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Rajput S, Jain S. Is Autoverification of Reports the Need of the Hour in Clinical Chemistry Laboratory? ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10054-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Popovic M, Campos-Möller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1248] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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103
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Thangamathesvaran L, Crane E, Modi K, Khouri AS. Outcomes of Resident-versus attending-performed Tube Shunt Surgeries in a United States Residency Program. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ohara T, Suzutani T. Intake of Bifidobacterium longum and Fructo-oligosaccharides prevents Colorectal Carcinogenesis. Euroasian J Hepatogastroenterol 2018; 8:11-17. [PMID: 29963455 PMCID: PMC6024036 DOI: 10.5005/jp-journals-10018-1251] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION We aimed to investigate the effects of intake of yogurt containing Bifidobacterium longum (BB536-y) and fructo-oligosaccharides (FOS) in preventing colorectal carcinogenesis in healthy subjects, and the preventive effects of short-chain fatty acids (SCFA), whose production was enhanced by the intake of BB536-y and FOS, in human colon cancer cell lines. MATERIALS AND METHODS The subjects were 27 healthy persons who were divided into a group taking yogurt containing BB536 (BB536-y group; n = 14) and a group taking yogurt containing BB536 and FOS (BB536-y with FOS group; n = 13) once a day for 5 weeks. The feces were sampled before and after the intake to analyze the amount of SCFA in the feces and the profile of intestinal flora, such as putrefactive bacteria and Bacteroides fragilis enterotoxin (ETBF). Subsequently, human colon cancer cell lines (DLD-1 cells, WirDr cells) were cultured in the presence of SCFA (butyric acid, isobutyric acid, acetic acid) in order to evaluate the cell growth-inhibitory activity of SCFA (WST-8 assay) by calculating the IC50 value from the dose-response curve. RESULTS Intake of BB536-y increased the total amount of SCFA in the feces and significantly suppressed the detection rate of ETBF and growth of putrefactive bacteria. Intake of BB536-y with FOS was associated with a higher Bifidobacterium detection rate than that of BB536-y alone. The contents of butyric acid, isobutyric acid, and acetic acid, namely, of SCFA, were also decreased. Analysis of the results of culture of DLD-1 cells and WirDr cells in the presence of butyric acid, isobutyric acid, and acetic acid revealed that each of the substances showed significant cell growth-inhibitory activity, with the activity being the highest for butyric acid, followed by that for isobutyric acid and acetic acid. CONCLUSION These findings suggest that intake of both BB536-y and BB536-y with FOS prevents colorectal carcinogenesis.How to cite this article: Ohara T, Suzutani T. Intake of Bifidobacterium longum and Fructo-oligosaccharides prevents Colorectal Carcinogenesis. Euroasian J Hepato-Gastroenterol 2018;8(1):11-17.
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Affiliation(s)
- Tadashi Ohara
- Department of Intestinal Bioscience and Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University, Fukushima City, Fukushima, Japan
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Arora V, Arora P, Soliman M. Evaluation of Coronal Leakage of Preheated Nanohybrid and Bulk Fill Composites in Endodontically Treated Teeth: An in vitro Study. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10015-1534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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J Lu L, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018; 12:19-28. [PMID: 29861578 PMCID: PMC5981089 DOI: 10.5005/jp-journals-10028-1239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/09/2017] [Indexed: 11/23/2022] Open
Abstract
Conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device (GDD) surgery, have been enhanced by surgeons to improve outcome and decrease complications. Over the last two decades, adjuncts, such as collagen matrix implants, fibrin adhesives, and amniotic membrane transplantation (AMT) have been found to be effective in modulating fibrosis and scarring during the wound-healing process, reducing postoperative inflammation, and repairing bleb leakage or conjunctival erosion. The use of these tools provides several advantages when used in trabeculectomy, GDD surgery, and surface reconstruction associated with glaucoma surgery complications. Their use will be discussed in this review. How to cite this article: Lu LJ, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018;12(1):19-28.
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Affiliation(s)
- Louise J Lu
- Medical Student, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
| | - Laura Hall
- Ophthalmologist, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
| | - Ji Liu
- Ophthalmologist, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
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Shiralkar VV, Jagtap PE, Belwalkar GJ, Nagane NS, Dhonde SP. Effect of Steam Sauna Bath on Fasting Blood Glucose Level in Healthy Adults. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10054-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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109
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Dong J, Syed ZA, Fan K, Yahya AF, Melki SA. Potential Savings from Visit Reduction of Continuous Intraocular Pressure Monitoring. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hossain E, Ahammed F, K Saha S, A Foez S, A Rahim M, M Noor-E-Alam S, S Abdullah A. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepatogastroenterol 2018; 8:18-22. [PMID: 29963456 PMCID: PMC6024039 DOI: 10.5005/jp-journals-10018-1252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV. Materials and methods In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated. Results Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%. Conclusion The platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case-control study would be required to validate this. How to cite this article: Hossain E, Ahammed F, Saha SK, Foez SA, Rahim MA, Noor-e-Alam SM, Abdullah AS. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2018;8(1):18-22.
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Affiliation(s)
- Enayet Hossain
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
| | - Ferdaus Ahammed
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
| | - Satyajit K Saha
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
| | - Syed A Foez
- Department of Hepatology, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
| | - Mohammad A Rahim
- Department of Hepatology, Abdul Malek Ukil Medical College, Noakhali, Bangladesh
| | - Sheikh M Noor-E-Alam
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Abu S Abdullah
- Department of Medicine, Moulvibazar District Sadar Hospital, Moulvibazar, Bangladesh
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Ali A, Almaroof A, Festy F, Banerjee A, Mannocci F. In vitro Remineralization of Caries-affected Dentin after Selective Carious Tissue Removal. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10015-1529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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112
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Muthiah M, H Chong C, G Lim S. Liver Disease in Singapore. Euroasian J Hepatogastroenterol 2018; 8:66-68. [PMID: 29963466 PMCID: PMC6024054 DOI: 10.5005/jp-journals-10018-1262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022] Open
Abstract
Liver disease is a significant health issue in Singapore. In the Singapore Burden of Disease Survey, liver cancer and liver cirrhosis contributed 3.2 and 0.9% of years of life lost (YLL) out of 182,753 YLL respectively. Liver cancer was ranked 8th and liver cirrhosis was ranked 20th in YLL. Liver cancer is the 5th most common cancer in males, and has an age-adjusted rate of 17.6 per 100,000 population. The underlying etiology of liver cirrhosis is chronic hepatitis B (CHB) in 63.3%, alcohol in 11.2%, cryptogenic in 9%, and chronic hepatitis C (CHC) in 6.9%. The overall seroprevalence rate of CHB is 3.6%, while CHC is approximately 0.1%. The trend in prevalence of liver cancer is gradually reducing as is CHB. However, less is known about alcoholic liver disease and fatty liver disease and there is some evidence that the latter is increasing. Singapore has a multilayered health care system designed to provide basic health care needs to the population. There are various schemes available that provide subsidized and assisted health care for treatment of hepatitis B and C as well as liver transplantation. Health policy with regard to a national action plan has not yet been developed and there is room for health care specialists, government and nongovernment agencies to work together to tackle liver disease in Singapore. How to cite this article: Muthiah M, Chong CH, Lim SG. Liver Disease in Singapore. Euroasian J Hepato-Gastroenterol 2018;8(1):66-68.
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Affiliation(s)
- Mark Muthiah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chern H Chong
- Division of Gastroenterology and Hepatology, National University Health System, Singapore; Division of General Medicine, Woodlands Health Campus, Singapore
| | - Seng G Lim
- Division of Gastroenterology and Hepatology, National University Health System, Singapore and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Weiss NS, Schreurs AMF, van der Veen F, Hompes PGA, Lambalk CB, Mol BW, van Wely M. Women's perspectives on ovulation induction with or without IUI as treatment for normogonadotrophic anovulation: a discrete choice experiment. Hum Reprod Open 2017; 2017:hox021. [PMID: 30895235 PMCID: PMC6276642 DOI: 10.1093/hropen/hox021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/04/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022] Open
Abstract
Study Question What are the treatment preferences of women with normogonadotrophic anovulation treated with ovulation induction with or without intrauterine insemination (IUI)? Summary Answer Women with normogonadotrophic anovulation differ in their treatment preference; half of them base their preference on the lowest burden and half of them on the highest effectiveness. What is Known Already Common treatments for anovulatory women who wish to conceive are ovulation induction using clomiphene citrate or letrozole taken in tablet form or with injections containing gonadotrophins, all optionally combined with IUI. Patient preferences for these alternatives have not yet been examined in these women. Study Design, Size, and Duration Between August 2014 and February 2017 we conducted a multicentre discrete choice experiment (DCE). The target sample size was calculated by including 20 women for six attributes in the main analysis resulting in the inclusion of 120 women to be able to assess heterogeneity across choices. Participants/Materials, Setting, Methods We invited treatment-naive women diagnosed with normogonadotropic anovulation and visiting the outpatient clinic of five Dutch centers (three teaching hospitals and two university hospitals) to participate in the DCE by completing a printed questionnaire. We asked women to indicate their preference in hypothetical alternative treatment scenarios by offering a series of choice sets from which they were to choose their preferred alternatives. The choice sets contained several treatment characteristics of interest, i.e. attributes concerning ovulation induction with clomiphene citrate or letrozole versus gonadotrophins, as well as intercourse and IUI. We selected six attributes: number of visits to the outpatient clinic during treatment; type of medication; intercourse or IUI; risk of side effects; willingness to pay; and pregnancy chances leading to the birth of a child after six treatment cycles. We used a multinominal logit model to determine the preferences of women and investigated heterogeneity in preferences through latent class analysis. To determine if women were willing to make a trade-off for higher pregnancy rates at the expense of a higher burden, we calculated the marginal rate of substitution. Main Results and the Role of Chance The questionnaire was completed by 145 women. All six attributes influenced women’s treatment preferences and those valued as most important were low risk of side effects, a minimal number of hospital visits and intercourse. A total of 55% of women were driven by the wish to conceive with the least medical interference and lowest burden. The remaining women were success driven and chose mainly for the highest chances to conceive, regardless of the burden. Age and duration of subfertility did not significantly differ between these women. Women were willing to trade-off some burden and costs for higher pregnancy chances. Limitations Reasons for Caution The sample size of our study is relatively small which made it not possible to perform interaction tests and subgroup analyses. Wider Implications of the Findings Our results may be used during the counseling of couples about their treatment options. These findings are an argument to explore if a woman prefers potentially fast success or a medically less intense route that might take longer. The preference for the less intense route would lead to the continuation of ovulation induction with oral drugs such as clomiphene citrate or letrozole rather than treatment with injected gonadotrophins, or even IVF. Study Funding/Competing Interest(s) B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for Merck, ObsEva and Guerbet. CBL reports grants from Merck and Ferring. Trial Registration Number None.
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Affiliation(s)
- N S Weiss
- Center of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Centre of Reproductive Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands
| | - A M F Schreurs
- Center of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - F van der Veen
- Centre of Reproductive Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands
| | - P G A Hompes
- Center of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - C B Lambalk
- Center of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - B W Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Norwich Centre, 55 King William St, North Adelaide SA 5006, Australia
| | - M van Wely
- Centre of Reproductive Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands
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Cauldwell M, Patel RR, Steer PJ, Swan L, Norman-Taylor J, Gatzoulis M, Johnson MR. Managing subfertility in patients with heart disease: What are the choices? Am Heart J 2017; 187:29-36. [PMID: 28454805 DOI: 10.1016/j.ahj.2017.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/08/2017] [Indexed: 11/19/2022]
Abstract
More women with heart disease are reaching reproductive age and will want to embark upon pregnancy. Furthermore, many of these women are delaying pregnancy until later in life when they may be exposed to a greater number of complications from their heart disease. A relatively high proportion of these women will pursue fertility treatment to achieve a pregnancy; consequently, the management of subfertile couples where the woman (or man) has heart disease is of growing importance. In this review, we discuss how fertility investigations and treatment can impact a women with heart disease and how some of the potential complications can be minimized or avoided. We also consider surrogacy, which is an important option when pregnancy is contraindicated.
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Affiliation(s)
- Matthew Cauldwell
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom.
| | - Roshni R Patel
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
| | - Lorna Swan
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney St, London, United Kingdom
| | - Julian Norman-Taylor
- Chelsea and Westminster Assisted Conception Unit, Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
| | - Michael Gatzoulis
- Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney St, London, United Kingdom
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London Chelsea and Westminster Hospital, 369 Fulham Rd, London, United Kingdom
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Lauritsen MP, Loft A, Pinborg A, la Cour Freiesleben N, Cohen A, Petersen JH, Mikkelsen AL, Bjerge MR, Nyboe Andersen A. Individualised gonadotrophin ovulation induction in women with normogonadotrophic anovulatory infertility: A prospective, observational study. Eur J Obstet Gynecol Reprod Biol 2016; 210:76-82. [PMID: 27960134 DOI: 10.1016/j.ejogrb.2016.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/30/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate an individualised gonadotrophin starting dose regimen for women with anovulatory infertility. STUDY DESIGN We included 71 normogonadotrophic anovulatory infertile women in a prospective, observational study. All underwent one ovulation induction cycle in a flexible, low-dose step-up protocol. The gonadotrophin starting dose (75-150IU/day) was individualised according to a nomogram incorporating menstrual cycle pattern (oligo- or amenorrhoea), BMI, and mean ovarian volume. The number of women who fulfilled the criteria for human chorionic gonadotrophin (hCG) administration (one follicle ≥17mm or 2-3 follicles ≥15mm) was assessed. RESULTS Of the 50 women (70.4%) who fulfilled the hCG criteria and underwent intrauterine insemination, 34 (47.9%) achieved monofollicular growth and 16 (22.5%) developed 2-3 mature follicles. Seventeen (23.9%) cycles were converted to in vitro fertilisation (IVF) due to the development of >3 mature follicles, and one (1.4%) cycle was cancelled due to risk of ovarian hyperstimulation syndrome. Baseline total antral follicle count was found to be significantly associated with fulfillment of the hCG criteria (OR 0.96, 95% CI: 0.92-0.99, P=0.01). CONCLUSIONS The nomogram-based dose regimen was not considered suitable for ovulation induction due to a tendency to overestimate the gonadotrophin starting dose. However, the model may serve as a mild IVF regimen, especially in women prone to excessive follicle growth.
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Affiliation(s)
- Mette Petri Lauritsen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Anne Loft
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; The Fertility Clinic, Department of Obstetrics and Gynaecology, Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Nina la Cour Freiesleben
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Arieh Cohen
- Department of Clinical Biochemistry and Immunology, Statens Serum Institute, 2300 Copenhagen, Denmark
| | | | - Anne Lis Mikkelsen
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Marianne Rich Bjerge
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Anders Nyboe Andersen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
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Soliman GM, Fetih G, Abbas AM. Thermosensitive bioadhesive gels for the vaginal delivery of sildenafil citrate: in vitro characterization and clinical evaluation in women using clomiphene citrate for induction of ovulation. Drug Dev Ind Pharm 2016; 43:399-408. [DOI: 10.1080/03639045.2016.1254239] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ghareb M. Soliman
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Gihan Fetih
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Ahmed M. Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, Stener-Victorin E, Fauser BCJM, Norman RJ, Teede H. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016; 22:687-708. [PMID: 27511809 DOI: 10.1093/humupd/dmw025] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/01/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Here we describe the consensus guideline methodology, summarise the evidence-based recommendations we provided to the World Health Organisation (WHO) for their consideration in the development of global guidance and present a narrative review on the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS). OBJECTIVE AND RATIONALE The aim of this paper was to present an evidence base for the management of anovulatory PCOS. SEARCH METHODS The evidence to support providing recommendations involved a collaborative process for: (i) identification of priority questions and critical outcomes, (ii) retrieval of up-to-date evidence and exiting guidelines, (iii) assessment and synthesis of the evidence and (iv) the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation, the methodologist evaluated the quality of the supporting evidence that was then graded as very low, low, moderate or high for consideration during consensus. OUTCOMES Evidence was synthesized and we made recommendations across the definition of PCOS including hyperandrogenism, menstrual cycle regulation and ovarian assessment. Metabolic features and the impact of ethnicity were covered. Management includes lifestyle changes, bariatric surgery, pharmacotherapy (including clomiphene citrate (CC), aromatase inhibitors, metformin and gonadotropins), as well as laparoscopic surgery. In-vitro fertilization (IVF) was considered as were the risks of ovulation induction and of pregnancy in PCOS. Approximately 80% of women who suffer from anovulatory infertility have PCOS. Lifestyle intervention is recommended first in women who are obese largely on the basis of general health benefits. Bariatric surgery can be considered where the body mass index (BMI) is ≥35 kg/m2 and lifestyle therapy has failed. Carefully conducted and monitored pharmacological ovulation induction can achieve good cumulative pregnancy rates and multiple pregnancy rates can be minimized with adherence to recommended protocols. CC should be first-line pharmacotherapy for ovulation induction and letrozole can also be used as first-line therapy. Metformin alone has limited benefits in improving live birth rates. Gonadotropins and laparoscopic surgery can be used as second-line treatment. There is no clear evidence for efficacy of acupuncture or herbal mixtures in women with PCOS. For women with PCOS who fail lifestyle and ovulation induction therapy or have additional infertility factors, IVF can be used with the safer gonadotropin releasing hormone (GnRH) antagonist protocol. If a GnRH-agonist protocol is used, metformin as an adjunct may reduce the risk of ovarian hyperstimulation syndrome. Patients should be informed of the potential side effects of ovulation induction agents and of IVF on the foetus, and of the risks of multiple pregnancy. Increased risks for the mother during pregnancy and for the child, including the exacerbating impact of obesity on adverse outcomes, should also be discussed. WIDER IMPLICATIONS 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.
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Affiliation(s)
- Adam H Balen
- Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals, Leeds LS14 6UH, UK
| | - Lara C Morley
- Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals, Leeds LS14 6UH, UK
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Stephen Franks
- Institute of Reproductive & Developmental Biology, Hammersmith Hospital, London, UK
| | - Richard S Legro
- Penn State College of Medicine, 500 University Drive, H103, Hershey, PA 17033, USA
| | | | | | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Robert J Norman
- The Robinson Institute, University of Adelaide, Norwich House, 55 King William Street, North Adelaide, SA 5005, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
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Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, Stener-Victorin E, Fauser BC, Norman RJ, Teede H. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016. [DOI: 10.1093/humupd/dmw025 [last accessed on 26.11.19]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Hart RJ. Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics. Physiol Rev 2016; 96:873-909. [DOI: 10.1152/physrev.00023.2015] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Across the Western World there is an increasing trend to postpone childbearing. Consequently, the negative influence of age on oocyte quality may lead to a difficulty in conceiving for many couples. Furthermore, lifestyle factors may exacerbate a couple's difficulty in conceiving due mainly to the metabolic influence of obesity; however, the negative impacts of low peripheral body fat, excessive exercise, the increasing prevalence of sexually transmitted diseases, and smoking all have significant negative effects on fertility. Other factors that impede conception are the perceived increasing prevalence of the polycystic ovary syndrome, which is further exacerbated by obesity, and the presence of uterine fibroids and endometriosis (a progressive pelvic inflammatory disorder) which are more prevalent in older women. A tendency for an earlier sexual debut and to have more sexual partners has led to an increase in sexually transmitted diseases. In addition, there are several genetic influences that may limit the number of oocytes within the ovary; consequently, by postponing attempts at childbearing, a limitation of oocyte number may become evident, whereas in previous generations with earlier conception this potentially reduced reproductive life span did not manifest in infertility. Environmental influences on reproduction are under increasing scrutiny. Although firm evidence is lacking however, dioxin exposure may be linked to endometriosis, phthalate exposure may influence ovarian reserve, and bisphenol A may interfere with oocyte development and maturation. However, chemotherapy or radiotherapy is recognized to lead to ovarian damage and predispose the woman to ovarian failure.
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Affiliation(s)
- Roger J. Hart
- School of Women's and Infants Health, University of Western Australia & Fertility Specialists of Western Australia, Subiaco, Perth Western Australia
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120
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Qiang G, Whang Kong H, Xu S, Pham HA, Parlee SD, Burr AA, Gil V, Pang J, Hughes A, Gu X, Fantuzzi G, MacDougald OA, Liew CW. Lipodystrophy and severe metabolic dysfunction in mice with adipose tissue-specific insulin receptor ablation. Mol Metab 2016; 5:480-490. [PMID: 27408774 PMCID: PMC4921803 DOI: 10.1016/j.molmet.2016.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/26/2016] [Accepted: 05/06/2016] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Insulin signaling plays pivotal roles in the development and metabolism of many tissues and cell types. A previous study demonstrated that ablation of insulin receptor (IR) with aP2-Cre markedly reduced adipose tissues mass and protected mice from obesity. However, multiple studies have demonstrated widespread non-adipocyte recombination of floxed alleles in aP2-Cre mice. These findings underscore the need to re-evaluate the role of IR in adipocyte and systemic metabolism with a more adipose tissue-specific Cre mouse line. METHODS We generated and phenotyped a new adipose tissue-specific IR mouse model using the adipose tissue-specific Adipoq-Cre line. RESULTS Here we show that the Adipoq-Cre-mediated IR KO in mice leads to lipodystrophy and metabolic dysfunction, which is in stark contrast to the previous study. In contrast to white adipocytes, absence of insulin signaling does not affect development of marrow and brown adipocytes, but instead is required for lipid accumulation particularly for the marrow adipocytes. Lipodystrophic IR KO mice have profound insulin resistance, hyperglycemia, organomegaly, and impaired adipokine secretion. CONCLUSIONS Our results demonstrate differential roles for insulin signaling for white, brown, and marrow adipocyte development and metabolic regulation.
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Affiliation(s)
- Guifen Qiang
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Hyerim Whang Kong
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Shanshan Xu
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Hoai An Pham
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Sebastian D Parlee
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Aaron A Burr
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Victoria Gil
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Jingbo Pang
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Amy Hughes
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Xuejiang Gu
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Ormond A MacDougald
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Chong Wee Liew
- Department of Physiology & Biophysics, University of Illinois at Chicago, Chicago, IL, USA.
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121
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Ansari RM. Potential use of durian fruit (Durio zibenthinus Linn) as an adjunct to treat infertility in polycystic ovarian syndrome. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2016; 14:22-8. [PMID: 26778225 DOI: 10.1016/s2095-4964(16)60240-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infertility due to polycystic ovarian syndrome (PCOS) is a worldwide problem that is increasing at alarming rates. Insulin resistance, the prime factor of PCOS, induces comorbid metabolic syndrome as well. Durian (Durio zibenthinus Linn), a fruit of Southeast Asia, is used as a natural supplement in healthy diets. This paper is a short literature review that examines the fruit's effects against various components of metabolic syndrome and its fertility-enhancing properties in PCOS. Various published literature was reviewed to learn of the anti-inflammatory, anti-oxidant, anti-obesity, anticholesterol, and antihypoglycaemic nature of the fruit. The literature search was done using PubMed, Google Scholar and library databases. The keywords used were polycystic ovarian syndrome, infertility, metabolic syndrome and Durian zibenthinus Linn. Reviewed studies showed that the fruit is effective against various components of metabolic syndrome, but the mechanisms of action against anovulation and menstrual disturbances in PCOS have yet to be studied. The traditional use of durian as a fertility-enhancing agent needs to be validated scientifically by isolating its various components and ascertaining its fertility enhancing properties.
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Affiliation(s)
- Reshma M Ansari
- Department of Basic Medical Sciences, Cyberjaya University College of Medical Sciences, Cyberjaya 63000, Selangor, Malaysia
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Elbohoty AEH, Amer M, Abdelmoaz M. Clomiphene citrate before and after withdrawal bleeding for induction of ovulation in women with polycystic ovary syndrome: Randomized cross-over trial. J Obstet Gynaecol Res 2016; 42:966-71. [PMID: 27126971 DOI: 10.1111/jog.12996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/18/2016] [Indexed: 12/01/2022]
Abstract
AIM To compare the ovarian response to early versus late clomiphene citrate (CC) in women with polycystic ovary syndrome (PCOS). METHODS This cross-over randomized controlled clinical trial included 90 infertile amenorrheic women with PCOS. After inducing withdrawal bleeding, patients were randomly divided into two equal groups to receive ovulation induction with CC 100 mg/day for 5 days. Group I started treatment the next day after finishing medroxyprogesterone acetate course for a menstrual cycle, and after a washout period of another menstrual cycle, the treatment was shifted to start on day 2 of withdrawal bleeding. Group II received a reversed protocol: late then early treatment. Women were followed up on transvaginal ultrasonography to monitor follicular growth, endometrial thickness and evidence of ovulation. Human chorionic gonadotropin 10 000 IU was given i.m. to trigger ovulation when at least one mature follicle measured ≥18 mm at day 14. RESULTS In all cases, early induction protocol resulted in significantly higher proportion of ovulating patients, thicker endometrium and higher number of follicles 14-17 mm in diameter, ≥ 18 mm in diameter and total number of follicles (P < 0.001 for all comparisons). CONCLUSION In women with PCOS, early initiation of CC before withdrawal bleeding or during the last days of the luteal phase can achieve a better ovulatory response.
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Affiliation(s)
- Ahmed E H Elbohoty
- Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt
| | - Mohamed Amer
- Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt
| | - Mohamed Abdelmoaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt
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A randomized controlled trial of clomifene citrate, metformin, and pioglitazone versus letrozole, metformin, and pioglitazone for clomifene-citrate-resistant polycystic ovary syndrome. Int J Gynaecol Obstet 2015; 132:206-9. [PMID: 26613820 DOI: 10.1016/j.ijgo.2015.06.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 06/17/2015] [Accepted: 10/20/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the efficacy of clomifene citrate, metformin, and pioglitazone versus letrozole, metformin, and pioglitazone among women with polycystic ovary syndrome (PCOS) resistant to clomifene citrate. METHODS A prospective double-blind randomized controlled trial of women younger than 40 years who had primary/secondary infertility associated with PCOS and had not ovulated in response to clomifene citrate regimens previously was conducted at a center in Cairo, Egypt, between August 1, 2013, and December 31, 2014. Computer-generated random number tables and opaque envelopes were used to assign participants to group A or group B. Participants allocated to group A received 100mg clomifene citrate daily for 5 days from the third day of the menstrual cycle, whereas those in group B received 5mg letrozole daily in the same regimen. All patients received 850 mg metformin and 15 mg pioglitazone for 10 days from the first day of the menstrual cycle. The primary outcome was cumulative ovulation rate. Analyses were by intention to treat. RESULTS Fifty women were assigned to each group. Ovulation occurred in 108 (92.3%) of 117 cycles in group A and 93 (86.9%) of 107 cycles in Group B (P=0.184). CONCLUSION Combined treatment with letrozole, metformin, and pioglitazone was efficacious among women with PCOS resistant to clomifene citrate. ClinicalTrials.gov: NCT01909141.
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Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo) 2015; 70:765-9. [PMID: 26602525 PMCID: PMC4642490 DOI: 10.6061/clinics/2015(11)09] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/25/2015] [Indexed: 12/02/2022] Open
Abstract
Polycystic ovary syndrome represents 80% of anovulatory infertility cases. Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption of tobacco and alcohol. The first-line pharmacological treatment for inducing ovulation consists of a clomiphene citrate treatment for timed intercourse. The second-line pharmacological treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective with cumulative live birth rates of approximately 70%. Ovarian drilling should be performed when laparoscopy is indicated; this procedure is typically effective in approximately 50% of cases. Finally, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is the third-line treatment and is recommended when the previous interventions fail. This option is also the first choice in cases of bilateral tubal occlusion or semen alterations that impair the occurrence of natural pregnancy. Evidence for the routine use of metformin in infertility treatment of anovulatory women with polycystic ovary syndrome is not available. Aromatase inhibitors are promising and longer term studies are necessary to prove their safety.
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Affiliation(s)
- Anderson Sanches Melo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ginecologia e Obstetrícia, Ribeirão Preto/SP, Brazil
| | - Rui Alberto Ferriani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ginecologia e Obstetrícia, Ribeirão Preto/SP, Brazil
| | - Paula Andrea Navarro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ginecologia e Obstetrícia, Ribeirão Preto/SP, Brazil
- Corresponding author: E-mail:
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Weiss NS, Nahuis M, Bayram N, Mol BWJ, Van der Veen F, van Wely M. Gonadotrophins for ovulation induction in women with polycystic ovarian syndrome. Cochrane Database Syst Rev 2015:CD010290. [PMID: 26350625 DOI: 10.1002/14651858.cd010290.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ovulation induction with follicle stimulating hormone (FSH) is the second-line treatment in women with polycystic ovary syndrome (PCOS) who do not ovulate or conceive on clomiphene citrate (CC). OBJECTIVES To compare the effectiveness and safety of gonadotrophins as a second-line treatment for ovulation induction in women with CC-resistant PCOS. SEARCH METHODS We searched the Menstrual Disorders & Subfertility Group's Specialist Register of controlled trials, the Cochrane Central Register of Controlled Trials, MEDLINE (1966 to October 2014), EMBASE (1980 to October 2014), CINAHL (1982 to October 2014), National Research Register and web-based trials databases such as Current Controlled Trials. There was no language restriction. SELECTION CRITERIA All randomised controlled trials reporting data on comparing clinical outcomes in women with PCOS who did not ovulate or conceive on CC, and undergoing ovulation induction with urinary FSH (uFSH: FSH-P or FSH-HP), HMG/HP-HMG or recombinant FSH. We included trials reporting on ovulation induction followed by intercourse or intrauterine insemination. We excluded studies that used co-treatment with CC, metformin, LH or letrozole. DATA COLLECTION AND ANALYSIS Three review authors (NW, MN and MvW) independently selected studies for inclusion, assessed study quality and extracted study data. Primary outcomes were live birth rate per woman (effectiveness outcome) and incidence of ovarian hyperstimulation syndrome (OHSS) per woman (safety outcome). Secondary outcomes were clinical pregnancy, miscarriage, multiple pregnancy, total gonadotrophin dose and total duration of stimulation per woman. We combined data using a fixed-effect model to calculate the odds ratio (OR). We summarised the overall quality of evidence for the main outcomes using GRADE criteria. MAIN RESULTS The review includes 14 trials with 1726 women. Ten trials compared rFSH versus urinary-derived gonadotrophins (three rFSH versus HMG and seven rFSH versus FSH-HP), four trials compared FSH-P with HMG. We found no trials that compared FSH-HP with FSH-P.We found no evidence of a difference in live birth for rFSH versus urinary-derived gonadotrophins (OR 1.26, 95% CI 0.80 to 1.99, 5 trials, 505 women, I² = 0%, low-quality evidence) or clinical pregnancy rate (OR 1.08, 95% CI 0.83 to 1.39, 8 trials, 1330 women, I² = 0, low-quality evidence). This suggests that for the observed average live birth per woman with urinary-derived FSH of 16%, the chance of live birth following rFSH is between 13% and 26%.For the comparison HMG or HP-HMG versus FSH-P there was also no difference in the evidence on live birth rate (OR 1.36, 95% CI 0.58 to 3.18, 3 trials, 138 women, I² = 0%, low-quality evidence). This suggests that for a woman with a live birth rate of 18% with HMG or HP-HMG, the chance of live birth following uFSH is between 9% and 37%.Trial authors used various definitions for OHSS. Pooling the data, we found no evidence of a difference for rFSH versus urinary-derived gonadotrophins (OR 1.52, 95% CI 0.81 to 2.84, 10 trials, 1565 women, I(2) = 0%, very low-quality evidence) and for HMG or HP-HMG versus FSH-P (OR 9.95, 95% CI 0.47 to 210.19, 2 trials, 53 women, I² = 0%, very low-quality evidence). AUTHORS' CONCLUSIONS In women with PCOS and CC resistance or CC failure, we found no evidence of a difference in live birth and OHSS rates between urinary-derived gonadotrophins and rFSH or HMG/HP-HMG. Evidence for all outcomes was of low or very low quality. We suggest weighing costs and convenience in the decision to use one or the other.
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Affiliation(s)
- Nienke S Weiss
- Center for Reproductive Medicine, Free Medical University, De Boelelaan 1105, Amsterdam, Netherlands, 1081 HV
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Palomba S, de Wilde MA, Falbo A, Koster MP, La Sala GB, Fauser BC. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update 2015; 21:575-592. [DOI: 10.1093/humupd/dmv029] [Citation(s) in RCA: 361] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Padmanabhan V, Veiga-Lopez A, Herkimer C, Abi Salloum B, Moeller J, Beckett E, Sreedharan R. Developmental Programming: Prenatal and Postnatal Androgen Antagonist and Insulin Sensitizer Interventions Prevent Advancement of Puberty and Improve LH Surge Dynamics in Prenatal Testosterone-Treated Sheep. Endocrinology 2015; 156:2678-92. [PMID: 25919188 PMCID: PMC4475717 DOI: 10.1210/en.2015-1235] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prenatal T excess induces maternal hyperinsulinemia, early puberty, and reproductive/metabolic defects in the female similar to those seen in women with polycystic ovary syndrome. This study addressed the organizational/activational role of androgens and insulin in programming pubertal advancement and periovulatory LH surge defects. Treatment groups included the following: 1) control; 2) prenatal T; 3) prenatal T plus prenatal androgen antagonist, flutamide; 4) prenatal T plus prenatal insulin sensitizer, rosiglitazone; 5) prenatal T and postnatal flutamide; 6) prenatal T and postnatal rosiglitazone; and 7) prenatal T and postnatal metformin. Prenatal treatments spanned 30-90 days of gestation and postnatal treatments began at approximately 8 weeks of age and continued throughout. Blood samples were taken twice weekly, beginning at approximately 12 weeks of age to time puberty. Two-hour samples after the synchronization with prostaglandin F2α were taken for 120 hours to characterize LH surge dynamics at 7 and 19 months of age. Prenatal T females entered puberty earlier than controls, and all interventions prevented this advancement. Prenatal T reduced the percentage of animals having LH surge, and females that presented LH surge exhibited delayed timing and dampened amplitude of the LH surge. Prenatal androgen antagonist, but not other interventions, restored LH surges without normalizing the timing of the surge. Normalization of pubertal timing with prenatal/postnatal androgen antagonist and insulin sensitizer interventions suggests that pubertal advancement is programmed by androgenic actions of T involving insulin as a mediary. Restoration of LH surges by cotreatment with androgen antagonist supports androgenic programming at the organizational level.
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Affiliation(s)
| | | | - Carol Herkimer
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48105
| | - Bachir Abi Salloum
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48105
| | - Jacob Moeller
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48105
| | - Evan Beckett
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48105
| | - Rohit Sreedharan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48105
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Weiss NS, Braam S, König TE, Hendriks ML, Hamilton CJ, Smeenk JMJ, Koks CAM, Kaaijk EM, Hompes PGA, Lambalk CB, van der Veen F, Mol BWJ, van Wely M. How long should we continue clomiphene citrate in anovulatory women? Hum Reprod 2014; 29:2482-6. [PMID: 25164024 DOI: 10.1093/humrep/deu215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What is the effectiveness of continued treatment with clomiphene citrate (CC) in women with World Health Organization (WHO) type II anovulation who have had at least six ovulatory cycles with CC but did not conceive? SUMMARY ANSWER When women continued CC after six treatment cycles, the cumulative incidence rate of the ongoing pregnancy rate was 54% (95% CI 37-78%) for cycles 7-12. WHAT IS KNOWN ALREADY If women with WHO type II anovulation fail to conceive with CC within six ovulatory cycles, guidelines advise switching to gonadotrophins, which have a high risk of multiple gestation and are expensive. It is however not clear what success rate could be achieved by continued treatment with CC. STUDY DESIGN, SIZE, DURATION We performed a retrospective cohort study of women with WHO II anovulation who visited the fertility clinics of five hospitals in the Netherlands between 1994 and 2010. We included women treated with CC who had had at least six ovulatory cycles without successful conception (n = 114) after which CC was continued using dosages varying from 50 to 150 mg per day for 5 days. PARTICIPANTS/MATERIALS, SETTING, METHODS Follow-up was a total of 12 treatment cycles. Primary outcome was the cumulative incidence rate of an ongoing pregnancy at the end of treatment. MAIN RESULTS AND THE ROLE OF CHANCE We recruited 114 women that had ovulated on CC for at least six cycles but had not conceived. Of these 114 women, 35 (31%) had an ongoing pregnancy resulting in a cumulative incidence rate of an ongoing pregnancy of 54% after 7-12 treatment cycles with CC. LIMITATIONS, REASONS FOR CAUTION Limitations of our study are its retrospective approach. WIDER IMPLICATIONS OF THE FINDINGS Randomized trials comparing continued treatment with CC with the relatively established second line treatment with gonadotrophins are justified. In the meantime, we suggest to only begin this less convenient and more expensive treatment for women who do not conceive after 12 ovulatory cycles with CC. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- N S Weiss
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, the Netherlands
| | - S Braam
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands Center for Reproductive Medicine, Jeroen Bosch Hospital, 5223 GZ Den Bosch, the Netherlands
| | - T E König
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - M L Hendriks
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - C J Hamilton
- Center for Reproductive Medicine, Jeroen Bosch Hospital, 5223 GZ Den Bosch, the Netherlands
| | - J M J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital, 5000 LC Tilburg, the Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Máxima Medical Center, 5504 DB Veldhoven, the Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, the Netherlands
| | - P G A Hompes
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - C B Lambalk
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - B W J Mol
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
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Baumgarten SC, Convissar SM, Fierro MA, Winston NJ, Scoccia B, Stocco C. IGF1R signaling is necessary for FSH-induced activation of AKT and differentiation of human Cumulus granulosa cells. J Clin Endocrinol Metab 2014; 99:2995-3004. [PMID: 24848710 PMCID: PMC4121023 DOI: 10.1210/jc.2014-1139] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT FSH is routinely administered to in vitro fertilization patients to induce follicle maturation. During this process, granulosa cells differentiate and acquire specific functional characteristics that are required to coordinate ovulation and oocyte maturation. OBJECTIVE The objective of the study was to gain insight into the molecular mechanisms regulating human granulosa cell differentiation. Design, Setting, Patients, and Interventions: Cumulus and mural granulosa cells were isolated from the follicular aspirates of in vitro fertilization patients and analyzed immediately or cultured in serum-free media in the presence of FSH, IGFs, or an inhibitor of type I IGF receptor (IGF1R) activity. MAIN OUTCOME We quantified the mRNA and protein levels of steroidogenic enzymes, components of the IGF system, and gonadotropin receptors; measured 17β-estradiol levels; and examined the activation of intracellular signaling pathways to assess the granulosa cell differentiation as well as the FSH and IGF actions in both cumulus and mural cells. RESULTS In freshly isolated cells, LH receptor (Lhr) and steroidogenic acute regulator (Star) were expressed at lower levels in cumulus than mural cells, whereas FSH receptor (Fshr) and anti-Müllerian hormone (Amh) were expressed at higher levels in cumulus than mural cells. In vitro, the expression of Igf2, the differentiation markers Lhr, Star, and Cyp19a1 (aromatase) as well as 17β-estradiol production remained low in untreated cumulus cells but increased significantly after FSH treatment. Strikingly, this stimulatory effect of FSH was abolished by the inhibition of IGF1R activity. FSH-induced activation of v-akt murine thymoma viral oncogene homolog 3 (AKT) required IGF1R activity, and overexpression of constitutively active AKT rescued the induction of differentiation markers and 17β-estradiol production by FSH in the presence of the IGF1R inhibitor. CONCLUSIONS The cumulus cell response to FSH resembles the differentiation of preantral to preovulatory granulosa cells. This differentiation program requires IGF1R activity and subsequent AKT activation.
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Affiliation(s)
- Sarah C Baumgarten
- Department of Physiology and Biophysics (S.C.B., S.M.C., C.S.) and Division of Reproductive Endocrinology and Infertility (M.A.F., N.J.W., B.S.), Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago, Illinois 60612
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Sivalingam VN, Myers J, Nicholas S, Balen AH, Crosbie EJ. Metformin in reproductive health, pregnancy and gynaecological cancer: established and emerging indications. Hum Reprod Update 2014; 20:853-68. [DOI: 10.1093/humupd/dmu037] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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131
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Kelekci S, Eris S, Demirel E. Ultra-short term clomiphene citrate in high responder women with polycystic ovary syndrome: a case series. Eur J Obstet Gynecol Reprod Biol 2014; 175:191-3. [PMID: 24594076 DOI: 10.1016/j.ejogrb.2013.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate a new trial of short-term clomiphene citrate (CC) in high responder women with polycystic ovary syndrome (PCOS). STUDY DESIGN This case series was conducted in the infertility outpatient clinics of two centres. Ovulation induction was performed with CC 50-100mg a day in six high-responder women with PCOS who had a history of cancellation of treatment because of ≥3 mature follicles between March 2010 and June 2013. Induction was initiated on the third day of their cycles and the duration of induction was only two days. Demographic data of the patients, number of mature follicles on hCG day, ovulation rate, luteal phase length, pregnancy rate, and type of pregnancy were recorded. All data were analysed by SPSS packet programme (SPSS, 17.0, SPSS Inc., Chicago, IL, USA). RESULT(S) The median number of mature follicles and duration of the follicular phase were 1.3 (1-2) and 11.9 (11-14) days, respectively. The ovulation rate was 80% (12/15) and pregnancy rate per cycle was 26.6%. CONCLUSION(S) If this hypothesis is supported by large prospective randomised controlled studies, ultra-short term ovulation induction with CC may provide an alternative approach for high-responder women with PCOS who have a history of treatment cycle cancellations.
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Affiliation(s)
- Sefa Kelekci
- Eagen Maternity and Gynaecology Education and Research Hospital, Izmir, Turkey; Izmir Katip Celebi University, School of Medicine, Department of Obstetrics and Gynaecology, Izmir, Turkey.
| | - Serenat Eris
- Izmir Katip Celebi University, School of Medicine, Department of Obstetrics and Gynaecology, Izmir, Turkey.
| | - Emine Demirel
- Izmir Katip Celebi University, School of Medicine, Department of Obstetrics and Gynaecology, Izmir, Turkey.
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Abstract
Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder affecting women of reproductive age. Some 20% of women will have polycystic ovaries on an ultrasound scan and around 7% of women have the additional clinical or biochemical features of PCOS. As a complex multisystem disorder its background can be confusing to understand. They key feature, however, is an increased production of androgen by the ovaries. This review uses ovarian biology to describe a strategy to aid understanding and explanation of PCOS. This framework can be also be used to teach about PCOS and to inform different approaches to its management.
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Affiliation(s)
- W Colin Duncan
- Scottish Senior Clinical Fellow and Consultant in Reproductive Medicine, MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
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Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6:1-13. [PMID: 24379699 PMCID: PMC3872139 DOI: 10.2147/clep.s37559] [Citation(s) in RCA: 553] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and polycystic ovaries. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include oligomenorrhea or amenorrhea, hirsutism, and frequently infertility. Risk factors for PCOS in adults includes type 1 diabetes, type 2 diabetes, and gestational diabetes. Insulin resistance affects 50%–70% of women with PCOS leading to a number of comorbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance, and diabetes. Studies show that women with PCOS are more likely to have increased coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS. Weight loss improves menstrual irregularities, symptoms of androgen excess, and infertility. Management of clinical manifestations of PCOS includes oral contraceptives for menstrual irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgen excess. Treatment options for infertility include clomiphene, laparoscopic ovarian drilling, gonadotropins, and assisted reproductive technology. Recent data suggest that letrozole and metformin may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications.
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Affiliation(s)
- Susan M Sirmans
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA
| | - Kristen A Pate
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA
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