Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS

Legro, Richard S.; Dodson, William C.; Kunselman, Allen R.; Stetter, Christy; Kris-Etherton, Penny M.; Williams, Nancy I.; Gnatuk, Carol L.; Estes, Stephanie J.; Allison, Kelly C.; Sarwer, David B.; Diamond, Michael P.; Schlaff, William D.; Casson, Peter R.; Christman, Gregory M.; Barnhart, Kurt T.; Bates, G. Wright; Usadi, Rebecca; Lucidi, Scott; Baker, Valerie L.; Zhang, Heping; Eisenberg, Esther; Coutifaris, Christos; Dokras, Anuja

doi:10.1210/jc.2016-1659

Cited by 125 publications

(74 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It will also reduce the high level of luteinizing hormone and reduce early pregnancy loss. A combination of lifestyle modification with weight loss before pharmacologic ovulation-inducing agents improved ovulation and live birth in women with PCOS in a USA study [23] and in addition, required lower doses of pharmacologic agent for ovulation induction.…”

Section: Weight Reduction and Ovulation Inductionmentioning

confidence: 99%

“…Other disadvantages of clomiphene citrate are its antagonist effect on the estrogen receptors within the endometrium, which is thought to reduce the pregnancy rates in women treated with clomiphene citrate. The rates of multiple pregnancies with clomiphene citrate are below 10% and the risk of ovarian hyperstimulation is rare when compared to follicle stimulating hormone with higher chances of both multiple pregnancy and ovarian hyperstimulation syndrome [23]. The prolonged use of clomiphene may increase the risk development of uterine fibroid or endometrial cancer.…”

Section: Clomiphene Citratementioning

confidence: 99%

See 1 more Smart Citation

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Oriji¹,

Nyengidiki²

2018

Debatable Topics in PCOS Patients

View full text Add to dashboard Cite

Infertility is a distressing medical and psychosocial problem afflicting about a quarter of all couples wanting to reproduce their offspring. Majority of the anovulatory problem in the female, as a cause of infertility, is due to polycystic ovary syndrome (PCOS). This condition is a complex interplay of factors, which affect women even beyond their fertility. It has been found to increase the risk of other adverse condit i o n ss u c ha st h em e t a b o l i cs y n d r o m e ,c a r diovascular diseases, type II diabetes mellitus, and endometrial cancer as well as infertility. Different groups have made diagnosis of PCOS with various diagnostic criteria. The Rotterdam criteria used in the diagnosis of PCOS mainly emphasize the reproductive malfunctions of this complex disease. The treatment of anovulatory infertility in PCOS is as enigmatic as the disease itself. Various methods have been deployed to treat the anovulation with variable success. Clomiphene citrate is a traditional first-line drug in treating anovulation in women with PCOS. Weight reduction, letrozole, metformin, folliclestimulating hormone (FSH) and ovarian drilling are some of the other ways in which anovulation has been treated in these women. What method is more likely to succeed in treating the infertility from anovulation in PCOS and in what circumstance are the subject matters of this discussion.

show abstract

Section: Weight Reduction and Ovulation Inductionmentioning

confidence: 99%

Section: Clomiphene Citratementioning

confidence: 99%

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Oriji¹,

Nyengidiki²

2018

Debatable Topics in PCOS Patients

View full text Add to dashboard Cite

show abstract

“…Progestins are also widely used to induce withdrawal bleed before infertility treatment (Diamond et al, 2012). However, there has been increasing concern about potential adverse effects of their use on pregnancy outcomes after infertility treatment (Diamond et al, 2012;Legro et al, 2015Legro et al, , 2016Jones et al, 2016). IVF is a common infertility treatment for women with PCOS, and is often used in those who fail to conceive with ovulation induction and those who have concomitant infertility factors.…”

Section: Introductionmentioning

confidence: 99%

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

Wei

Shi

et al. 2016

Hum. Reprod.

Self Cite

View full text Add to dashboard Cite

STUDY QUESTION: Do oral contraceptives (OCs) and progestins impact live birth rate of IVF when used for cycle scheduling in women with polycystic ovary syndrome (PCOS)?SUMMARY ANSWER: OCs used for scheduling IVF cycle were associated with lowered rates of pregnancy and live birth after fresh embryo transfer, whereas progestins used for this purpose yield higher rates of pregnancy and live birth than OCs.WHAT IS KNOWN ALREADY: Due to oligo-menorrhea in PCOS, OCs and progestin are extensively used to schedule the start of an IVF cycle in women with PCOS. Little is known about the effect of such pretreatments on outcomes, especially, the rate of live birth.STUDY DESIGN, SIZE, DURATION: This was a nested cohort study and secondary analysis of a multicenter randomized trial, which was designed to compare live birth rate after fresh embryo transfer vs frozen embryo transfer (FET) in women with PCOS (Frefro-PCOS). A total of 1508 women were enrolled from 14 centers between June 2013 and May 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS:At the discretion of local investigators, subjects were instructed to wait for spontaneous menses (Control group, n = 323), or were prescribed progestins (P group, n = 283) or OCs (OCs group, n = 902) to induce menstruation prior to the start of ovarian stimulation. GnRH antagonist protocol was initiated at Day 2 or 3 of induced or spontaneous menses cycle. The rates of pregnancy, pregnancy loss and live birth after either fresh embryo transfer or FET were compared among these three groups.MAIN RESULTS AND THE ROLE OF CHANCE: With fresh embryo transfer, women with OC-induced menses had lower rates of clinical pregnancy (48.8% vs 63.6%, relative rate (RR): 0.77, 95% CI: 0.66-0.89) and live birth (36.1% vs 48.1%, RR: 0.75, 95% CI: 0.61-0.92) than women with spontaneous menses. With freeze-all and deferred FET, women with OC-induced menses had a similar pregnancy rate but a higher pregnancy loss rate (27.7% vs 13.0%, RR: 2.13, 95% CI: 1.28-3.52) after FET than women with spontaneous menses. The live birth rate after FET in women with OC-induced menses, progestin-induced menses and spontaneous menses was 49.4%, 50.7% and 60.2%, respectively (P = 0.06). Progestin-induced menses was associated with similar rates of pregnancy, pregnancy loss and live birth after transfer © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com of either fresh or frozen embryos compared with spontaneous menses. Multivariate logistic regression analysis showed that OCs used for menses induction was associated with lower rate of live birth. LIMITATIONS, REASONS FOR CAUTION:The methods for menses induction were not assigned randomly, thus selection bias was highly likely because of the study design and significant differences that were observed in the baseline characteristics of the women in the different groups. The mean BMI in this study population was relative...

show abstract

“…A secondary analysis228 of 319 women from two RCTs of women aged 18–40 years who were overweight or had obesity (BMI 27–42 kg/m 2 ) and infertile with PCOS reported on serious adverse events and side effects with concomitant orlistat and COC use. In one arm of that study, 43 women received concomitant orlistat and COC (20 EE/1 NET) for 16 weeks prior to clomifene treatment (the other arms received either orlistat or COC alone).…”

Section: Contraception and Weight Management Treatmentmentioning

confidence: 99%

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

2019

BMJ Sex Reprod Health

View full text Add to dashboard Cite

Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS

Cited by 125 publications

References 28 publications

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

Contact Info

Product

Resources

About