Good clinical practice recommendations on management of infertility in patients from India with polycystic ovary syndrome

Malik, Sonia; Verma, Susheel; Jain, Kuldeep; Talwar, Pankaj; Dhorepatil, Bharati; Devi, G. Gayathiri; Jindal, Umesh; Prasad, Sudha; Nayar, Kanad Dev; Malhotra, Neena; Singh, Neeta; Radhakrishnan, Gita; Sharma, Rashmi; Wadhwa, Leena; Chandhiok, Nomita; Khanna, Gita; Sinha, Sushma

doi:10.4103/2394-4285.196786

Cited by 5 publications

(6 citation statements)

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“…LSM plus metformin arms had a statistically significantly higher number of menstrual cycles during six months compared to lifestyle plus placebo arms with a mean difference of 1.06 and P values of 0.006. Studies have shown diminished subcutaneous adipose tissue among subjects assigned lifestyle modification plus metformin compared to lifestyle plus placebo and had a mean difference of -92.49 cm² (P = 0.01) [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Management of Polycystic Ovary Syndrome: Effect of Pharmacotherapy, Lifestyle Modification, and Enhanced Adherence Counseling

Jungari¹,

Choudhary²,

Gill³

2023

Cureus

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IntroductionPolycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age in India, which often presents as menstrual irregularities, infertility, acanthosis nigricans, etc. Metabolic disturbances associated with PCOS predispose patients to cardiovascular diseases, which may be avoided by effective management. The aim of the current study was to evaluate the role of lifestyle modification (LSM) and metformin in PCOS management. MethodsThis is a retrospective cohort study conducted among 130 PCOS patients who attended the outpatient department of the tertiary care hospital in central India from October 2019 to March 2020. The study describes the effect of a combined package of LSM (physical exercise and dietary changes) and metformin on anthropometric, clinical, and biochemical parameters at three and six months. ResultsOut of the total 130 women, 12 were lost to follow-up and were omitted from further analysis. At six months of the treatment package (LSM, metformin, and enhanced adherence counseling (EAC)), a significant decrease was seen in body mass index, blood sugar, follicle-stimulating hormone, luteinizing hormone, and insulin. Following the intervention, the menstruation cycle became regular in 91% of the women while volume, theca, and appearance of polycystic ovaries on ultrasound decreased in 86% of women. Insulin resistance (IR) and hyperinsulinemia are the major causes of pathophysiological changes associated with PCOS. Metformin along with LSM primarily acts by decreasing IR, while EAC ensures treatment compliance. ConclusionMetformin along with LSM in the form of calories restricted, high-protein diet, and physical activity reduce IR and hyperandrogenaemia, resulting in improved anthropometric, glycemic indices, hormonal profiles, and features of hyperandrogenaemia. The combined therapy is beneficial to 85-90% of women with PCOS.

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Section: Discussionmentioning

confidence: 99%

Comprehensive Management of Polycystic Ovary Syndrome: Effect of Pharmacotherapy, Lifestyle Modification, and Enhanced Adherence Counseling

Jungari¹,

Choudhary²,

Gill³

2023

Cureus

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“…Good clinical practice recommendations on the treatment of infertility in patients from India with PCOS recommended the administration of LPS in subfertile PCOS women undergoing OI [20].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Rate Following Luteal Phase Support in Polycystic Ovary Women Using Letrozole With or Without Gonadotropin as Ovulation Induction

Alizzi

2018

Asian J Pharm Clin Res

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Objective: The objective of the study was to evaluate the effect of luteal phase progesterone supplementation on pregnancy rates in anovulatory infertile polycystic ovary women using letrozole with or without gonadotropin as ovulation induction (OI).Method: A prospective randomized clinical study conducted in the infertility clinic - Al-Yarmouk Teaching Hospital, Baghdad/Iraq from June 2016 to January 2018. A total of 149 infertile polycystic ovary women who achieved ovulation using letrozole alone or with gonadotropin as OI protocol enrolled. Accordingly, the study group divided into two: Group A (letrozole group, no=99) and Group B (letrozole gonadotropin group, no=50). After triggering with human Chorionic Gonadotropin, the women in each group were randomly divided into two subgroup women with luteal phase support (LPS) and women without. The primary outcome measure was pregnancy rate.Results: The study shows that pregnancy rate was higher with letrozole group using LPS although the difference did not reach statistical significant (p=0.08). After adjustment of possible confounders; patients receiving letrozole with gonadotropin with LPS had significantly higher successful pregnancy rate.Conclusion: Administration of LPS after OI in infertile polycystic ovarian syndrome women may improve pregnancy rate.

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“…The prevalence of PCOS in India has varied from 3.7% to 22.5% across Indian studies [2]. Prevalence of anxiety and depression has been reported to be 38.6% and 25.7% respectively [12].…”

Section: Sampling Methods and Sample Sizementioning

confidence: 99%

“…Formula used to calculate sample size was: n ≥ {p (1 -p)}/(ME/z α ) 2 where Z α is value of Z at two-sided alpha error of 5%, ME is margin of error and p is the prevalence of anxiety or depression.…”

Section: Sampling Methods and Sample Sizementioning

confidence: 99%

“…Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age [1]. In India, the prevalence of Polycystic Ovary syndrome was reported to be between 3.7% -22.5%, [2] and is characterized, as per the Rotterdam criteria, by presence of any two features of the following: irregular menstruation, signs of biochemical hyperandrogenism and /or polycystic ovarian morphology on ultrasound [3]. Apart from the typical clinical presentation such women also experience a wide range of symptoms such as infertility, presence of excessive thick, coarse hair in a male-like pattern at various 206 Relationship between Clinico-Socio-Demographic Factors and Psychology of Women Diagnosed with Polycystic Ovary Syndrome sites -face, neck, chest and back, excessive weight gain in a short span of time, acne, male pattern baldness with gradual disappearance of hair from areas of scalp as well as disturbed mental health [4].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between Clinico-Socio-Demographic Factors and Psychology of Women Diagnosed with Polycystic Ovary Syndrome

Bansal¹,

Sethi²,

Parasher³

et al. 2023

ujph

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Background: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting up to 22.5% of women of reproductive age. Women with PCOS experience high rates of depression and anxiety. Settings and Design: Cross sectional study design. Objective: Primary objective of study was to estimate the prevalence of depression, anxiety and stress among women with PCOS. Secondary objective was to analyze association of psychological factors (depression, anxiety and stress) with sociodemographic factors and clinical aspects among Indian women with PCOS. Methods: One hundred and four women in the reproductive age group (18-45 years) diagnosed with PCOS as per Rotterdam criteria, without any pre-existing psychiatric illness were interviewed for depression, anxiety and stress using DASS21 scale. Result: Out of 104 women with PCOS 46.16% suffered from mild to moderate levels of depression, 64.42% experienced (mild to extremely severe) anxiety while 53.85% reported varying degrees of stress. Women with higher BMI (overweight and obese), hirsutism scores and having acne were more susceptible to being depressed. The odds ratio for women experiencing depression were as follows: hirsutism scores was 1.113, being overweight, 5.023 (1.359 to 18.566), being obese was 3.298 (1.167 to 9.314), and having acne was 3.29 (1.267 to 8.541). Conclusion: It is observed a large percentage of women with PCOS suffer from psychological factors such as depression, anxiety and stress. Also, BMI, hirsutism and acne were found to be significant contributors to depression among women with PCOS. It is suggested that clinicians and healthcare practitioners develop and utilize a comprehensive approach in the management of PCOS based on biopsychosocial model of health.

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Good clinical practice recommendations on management of infertility in patients from India with polycystic ovary syndrome

Cited by 5 publications

References 0 publications

Comprehensive Management of Polycystic Ovary Syndrome: Effect of Pharmacotherapy, Lifestyle Modification, and Enhanced Adherence Counseling

Comprehensive Management of Polycystic Ovary Syndrome: Effect of Pharmacotherapy, Lifestyle Modification, and Enhanced Adherence Counseling

Pregnancy Rate Following Luteal Phase Support in Polycystic Ovary Women Using Letrozole With or Without Gonadotropin as Ovulation Induction

Relationship between Clinico-Socio-Demographic Factors and Psychology of Women Diagnosed with Polycystic Ovary Syndrome

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