Polycystic Ovary Syndrome

McCartney, Christopher R.; Marshall, John C.

doi:10.1056/nejmcp1514916

Cited by 466 publications

(403 citation statements)

References 53 publications

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“…Yet, as aforementioned, whether metformin is of benefit in treating PCOS remains unclear [37,38]. The majority of therapeutic studies have been small in size and have used metformin for a relatively brief period of time [33]. Hence, at present, a paucity of reliable clinical data does not permit firm indication for broad use of metformin to treat many of the reproductive and metabolic abnormalities associated with PCOS, as discussed below.…”

Section: Impact Of Metformin On the Clinical Features Of Pcosmentioning

confidence: 99%

“…Effects on androgens Metformin lowers testosterone levels by approximately 20 to 25% in women with PCOS [33]. This effect may be more pronounced among non-obese women with PCOS [18].…”

Section: Impact Of Metformin On Reproductive Features Of Pcosmentioning

confidence: 99%

“…Original studies demonstrated a reduction in CYP17 (also known as CYP17A1) activity in women with PCOS upon metformin treatment consequent to lowering of serum insulin levels [16]. However, there is evidence that metformin directly inhibits ovarian steroidogenesis [33,34]. Inhibition of mitochondrial Complex I has been implicated as one potential mechanism for this action [35].…”

Section: Mechanisms Of Metformin Action In Target Tissues Relevant Tomentioning

confidence: 99%

“…However, studies investigating the impact of metformin on diabetes risk specifically in women with PCOS have not been performed. Nonetheless, considering that these women are at very high risk for developing diabetes [5,6], it has been suggested that they will benefit from metformin therapy in case of glucose intolerance to reduce diabetes risk [33].…”

Section: Impact Of Metformin On Metabolic Features Of Pcosmentioning

confidence: 99%

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Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Sam

Ehrmann

2017

Diabetologia

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Polycystic ovary syndrome (PCOS), the most common hormonal disorder among women of reproductive age, has various metabolic and reproductive consequences. Metformin was originally shown to lower testosterone levels in women with PCOS in the 1990s, an effect presumably related to its insulin sensitising actions. However, the precise mechanisms of metformin action in PCOS remain unclear and there is considerable heterogeneity in the clinical response to this therapy in women with PCOS. Recent evidence indicates that genetic factors may play a significant role in predicting response to metformin therapy in PCOS and future studies are needed to further identify women who are most likely to benefit from this therapy. At present, there is no clear evidence to support broad metformin use in PCOS. Well-designed prospective trials are needed to establish clear benefit for metformin use in the treatment of the reproductive and metabolic consequences associated with PCOS.

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Section: Impact Of Metformin On the Clinical Features Of Pcosmentioning

confidence: 99%

“…Effects on androgens Metformin lowers testosterone levels by approximately 20 to 25% in women with PCOS [33]. This effect may be more pronounced among non-obese women with PCOS [18].…”

Section: Impact Of Metformin On Reproductive Features Of Pcosmentioning

confidence: 99%

Section: Mechanisms Of Metformin Action In Target Tissues Relevant Tomentioning

confidence: 99%

Section: Impact Of Metformin On Metabolic Features Of Pcosmentioning

confidence: 99%

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Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Sam

Ehrmann

2017

Diabetologia

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“…Oral contraceptives (OCs) are commonly used to resolve the classic symptom(s) of PCOS, such as hirsutism, acne and irregular menses (McCartney and Marshall, 2016). Progestins are also widely used to induce withdrawal bleed before infertility treatment (Diamond et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

Wei

Shi

et al. 2016

Hum. Reprod.

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STUDY QUESTION: Do oral contraceptives (OCs) and progestins impact live birth rate of IVF when used for cycle scheduling in women with polycystic ovary syndrome (PCOS)?SUMMARY ANSWER: OCs used for scheduling IVF cycle were associated with lowered rates of pregnancy and live birth after fresh embryo transfer, whereas progestins used for this purpose yield higher rates of pregnancy and live birth than OCs.WHAT IS KNOWN ALREADY: Due to oligo-menorrhea in PCOS, OCs and progestin are extensively used to schedule the start of an IVF cycle in women with PCOS. Little is known about the effect of such pretreatments on outcomes, especially, the rate of live birth.STUDY DESIGN, SIZE, DURATION: This was a nested cohort study and secondary analysis of a multicenter randomized trial, which was designed to compare live birth rate after fresh embryo transfer vs frozen embryo transfer (FET) in women with PCOS (Frefro-PCOS). A total of 1508 women were enrolled from 14 centers between June 2013 and May 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS:At the discretion of local investigators, subjects were instructed to wait for spontaneous menses (Control group, n = 323), or were prescribed progestins (P group, n = 283) or OCs (OCs group, n = 902) to induce menstruation prior to the start of ovarian stimulation. GnRH antagonist protocol was initiated at Day 2 or 3 of induced or spontaneous menses cycle. The rates of pregnancy, pregnancy loss and live birth after either fresh embryo transfer or FET were compared among these three groups.MAIN RESULTS AND THE ROLE OF CHANCE: With fresh embryo transfer, women with OC-induced menses had lower rates of clinical pregnancy (48.8% vs 63.6%, relative rate (RR): 0.77, 95% CI: 0.66-0.89) and live birth (36.1% vs 48.1%, RR: 0.75, 95% CI: 0.61-0.92) than women with spontaneous menses. With freeze-all and deferred FET, women with OC-induced menses had a similar pregnancy rate but a higher pregnancy loss rate (27.7% vs 13.0%, RR: 2.13, 95% CI: 1.28-3.52) after FET than women with spontaneous menses. The live birth rate after FET in women with OC-induced menses, progestin-induced menses and spontaneous menses was 49.4%, 50.7% and 60.2%, respectively (P = 0.06). Progestin-induced menses was associated with similar rates of pregnancy, pregnancy loss and live birth after transfer © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com of either fresh or frozen embryos compared with spontaneous menses. Multivariate logistic regression analysis showed that OCs used for menses induction was associated with lower rate of live birth. LIMITATIONS, REASONS FOR CAUTION:The methods for menses induction were not assigned randomly, thus selection bias was highly likely because of the study design and significant differences that were observed in the baseline characteristics of the women in the different groups. The mean BMI in this study population was relative...

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Molecular Imaging of Ovarian Follicles and Tumors With Near‐Infrared II Bioconjugates

Wang,

Lu,

Chen

et al. 2024

Advanced Materials

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Follicular tracking is typically conducted using ultrasound technology, but its effectiveness is constrained by limited resolution. High‐resolution imaging of deep tissues can be accomplished using luminescence imaging in the near‐infrared II window (NIR‐II, 1000–1700 nm); however, the contrast agents that are used lack specificity. Here, it is reported that the FDA‐approved indocyanine green (ICG)‐conjugated recombinant human chorionic gonadotropin (hCG) protein can target early follicles with long‐term effectiveness. A novel high‐resolution NIR‐II imaging approach is developed for monitoring follicular development as well as ovulation using multi‐color imaging of ovarian vessels with a combination of non‐overlapping downconversion nanoparticles (DCNPs). The results showed that the ability to monitor early follicles of around 50 µm in diameter exceeded the spatial and temporal resolution of ultrasound or MRI without the reproductive damage associated with computed tomography radiation, and this enabled the clinical identification of the follicular reserve in patients with infertility diseases such as polycystic ovary syndrome (PCOS). In addition, NIR‐II imaging clearly targeted ovarian tumors and showed micro‐metastatic lesions, thus providing a new tool for monitoring tumors in vivo and guiding surgical resection.

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Polycystic Ovary Syndrome

Cited by 466 publications

References 53 publications

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

Molecular Imaging of Ovarian Follicles and Tumors With Near‐Infrared II Bioconjugates

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