Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta‐analysis

Kollmann, Markus; Martins, W.P.; Lima, M. L. S.; Craciunas, Laurentiu; Nastri, C.O.; Richardson, Alison; Raine‐Fenning, Nick

doi:10.1002/uog.15898

Cited by 56 publications

(35 citation statements)

References 101 publications

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“…At present, metformin therapy in PCOS during pregnancy is considered experimental and metformin during pregnancy in PCOS is not yet generally recommended. A recent meta-analysis found that metformin improved live birth/ongoing pregnancy (RR, 1.28 (95% CI, 1.01-1.63)) and clinical pregnancy rates (RR, 1.26 (95% CI, 1.04-1.53)) when compared with placebo or no intervention (106), but the studies were of low quality and the effect of metformin was only modest. A randomized controlled trial in pregnant women with PCOS, comparing metformin to placebo, reported no significant difference in GDM prevalence 17.6% and 16.9%, respectively (107); however, the study could have been underpowered to detect change in GDM prevalence.…”

Section: Metformin During Pregnancy In Pcosmentioning

confidence: 99%

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen

Glintborg

2018

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) is common in premenopausal women. The majority of women with PCOS have insulin resistance and the risk of type 2 diabetes mellitus (T2D) is higher in women with PCOS compared to controls. In non-pregnant women with PCOS, glycemic status may be assessed by oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) or HbA1c. OGTT has been reckoned gold standard test for diagnosing T2D, but OGTT is rarely used for diagnostic purpose in other non-pregnant individuals at risk of T2D, apart from PCOS. OGTT has questionable reproducibility, and high sensitivity of the 2-h glucose value is at the expense of relatively low specificity, especially regarding impaired glucose tolerance (IGT). Furthermore, lean women with PCOS are rarely diagnosed with T2D and only few percent of normal-weight women have prediabetes. Glycemic status is necessary at diagnosis and during follow-up of PCOS, especially in women with high risk of T2D (obesity, previous gestational diabetes (GDM)). We suggest that OGTT should be used in the same situations in PCOS as in other patient groups at risk of T2D. OGTT is indicated for diagnosing GDM; however, OGTT during pregnancy may not be indicated in lean women with PCOS without other risk factors for GDM.

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Section: Metformin During Pregnancy In Pcosmentioning

confidence: 99%

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen

Glintborg

2018

European Journal of Endocrinology

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“…The systematic review conducted by Kollmann et al 22 had different conclusions than the majority. They included 66 studies in their review of current evidence regarding the efficacy of strategies aimed at improving assisted reproductive techniques in women with PCOS, and measured the primary outcomes of live birth/ongoing pregnancy and ovarian hyper stimulation syndrome.…”

Section: Findings Metformin Use In Pcosmentioning

confidence: 95%

“…They concluded that there is low-quality evidence pointing to a benefit of metformin supplementation on clinical pregnancy and live birth rates. 22 Lastly, Sohrevardi et al 23 attempted to determine the effect of metformin and pioglitazone on clinical, hormonal and metabolic parameters in women with PCOS. They concluded that insulinsensitizing drugs induce beneficial effects in insulin resistance and menstrual cycle, but only metformin aided in reducing hyperandrogenemia in women with PCOS.…”

Section: Findings Metformin Use In Pcosmentioning

confidence: 99%

Efficacy of metformin use to induce ovulation in women with polycystic ovarian syndrome

Mellott¹,

Metcalfe²,

Hensley³

2018

OGIJ

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Polycystic Ovarian Syndrome (PCOS), a common disorder of the endocrine system, is diagnosed based on inclusion criteria of an ovulation or oligo-ovulation, clinical signs of hyperandrogenism, and/or presence of polycystic ovaries on ultrasound. Many women with PCOS also have hyperinsulinemia, leading to over production of ovarian androgens. Due to this differential, the use of the insulin-sensitizing agent metformin has been explored to induce ovulation in women with PCOS. The use of metformin combined with the fertility drug clomiphene citrate (clomid) has shown to be more effective than the placebo in stimulating ovulation. While metformin has not yet gained the title of a first-line pharmacological agent for ovulation induction, research shows it has many benefits in PCOS treatment.

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“…The most important problem is that fertility treatment is expensive, not being affordable for the majority of couples, particularly in middle‐ and low‐income countries. Additionally, OS might result in ovarian hyperstimulation syndrome (OHSS), especially in women with ovulatory dysfunction secondary to hyperandrogenism. Another consideration is that standard OS protocols require daily injections, causing pain and being a potential source of bleeding/infection; the effect of psychological distress should not be overlooked.…”

Section: Introductionmentioning

confidence: 99%

Clomiphene citrate and letrozole to reduce follicle‐stimulating hormone consumption during ovarian stimulation: systematic review and meta‐analysis

Bechtejew

Nadai

Nastri³

et al. 2017

Ultrasound in Obstet & Gyne

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The use of CC to reduce FSH consumption in women with expected poor ovarian response has the advantage of providing similar reproductive outcomes with reduced costs. For the other women, the use of CC for reducing FSH consumption has the additional advantage of reducing OHSS, but also reduces the total number of oocytes retrieved. More studies are needed to evaluate the effect of LTZ for the same purpose. Future studies should focus on cumulative pregnancy per oocyte retrieval, patient dissatisfaction and agreement to repeat the cycle if not pregnant, which are important outcomes for clinical decisions. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta‐analysis

Cited by 56 publications

References 101 publications

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Efficacy of metformin use to induce ovulation in women with polycystic ovarian syndrome

Clomiphene citrate and letrozole to reduce follicle‐stimulating hormone consumption during ovarian stimulation: systematic review and meta‐analysis

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