Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome

Koçak, Müberra; Çalışkan, Eray; Şimşir, Çoşkun; Haberal, Alı

doi:10.1016/s0015-0282(01)02941-7

Cited by 245 publications

(140 citation statements)

References 25 publications

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“…However, having random side effects such as Hyperinsulinemia, insulin resistance and even growth in androgen production led to more investigations on new drugs. [13][14][15] Letrozole-metformin is a widely recommended substitute that can stimulate FSH secretion and ovarian follicular development. 16,17 This study was performed to investigate the effects of letrozole-metformin and clomiphene-metformin on ovarian and uterine arteries on 108 women with secondary infertility due to Polycystic Ovary Syndrome (PCOS).…”

Section: Discussionmentioning

confidence: 99%

The combination of letrozole and metformin has a better therapeutic effect on uterine and ovarian arteries in PCOS patients

Farshchian¹,

Nezhad²,

Kamangar³

2018

AMJ

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BackgroundPolycystic ovary syndrome (PCOS) is the most prevalence endocrine disorder in the reproductive age of women. In these patients, medications such as clomiphene citrate, letrozole and metformin are used to induce ovulation and overcome infertility. AimsThis study was done for comparing the findings of Color Doppler sonography of the uterine and ovarian arteries in women with PCOS under treatment of two drug groups of letrozole-metformin and clomiphene-metformin. MethodsIntervention-applied study was performed on 108 women with secondary infertility due to PCOS in Imam Reza Hospital of Kermanshah in 2016. Women were divided in two groups of 54 people, for investigating the effect of letrozole-metformin and clomiphene-metformin on ovarian and uterine arteries. ResultsBlood flow in the uterus and ovaries significantly increased after treatment with letrozole-metformin and clomiphenemetformin (P<0.05). However, the effect of letrozolemetformin was significantly higher than that of clomiphenemetformin on uterine and ovarian arteries Resistance Index (RI) (P<0.05). ConclusionLetrozole-metformin as well as clomiphene-metformin have a significant effect on blood flow in the uterus and ovaries. The group which received letrozole-metformin had a better response in this regard. Key WordsInfertility, Resistance Index (RI), Polycystic Ovary Syndrome (PCOS) What this study adds:1. What is known about this subject? PCOD is one of the most common fertility disorders in women of reproductive age with several treatment methods. What new information is offered in this study?The reduction of RI in the uterine and ovarian arteries was greater in letrozole-metformin group compared to clomiphene citrate-metformin. Treatment with letrozolemetformin is recommended. What are the implications for research, policy, or practice?Since polycystic ovary can cause infertility, treatment or control of this disease can help infertile couples in fertility.

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Section: Discussionmentioning

confidence: 99%

The combination of letrozole and metformin has a better therapeutic effect on uterine and ovarian arteries in PCOS patients

Farshchian¹,

Nezhad²,

Kamangar³

2018

AMJ

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“…(64,79) Metformin therapy not only decreases hyperandrogenism and insulin resistance but also improves ovulation rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with PCOS. (80) Alleviation of hyperandrogenism by metformin in women with PCOS is proven to be in part through a reduction in stimulated ovarian cytochrome P-450c17α activity. (81) Adding metformin to the OC treatment significantly enhances the insulin sensitivity, and further suppresses the hyperandrogenemia in non-obese women with PCOS.…”

Section: Treatment With Insulin-sensitizing Agents In Pcosmentioning

confidence: 99%

Diagnosis of Polycystic Ovary Syndrome

Trivax

Azziz²

2007

Clinical Obstetrics and Gynecology

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P olycystic ovary syndrome (PCOS), characterized by amenorrhea or severe oligomenorrhea, anovulation and hyperandrogenism, is the most frequent androgen disorder of ovarian function, (1) and affects 5%-10% of all women.(2) Clinically, PCOS is a combination of three components: hyperandrogenic state, disorder of ovulation (anovulatory) and disorder of metabolism (dysmetabolic).There is accumulating evidence that PCOS patients have a higher risk to develop diabetes mellitus, hypertension and cardiovascular disease as compared to age-matched women.(3-6) Lifelong exposure to an adverse cardiovascular risk profile in women with PCOS may lead to premature atherosclerosis. The sequelae of PCOS beyond reproductive health and the adverse health consequences associated with PCOS are substantial. Unfortunately, most women are not aware of these risks. Thus, physicians should pay much attention on the clarification of the genetics, etiology, clinical associations and assessment of treatment and later sequelae of the syndrome. Diagnosis of Polycystic Ovary Syndrome (PCOS)Although there has been much debate on clini- Polycystic Ovary Syndrome (PCOS), Insulin Resistance and Insulin-Like Growth Factors (IGFs)/IGF-Binding Proteins (IGFBPs)Hsin-Shih Wang 1,2 , MD, PhD; Tzu-Hao Wang 1 , MD, PhDPolycystic ovary syndrome (PCOS) is the most frequent androgen disorder of ovarian function. Hyperinsulinemia with insulin resistance is believed to be a key link in the enigmatic generation of the symptoms of PCOS such as anovulatory infertility and hyperandrogenism. Regression of these symptoms may be achieved by reducing the hyperinsulinemia. A growing body of evidence suggests that PCOS patients with hyperinsulinemia have a higher risk to develop diabetes mellitus, hypertension and cardiovascular disease as compared to age-matched women. Although oral contraceptives, progestins, antiandrogens, and ovulation induction agents remain standard therapies, weight loss should also be vigorously encouraged to ameliorate the metabolic consequences of PCOS. In addition, insulin-sensitizing agents are now being shown to be useful alone or combined with standard therapies to alleviate hyperinsulinemia in PCOS. Finally and most importantly, early identification of patients at risk and prompt initiation of therapies, followed by long-term surveillance and management, may promote the patient's long-term health. (Chang Gung Med J 2003;26: 540-53)

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“…In terms of adverse effects, orlistat was associated with gastrointestinal disturbances, sibutramine with small increases in blood pressure and pulse rate, and rimonabant with nervous, psychiatric or gastrointestinal-related effects [116] Women's Health (2007) 3(1) future science group future science group Metformin is increasingly prescribed for PCOS women to treat PCOS-related symptoms. While some studies in PCOS women found that metformin resulted in greater weight loss and fat loss compared with placebo [34,[117][118][119], a recent meta-analysis found that metformin has no net effect on BMI or waist:hip ratio in this population [120]. In contrast, studies in younger non-PCOS patients have consistently shown a beneficial effect of metformin on body weight and body composition [121][122][123][124].…”

Section: Medicationmentioning

confidence: 99%

Obesity Management in Women with Polycystic Ovary Syndrome

Lim

Clifton

Noakes

et al. 2007

Womens Health (Lond Engl)

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Obesity and insulin resistance play an important role in initiating or maintaining ill health in polycystic ovary syndrome (PCOS). This implies that treatment that reduces body weight and insulin resistance would alleviate the symptoms of PCOS. Lifestyle modification has been found to be effective in restoring reproductive function in up to 80% of individuals who achieve at least 5% weight loss. However, long-term weight maintenance is a challenge. This article provides a review of reduced glycemic load diets, including low glycemic index, very low carbohydrate, high-protein and high monounsaturated fat diets, on metabolic and reproductive health in PCOS and non-PCOS populations. Dietary trials in non-PCOS women suggest that higher-protein, reduced glycemic load diets were probably more beneficial than the conventional low-fat, high-carbohydrate diet but further studies are required to confirm this in PCOS women. Similarly, the optimal exercise regime for PCOS women remains to be investigated.Obesity & polycystic ovary syndrome Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions that affects obese and nonobese women during reproductive age. Its symptoms include irregular menses, infertility, acne and hirsutism (excessive hair growth). During pregnancy, PCOS probably also increases the risk of early miscarriages and complications such as pre-eclampsia and gestational diabetes [1]. As a result of these physical manifestations, women with PCOS tend to have poorer psychological health and lower quality of life [2]. Increasing evidence also suggests that women with PCOS may be at greater risk of developing metabolic diseases such as type 2 diabetes and cardiovascular disease in the long term [3,4].Owing to its heterogeneity, the diagnostic criteria for PCOS have been a contentious issue among experts. The 1990 National Institutes of Health (NIH) meeting defined PCOS as the coexistence of chronic anovulation and hyperandrogenism, with the exclusion of other diseases such as thyroid disorder, hyperprolactinemia, congenital adrenal hyperplasia, androgensecreting tumors and Cushing syndrome [5]. In 2003, this definition was broadened to include women with either hyperandrogenism or anovulation in addition to having polycystic ovaries. Using the previous NIH definition, the prevalence of PCOS was estimated to be 5-8% of women of reproductive age [6][7][8][9]. This number is estimated to increase by 65% using the latest revised diagnostic criteria [10]. Obesity & fat distribution in PCOS womenIt is estimated that 30-60% of women with PCOS are overweight or obese in the Western world [7,[11][12][13][14]. Some suggest that the prevalence of obesity is higher in PCOS women compared with healthy controls [7,15,16]. In a study involving 3094 women, Glueck and colleagues found that approximately 73-78% of women with PCOS aged between 20 and 41 years were obese (body mass index [BMI]>30 kg/m 2 ) compared with 7-14% in the general population [16]. In addition to being potentially predisposed to obesity,...

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Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome

Cited by 245 publications

References 25 publications

The combination of letrozole and metformin has a better therapeutic effect on uterine and ovarian arteries in PCOS patients

The combination of letrozole and metformin has a better therapeutic effect on uterine and ovarian arteries in PCOS patients

Diagnosis of Polycystic Ovary Syndrome

Obesity Management in Women with Polycystic Ovary Syndrome

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