Efficacy predictors for metformin and clomiphene citrate treatment in anovulatory infertile patients with polycystic ovary syndrome

Palomba, Stefano; Falbo, Angela; Orio, Francesco; Tolino, Achille; Zullo, Fulvio

doi:10.1016/j.fertnstert.2008.03.011

Cited by 37 publications

(28 citation statements)

References 46 publications

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“…As possible predictive factors for CC stimulation outcome, the following parameters were included: age, BMI, insulin resistance, testosterone, and androstenedione (14); the LH:FSH ratio, PTH, serum calcium, 25OHD3, and 25OHD3 deficiency were new candidates for predicting the success of CC stimulation.…”

Section: Methodsmentioning

confidence: 99%

Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study

Ott

Wattar

Kurz

et al. 2012

European Journal of Endocrinology

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Objective: To evaluate whether parameters for calcium metabolism were associated with characteristics of polycystic ovary syndrome (PCOS). Design: A prospective cohort study. Methods: Ninety-one anovulatory, infertile women with PCOS patients underwent clomiphene citrate (CC) stimulation. Main outcome measures were parathyroid hormone (PTH); 25-hydroxyvitamin D3 (25OHD3); serum levels of calcium, phosphorus, magnesium, albumin, and total protein; the serum calcium-phosphorus product; LH; FSH; sexual hormone binding globulin; testosterone; and androstenedione. Results: PTH correlated inversely with serum calcium (rZK0.235; PZ0.004) and 25OHD3 (rZK0.664; P!0.001), whereas positive correlations were found between PTH and body mass index (BMI; rZ0.270; PZ0.010) and between PTH and testosterone (rZ0.347; PZ0.001). After stimulation with 50 mg CC, 57.1% (52/91) developed a follicle, whereas 26.4% (24/91) became pregnant. In a multivariate model to predict both follicle development and pregnancy, BMI and 25OHD3 deficiency were significant predictive parameters. Conclusions: 25OHD3 deficiency was an independent predictive parameter of CC stimulation outcome, in terms of follicle development and pregnancy. Our results suggest a substantial role of vitamin D in PCOS and infertility treatment in these patients.

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Section: Methodsmentioning

confidence: 99%

Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study

Ott

Wattar

Kurz

et al. 2012

European Journal of Endocrinology

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“…However, clomiphene citrate has also been shown to be superior at inducing ovulation in women with a BMI > 30 Kg/m 2 when compared with metformin [12]. Metformin has been shown to have better efficacy in patients who demonstrate insulin resistant polycystic ovarian syn-drome (PCOS) [13].…”

Section: Bmi Clomiphene Citrate and Metformin Therapymentioning

confidence: 99%

The Impact of Body Mass Index on Assisted Reproductive Treatments

Supramaniam¹,

Mittal²,

Lim³

2017

OJOG

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Multiparity amongst women with a body mass index (BMI) ≥ 30 Kg/m 2 is a common occurrence despite there being a known clear association with a decline in fecundity in women who are overweight or obese. These women, also pose further concerns, as they are at increased risk of antenatal complications such as preeclampsia and gestational diabetes. Over the years, a number of different modalities of fertility treatments have been tried and tested in this cohort of women to find the optimal treatment to improve their reproductive capacity. There has been an exponential increase in knowledge and understanding towards managing patients with a raised BMI, particularly through assisted reproductive treatments. Although the efficacies of various forms of fertility treatments have been shown to be affected by a rise in BMI, there is yet to be a definitive understanding as to the optimal management of these patients. The literature supports weight loss alone as an effective intervention in improving the reproductive capacity of women with a raised BMI with unexplained infertility. Furthermore, if live birth rate is taken as the desired outcome measure, then ovarian drilling and in vitro fertilisation (IVF) treatment have been shown to yield the best results in overweight and obese patients when comparisons are drawn to other interventions such as natural conception and treatment with clomiphene citrate.

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“…As expected, advanced age and longer duration of infertility had an adverse impact on pregnancy response under metformin. This study has also attempted to distinguish between the phenotype who may benefit from metformin therapy and the one who may respond better to CC therapy (173). Insulin-resistant PCOS patients with low BMI were reported to be more likely to respond to metformin, whereas CC treatment was more effective in less hyperandrogenic and more insulin-sensitive patients with low BMI.…”

Section: Predictors Of Response To Metforminmentioning

confidence: 99%

Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome

Diamanti-Kandarakis

Christakou

Kandaraki

et al. 2010

European Journal of Endocrinology

208

184

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Polycystic ovary syndrome (PCOS) is now recognized to be the most common endocrinopathy in women of reproductive age with a prevalence of 6.6-6.8%. PCOS, a syndrome of unknown etiology, was initially regarded as a reproductive disorder. However, in the last 15 years the role of insulin resistance (IR) has been identified as a significant contributor to the pathogenesis of PCOS, and the metabolic and cardiovascular sequelae of the syndrome have been increasingly appreciated. The coexistence and interaction of reproductive and cardiometabolic abnormalities in the context of PCOS have created a need for a modified therapeutic management of affected women. Insulin sensitizers, particularly metformin, have been introduced as a pharmaceutical option targeting not only IR, but several other aspects of the syndrome, including reproductive abnormalities. The landscape of the multifaceted actions of metformin evolves to broaden the therapeutic implications of this old drug in a new fashion for patients with PCOS. Most recently, the spectrum of metformin's targets has been expanded, and molecular studies have explored the tissue-specific mechanisms of metformin in the liver, the muscle, the endothelium, and the ovary. The use of metformin in pregnant women with PCOS comprises another scarcely explored, but promising area of research. This review attempts to cover the spectrum of metformin's cellular actions in different tissues and to summarize the current literature regarding the potential medical value of this medication in PCOS. Even if many of these actions are individually modest, they seem to be collectively sufficient to confer therapeutic benefits not only in cardiometabolic aspects but also in reproductive aspects of PCOS.

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Efficacy predictors for metformin and clomiphene citrate treatment in anovulatory infertile patients with polycystic ovary syndrome

Cited by 37 publications

References 46 publications

Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study

Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study

The Impact of Body Mass Index on Assisted Reproductive Treatments

Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome

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