Endometrial Shedding Effect on Conception and Live Birth in Women With Polycystic Ovary Syndrome

Abstract

Objective To estimate whether progestin-induced endometrial shedding, prior to ovulation induction with clomiphene citrate, metformin, or a combination of both, affects ovulation, conception, and live birth rates in women with polycystic ovary syndrome (PCOS). Methods A secondary analysis of the data from 626 women with PCOS from the National Institutes of Child Health and Human Development Cooperative Reproductive Medicine Network trial was performed. Women had been randomized to up to six cycles of clomiphene citrate alone, metformin alone, or clomiphene citrate plus metformin. Women were assessed for occurrence of ovulation, conception, and live birth in relation to prior bleeding episodes (after either ovulation or exogenous progestin-induced withdrawal bleed). Results While ovulation rates were higher in cycles preceded by spontaneous endometrial shedding than after anovulatory cycles (with or without prior progestin withdrawal), both conception and live birth rates were significantly higher after anovulatory cycles without progestin-induced withdrawal bleeding (live birth per cycle: spontaneous menses 2.2%; anovulatory with progestin withdrawal 1.6%; anovulatory without progestin withdrawal 5.3%; p<0.001). The difference was more marked when rate was calculated per ovulation (live birth per ovulation: spontaneous menses 3.0%; anovulatory with progestin withdrawal 5.4%; anovulatory without progestin withdrawal 19.7%; p < .001). Conclusion Conception and live birth rates are lower in women with PCOS after a spontaneous menses or progestin-induced withdrawal bleeding as compared to anovulatory cycles without progestin withdrawal. The common clinical practice of inducing endometrial shedding with progestin prior to ovarian stimulation may have an adverse effect on rates of conception and live birth in anovulatory women with PCOS.

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

“…Oral contraceptives (OCs) are commonly used to resolve the classic symptom(s) of PCOS, such as hirsutism, acne and irregular menses (McCartney and Marshall, 2016). 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).…”

“…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.…”

Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome

“…23 We left the choice of inducing withdrawal bleeding after an anovulatory cycle to the site investigator's discretion and found no adverse effect of withdrawal bleeding on fecundity, in contrast to the findings in our previous study. 2 , 24 Another potential weakness of the study is the relatively high dropout rate; however, it is similar to the dropout rate in the clomiphene group in our prior study (26%) 2 and to the rate in a similar multicenter trial involving 320 patients (19%). 21 We speculate that the dropout rates may be relatively high in such infertility trials because a woman or her male partner may individually discontinue participation.…”

Clinical view of the ineffectiveness of IVF problem with endometrial receptivity

“…Класси-ческим примером является применение кломифенцитрата (клостильбегита), при использовании которого частота ову-ляции составляет 50-70%, а частота наступления беременно-сти -только 5-10% [4]. Основным фактором, определяющим такую диспропорцию, считается антиэстрогенное действие кломифенцитрата на рецепторы эстрогенов в эндометрии [5].…”