Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome

Nugent, David; Vanderkerchove, Patrick; Hughes, Edward G.; Arnot, Michelle I.; Lilford, Richard

doi:10.1002/14651858.cd000410.pub2

Cited by 26 publications

(9 citation statements)

References 46 publications

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“…[3] First-line agent of choice is the antiestrogen clomiphene citrate, while exogenous gonadotropins are commonly used as secondline intervention. [3,4] Unfortunately, multiple pregnancy rates with the above, especially with gonadotropins, are considerably high. [5] While some patients will benefit from any of these treatments, a considerable number will require other forms of assisted conception such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).…”

Section: Introductionmentioning

confidence: 99%

Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility

Okohue¹,

Onuh²,

Ikimalo

2013

Niger J Clin Pract

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Section: Introductionmentioning

confidence: 99%

Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility

Okohue¹,

Onuh²,

Ikimalo

2013

Niger J Clin Pract

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“…Cochrane systemic reviews and meta-analyses comparing different types of gonadotropin therapies indicated no significant difference between FSH and hMG in improving live birth rates in both CCR-PCOS and non-CCR PCOS 5 , 39 . However, the above evidences were at low or very low quality.…”

Section: Discussionmentioning

confidence: 95%

Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis

Fang

Zhang

et al. 2017

Sci Rep

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The comparative efficacies of ovulation-induction treatments in patients with clomiphene citrate-resistant (CCR) polycystic ovary syndrome (PCOS) are not well known. Therefore, we conducted a network meta-analysis to rank the reproductive efficacies of these treatments. We ultimately included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unilateral laparoscopic ovarian drilling (ULOD), bilateral laparoscopic ovarian drilling (BLOD), the combination of metformin with letrozole (metformin+letrozole), and the combination of metformin with CC (metformin+CC). The network meta-analysis demonstrates that hMG therapy result in higher pregnancy rates than BLOD, ULOD and CC therapies. Pregnancy, live birth and ovulation rates are significantly higher in metformin+letrozole and FSH groups than CC group. The abortion rate in the metformin+letrozole group is significantly lower than that in the metformin+CC group. Ranking probabilities show that, apart from gonadotropin (FSH and hMG), metformin+letrozole is also potentially more effective in improving reproductive outcomes than other therapies. In conclusion, owing to the low quality of evidence and the wide confidence intervals, no recommendation could be made for the treatment of ovulation-induction in patients with CCR PCOS.

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“…Although urinary-derived FSH preparations do not improve pregnancy rates when compared with traditional and less expensive HMG preparations, the use of urinary (u) FSH does result in a reduced risk of OHSS [67]. It might be expected that recombinant (r) FSH preparations with greater purity, would be superior to uFSH preparations.…”

Section: Follicle Stimulating Hormonementioning

confidence: 99%

Treatment Strategies for the Infertile Polycystic Ovary Syndrome Patient

Tannus

Burke

Kol

2015

Womens Health (Lond Engl)

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Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Infertility is a prevalent presenting feature of PCOS, and approximately 75% of these women suffer infertility due to anovulation. Lifestyle modification is considered the first-line treatment and is associated with improved endocrine profile. Clomiphene citrate (CC) should be considered as the first line pharmacologic therapy for ovulation induction. In women who are CC resistant, second-line treatment should be considered, as adding metformin, laparoscopic ovarian drilling or treatment with gonadotropins. In CC treatment failure, Letrozole could be an alternative or treatment with gonadotropins. IVF is considered the third-line treatment; the 'short', antagonist-based protocol is the preferred option for PCOS patients, as it is associated with lower risk of developing ovarian hyperstimulation syndrome (specifically by using a gonadotropin--releasing hormone agonist as ovulation trigger), but with comparable outcomes as the long protocol.

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Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome

Cited by 26 publications

References 46 publications

Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility

Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility

Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis

Treatment Strategies for the Infertile Polycystic Ovary Syndrome Patient

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