Ovulation Induction for the General Gynecologist

Lindheim, Steven R.; Glenn, Tanya L.; Smith, Megan; Gagneux, Pascal

doi:10.1007/s13224-018-1130-8

Cited by 12 publications

(19 citation statements)

References 60 publications

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“…Independent of the insulin status, current approaches to induce ovulation rely either on exogenous gonadotropin injection or on the anti-estrogenic activity necessary to stimulate the hypothalamic–pituitary response [ 34 , 37 ]. Clomiphene citrate is still the most widely used drug to stimulate ovulation [ 38 ]. It is a SERM and binds to the estrogen receptors in the hypothalamus, preventing the negative feedback of estrogens and allowing the release of FSH, which stimulates the follicles to grow.…”

Section: Discussionmentioning

confidence: 99%

D-chiro-inositol Induces Ovulation in Non-Polycystic Ovary Syndrome (PCOS), Non-Insulin-Resistant Young Women, Likely by Modulating Aromatase Expression: A Report of 2 Cases

Espinola¹,

Laganà

Bilotta³

et al. 2021

Am J Case Rep

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Case series Patients: Female, 19-year-old • Female, 23-year-old Final Diagnosis: Anovulation Symptoms: Oligomenorrhea Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unknown etiology Background: Anovulation consists in the lack of oocyte release during the menstrual cycle, leading to an irregular menstrual cycle. Untreated chronic anovulation is one of the major causes of female infertility and can induce hypoestrogenism. Different etiological factors can contribute to anovulation; therefore, the clinical approaches to manage this condition should take into account the specific patient characteristics. Oral ovulation-inducing agents are first-line treatments for most anovulatory patients. Drugs used include selective estrogen receptor modulators (SERMs) such as clomiphene citrate and aromatase inhibitors (AIs) such as letrozole. The latter, in particular, halts the estrogen biosynthesis by blocking the activity of steroidogenic enzyme aromatase, which catalyzes the conversion of androgens to estrogens. Similarly, d -chiro-inositol (DCI) modulates the activity of aromatase by reducing the corresponding gene expression, and DCI supplementation was successfully used to induce ovulation in anovulatory PCOS patients. Here, we report the use of DCI to induce ovulation in non-PCOS anovulatory oligomenorrheic women. Case Reports: Two young non-PCOS anovulatory oligomenorrheic women received treatment with high-dose (1200 mg) DCI for 6 weeks. Based on an initial evaluation, both patients had normal hormone levels and were non-insulin-resistant. Ovulation assessment was based on the increment of progesterone and LH levels, as well as on the endometrial thickening. Also, the treatment with DCI resulted in a reduction of testosterone levels relative to baseline values. Conclusions: After the 6-week treatment with 1200 mg DCI, ovulation was restored in both women, as confirmed by increased progesterone and LH and endometrial thickening.

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Section: Discussionmentioning

confidence: 99%

D-chiro-inositol Induces Ovulation in Non-Polycystic Ovary Syndrome (PCOS), Non-Insulin-Resistant Young Women, Likely by Modulating Aromatase Expression: A Report of 2 Cases

Espinola¹,

Laganà

Bilotta³

et al. 2021

Am J Case Rep

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“…Ovulation results from coordinated signaling by the hypothalamus-pituitary axis, ovarian granulosa cells, ovarian theca cells, and the developing follicle ( 66 ). In women with PCOS, this process malfunctions because of the abnormal development and failure in selecting a dominant follicle, thus inducing anovulation ( 67 ). The ovulatory dysfunction is characterized by increased activation of the follicles, followed by arrested growth before the maturation of these follicles can occur.…”

Section: Introductionmentioning

confidence: 99%

Impact of Increased Oxidative Stress on Cardiovascular Diseases in Women With Polycystic Ovary Syndrome

et al. 2021

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Polycystic ovary syndrome (PCOS) is a complex disorder that affects around 5% to 10% of women of childbearing age worldwide, making it the most common source of anovulatory infertility. PCOS is defined by increased levels of androgens, abnormal ovulation, irregular menstrual cycles, and polycystic ovarian morphology in one or both ovaries. Women suffering from this condition have also been shown to frequently associate certain cardiovascular comorbidities, including obesity, hypertension, atherosclerosis, and vascular disease. These factors gradually lead to endothelial dysfunction and coronary artery calcification, thus posing an increased risk for adverse cardiac events. Traditional markers such as C-reactive protein (CRP) and homocysteine, along with more novel ones, specifically microRNAs (miRNAs), can accurately signal the risk of cardiovascular disease (CVD) in PCOS women. Furthermore, studies have also reported that increased oxidative stress (OS) coupled with poor antioxidant status significantly add to the increased cardiovascular risk among these patients. OS additionally contributes to the modified ovarian steroidogenesis, consequently leading to hyperandrogenism and infertility. The present review is therefore aimed not only at bringing together the most significant information regarding the role of oxidative stress in promoting CVD among PCOS patients, but also at highlighting the need for determining the efficiency of antioxidant therapy in these patients.

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“…Approximately 20% of the patients is refractory to CC regimen. Although the maximum dose of CC is 250 mg/day, clinicians prefer not to use doses above 150 mg/day and these patients are regarded as CC resistant [3].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study between Stair-step Protocol of Clomiphene Citrate and Combined Clomiphene and Gonadotropins for Induction of Ovulation in Women with Polycystic Ovary Syndrome

Sallam

Elshwaikh

Hodeib

et al. 2021

JAMMR

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Background: Polycystic ovary syndrome affects 7 to 8% of women and may be the most common cause of female infertility. Anovulation, early pregnancy loss has all been implicated in the low fecundity. The aim of this study was to compare between the use of clomiphene citrate by stair-step protocol and use of combined clomiphene citrate and gonadotropins in patients with polycystic ovary syndrome. Methods: This randomized non blinded controlled clinical study was carried out on 60 Patients who was selected from outpatient clinic of Tanta university hospitals from September 2019 to September 2020. Selected patients were allocated into two groups with 1:1 ratio. Group (A): was subjected to clomiphene citrate stair-step stimulation protocol. Group (B): was subjected to combined clomiphene and gonadotropins stimulation protocol. Results: Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Age, BMI and duration of infertility). Significance defined by p < 0.05. Chi-square analysis was used for the categorical variable (number of MGF). Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Size of larger follicle and Endometrial thickness), Chi-square analysis was used for the categorical variables (Ovulation rate and Pregnancy rate). Mann-Whitney U test was used to compare quantitative data which are not normally distributed (FSH and LH). Student t test was used for the quantitative data which are normally distributed (Prolactin and TSH). Conclusions: In conclusion, the CC stair‐step protocol is a safe, simple option for the management of PCOS patients, having a larger number of mature Grafian follicle, lower endometrial thickness and higher ovulation rate compared to combined clomophine and gonadotrophin protocol.

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Ovulation Induction for the General Gynecologist

Cited by 12 publications

References 60 publications

D-chiro-inositol Induces Ovulation in Non-Polycystic Ovary Syndrome (PCOS), Non-Insulin-Resistant Young Women, Likely by Modulating Aromatase Expression: A Report of 2 Cases

D-chiro-inositol Induces Ovulation in Non-Polycystic Ovary Syndrome (PCOS), Non-Insulin-Resistant Young Women, Likely by Modulating Aromatase Expression: A Report of 2 Cases

Impact of Increased Oxidative Stress on Cardiovascular Diseases in Women With Polycystic Ovary Syndrome

Comparative Study between Stair-step Protocol of Clomiphene Citrate and Combined Clomiphene and Gonadotropins for Induction of Ovulation in Women with Polycystic Ovary Syndrome

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