Gonadotrophins for ovulation induction in women with polycystic ovary syndrome

Weiss, N S; Kostova, Elena; Nahuis, Marleen; Mol, Ben W.; Veen, Fulco van der; Wely, Madelon van

doi:10.1002/14651858.cd010290.pub3

Cited by 39 publications

(44 citation statements)

References 55 publications

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“…Ovarian stimulation: Clomiphene citrate or gonadotrophins is commonly used as an attempt to induce ovulation. Although CC with IUI in ovulatory couples show more effective than timed intercourse in natural cycles, ovarian stimulation with gonadotrophins is reported superior than CC [1, 4,43,44]. Similarly, our results showed significantly higher CPR for women stimulated with gonadotrophins than those stimulated with CC (13.9% versus 9.5%, P < 0.05).…”

Section: Cycle Relevant Factorssupporting

confidence: 60%

What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

Herrero²,

Zhu

et al. 2019

Preprint

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Background: Although it is well documented on the study of intrauterine insemination (IUI), the effectiveness of various factors on IUI treatment is inconsistent. The aim of this study is to investigate the various factors that influence IUI outcome and attempt to set up optimal protocol for IUI patients. Methods: This was a retrospective cohort study including1948 cycles (843 couples) that performed IUI between January 2012 and December 2013 in a single centre. Various factors that may affect IUI outcome were analyzed using chi-square. Moreover, we conducted multiple logistic regression to evaluate the main factors on the effects of IUI outcome. In addition, follicle growth and endometrial development relevant to conception were also assessed among protocols. Results: The clinical pregnancy rate (CPR) per cycle was 12.5% in the present study. Seven factors were identified to be associated significantly with CPR by multivariate logistic regression analysis: female age, type of infertility, ovarian stimulation protocol, preovulatory follicles, endometrial thickness, growing length of preovulatory follicle, post-washed total motile spermatozoa count (TMSC). Comparing with 11 days or less, more than 15 days for ovarian response and endometrial development before insemination induced a better success rate. Although ovarian stimulation with gonadotrophin or letrozole induced higher CPR when comparing to stimulation with clomiphene citrate or without stimulation, ovarian stimulation with letrozole was superior to gonadotrophin by its similar CPR to gonadotrophin but lower follicle number, without the risk of multiple pregnancy. Women younger than 41 years with elevated endometrial thickness inseminated with TMSC ≥ 4.0 million had better chance to obtain pregnancy. Number of treatment cycle was not a factor to affect CPR, with a stable CPR in the first four cycles. Conclusions: We conclude that women no more than 41 years old are suitable to perform at least 4 cycles of IUI before proceeding to IVF. The optimized IUI treatment requires ovarian stimulation with letrozole to induce one/two follicles and fertilize with four or more million motile spermatozoa and an elevated endometrium on day 15 or after in the cycle. Key words: infertility, intrauterine insemination, effective factors, clinical pregnancy rate.

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Section: Cycle Relevant Factorssupporting

confidence: 60%

What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

Herrero²,

Zhu

et al. 2019

Preprint

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“…Furthermore, estradiol decreased the secretion of pituitary FSH due to negative feedback regulation, and the follicles lacked FSH stimulation and grew slowly, leading to the accumulation of preantral follicles and small sinusoidal follicles. The immaturity of follicles resulted in the accumulation of a large number of sinusoidal follicles and the formation of a unique polycystic ovary [31,32]. Insulin is also one of the most powerful factors affecting plasma plasminogen activator inhibitor-1 (PAI-1).…”

Section: Effect Of Ir On the Development Of Ovarian Folliclesmentioning

confidence: 99%

Expression and Contribution of Insulin Signaling Pathway to the Development of Polycystic Ovary Syndrome

Q¹,

Zhang²,

Zhao³

et al. 2020

Polycystic Ovarian Syndrome

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Our previous studies have demonstrated that insulin signaling pathway has an important role in the pathophysiology of polycystic ovary syndrome (PCOS), including phosphatidylinositol 3-kinase and protein kinase B signaling, which is critically implicated in insulin resistance, androgen secretion, obesity, and follicular development. PCOS manifests as defective ovarian steroid biosynthesis and hyperandrogenemia, and 50-70% of women with PCOS exhibit insulin resistance and are hyperinsulinemic, indicating that insulin resistance and hyperinsulinism may have an important role in the pathophysiology of PCOS. Therefore, the present article will review the contribution of insulin signaling pathway to the abnormal regulation of follicular growth and ovulation, which can cause corresponding reproductive endocrine diseases and affect women's reproductive health. Exploring the mechanism of insulin signaling pathway in PCOS will help not only to understand the physiology and pathology of follicular development but also to provide theoretical basis for the treatment of PCOS.

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“…A 5-10% loss in BW over a period of six months, regardless of body mass index (BMI), may be associated with improvements in central obesity, hyperandrogenism, and ovulation rate [18,19]. For women who desire to become pregnant, clomiphene citrate (CC) has been long considered as the front-line treatment based on its high cost-effectiveness [2,[19][20][21][22][23][24], although recommendations from the international evidence-based guideline for the assessment and management of PCOS favored that letrozole should be considered first line pharmacological treatment for ovulation induction in women with PCOS with anovulatory infertility and no other infertility factors to improve ovulation, pregnancy and liver birth rates [10]. CC is a competitive inhibitor of estrogen that binds to estrogen receptors (ERs), resulting in an increase of the hypothalamic gonadotropin-releasing hormone (GnRH) pulse frequency and circulating concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).…”

Section: Introductionmentioning

confidence: 99%

“…Most importantly, the cost of CC is very low. CC treatment also has fewer side effects and a lower chance of multiple pregnancies (2-13%) compared to other medical treatments, such as using GnRH agonists or antagonists, aromatase inhibitors (AIs), and gonadotropin stimulation treatments [2,[19][20][21][22][23][24]. The initial dose of CC is 50 mg per day.…”

Section: Introductionmentioning

confidence: 99%

“…Directly using another agent alone in place of CC in the management of POCS women is also widely used. These agents include metformin [18,19,25,[30][31][32][33][34][35][36][37]40]; rosiglitazone or rosiglitazone alone [21,33,40]; and AIs, such as letrozole [21,23,42] and gonadotropins [20,[22][23][24][26][27][28][29][30][31][32][33][34][35][36][37]. A Cochrane Database Systematic Review in 2017 suggested the potential benefits of a combination of metformin and CC in clinical pregnancy and ovulation among PCOS women with infertility compared to the use of CC alone [40].…”

Section: Introductionmentioning

confidence: 99%

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Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

Seow¹,

Chang

Chen

et al. 2020

IJMS

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Polycystic ovary syndrome (PCOS) is a common endocrinopathy, characterized by chronic anovulation, hyperandrogenism, and multiple small subcapsular cystic follicles in the ovary during ultrasonography, and affects 5–10% of women of reproductive age. PCOS is frequently associated with insulin resistance (IR) accompanied by compensatory hyperinsulinemia and, therefore, presents an increased risk of type 2 diabetes mellitus (DM). The pathophysiology of PCOS is unclear, and many hypotheses have been proposed. Among these hypotheses, IR and hyperandrogenism may be the two key factors. The first line of treatment in PCOS includes lifestyle changes and body weight reduction. Achieving a 5–15% body weight reduction may improve IR and PCOS-associated hormonal abnormalities. For women who desire pregnancy, clomiphene citrate (CC) is the front-line treatment for ovulation induction. Twenty five percent of women may fail to ovulate spontaneously after three cycles of CC treatment, which is called CC-resistant PCOS. For CC-resistant PCOS women, there are many strategies to improve ovulation rate, including medical treatment and surgical approaches. Among the various surgical approaches, one particular surgical method, called laparoscopic ovarian drilling (LOD), has been proposed as an alternative treatment. LOD results in an overall spontaneous ovulation rate of 30–90% and final pregnancy rates of 13–88%. These benefits are more significant for women with CC-resistant PCOS. Although the intra- and post-operative complications and sequelae are always important, we believe that a better understanding of the pathophysiological changes and/or molecular mechanisms after LOD may provide a rationale for this procedure. LOD, mediated mainly by thermal effects, produces a series of morphological and biochemical changes. These changes include the formation of artificial holes in the very thick cortical wall, loosening of the dense and hard cortical wall, destruction of ovarian follicles with a subsequently decreased amount of theca and/or granulosa cells, destruction of ovarian stromal tissue with the subsequent development of transient but purulent and acute inflammatory reactions to initiate the immune response, and the continuing leakage or drainage of “toxic” follicular fluid in these immature and growth-ceased pre-antral follicles. All these factors contribute to decreasing local and systemic androgen levels, the following apoptosis process with these pre-antral follicles to atresia; the re-starting of normal follicular recruitment, development, and maturation, and finally, the normalization of the “hypothalamus–pituitary–ovary” axis and subsequent spontaneous ovulation. The detailed local and systematic changes in PCOS women after LOD are comprehensively reviewed in the current article.

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Gonadotrophins for ovulation induction in women with polycystic ovary syndrome

Abstract: Gonadotrophins for ovulation induction in women with polycystic ovary syndrome (Review)

Cited by 39 publications

References 55 publications

What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

Expression and Contribution of Insulin Signaling Pathway to the Development of Polycystic Ovary Syndrome

Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

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