Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome

Legro, Richard S.; Dodson, William C.; Kris-Etherton, Penny M.; Kunselman, Allen R.; Stetter, Christy; Williams, Nancy I.; Gnatuk, Carol L.; Estes, Stephanie J.; Fleming, Jennifer; Allison, Kelly C.; Sarwer, David B.; Coutifaris, Christos; Dokras, Anuja

doi:10.1210/jc.2015-2778

Cited by 188 publications

(209 citation statements)

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“…In many countries, lifestyle intervention is recommended as this has led to higher spontaneous ovulation rates and natural conception rates [20,21].…”

Section: Weight Reduction and Ovulation Inductionmentioning

confidence: 99%

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Oriji¹,

Nyengidiki²

2018

Debatable Topics in PCOS Patients

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Infertility is a distressing medical and psychosocial problem afflicting about a quarter of all couples wanting to reproduce their offspring. Majority of the anovulatory problem in the female, as a cause of infertility, is due to polycystic ovary syndrome (PCOS). This condition is a complex interplay of factors, which affect women even beyond their fertility. It has been found to increase the risk of other adverse condit i o n ss u c ha st h em e t a b o l i cs y n d r o m e ,c a r diovascular diseases, type II diabetes mellitus, and endometrial cancer as well as infertility. Different groups have made diagnosis of PCOS with various diagnostic criteria. The Rotterdam criteria used in the diagnosis of PCOS mainly emphasize the reproductive malfunctions of this complex disease. The treatment of anovulatory infertility in PCOS is as enigmatic as the disease itself. Various methods have been deployed to treat the anovulation with variable success. Clomiphene citrate is a traditional first-line drug in treating anovulation in women with PCOS. Weight reduction, letrozole, metformin, folliclestimulating hormone (FSH) and ovarian drilling are some of the other ways in which anovulation has been treated in these women. What method is more likely to succeed in treating the infertility from anovulation in PCOS and in what circumstance are the subject matters of this discussion.

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“…In many countries, lifestyle intervention is recommended as this has led to higher spontaneous ovulation rates and natural conception rates [20,21].…”

Section: Weight Reduction and Ovulation Inductionmentioning

confidence: 99%

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Oriji¹,

Nyengidiki²

2018

Debatable Topics in PCOS Patients

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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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“…But this is a dubious claim as the women in the control group with prompt treatment were unlikely to receive expectant management for an ovulatory defect and thus had less opportunity for unassisted pregnancy than the lifestyle group with their 6-month delay in fertility treatment. Our randomized trial in overweight and obese infertile women with PCOS (Legro et al, 2015) showed an improved ovulation rate in response to clomiphene citrate in a preconception lifestyle intervention group, but no significant difference in live birth rate compared to preconception oral contraceptives in a control group. The sample size of this subgroup analysis (Van Oers et al, 2016) included 263 anovulatory women, significantly larger than our trial (N = 149) and most previous trials of preconception lifestyle intervention, thus giving added power to their findings.…”

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confidence: 72%

“…Our preconception lifestyle modification group (with a similar starting BMI of 35 kg/m 2 ) had in a shorter period of treatment (16 weeks) a greater weight loss (i.e. −6.2 kg, 95% CI, −7.1 to −5.3 kg, P < 0.001) (Legro et al, 2015). However, there are many concerns about weight loss drugs in women seeking fertility, including their effects on the cardiovascular system.…”

mentioning

confidence: 89%

“…More detailed study of compartmental weight loss and changes in body composition with lifestyle intervention are needed. Our own studies of changes in body composition by dual-energy X-ray absorptiometry in both obese women undergoing bariatric surgery and women with PCOS undergoing intensive lifestyle modification document that android fat is preferentially lost compared to gynoid fat during weight loss (Legro et al, 2012;Legro et al, 2015). Thus, excessive weight loss in obese women with normal centripetal fat may have negative reproductive implications bringing abdominal fat below some critical mass required for reproductive homeostasis.…”

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confidence: 99%

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Mr. Fertility Authority, Tear Down That Weight Wall!

Legro

2016

Hum. Reprod.

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Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome

Abstract: A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates.

Cited by 188 publications

References 40 publications

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

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

Mr. Fertility Authority, Tear Down That Weight Wall!

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