Randomized Trial Comparing the Effect of Endometrial Shedding With Medroxyprogesterone Acetate With Random Start of Clomiphene Citrate for Ovulation Induction in Oligo-ovulatory and Anovulatory Women

Jones, Claire; Garbedian, Kimberly; Dixon, Marjorie; Murphy, Kellie; Shapiro, Heather

doi:10.1016/j.jogc.2016.01.009

Cited by 2 publications

(2 citation statements)

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“…Progestins are also widely used to induce withdrawal bleed before infertility treatment (Diamond et al, 2012). However, there has been increasing concern about potential adverse effects of their use on pregnancy outcomes after infertility treatment (Diamond et al, 2012;Legro et al, 2015Legro et al, , 2016Jones et al, 2016). IVF is a common infertility treatment for women with PCOS, and is often used in those who fail to conceive with ovulation induction and those who have concomitant infertility factors.…”

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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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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“…Aromatase blockers Androstenedione and testosterone are changed into oestrone and oestradiol, respectively, by the enzyme aromatase. By decreasing the negative feedback to the hypothalamic-pituitary axis by preventing the synthesis of oestrogen, aromatase inhibitors increase endogenous FSH secretion (18) . Patients with PCOS who were clomiphene citrate resistant responded favourably to letrozole, ovulating at a rate of 70-84% and became pregnant at a rate of 20-27% each cycle.…”

Section: Medical Options For Ovulation Induction Anti-oestrogens Clom...mentioning

confidence: 99%

Ovulation Induction Techniques in Women with Polycystic Ovary Syndrome: A Review of literature

Serour¹,

Shahat²,

Mohammed³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Amenorrhea, oligomenorrhea, and irregular uterine bleeding are a few of the many clinical signs of anovulation, which is fairly prevalent. Anovulation can result from a number of mechanisms. Polycystic ovarian syndrome (PCOS), which has clinical repercussions and is the most prevalent chronic anovulatory illness, affects 6 to 10% of people worldwide. While a variety of factors may eventually lead to PCOS, a number of therapeutic strategies have been documented in the literature, frequently without addressing the underlying reason. Ovulation Induction (OI) is a series of methods used by PCOS-afflicted women who want to get pregnant but are unable to do so naturally. Aim: The current review discusses OI in PCOS-affected women, with an emphasis on their effectiveness and application. Development: Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, and EMBASE, up to November 2022, search by keyword of "Polycystic Ovarian Syndrome" and "Ovulation Induction". Conclusion:The likelihood of a good pregnancy outcome in PCOS patients receiving OI should be able to be determined by clinicians, taking into account age, body weight, the various protocols employed, and the length of infertility. A recommendation to a specialised fertility clinic for in vitro fertilisation would be a good backup plan if the aforementioned therapies don't succeed in conceiving a child. Future research should evaluate the results of the various OI techniques outlined above and stratify the efficiency of laparoscopic ovarian drilling in comparison to current medical therapy.

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Randomized Trial Comparing the Effect of Endometrial Shedding With Medroxyprogesterone Acetate With Random Start of Clomiphene Citrate for Ovulation Induction in Oligo-ovulatory and Anovulatory Women

Cited by 2 publications

References 25 publications

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

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

Ovulation Induction Techniques in Women with Polycystic Ovary Syndrome: A Review of literature

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