A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome

Costello, Michael; Misso, Marie; Balen, Adam; Boyle, Jacqueline; Devoto, Luigi; Garad, Rhonda; Hart, Roger; Johnson, Louise; Jordan, Cailin; Legro, Richard S.; Norman, Robert J.; Moran, Lisa; Mocanu, Edgar; Qiao, Jie; Rodgers, Raymond J.; Rombauts, Luk; Tassone, Eliza C.; Thangaratinam, Shakila; Vanky, Eszter; Teede, Helena

doi:10.1111/ajo.13051

Cited by 49 publications

(49 citation statements)

References 34 publications

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“…There is substantial evidence that statins can assist with PCOS treatment. Statins (atorvastatin ,fluvastatin, pravastatin, rosuvastatin, and simvastatin) inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, a rate-controlling enzyme in the cholesterol biosynthesis pathway (Costello et al, 2019). By inhibiting this enzyme, the conversion of HMG-CoA to mevalonate is halted, and thus cholesterol synthesis is halted.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Endocrine Therapy for Improved Reproductive and Metabolic Outcomes in PCOS Women

Rahmawati

Yunitasari

Armini

et al. 2021

Pediomaternal Nurs. J.

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Introduction: Polycystic ovarian syndrome (PCOS) is characterized by infrequent or absent ovulation as well as elevated levels of androgens and insulin (hyperinsulinaemia). The purpose of this study was to determine the efficacy of endocrine treatment in improving reproductive and metabolic outcomes in women with PCOS.Methods: We searched the following databases from inception to Maret 2020: PubMed, Proquest, ScienceDirect, Scopus and CINAHL. We investigated at metformin, clomiphene citrate, metformin plus clomiphene citrate, D-chiro-inositol, statins, and resveratrol as treatments. We compared them to each other, as well as to a placebo or no therapy. The quality of the evidence ranged from extremely low to moderate. The risks of bias (poor reporting of technique and inadequate outcome data), imprecision, and inconsistency were the limitations.Results: Although the evidence quality was low, our latest evaluation indicated that metformin alone may be superior to placebo for live birth. Data for live birth were equivocal when metformin was compared to clomiphene citrate, and our conclusions were hampered by a paucity of evidence. Body mass index (BMI) varies in the results, emphasizing the need of stratifying data by BMI.Conclusion: Clinical pregnancy and ovulation improvements demonstrate that clomiphene citrate is still preferred to metformin for ovulation induction in obese women with PCOS.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of Endocrine Therapy for Improved Reproductive and Metabolic Outcomes in PCOS Women

Rahmawati

Yunitasari

Armini

et al. 2021

Pediomaternal Nurs. J.

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“…Um não comparou essa associação, e o outro discorre ser letrozol melhor na indução da ovulação quando comparado a metformina. 6,12 Metformina e fertilização in vitro (FIV) 2 Uso de metformina antes e ao longo da estimulação ovariana para FIV diminui risco de hiperestimulação ovariana após tratamento. 7,13 Ao uso do protocolo longo de agonista de GnRH, a metformina aumentou a taxa de gravidez, porém não se sabe muito sobre a taxa de nascidos vivos.…”

Section: Metformina E Letrozolunclassified

“…Em casos de sobre-resposta, considerar dose de 25mg/dia; já se persistir a anovulação com dosagem de 100mg/dia, é indicado interrupção da terapia 1. Quando a ovulação não é alcançada com 150mg/dia de CC, a paciente é caracterizada como resistente à medicação; já se a gravidez não for viável após seis ciclos ovulatórios de tratamento, considera-se a mulher com insuficiência/falha ao CC 10,12. Além de provocar aumento das gonadotrofinas e hormônio folículo estimulante, o CC também atua na liberação concomitante do hormônio luteinizante (LH).…”

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Manejo Terapêutico Da Infertilidade Em Mulheres Portadoras De Síndrome Do Ovário Policístico

Rodrigues¹,

Borges²,

Oliveira³

et al. 2021

bjdv

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INTRODUÇÃO: A Síndrome do Ovário Policístico (SOP) é uma desordem ovulatória comum entre as mulheres, que consiste em um distúrbio endócrino e genital heterogêneo com um amplo espectro clínico. Para o diagnóstico de SOP, a mulher deve apresentar, segundo os critérios de Rotterdam, pelo menos duas das seguintes três características bioquímicas: hiperandrogenismo, ciclos anovulatórios e morfologia ovariana micro policística verificada por ultrassom. Ademais, a SOP é frequentemente associada a infertilidade. METODOLOGIA: Busca nas plataformas Pubmed e Cochrane Library na língua portuguesa e inglesa. RESULTADOS: 27 artigos produzidos entre 2016 e 2021. DISCUSSÃO: Foram abordadas como formas de tratamento a mudança no estilo de vida, metformina, metformina e citrato de clomifeno, metformina e FIV, metformina e letrozol, letrozol, análogos de GLP-1 e inibidores de DPP-4, citrato de clomifeno, inositol, gonadotrofinas, 25-hidroxi-vitamina D, acupuntura, ervas medicinais e drilling ovariano. CONCLUSÃO: Estudos apontaram a importância da mudança no estilo de vida como primeiro tratamento não farmacológico. Citrato de clomifeno pode ser utilizado como primeira linha farmacológica. Metformina, letrozol, inositol e antidiabéticos são eficazes. Cirurgia ovariana e gonadotrofinas são opções para pacientes com insucesso. Acupuntura e ervas medicinais podem ser usadas para regular o ciclo menstrual.

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“…73 Table 4: Highlighting recommendation for the treatment of infertility in polycystic ovarian syndrome. 74…”

Section: Surgical Approachmentioning

confidence: 99%

Polycystic ovarian syndrome: pathogenesis and management

Thiam

Antoine

Antoine-Frank

2021

Int J Reprod Contracept Obstet Gynecol

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Polycystic ovarian syndrome (PCOS) is an endocrine disorder that commonly affects women of reproductive age. Its prevalence varies quite significantly and its clinical presentation includes: reproductive, metabolic and psychological issues. PCOS develops due to a variety of factors some of which are not yet fully understood. Due to the complexity in the development and presentation of this condition, the management of PCOS in most instances is complicated and involves the combination of pharmacological, non-pharmacological and surgical interventions. This review discusses the pathogenesis and management of PCOS as means of providing information that would enhance understanding and control of this disease.

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A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome

Cited by 49 publications

References 34 publications

A Systematic Review of Endocrine Therapy for Improved Reproductive and Metabolic Outcomes in PCOS Women

A Systematic Review of Endocrine Therapy for Improved Reproductive and Metabolic Outcomes in PCOS Women

Manejo Terapêutico Da Infertilidade Em Mulheres Portadoras De Síndrome Do Ovário Policístico

Polycystic ovarian syndrome: pathogenesis and management

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