Polycystic ovarian syndrome: Treatment options for infertility

INTRODUCTIONPolycystic ovarian syndrome (PCOS) is the commonest hyperandrogenic disorder in women and one of the most common causes of anovulatory infertility, with an estimated prevalence of 4-7% worldwide. 1 It is an overdiagnosed and disproportionately treated condition.Lifestyle modification, weight loss, and exercise form the first line of treatment in infertile women with PCOS. 2The recommended first-line drug for ovulation induction remains clomiphene citrate (CC), while metformin is helpful in cases with glucose intolerance, or those with a BMI >35 kg/m. 3 ABSTRACT Background:The current study aims to estimate additional values of laparoscopic intervention for diagnosis and treatment of concomitant pelvic pathologies among infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS) subjected to laparoscopic ovarian drilling (LOD) in comparison to non-PCOS infertile women subjected to diagnostic/therapeutic laparoscopy. Methods: A prospective cross sectional observational study was carried out in the Endoscopic unit of a tertiary care university hospital. The study included 232 infertile women planned for laparoscopy were divided into a study group A (116 cases) with clomiphene-resistant PCOS and a control group B (116 cases) without PCOS. Each group was further subdivided into two subgroups according to the presence and absence of risk factors (RF) for adhesion formation. Diagnostic/operative laparoscopy was done. The main study outcome was the prevalence of any pelvic abnormalities seen during laparoscopy. Results: Both groups showed insignificant difference regarding socio-demographic history and basic data. Laparoscopy detected pelvic pathologies in 44 cases (37.9%) and 86 cases (74.1%) in both groups respectively. In group A, we diagnosed pelvic pathologies in 29 (32.6%) and 15 (55.6%) cases with and without RF respectively while in group B they were diagnosed in 76 (84.4%) and 10 (38.5%) cases with and without RF respectively. If compared to women with unexplained infertility, PCO patients without risk factors have an insignificant but higher prevalence of pelvic abnormalities. All concomitant pelvic pathologies in both groups were treated on a one-stop (see and treat) basis. Conclusions: Detection and proper management of associated pelvic pathologies at laparoscopy is a valuable additional advantage of LOD particularly in women with positive risk factors. LOD plus see and treat associated pathologies is a time saving and prompt management approach for women with PCO-associated infertility.

Section: Introductionmentioning

confidence: 99%

Laparoscopic ovarian drilling-plus: a one-stop management approach for PCO-associated infertility

Darwish

Kamel

Othman

et al. 2017

“…1 The principal features of PCOD include androgen excess, ovulatory dysfunction, and/or polycystic ovaries. 2 PCOD is also associated with insulin resistance (IR), obesity and lipid metabolism disorders, as well as infertility, although these findings have not been addressed in the Rotterdam criteria. 3 Recent studies suggest that anovulation resulting from ovarian follicle abnormalities in PCOD patients is 2-fold of normal ovaries.…”

Section: Introductionmentioning

confidence: 99%

“…6 The second-line treatment involves gonadotropins or laparoscopic ovarian drilling (LOD). 2 The main drawbacks of LOD are the possibility of occurrence of premature ovarian failure, decrease ovarian reserve and adhesions. 7,8 This study aims to assess the rate of spontaneous ovulation and pregnancy in patients with PCOD.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous ovulation and pregnancy in women with polycystic ovarian disease; a cross sectional study

Sleem

Mohamed

Zakherah

et al. 2018

INTRODUCTIONPolycystic ovary disease (PCOD) is the most common endocrine disorder in women of reproductive age, with a prevalence of approximately 5-10%. 1 The principal features of PCOD include androgen excess, ovulatory dysfunction, and/or polycystic ovaries. 2PCOD is also associated with insulin resistance (IR), obesity and lipid metabolism disorders, as well as infertility, although these findings have not been addressed in the Rotterdam criteria.3 Recent studies suggest that anovulation resulting from ovarian follicle abnormalities in PCOD patients is 2-fold of normal ovaries.Firstly, early follicular growth is excessive, thus women with PCOD are characterized by an excessive number of small antral follicles. Secondly, the selection of one follicle and its further maturation to a dominant follicle does not occur. This abnormality in the folliculogenesis leads to menstrual dysfunction presented as oligomenorrhea or amenorrhea. 4 A related mechanism of ABSTRACT Background: Polycystic ovary disease (PCOD) is the most common endocrine disorder in women of reproductive age, with a prevalence of approximately 5-10%. This study aims to assess the rate of spontaneous ovulation and pregnancy in patients. The present study was a cross sectional study conducted at Woman's Health Hospital, Assiut University, Assiut, Egypt. Methods:The current study was a cross sectional study carried out in Assiut Women's Health Hospital between the 1 st October 2016 and 31 st July 2017. The patients were selected as infertile patients with PCOD. The patient ages range between 20 and 35 years. The BMI is between 18 and 30 Kg/m 2 . The main outcome measure was the rate of spontaneous ovulation and spontaneous pregnancy in the 3 cycles. Results: The mean age of the study participants was 26.64±4.59 years and the mean BMI was 24.46±2.62Kg/m 2 . The sonographic ovarian volume was 12.47±0.69 mm 3 for the right ovary and 12.74±0.73 mm 3 for the left ovary. No difference in the serum FSH, LH, FSH/LH ratio and prolactin over the 3 consecutive cycles. The rate of spontaneous ovulation in the 3 cycles was 6 women (8.6%) and 2 cases (2.8%) became pregnant spontaneously during the study period. There is no statistical significant difference between ovulating and non-ovulating women according to the BMI and ovarian volume. Conclusions: The present study concluded that the rate of spontaneous ovulation was 8.6% in women with PCOD within 3 cycles with no adverse effects of drugs or surgical interference.

“…PCOS is a complex disease, and treatment should include interventions to address the problems of infertility, hyperandrogenism, obesity, insulin resistance, and other features. 18 Often a single intervention may not address this issue, and a combination of two may have a beneficial effect. The treatment options for infertility include lifestyle modification (diet and exercise), ovulation induction (clomiphene citrate [CC] and other medications like metformin, anastrozole, tamoxien, gonadotropins surgical, laparoscopic ovarian drilling (LOD), ovulation induction with homologous intrauterine insemination (IUI), in vitro fertilization (IVF).…”

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confidence: 99%

“…The treatment options for infertility include lifestyle modification (diet and exercise), ovulation induction (clomiphene citrate [CC] and other medications like metformin, anastrozole, tamoxien, gonadotropins surgical, laparoscopic ovarian drilling (LOD), ovulation induction with homologous intrauterine insemination (IUI), in vitro fertilization (IVF). [18][19][20][21] The aim and objective of our study was to study the effect of letrozole alone on induction of ovulation and clinical pregnancy in PCOD patients, to study the effect of letrozole in combination with HMG on induction of ovulation and clinical pregnancy in PCOD patients and to compare the effects of letrozole alone and letrozole in combination with HMG on induction of ovulation and clinical pregnancy in PCOD patients.…”

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confidence: 99%

Effects of letrozole alone or letrozole in combination with low-dose intramuscular injection of human menopausal gonadotropin on ovulation and pregnancy of 150 patients with polycystic ovary syndrome

Ahmad

Muzaffar

Bashir

et al. 2020

Background: Objective of the study was to explore the effects of letrozole (LE) in combination with low-dose intramuscular injection of human menopausal gonadotropin (HMG) on the ovulation induction and pregnancy of patients with polycystic ovary syndrome (PCOS).Methods: The study comprised of 150 couples who were randomly divided into two groups of 75 each. Group “A” received letrozole (LE) in a dose of 2.5 mg to 5mg /d. LE was started orally starting on 3rd to 5th day of menstrual cycle for 5 consecutive days. Group “B” received letrozole in a dose of 2.5 to 5 mg/day starting on the 3rd to 5th day of menstrual cycle for 5 consecutive days. Starting from the day of oral administration of letrozole, 75 IU HMG was injected intramuscularly on alternate days for 5 consecutive doses. The ovulation induction parameters and pregnancy outcomes were observed.Results: The Group A (LE group) had the most completed cycle (310 cycles), 157 (52.3%) of which had ovulation. The Group B (LE+HMG) group completed the fewest cycles (258 cycles), with 168 (65.1%) of them ovulating. This difference was statistically significant (P<0.05). On HCG injection day, both the endometrial thickness (11.5±1.2) and number of mature follicles (2.1±1.3) of the Group B were significantly higher than those of Group A (P<0.001), but the follicle diameters were similar (P>0.05) The pregnancy rate of the Group B was 54.7%, which was significantly higher than that of the Group A (29.3 %) (P<0.05) The average medication cycle of the Group B group was significantly shorter than that of the Group A (P<0.05).Conclusions: The regimen using LE in combination with low-dose intramuscular injection of HMG has satisfactory therapeutic effects on ovulation induction, short medication cycle and high clinical pregnancy rate, which is promising for treating patients with PCOS infertility.