The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance

Balen, Adam; Morley, Lara; Misso, Marie; Franks, Stephen; Legro, Richard S.; Wijeyaratne, Chandrika; Stener-Victorin, Elisabet; Fauser, Bart C.J.M.; Norman, Robert J.; Teede, Helena

doi:10.1093/humupd/dmw025

Cited by 523 publications

(421 citation statements)

References 158 publications

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“…Similarly, in a more recent review consisting of 4227 women with PCOS, metformin only resulted in a marginal improvement in live birth rate when compared with placebo [45]. Therefore, metformin appears to have a limited role in improving fertility and live birth rate in women with PCOS and it is not recommended as a primary treatment for anovulatory infertility in this population [37,38].…”

Section: Menstrual Irregularity and Clinical Hyperandrogenismmentioning

confidence: 99%

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Sam

Ehrmann

2017

Diabetologia

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Polycystic ovary syndrome (PCOS), the most common hormonal disorder among women of reproductive age, has various metabolic and reproductive consequences. Metformin was originally shown to lower testosterone levels in women with PCOS in the 1990s, an effect presumably related to its insulin sensitising actions. However, the precise mechanisms of metformin action in PCOS remain unclear and there is considerable heterogeneity in the clinical response to this therapy in women with PCOS. Recent evidence indicates that genetic factors may play a significant role in predicting response to metformin therapy in PCOS and future studies are needed to further identify women who are most likely to benefit from this therapy. At present, there is no clear evidence to support broad metformin use in PCOS. Well-designed prospective trials are needed to establish clear benefit for metformin use in the treatment of the reproductive and metabolic consequences associated with PCOS.

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Section: Menstrual Irregularity and Clinical Hyperandrogenismmentioning

confidence: 99%

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Sam

Ehrmann

2017

Diabetologia

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“…57 IVF is a third-line treatment for PCOS indicated in those who have not responded to first-or second-line ovulation induction therapies or in those who require IVF for other indications and can be used with the safer gonadotropinreleasing hormone antagonist protocol and metformin as an adjunct, although no ideal protocol has been identified yet and no dietary associations with IVF have been reported. 5,47,58 Obesity increases the risk of conception failure with IVF. 5,47,58 Fertility in women with PCOS is maintained until the age of 38 years using IVF, but thereafter pregnancy rates decrease.…”

Section: Options For Pcos Treatmentmentioning

confidence: 99%

“…5,47,58 Obesity increases the risk of conception failure with IVF. 5,47,58 Fertility in women with PCOS is maintained until the age of 38 years using IVF, but thereafter pregnancy rates decrease. 59 Women with PCOS who conceive singleton pregnancies after IVF may be at increased risk of pregnancy complications and may require close antenatal monitoring.…”

Section: Options For Pcos Treatmentmentioning

confidence: 99%

“…15,16,48,49,58,[60][61][62][63][64] Results from a cross-sectional study showed that women with PCOS were more likely to follow a number of both healthy body weight management practices (balanced diet, reduced fat or sugar intake, adoption of a low-GI diet) as well as paradoxical nonhealthy attitudes (ie, increased smoking, use of laxative and diet pills) compared to women without PCOS. 65 Although most clinicians are in favor of lifestyle changes for the management of PCOS, the majority of women with PCOS reported that they rarely receive lifestyle advice from their therapists.…”

Section: Lsm Programs and Pcosmentioning

confidence: 99%

“…A team-based approach along with lifestyle interventions may be more suitable for the management and treatment of PCOS. 49,58,74,75 Negative energy balance and PCOS Several studies assessing the effects of caloric restriction along with modified dietary macronutrient composition on multiple health outcomes and biochemical indices have shown that there is no optimal dietary macronutrient composition or dietary pattern for PCOS. 38,41,76 Overall, there is little variation in weight loss with different diets, and this variation may be due to the differences in compliance and not how the body handles different macro-or micronutrients.…”

Section: Lsm Programs and Pcosmentioning

confidence: 99%

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Nutritional support and dietary interventions for women with polycystic ovary syndrome

Papavasiliou¹,

Papakonstantinou²

2017

NDS

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductiveaged women, which leads to reproductive, metabolic and hormonal abnormalities. Hyperinsulinemia, insulin resistance, androgen excess, ovulatory dysfunction, polycystic ovaries, gonadotropin abnormalities, obesity, adipose tissue dysfunction, difficulty to conceive and high-risk pregnancy are the most common PCOS-associated complications. The aim of this review was to describe and evaluate the effects of dietary interventions on PCOS-associated outcomes and to provide some evidence-based dietary advice for use in clinical practice. There is no optimal diet or macronutrient composition for PCOS. However, lifestyle modification, including a small-to-moderate weight loss of 5-10% (combined diet with regular physical activity) with any dietary pattern of choice, depending on the individuals' preferences, culture, habits and metabolic needs (ie, Mediterranean diet, Dietary Approaches to Stop Hypertension [DASH] diet or moderately low-carbohydrate diets [30-45% of energy]), as well as alternative dietary interventions, including small, frequent meal (five to six meals daily) consumption at regular times, with the majority of carbohydrates consumed at lunch time or equally distributed throughout the day, seems to offer the evidence-based first-line strategy for the management of PCOS symptoms and insulin resistance. No conclusions can be drawn at this time for high protein diets, polyunsaturated fatty acids or micronutrient supplementation.

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Association of Metformin With Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome Undergoing In Vitro Fertilization

Huang

et al. 2020

JAMA Netw Open

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Key Points Question Is metformin associated with improved outcomes among women with polycystic ovarian syndrome undergoing in vitro fertilization? Findings This meta-analysis of 12 randomized clinical trials, which collectively included 1123 women, found that metformin treatment was associated with a decreased risk of ovarian hyperstimulation syndrome among women with polycystic ovarian syndrome undergoing in vitro fertilization but had no association with clinical pregnancy or live birth rates in the total population studied. However, among women with a body mass index of 26 or greater, metformin treatment was associated with an improved clinical pregnancy rate. Meaning The findings of this study suggest that metformin treatment should be carefully considered for women with polycystic ovarian syndrome undergoing in vitro fertilization and may be more preferred among women with a body mass index of 26 or greater.

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The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance

Abstract: This guidance generation and evidence-synthesis analysis has been conducted in a manner to be considered for global applicability for the safe administration of ovulation induction for anovulatory women with PCOS.

Cited by 523 publications

References 158 publications

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Nutritional support and dietary interventions for women with polycystic ovary syndrome

Association of Metformin With Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome Undergoing In Vitro Fertilization

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