Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction

Petersen, Kathrine Birch; Pedersen, Niels Wisbech; Pedersen, Anette Tønnes; Lauritsen, Mette Petri; Freiesleben, Nina la Cour

doi:10.1016/j.rbmo.2016.03.006

Cited by 37 publications

(22 citation statements)

References 97 publications

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“…In clinical practice, treatment of women who have PCOS with clomiphene (CC) or exogenous gonadotropins for ovulation induction carries a risk of multifollicular development, resulting in ovarian hyperstimulation and multiple pregnancy [35,36]. Moreover, cancelation of cycles may be required due to either a poor or an excessive ovarian response.…”

Section: Discussionmentioning

confidence: 99%

Effects of Oral Contraceptives and Metformin on The Concentrations of Anti-Müllerian Hormone in Women with Polycystic Ovary Syndrome

Wang

Hua

Cai

et al. 2020

Preprint

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Abstract Background: Whether treatment with oral contraceptives (OC) and metformin can reduce anti-Müllerian hormone (AMH) levels in PCOS remains controversial. This study aims to investigate the effects of OC and metformin on serum AMH concentrations in women with polycystic ovary syndrome (PCOS). Methods: This prospective study included 120 women with PCOS. Patients were treated with OC (35 μg of ethinyl estradiol plus 2 mg of cyproterone acetate), metformin, or OC plus metformin for 3 months according to their different endocrine/metabolic disturbances. Forty-eight patients with hyperandrogenism (HA) were treated with OC, 32 patients with insulin resistance (IR) were treated with metformin, and 40 patients with HA and IR were treated with a combination of OC and metformin. Serum AMH levels were compared before and after treatment within each group.Results: AMH levels decreased significantly in both OC groups (from 12.54 ± 5.59 ng/mL before treatment to 9.03 ± 4.49 ng/mL after treatment, P < 0.01) as well as in the OC + metformin group (from 10.62 ± 4.57 ng/mL to 7.74 ± 3.19 ng/mL, P < 0.01). However, AMH concentrations remained unchanged in the metformin group, although insulin sensitivity was improved. Conclusion: Treatment with OC alone or OC plus metformin led to a significant reduction of serum AMH in PCOS patients with HA, while metformin treatment alone did not affect AMH levels in patients with IR.

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Section: Discussionmentioning

confidence: 99%

Effects of Oral Contraceptives and Metformin on The Concentrations of Anti-Müllerian Hormone in Women with Polycystic Ovary Syndrome

Wang

Hua

Cai

et al. 2020

Preprint

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“…But this tentative finding should be substantiated and strengthened by high quality evidence. What was more, therapies should be individualized based on local facilities, physical signs as well as patient preference 49–51 .…”

Section: Discussionmentioning

confidence: 99%

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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“…More recently, ovulation induction with aromatase inhibitors has gained popularity. Ovulation induction with gonadotrophins has been reserved as a second‐line treatment, because of the perceived risks of multi‐fetal gestation, up to 36%, and ovarian hyperstimulation syndrome (OHSS) rates as high as 4.6% . This is despite evidence to suggest increased clinical pregnancy rates with the use of gonadotrophins compared to conventional approaches .…”

Section: Introductionmentioning

confidence: 99%

The cumulative success of ovulation induction therapy with gonadotrophins in therapy‐naïve anovulatory women: An observational study

Pontré

Langdon

Murray

et al. 2020

Aust NZ J Obst Gynaeco

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Background The use of gonadotrophins as a first‐line treatment for anovulatory infertility has been limited by a perception of a risk of multi‐fetal gestation and ovarian hyperstimulation syndrome (OHSS). However, it has recently been recognised as an acceptable first‐line treatment if appropriate monitoring is performed. Aims To determine the cumulative live birth rate, incidence of multiple gestation, cycle cancellation rate and incidence of OHSS for therapy‐naïve anovulatory women undergoing ovulation induction with gonadotrophins. Materials and Methods A prospective observational study of 258 patients undergoing ovulation induction with a ‘low‐dose step‐up’ protocol was performed over a three‐year period across two fertility centres (40% of patients were currently or recently prescribed metformin). Results Twenty‐six percent of patients required concurrent use of luteinising hormone. The cumulative pregnancy and live birth rates were 22.5% and 18.2%, 40.3% and 34.5%, 47.7% and 41.1% after completion of the first, second and third cycles of stimulation, respectively, with a median duration of stimulation of 15 days. No patients developed OHSS and 10.5% of cycles were cancelled due to an excessive or no follicular response. The multiple pregnancy rate was 2%. The cumulative pregnancy rate was reduced for women over 35 years of age (23.8 vs 55.3%, P = 0.006) and for women with a body mass index greater than 25 kg/m2 (40.6 vs 56.7%, P = 0.027). Conclusions This study demonstrated that ovulation induction with gonadotrophin therapy, in the context of appropriate monitoring, is a safe and effective treatment for young therapy‐naïve patients with anovulatory infertility.

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Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction

Cited by 37 publications

References 97 publications

Effects of Oral Contraceptives and Metformin on The Concentrations of Anti-Müllerian Hormone in Women with Polycystic Ovary Syndrome

Effects of Oral Contraceptives and Metformin on The Concentrations of Anti-Müllerian Hormone in Women with Polycystic Ovary Syndrome

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

The cumulative success of ovulation induction therapy with gonadotrophins in therapy‐naïve anovulatory women: An observational study

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