Medical management of clomiphene-resistant polycystic ovarian syndrome: an update

Kaur, Sharonjeet; Saha, Lekha

doi:10.5455/2319-2003.ijbcp20140232

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…Figure(7) Correlation analysis between insulin resistance versus leptin and ghrelin levels in OT-PCOS group were no significant correlation observed.…”

mentioning

confidence: 93%

“…Ghrelin stimulates growth hormone secretion; also it has different functions such as the regulations of glucose metabolism, appetite, body weight, endocrine pancreatic, and ovarian functions [6] . In other hand the implication of the insulin resistance and compensatory hyperinsulinemia accelerate the effect of luteinizing hormone (LH) on ovarian theca cells and androgen synthesis which in turn inhibits ovulation through cessation of the follicular maturity process and PCOS development [7] . Leptin, is a single-chain proteohormone with a molecular mass of 16kDa that is thought to works as a mediator in the stomachhypothalamus pathway and provides information about the body's energy storage in adipocytes in addition, its level is associated with obesity [8] .…”

Section: Introductionmentioning

confidence: 99%

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Serum Leptin, Ghrelin and Insulin Resistance in Iraqi Women with Clomiphene Resistance Polycystic Ovary Syndrome

Sheri

Jaccob

Hadi

et al. 2015

Kufa Jour. Nurs. Sci.

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Background: Polycystic ovary syndrome is the most common endocrine disorder in women with reproductive age. it has a multifactorial etiology characterized by menstrual irregularities, manifesting as oligomenorrhea or amenorrhea, a part of abnormalities of hyperandrogenism and polycystic ovaries. Recent evidence has demonstrated the complex function of adipose tissue and stomach as endocrine organs through release of hormones into the blood stream involved in physiological activities of the body with potential implication in PCOS development. One of the most important of these hormones are ghrelin, leptin and insulin that have role in process of PCOS development. Aims of the study: The aim of present study to evaluate serum ghrelin, leptin and insulin resistance in clomiphene resistance PCOS women and to find correlation between these parameters. Methodology: During Sep 2013 to May 2014, already diagnosed infertile Iraqi women with PCOS they are recruited in the private medical clinic of Dr. Ahlam ali naser during their periodic visit. There were 23 girls at mean age 21.3±1.2 on clomiphene therapy as clomiphene resistant PCOS group (CR-PCOS), 25 PCOS girls at mean age 23.5±1.4 consumed drugs other than clomiphene for PCOS treatment consider as (OT-PCOS) and 20 girls at mean age 22±2.4 as control group included in the present study. Blood samples were taken after at least 8 hours of fasting in all PCOS girls and control, serum glucose, ghrelin and leptin were measure, insulin resistance value were calculated using HOMA-IR model. Results: The highest Ghrelin, leptin and IR levels were observed in CR-PCOS group and this level considered significantly high when compared with control and OT-PCOS groups. The only significant positive correlation between IR and ghrelin was observed in CR-PCOS group with no significant correlation in all study groups were observed. In other hand when we make correlation between ghrelin and study parameters, significant negative correlations that observed with leptin in control group not observed in CR-PCOS and OT-PCOS, meanwhile no significant correlation between ghrelin and leptin or IR in OT-PCOS group. Conclusions: Women with clomiphene resistance PCOS exhibit significantly increased serum ghrelin, leptin and insulin resistance levels than control subjects and PCOS women taking therapy other than clomiphene indicating good biochemical markers in detection clomiphene resistance status in PCOS women. Furthermore we speculate significant positive correlation between ghrelin and IR in CR-PCOS group. Recommendation: Assessment of ghrelin and leptin levels in women taking metformin and clomiphene combination therapy for PCOS treatment

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“…Figure(7) Correlation analysis between insulin resistance versus leptin and ghrelin levels in OT-PCOS group were no significant correlation observed.…”

mentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Serum Leptin, Ghrelin and Insulin Resistance in Iraqi Women with Clomiphene Resistance Polycystic Ovary Syndrome

Sheri

Jaccob

Hadi

et al. 2015

Kufa Jour. Nurs. Sci.

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“…1 Clomiphene citrate (CC) was the gold standard drug for the ovulation induction in PCOS, but clomiphene citrate resistance is still seen approximately 15-40%. 2,3 While CC is the first line of treatment in women with PCOS for chronic anovulation, failure to ovulate is frequent after 150mg/day is received. 4 N-acetyl cysteine (NAC), a safe and cheap medication that was available several years ago in the market as a mucolytic agent and an alternative to the toxicity of acetaminophen, played an important role in the treatment of infertility.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Clomiphene Citrate Plus N-Acetyl Cysteine and Clomiphene Citrate Alone for Induction of Ovulation in Polycystic Ovary Syndrome

Waseem¹,

Gohar²,

Afzal³

et al. 2021

PJMHS

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Aim: To compare the frequency of ovulation with clomiphene citrate plus N-acetyl cysteine versus clomiphene citrate alone in married females presenting with polycystic ovarian syndrome. Study design: Randomized clinical trial Place and duration of study: Department of Obstetrics and Gynaecology, Unit-3 Jinnah Hospital, Lahore from 1st September 2018 to 28th February 2019. Methodology: A total of 60 patients (30 in each group) were enrolled. In group A, females were prescribed clomiphene citrate 50-mg tablets twice daily with N-acetyl cysteine 1200 mg/day orally for 5 days starting on day 3 of the menstrual cycle and in group B, females were prescribed clomiphene citrate 50-mg tablets twice daily. Results: Patients ranged between 18-35 years of age. Mean age of the patients was 28.5±3.3 and 28.1±3.1 years in group A and B, respectively. Mean duration of marriage in group A was 3.4±0.9 and in group B 3.5±0.9 year. Mean BMI in group-A was 3.4±0.9 while in group-B 3.5±0.9 (kg/m2). Ovulation was observed at 1st month in group A was 12 (40%) and in group B 9 (30%). Ovulation was observed at 2nd month in group A was 16 (53.3%) and in group B 13 (43.3%). In 3rd months ovulation was seen in 19 patients (63.3%) of group A and 18 patients (60%) of group B. Stratification for age and BMI was also carried out. Conclusion: This study could not find any clinical superiority for clomiphene citrate plus N-acetyl cysteine versus clomiphene citrate alone in term of ovulation rate. Keywords: N-acetyl cysteine, Polycystic ovary syndrome, Ovulation induction

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“…Women who do not conceive following CC are usually offered other antiestrogen agents (tamoxifen), aromatase inhibitors (anastrozole), insulin-sensitizing drugs, exogenous gonadotropins, and, in some cases, LOD. 4 Laparoscopic ovarian drilling has replaced the more invasive ovarian wedge resection as a surgical treatment option for PCOS women with anovulatory infertility. 5 In contemporary practice, LOD is mainly indicated for CC resistance women who constitute approximately 20 to 25% of PCOS women undergoing CC therapy.…”

Section: Introductionmentioning

confidence: 99%

“…5 In contemporary practice, LOD is mainly indicated for CC resistance women who constitute approximately 20 to 25% of PCOS women undergoing CC therapy. 4 The actual mechanism of how LOD works has not been fully elucidated. It is hypothesized that LOD destroys the ovarian androgenproducing tissue and, hence, reduces the peripheral conversion of androgens to estrogens.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis

Kamath¹,

Thomas²,

Vithayathil³

et al. 2017

International Journal of Infertility &Amp; Fetal Medicine

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Introduction Ovulation induction in women with polycystic ovarian syndrome (PCOS) can be carried out with drugs, such as clomiphene citrate (CC), which remains the first-line treatment option, and surgery, such as laparoscopic ovarian drilling (LOD), which is usually recommended as one of the second-line treatment options. Laparoscopic ovarian drilling may avoid or reduce the need for gonadotropins and at the same time reduce ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. Aim We aimed to evaluate the effectiveness of LOD in clomiphene-resistant women and to identify the clinical factors that might predict its success. Study design Retrospective analysis in a tertiary level infertility unit. Materials and methods All CC-resistant PCOS women who underwent LOD over a 10-year period were included. Polycystic ovarian syndrome was defined as per the Rotterdam criteria. The follow-up period was up to 3 years post-LOD. Outcomes, such as onset of regular cycles, spontaneous pregnancies, and live births were recorded. Results A total of 59 PCOS women who underwent LOD and were available for follow-up were included in the study. Majority of the patients were less than 30 years of age with a body mass index (BMI) > 24 kg/m2. Out of those, 12 conceived (20.3%) spontaneously and 14 (23.7%) had regular menstrual cycles after the procedure. The live birth rate was 16.9% (10/59). We did not find any association of clinical factors, such as age, BMI, type of infertility, and history of irregular cycles with LOD success. Conclusion Laparoscopic ovarian drilling can be offered as a treatment option in select group of CC-resistant women with reasonable success. Post-LOD, for those who do not have resumption of regular cycles, alternate method of ovulation induction can be initiated. How to cite this article Thomas S, Vithayathil VP, Chandy A, Aleyamma TK, Kamath MS. Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis. Int J Infertil Fetal Med 2017;8(3):93-96.

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Medical management of clomiphene-resistant polycystic ovarian syndrome: an update

Cited by 3 publications

References 32 publications

Serum Leptin, Ghrelin and Insulin Resistance in Iraqi Women with Clomiphene Resistance Polycystic Ovary Syndrome

Serum Leptin, Ghrelin and Insulin Resistance in Iraqi Women with Clomiphene Resistance Polycystic Ovary Syndrome

Comparison of Clomiphene Citrate Plus N-Acetyl Cysteine and Clomiphene Citrate Alone for Induction of Ovulation in Polycystic Ovary Syndrome

Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis

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