1
|
Guixue G, Yifu P, Yuan G, Xialei L, Fan S, Qian S, Jinjin X, Linna Z, Xiaozuo Z, Wen F, Wen Y. Progress of the application clinical prediction model in polycystic ovary syndrome. J Ovarian Res 2023; 16:230. [PMID: 38007488 PMCID: PMC10675861 DOI: 10.1186/s13048-023-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/05/2023] [Indexed: 11/27/2023] Open
Abstract
Clinical prediction models play an important role in the field of medicine. These can help predict the probability of an individual suffering from disease, complications, and treatment outcomes by applying specific methodologies. Polycystic ovary syndrome (PCOS) is a common disease with a high incidence rate, huge heterogeneity, short- and long-term complications, and complex treatments. In this systematic review study, we reviewed the progress of clinical prediction models in PCOS patients, including diagnosis and prediction models for PCOS complications and treatment outcomes. We aimed to provide ideas for medical researchers and clues for the management of PCOS. In the future, models with poor accuracy can be greatly improved by adding well-known parameters and validations, which will further expand our understanding of PCOS in terms of precision medicine. By developing a series of predictive models, we can make the definition of PCOS more accurate, which can improve the diagnosis of PCOS and reduce the likelihood of false positives and false negatives. It will also help discover complications earlier and treatment outcomes being known earlier, which can result in better outcomes for women with PCOS.
Collapse
Affiliation(s)
- Guan Guixue
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Pu Yifu
- Laboratory of Genetic Disease and Perinatal Medicine, Key laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Gao Yuan
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Liu Xialei
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Shi Fan
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Sun Qian
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Xu Jinjin
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Zhang Linna
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Zhang Xiaozuo
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Feng Wen
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Yang Wen
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China.
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China.
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
5
|
Ertunc D, Tok EC, Savas A, Ozturk I, Dilek S. Gonadotropin-releasing hormone antagonist use in controlled ovarian stimulation and intrauterine insemination cycles in women with polycystic ovary syndrome. Fertil Steril 2010; 93:1179-84. [PMID: 19200979 DOI: 10.1016/j.fertnstert.2008.11.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 10/15/2008] [Accepted: 11/26/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To observe the effects of ganirelix on controlled ovarian stimulation and intrauterine insemination (COS/IUI) cycles in women with polycystic ovary syndrome (PCOS). DESIGN Prospective, randomized, controlled clinical study. SETTING An academic clinical research center. PATIENT(S) Women with PCOS and anovulatory infertility undergoing COS/IUI. INTERVENTION(S) Recombinant FSH therapy was started on day 3. In women assigned to the control group (n = 47), treatment was continued up to the day of hCG administration. In patients assigned to receive GnRH antagonist (n = 42), ganirelix was added when the leading follicle was > or =14 mm. MAIN OUTCOME MEASURE(S) Pregnancy rates, serum E(2), P, and LH levels, and follicle numbers at hCG day, prevalence of premature luteinization, and cost of stimulation. RESULT(S) Serum E(2), P, and LH levels were significantly lower in the ganirelix group. Although premature luteinization and cycle cancellation was encountered less in the ganirelix group, the pregnancy rates per cycle were similar (15.4% vs. 10.7%). Patients would pay 6,153 dollars more for each pregnancy when using ganirelix. CONCLUSION(S) Gonadotropin-releasing hormone antagonist resulted in more monofollicular development, less premature luteinization, and less cycle cancellation in IUI cycles of patients with PCOS; however, the cost of stimulation increased without an improvement in pregnancy rates.
Collapse
Affiliation(s)
- Devrim Ertunc
- Department of Obstetrics and Gynecology, School of Medicine, Mersin University, Mersin, Turkey.
| | | | | | | | | |
Collapse
|
6
|
Factors related to successful ovulation induction in patients with WHO group II anovulatory infertility. Reprod Biomed Online 2009; 20:182-90. [PMID: 20113956 DOI: 10.1016/j.rbmo.2009.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 06/04/2009] [Accepted: 11/11/2009] [Indexed: 11/21/2022]
Abstract
To identify baseline characteristics related to successful ovulation induction, data were analysed from oligo- or anovulatory patients undergoing their first cycle of human recombinant FSH (r-hFSH; follitropin alfa) in a chronic low-dose (75 IU starting dose), step-up protocol in two clinical trials (n=446). Patients were grouped according to response: group A, ovulated within 14 days (75 IU follitropin alfa); group B, ovulated after 14 days (>75 IU follitropin alfa); group C, not administered human chorionic gonadotrophin (HCG) because of poor response; group D, cycle cancelled due to over-response (HCG not administered); group E, spontaneous ovulation prior to obtaining criteria for administration of HCG. Mean body mass index (BMI) of group A (25.0 kg/m(2)) was significantly lower than groups B (27.1 kg/m(2), P<0.001) or C (28.2 kg/m(2), P<0.0001), but similar to group D (24.3 kg/m(2)). Mean antral follicle count (AFC) of group A was also significantly lower than group C (18.3 versus 22.7; P=0.018), but not significantly different from groups B (21.5) or D (19.5); group E had the highest mean AFC (35.7). Comparatively low BMI, low AFC and higher (although still within the normal range) FSH concentration at baseline were associated with successful ovulation induction in infertile women undergoing a chronic low-dose, step-up stimulation protocol.
Collapse
|
8
|
Fauser BCJM, Diedrich K, Devroey P. Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2007; 14:1-14. [PMID: 18006561 DOI: 10.1093/humupd/dmm034] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian stimulation is applied in the clinic to restore mono-ovulatory cycles in anovulatory women (ovulation induction) or to induce the development of multiple dominant follicles for assisted reproduction. Ovarian response is the endocrine and follicular reaction of the ovaries to stimulation. Achieving an appropriate ovarian response to anti-estrogens or exogenous gonadotrophins is central to ovulation induction and ovarian stimulation protocols. However, achieving an adequate response, without cycle cancellation or adverse events related to under- or over-stimulation, is complicated by high intra- and inter-individual variability. To predict each patient's ovarian response to medication for ovarian stimulation and to individualize the starting dose of exogenous gonadotrophin or the need for exogenous luteinizing hormone, various clinical, endocrine, ovarian ultrasonographic and genetic characteristics have been explored. Some of these features have been incorporated into prediction models. In this review, the methodology behind predictive factors and prediction models and their potential clinical applicability across ovulation induction and ovarian stimulation are explored.
Collapse
Affiliation(s)
- B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | | | | | | |
Collapse
|