Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

Yıldızhan, Recep; Adalı, Ertan; Kolusarı, Ali; Kurdoğlu, Mertihan; Yıldızhan, Begüm; Şahin, H. Güler; Kamacı, Mansur

doi:10.1177/147323000803600605

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Adiponectin has many functions (174), including its ability to promote oocyte maturation and blastocyst formation (175), and is reduced in the circulation of women with PCOS (176), together with tumor necrosis factor-α-induced dysregulation of adiponectin secretion by PCOS adipocytes in vitro (177). In addition, leptin impairs FSH-stimulated steroidogenesis in human granulosa cells, thereby reducing ovarian responsiveness to FSH (178–181). Obesity also lowers LH pulse amplitude and alters LH pharmacokinetic structure (182, 183), contributing to reduced serum LH levels in obese women with PCOS (184, 185), who may be more susceptible to the modulatory effects of insulin excess than LH.…”

Section: Antral Follicle Developmentmentioning

confidence: 99%

Ontogeny of the ovary in polycystic ovary syndrome

Dumesic

Richards

2013

Fertility and Sterility

100

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Activation of primordial follicles into the growing pool, selection of the dominant follicle, and its eventual ovulation require complex endocrine and metabolic interactions as well as intraovarian paracrine signals to coordinate granulosa cell proliferation, theca cell differentiation, and oocyte maturation. Early preantral follicle development relies mostly upon mesenchymal-epithelial cell interactions, intraovarian paracrine signals, and oocyte-secreted factors, whereas development of the antral follicle depends on circulating gonadotropins as well as locally derived regulators. In women with polycystic ovary syndrome (PCOS), ovarian hyperandrogenism, hyperinsulinemia from insulin resistance, and altered intrafollicular paracrine signaling perturb the activation, survival, growth, and selection of follicles, causing accumulation of small antral follicles within the periphery of the ovary, giving it a polycystic morphology. Altered adipocyte-ovarian interactions further compound these adverse events on follicle development and also can harm the oocyte, particularly in the presence of increased adiposity. Finally, endocrine antecedents of PCOS occur in female infants born to mothers with PCOS, which suggests that interactions between genes and the maternal-fetal hormonal environment may program ovarian function after birth.

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Section: Antral Follicle Developmentmentioning

confidence: 99%

Ontogeny of the ovary in polycystic ovary syndrome

Dumesic

Richards

2013

Fertility and Sterility

100

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“…A low-dose Gn stimulation strategy for PCOS patients was recommended (16). As previously reported, it was suggested that a low starting Gn dose of < 150 IU/day and 25-IU incremental doses every third day should be considered in a COS protocol for PCOS patients with a high HOMA-IR score (42). It is necessary to decide on both the initial Gn dose and the incremental dose when a low-dose step-up regimen is used.…”

Section: Discussionmentioning

confidence: 99%

Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study

Wang²,

Liu³

et al. 2023

Front. Endocrinol.

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IntroductionInsulin resistance (IR) may play a central role in the pathophysiology of polycystic ovary syndrome (PCOS). Controlled ovarian stimulation (COS) in PCOS women in the setting of assisted reproductive technology (ART) is always a challenge for clinicians. However, it remains unclear whether IR in women with PCOS correlates with reduced ovarian sensitivity to exogenous gonadotropin (Gn). This study aimed to explore the association between homeostasis model assessment of insulin resistance (HOMA-IR) and ovarian sensitivity index (OSI).MethodsIn this retrospective cohort study, we explored the association between Ln HOMA-IR and Ln OSI based on smoothing splines generated by generalized additive model (GAM). Then the correlation between HOMA-IR and OSI was further tested with a multivariable linear regression model and subgroup analysis.Results1508 women with PCOS aged 20-39 years undergoing their first oocyte retrieval cycle were included consecutively between 2018 until 2022. We observed a negative association between Ln HOMA-IR and Ln OSI by using smoothing splines. In multivariable linear regression analysis, the inverse association between Ln HOMA-IR and Ln OSI was still found in PCOS women after adjustment for potential confounders (β = -0.18, 95% CI -0.25, -0.11). Compared with patients with the lowest tertile of HOMA-IR, those who had the highest tertile of HOMA-IR had lower OSI values (β = -0.25, 95% CI -0.36, -0.15).DiscussionOur study provided evidence for the inverse correlation between IR and the ovarian sensitivity during COS in PCOS women. Herein, we proposed new insights for individualized manipulation in PCOS patients with IR undergoing ART.

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“…The cumulative pregnancy rate after six treatment cycles was 53.1%, and 6.0% of the 136 clinical pregnancies were twins (Calaf Alsina et al, 2003). Another cohort study with a focus on BMI included 67 patients with PCOS in a low-dose step-up protocol with a starting dose of 50 IU recombinant FSH/day (Yildizhan et al, 2008). The median threshold recombinant FSH dose was 50 IU/day in non-obese (BMI <25 kg/m 2 ) patients compared with 75 IU/day in obese (BMI ≥25 kg/m 2 ) patients (P < 0.01).…”

Section: Gonadotrophinsmentioning

confidence: 99%

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

Petersen

Pedersen

et al. 2016

Reproductive BioMedicine Online

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Polycystic ovary syndrome (PCOS) affects 5-10% of women of reproductive age and is the most common cause of anovulatory infertility. The treatment approaches to ovulation induction vary in efficacy, treatment duration and patient friendliness. The aim was to determine the most efficient, evidence-based method to achieve mono-ovulation in women diagnosed with PCOS. Publications in English providing information on treatment, efficacy and complication rates were included until September 2015. Systematic reviews, meta-analyses and randomized controlled trials were favoured over cohort and retrospective studies. Clomiphene citrate is recommended as primary treatment for PCOS-related infertility. It induces ovulation in three out of four patients, the risk of multiple pregnancies is modest and the treatment is simple and inexpensive. Gonadotrophins are highly efficient in a low-dose step-up regimen. Ovulation rates are improved by lifestyle interventions in overweight women. Metformin may improve the menstrual cycle within 1-3 months, but does not improve the live birth rate. Letrozole is effective for ovulation induction, but is an off-label drug in many countries. Ovulation induction in women with PCOS should be individualized with regard to weight, treatment efficacy and patient preferences with the aim of achieving mono-ovulation and subsequently the birth of a singleton baby.

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Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

Cited by 7 publications

References 23 publications

Ontogeny of the ovary in polycystic ovary syndrome

Ontogeny of the ovary in polycystic ovary syndrome

Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study

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

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