Menstrual preconditioning for the prevention of major obstetrical syndromes in polycystic ovary syndrome

Abstract

The presence of multiple ovarian cysts, anovulation, and endometrial progesterone resistance in the neonate seems remarkably similar to ovarian and endometrial features of the polycystic ovary syndrome (PCOS) of adolescent and adult women. In fact, in the absence of cyclic menstruations after menarche, the neonatal progesterone resistance is likely to persist and adversely affect young women with PCOS at the time of pregnancy after induction of ovulation, because any persisting defect in progesterone response can interfere with the process of decidualization and trophoblast invasion. The primigravid woman with PCOS therefore is likely to be at risk of defective deep placentation as manifested by the increased risk of major obstetric syndromes. A recent, large epidemiologic study has demonstrated that the risk of preeclampsia and preterm delivery is elevated in the 13- to 15-year old group, although it does not persist in the 16- to 17-year old group. It is proposed therefore that induction of ovulation in the infertile nulligravid woman with PCOS should be preceded by a period of progesterone withdrawal bleedings to achieve full endometrial progesterone response by the time of pregnancy. The cyclic administration of clomiphene citrate for a period to be determined by vascular response may be an appropriate tool to reduce the risk of major obstetric syndromes by menstrual preconditioning.

Structured teaching programme on knowledge about polycystic ovarian syndrome among adolescent girls

“…Polycystic disease is a most common female Himalayan College of Nursing, SRHU, Dehradun, Uttarakhand, India endocrine disorder which occurs in 4-18 % of women in their reproductive age worldwide. 4 The short-term complications of polycystic ovarian disease include menstrual irregularities, hyperandrogenism, insulin resistance and hyperinsulimia, obstructive sleep apnea, dyslipedemia, oligoovulation anovulation and long-term complication includes endometrial hyperplasia, metabolic syndrome, cardiovascular disease, psychological disorders. 5 A healthy lifestyle is one of the most important aspects of managing Polycystic Ovarian Syndrome successfully.…”

The impact of ovulation induction and ovarian stimulation on the risk of pregnancy-induced hypertension and on neonatal outcomes: A case/control study

“…Moreover, there might be a small proportion of women with PCOS in the 'spontaneous pregnancy' group because this group was not screened for PCOS, as a result, the observed correlations between PCOS and PIH might be rather an underestimation of the true link, and prospective epidemiological studies are needed to address this question that could have public health impact [34]. Lastly, it may be assumed that mild ovarian stimulation preferentially used in this cohort [14] as a method to avoid multi follicular development in PCOS could have minimised the over risk of PIH in this group [9,15].…”

“…PCOS has also been associated with a particular state of endometrial progesterone resistance [8]. These mechanisms could interfere with the process of decidualization, with restrictive trophoblast endovascular invasion associated with defective spiral artery remodeling [8,9,28,29] and placental alterations [30].…”

“…Indeed, after exclusion of twin pregnancies, that carry specific over risks [1,2], the role of the underlying cause of infertility, such as a polycystic ovarian syndrome (PCOS) [8] through the hormonal environment induced by hormonal stimulation and menstrual preconditioning [9], and the role of the diverse types of ovarian stimulation and assisted reproductive technology (ART) procedures with mild or high estrogen levels [10], have been questioned. In the meta-analysis of Boosman et al [8], women with PCOS demonstrated a significantly higher risk of developing pregnancyinduced hypertension (PIH); but two more recent reviews [11,12] suggested that heterogeneous aetiological factors associated with PCOS, such as obesity, could be involved in this adverse outcome.…”

How do red and infrared low-level lasers affect folliculogenesis cycle in rat’s ovary tissue in comparison with clomiphene under in vivo condition

“…In the reproductive age, 5 to 10% of reproductive age woman with PCOS are infertile [10,11]. Search for a definite treatment of PCOS started in the early 1930s and still continues [11,12]. The available modalities for induction of ovulation are weight reduction, clomiphene citrate, gonadotropin therapy, insulin sensitizer as metformin, and finally, ovarian drilling using laser or bipolar diathermy.…”