat clinical hirsutism in patients with PCOS after 12 months of treatment.

There is a high probability that metformin use is associated with reduced HDP incidence when compared with other treatments or placebo. The small number of studies included in the analysis, the low quality of evidence and the clinical heterogeneity preclude generalization of these results to broader populations. Given the clinical importance of this topic and the magnitude of effect observed in this meta-analysis, further prospective trials are urgently needed. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Review 190 IntroductionThe fertility capacity of women diminishes in parallel with aging. As the level of education of women has increased since the 1960s and they have become more active in working life and have had easier access to contraceptive methods, the need to have children has been postponed to advanced ages by more women (1, 2). As a result of the postponing of maternal age, the number of patients that are not able to get pregnant within 12 months and apply to artificial reproductive technologies (ART) with a female infertility diagnosis has been increased. Among women, the normal process of reproductive aging has great variations; some women continue to be highly fertile in their 40s, while others lose their fertility in their 30s. The process of reproductive aging in women mostly stems from the changes in ovarian function due to chronological aging. Ovaries are affected by natural aging more than all other tissues. Although the reason is not fully understood, endocrine, paracrine, genetic, and metabolic factors are thought to be affecting the decrease in the quality of the follicular pool and oocytes. Ovarian aging resulting in ovarian failure and menopause is an on-going process. Of the early signs of ovarian aging, failure to adequately respond to ovarian stimulation, followed by menstrual irregularity and the loss of follicle functions, can be listed. In accordance with the 'fixed interval hypothesis,' the period between the first menstrual cycle irregularities and menopause is constant-approximately 6 years-and is independent from the age of menopause (3, 4). It is believed that the process of physiological reproductive aging stems from the decrease in the number and quality of the oocytes in the ovarian cortex follicles. This reduction process in the oocytes accelerates with aging and increases especially after the age of 38 with a biphasic pattern (5). The monthly fecundity decreases approximately from the age of 30 (6, 7). The first but inconspicuous sign of reproductive aging process is 2-3 days of shortening of the menstrual cycle (8). Menopausal transition is defined as the stage of ovarian aging and starts approximately at the age of 46 (8). The last menstrual period (menopause) is expected approximately at the age of 51 (range 40-60) and is considered as the physiological sequel of ovarian aging (9, 10). In the last century, in spite of the increase in life expectancy and decrease in menarche age, there has been no significant change in menopausal age. It is thought that genetic control is important and that environmental factors are effective in determining the natural menopausal age (11). Endocrinological Factors in Ovarian AgingDuring reproductive life, the length of a regular menstrual cycle is typically 28 days. The increase in the early follicular FSH level before the onset of menstrual irregularity during the menopausal transition period may point out a decrease in the number follicles. During the menopausal transition period, the menstrual cycles worsen further due to the decrease...