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Buczyńska A, Sidorkiewicz I, Krętowski AJ, Adamska A. Examining the clinical relevance of metformin as an antioxidant intervention. Front Pharmacol 2024; 15:1330797. [PMID: 38362157 PMCID: PMC10867198 DOI: 10.3389/fphar.2024.1330797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
In physiological concentrations, reactive oxygen species play a vital role in regulating cell signaling and gene expression. Nevertheless, oxidative stress is implicated in the pathogenesis of numerous diseases and can inflict damage on diverse cell types and tissues. Thus, understanding the factors that mitigate the deleterious effects of oxidative stress is imperative for identifying new therapeutic targets. In light of the absence of direct treatment recommendations for reducing oxidative stress, there is a continuing need for fundamental research that utilizes innovative therapeutic approaches. Metformin, known for its multifaceted beneficial properties, is acknowledged for its ability to counteract the adverse effects of increased oxidative stress at both molecular and cellular levels. In this review, we delve into recent insights regarding metformin's antioxidant attributes, aiming to expand its clinical applicability. Our review proposes that metformin holds promise as a potential adjunctive therapy for various diseases, given its modulation of oxidative stress characteristics and regulation of diverse metabolic pathways. These pathways include lipid metabolism, hormone synthesis, and immunological responses, all of which may experience dysregulation in disease states, contributing to increased oxidative stress. Furthermore, our review introduces potential novel metformin-based interventions that may merit consideration in future research. Nevertheless, the necessity for clinical trials involving this drug remains imperative, as they are essential for establishing therapeutic dosages and addressing challenges associated with dose-dependent effects.
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Affiliation(s)
- Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Iwona Sidorkiewicz
- Clinical Research Support Centre, Medical University of Bialystok, Bialystok, Poland
| | - Adam Jacek Krętowski
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
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2
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Fan H, Ren Q, Sheng Z, Deng G, Li L. The role of the thyroid in polycystic ovary syndrome. Front Endocrinol (Lausanne) 2023; 14:1242050. [PMID: 37867519 PMCID: PMC10585146 DOI: 10.3389/fendo.2023.1242050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disease in women of childbearing age and can cause metabolic disorder, infertility, and increased anxiety and depression; as a result, it can seriously affect the physical and mental health of fertile women. PCOS is a highly clinically heterogeneous disease with unclear etiology and pathogenesis, which increases the difficulty of treatment. The thyroid gland has complex regulatory effects on metabolism, reproduction, and emotion, and produces hormones that act on almost all cells of the human body. The clinical manifestations of PCOS are similar to some thyroid diseases. Furthermore, some thyroid diseases, such as subclinical hypothyroidism (SCH), not only increase the incidence rate of PCOS, but also exacerbate its associated metabolic abnormalities and reproductive disorders. Interestingly, PCOS also increases the incidence of some thyroid diseases. However, the role of the thyroid in PCOS remains unclear. This review is intended to thoroughly explore the critical role of the thyroid in PCOS by summarizing the comorbidity of PCOS and thyroid diseases and their combined role in metabolic disorders, related metabolic diseases, and reproductive disorders; and by analyzing the potential mechanism through which the thyroid influences the development and progression of PCOS and its symptoms. We hope this review will provide a valuable reference for the role of the thyroid in PCOS.
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Affiliation(s)
- Huanhuan Fan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qingling Ren
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhejin Sheng
- School of Life Science and Technology, Tongji University, Shanghai, China
| | - Ganxiu Deng
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Limei Li
- Research Center for Translational Medicine, Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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3
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Bhandary P, Shetty PK, Manjeera L, Patil P. Hormonal, genetic, epigenetic and environmental aspects of polycystic ovarian syndrome. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Akre S, Sharma K, Chakole S, Wanjari MB. Recent Advances in the Management of Polycystic Ovary Syndrome: A Review Article. Cureus 2022; 14:e27689. [PMID: 36072214 PMCID: PMC9440853 DOI: 10.7759/cureus.27689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Polycystic ovarian syndrome (PCOS) is an endocrine disorder. This condition is characterized by chronic anovulation and ovarian dysfunction, unlike other ovulation disorders when the ovaries are non-functional or abnormal. Currently, most therapy is centred on the patient's primary complaint. Treatment focuses on reducing hyperandrogenism symptoms, restoring menstrual regularity, and achieving conception. In treating infertility caused by polycystic ovarian syndrome, letrozole (an aromatase inhibitor) appears to be more successful than clomiphene citrate (an anti-estrogen and a reference infertility drug). When provided by a multidisciplinary team, it can help patients maintain appropriate lifestyle changes, such as reducing body fat, increasing metabolism, and enhancing reproductive health. Compound oral contraceptives are the most common kind of androgen inhibitor and are the preferred therapy for menstrual disruption in PCOS patients who do not want to get pregnant. Weight loss should be prioritized for women with PCOS since a healthy, balanced diet combined with regular exercise can boost metabolism, increase insulin sensitivity, and aid weight loss safely. This will improve their physical health. Other than reproductive symptoms, PCOS symptoms include insulin resistance (IR), metabolic syndrome (MS), and chronic low-grade inflammation. Our understanding of the pathophysiological process, diagnosis, and therapy of PCOS has advanced recently.
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Zehravi M, Maqbool M, Ara I. Depression and anxiety in women with polycystic ovarian syndrome: a literature survey. Int J Adolesc Med Health 2021; 33:367-373. [PMID: 34420269 DOI: 10.1515/ijamh-2021-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/15/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is the most frequent endocrine disorder among women of reproductive age. Some of the indications and symptoms of PCOS include amenorrhoea, hirsutism, infertility, obesity, acne vulgaris and androgenic alopecia. PCOS is a crippling condition that affects a woman's identity, mental health and overall quality of life (QOL). In persons with PCOS, anxiety and sadness are assumed to be multifactorial. According to some specialists, physical symptoms like acne, hirsutism and obesity have been linked to psychiatric morbidities. Many aspects of it remain unknown, including its cause, progression throughout life, symptom spectrum and level of morbidity. PCOS is a complex disease that has an impact on many aspects of a person's health, including their mental health. Anxiety and depression are three times as common in PCOS patients as in non-PCOS people. Anxiety and depression symptoms are also more common and more intense in those with PCOS. There isn't enough research on the prevalence of anxiety and depression in patients with PCOS. It's unclear what causes persons with PCOS to be more anxious and depressed. It could be the result of PCOS symptoms, hormonal changes, or a combination of factors that are currently unclear. Our review article will help to highlight the most recent research on anxiety and depression in PCOS women.
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Affiliation(s)
- Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudia Arabia
| | - Mudasir Maqbool
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Irfat Ara
- Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
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Dube R. Does endothelial dysfunction correlate with endocrinal abnormalities in patients with polycystic ovary syndrome? Avicenna J Med 2021; 6:91-102. [PMID: 27843797 PMCID: PMC5054651 DOI: 10.4103/2231-0770.191445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To study and critically analyze the published evidence on correlation of hormonal abnormalities and endothelial dysfunction (ED) in polycystic ovary syndrome (PCOS) through a systematic review. The databases including MEDLINE, PubMed, Up-To-Date, and Science Direct were searched using Medical subject handling terms and free text term keywords such as endocrine abnormalities in PCOS, ED assessment in PCOS, ED in combination with insulin resistance (IR), hyperandrogenism (HA), increased free testosterone, free androgen index (FAI), gonadotrophin levels, luteinizing hormone (LH), prolactin, estrogen, adipocytokines to search trials, and observational studies published from January 1987 to September 2015. Authors of original studies were contacted for additional data when necessary. PCOS increases the risk of cardiovascular disease in women. ED, which is a reliable indicator of cardiovascular risk in general population, is seen in most (but not all) women with PCOS. IR, seen in 70% patients with PCOS, is associated with ED in these women, but patients can have normal endothelial function even in the presence of IR. Free testosterone and FAI are consistently associated with ED, but endothelial function can be normal despite HA. Estradiol (not estrone) appears to be protective against ED though estrone is the predominant estrogen produced in PCOS. Increased levels of adipocytokines (visfatin) are promising in predicting ED and cardiovascular risk. However, more studies are required focusing on direct correlation of levels of prolactin, LH, estrone, and visfatin with ED in PCOS.
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Affiliation(s)
- Rajani Dube
- Department of Obstetrics and Gynaecology, Ras al-Khaimah Medical and Health Sciences University, Al Qusaidat, Ras al-Khaimah, United Arab Emirates
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Papadakis G, Kandaraki EA, Garidou A, Koutsaki M, Papalou O, Diamanti-Kandarakis E, Peppa M. Tailoring treatment for PCOS phenotypes. Expert Rev Endocrinol Metab 2021; 16:9-18. [PMID: 33382003 DOI: 10.1080/17446651.2021.1865152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in reproductive-aged women. Hyperandrogenism, polycystic ovaries, chronic anovulation, and metabolic aberrations are its common features. The treatment approach focuses on the main aberrations, which characterize the different phenotypes. Areas covered: Management strategies targeting the metabolic phenotype include lifestyle modifications for weight loss and improvement of dietary habits, as well as medication, such as insulin-sensitizers. The treatment of hyperandrogenic phenotype includes cosmetic procedures and the combined oral contraceptives with or without antiandrogens. The therapeutic approach to reproductive phenotype includes diet and lifestyle modifications, clomiphene citrate, and aromatase inhibitors. Alternative treatments include dietary supplements, herbs, resveratrol, myo-inositol, and acupuncture. Expert opinion: New studies have shown that higher anti-Müllerian hormone levels, gut microbiome composition, and plasma metabolomics are new parameters that are related to the most severe phenotypes. The clinical phenotypes can change over the lifespan with weight gain and can coexist in the same individual. Individualized treatment remains the main approach but grouping the phenotypes and following therapeutic recommendations may prove to be also clinically appropriate.
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Affiliation(s)
- Georgios Papadakis
- Endocrinology and Diabetes, STEPS Stoffwechselzentrum , Biel/Bienne, Switzerland
| | - Eleni A Kandaraki
- Endocrinology &Diabetes, European University Cyprus (EUC) , Nicosia, Cyprus
- Department of Endocrinology and Diabetes, HYGEIA Hospital Athens , Greece
| | - Anna Garidou
- Private Practice, Endocrinologist and Diabetologist , Chalandri, Athens, Greece
| | - Maria Koutsaki
- Private Practice, Endocrinologist and Diabetologist , Kesariani, Athens, Greece
| | - Olga Papalou
- Department of Endocrinology and Diabetes, HYGEIA Hospital Athens , Greece
| | | | - Melpomeni Peppa
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Attikon University Hospital , Greece
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Controversial conclusions from two randomized controlled trials for acupuncture’s effects on polycystic ovary syndrome or in vitro fertilization support. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:89-91. [DOI: 10.1016/j.joim.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
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9
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Ovarian mitochondrial dynamics and cell fate regulation in an androgen-induced rat model of polycystic ovarian syndrome. Sci Rep 2020; 10:1021. [PMID: 31974436 PMCID: PMC6978404 DOI: 10.1038/s41598-020-57672-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022] Open
Abstract
In this study, we investigated in an androgenized rat model the involvement of autophagy and mitochondrial dynamics in granulosa cells in the pathogenesis of polycystic ovarian syndrome (PCOS) and its modulation by exogenous gonadotropin (eCG). We found 5α-dihydrotestosterone (DHT) treatment reduces ovarian length and weight with predominantly late antral and/or preovulatory stage follicles and no corpora lutea. DHT increased the population of large lysosomes (>50 micron) and macroautophagy, an event associated with granulosa cell apoptosis. Increased granulosa cell Dynamin Related Protein 1 (Drp1) content in the DHT group was accompanied by increased circular and constricted, but reduced rod-shaped, mitochondria. eCG eliminated all atypical follicles and increased the number of late antral and preovulatory follicles with less granulosa cell apoptosis. eCG-treated rats had a higher proportion of connected mitochondria, and in combination with DHT had a lower proportion of circular and constricted mitochondria than rats treated with DHT alone, suggesting that eCG induces mitochondrial fusion and attenuates fission in granulosa cells. In summary, we observed that DHT-induced up-regulation of Drp1 is associated with excessive mitochondrial fission, macroautophagy and apoptosis in granulosa cells at the antral stage of development in an androgenized rat model for PCOS, a response partially attenuated by exogenous gonadotropin.
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Gadalla MA, Norman RJ, Tay CT, Hiam DS, Melder A, Pundir J, Thangaratinam S, Teede HJ, Mol BWJ, Moran LJ. Medical and Surgical Treatment of Reproductive Outcomes in Polycystic Ovary Syndrome: An Overview of Systematic Reviews. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 13:257-270. [PMID: 31710185 PMCID: PMC6875858 DOI: 10.22074/ijfs.2020.5608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/10/2019] [Indexed: 12/28/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common, complex condition that affects up to 18% of reproductiveaged women, causing reproductive, metabolic and psychological dysfunctions. We performed an overview and appraisal of methodological quality of systematic reviews that assessed medical and surgical treatments for reproductive outcomes in women with PCOS. Databases (MEDLINE, EMBASE, CINAHL PLUS and PROSPERO) were searched on the 15th of September 2017. We included any systematic review that assessed the effect of medical or surgical management of PCOS on reproductive, pregnancy and neonatal outcomes. Eligibility assessment, data extraction and quality assessment by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. We identified 53 reviews comprising 44 reviews included in this overview; the majority were moderate to high quality. In unselected women with PCOS, letrozole was associated with a higher live birth rate than clomiphene citrate (CC), while CC was better than metformin or placebo. In women with CC-resistant PCOS, gonadotrophins were associated with a higher live birth rate than CC plus metformin, which was better than laparoscopic ovarian drilling (LOD). LOD was associated with lower multiple pregnancy rates than other medical treatments. In women with PCOS undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), the addition of metformin to gonadotrophins resulted in less ovarian hyperstimulation syndrome (OHSS), and higher pregnancy and live birth rates than gonadotrophins alone. Gonadotrophin releasing hormone (GnRH) antagonist was associated with less OHSS, gonadotrophin units and shorter stimulation length than GnRH agonist. Letrozole appears to be a good first line treatment and gonadotrophins, as a second line treatment, for anovulatory women with PCOS. LOD results in lower multiple pregnancy rates. However, due to the heterogeneous nature of the included populations of women with PCOS, further larger scale trials are needed with more precise assessment of treatments according to heterogeneous variants of PCOS.
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Affiliation(s)
- Moustafa A Gadalla
- Women's Health Hospital, Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt.Elevtronic Address:
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
| | - Robert J Norman
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia
- Monash Diabetes and Endocrinology Units, Monash Health, Victoria, Melbourne, Australia
| | | | - Danielle S Hiam
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia
| | - Jyotsna Pundir
- Centre of Reproductive Medicine, St Bartholomew's Hospital, London, United Kingdom
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia
- Monash Diabetes and Endocrinology Units, Monash Health, Victoria, Melbourne, Australia
| | - Ben W J Mol
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Melbourne, Australia
| | - Lisa J Moran
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia
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Yildirim E, Derici MK. A Case-Control Study on the Oxidative Status in Women with Polycystic Ovary Syndrome Treated with Clomiphene Citrate. Med Sci Monit 2019; 25:3910-3917. [PMID: 31129677 PMCID: PMC6556075 DOI: 10.12659/msm.914338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/06/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is associated with infertility or subfertility due to impaired ovulation. Clomiphene citrate is a first-line treatment option for the induction of ovulation in women with PCOS. The study aimed to compare markers of oxidative stress or the total oxidative status (TOS), total antioxidant status (TAS), and levels of paraoxonase-1 (PON-1) before and after day 21 of the menstrual cycle in women with PCOS treated with clomiphene citrate to induce ovulation. MATERIAL AND METHODS The study included 75 women who were divided into a control group (n=25) that included healthy untreated women, untreated women with PCOS (n=24) who had spontaneous ovulation, and women with PCOS who were treated with clomiphene citrate for subfertility or infertility (n=26) (the PCOS-CC group). The study group was treated for five days with clomiphene citrate (50 mg/day). Peripheral venous blood was sampled on day 3 and day 21 of the menstrual cycle from women in all three groups, and TAS, TOS, and PON-1 levels were measured. RESULTS In all three groups, TAS and PON levels were significantly reduced and TOS values were significantly increased on day 21 of the menstrual cycle. Comparison of TAS, TOS, and PON-1 levels between the three study groups on day 3 and day 21 of the menstrual cycle showed no significant difference (p=0.600, p=0.223, p=0.956, respectively). CONCLUSIONS This study showed that spontaneous ovulation occurs in association with an oxidative state in healthy women and women with PCOS, and women with PCOS following treatment with clomiphene citrate.
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Affiliation(s)
- Engin Yildirim
- Department of Obstetrics and Gynecology, Hitit University Medical School, Çorum, Turkey
| | - Mehmet Kürşat Derici
- Department of Medical Pharmacology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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12
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Wu S, Xue P, Grayson N, Bland JS, Wolfe A. Bitter Taste Receptor Ligand Improves Metabolic and Reproductive Functions in a Murine Model of PCOS. Endocrinology 2019; 160:143-155. [PMID: 30418546 DOI: 10.1210/en.2018-00711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022]
Abstract
Polycystic ovary syndrome (PCOS) results from functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Cultured theca cells from polycystic ovaries of women with the most common form of PCOS overexpress most androgen producing enzymes, particularly CYP450c17. In this study, a murine model was used of PCOS induced by chronic feeding with a high-fat diet that exhibits the reproductive, hyperandrogenic, and metabolic constellation of PCOS symptoms seen in women. Oral administration of KDT501, a hops-derived bitter taste receptor (Tas2R 108) isohumulone ligand resulted in resolution of PCOS-associated endocrine and metabolic disturbances and restored reproductive function. Pioglitazone, a PPARγ agonist, also improved metabolic and reproductive function, though not to the same degree as KDT501. Specifically, treatment of the murine PCOS model with KDT501 resulted in reduced testosterone and androstenedione levels in the absence of significant changes in LH or FSH, improved glucose tolerance and lipid metabolism, and reduced hepatic lipid infiltration and adiposity. There was significant improvement in estrous cyclicity and an increase in the number of ovarian corpora lutea, indicative of improved reproductive function after exposure to KDT501. Finally, ex vivo exposure of murine ovaries to KDT501 attenuated androgen production and ovarian expression of CYP450c17. Interestingly, the ovaries expressed Tas2R 108, suggesting a potential regulation of ovarian steroidogenesis through this chemosensory receptor family. In summary, a therapeutic strategy for PCOS possibly could include direct influences on ovarian steroidogenesis that are independent of gonadotrophic hormone regulation.
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Affiliation(s)
- Sheng Wu
- Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ping Xue
- Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neile Grayson
- Kindex Pharmaceutical, Bainbridge Island, Washington
| | | | - Andrew Wolfe
- Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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13
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Puscheck EE, Bolnick A, Awonuga A, Yang Y, Abdulhasan M, Li Q, Secor E, Louden E, Hüttemann M, Rappolee DA. Why AMPK agonists not known to be stressors may surprisingly contribute to miscarriage or hinder IVF/ART. J Assist Reprod Genet 2018; 35:1359-1366. [PMID: 29882092 PMCID: PMC6086802 DOI: 10.1007/s10815-018-1213-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/16/2018] [Indexed: 12/20/2022] Open
Abstract
Here we examine recent evidence suggesting that many drugs and diet supplements (DS), experimental AMP-activated protein kinase (AMPK) agonists as well as energy-depleting stress, lead to decreases in anabolism, growth or proliferation, and potency of cultured oocytes, embryos, and stem cells in an AMPK-dependent manner. Surprising data for DS and drugs that have some activity as AMPK agonists in in vitro experiments show possible toxicity. This needs to be balanced against a preponderance of evidence in vivo that these drugs and DS are beneficial for reproduction. We here discuss and analyze data that leads to two possible conclusions: First, although DS and drugs that have some of their therapeutic mechanisms mediated by AMPK activity associated with low ATP levels, some of the associated health problems in vivo and in vitro fertilization/assisted reproductive technologies (IVF/ART) may be better-treated by increasing ATP production using CoQ10 (Ben-Meir et al., Aging Cell 14:887-895, 2015). This enables high developmental trajectories simultaneous with solving stress by energy-requiring responses. In IVF/ART, it is ultimately best to maintain handling and culture of gametes and embryos in the quietest state with low metabolic activity (Leese et al., Mol Hum Reprod 14:667-672, 2008; Leese, Bioessays 24 (9):845-849, 2002) using back-to-nature or simplex algorithms to identify optima (Biggers, Reprod Biomed Online 4 Suppl 1:30-38, 2002). Stress markers, such as checkpoint proteins like TRP53 (aka p53) (Ganeshan et al., Exp Cell Res 358:227-233, 2017); Ganeshan et al., Biol Reprod 83:958-964, 2010) and a small set of kinases from the protein kinome that mediate enzymatic stress responses, can also be used to define optima. But, some gametes or embryos may have been stressed in vivo prior to IVF/ART or IVF/ART optimized for one outcome may be suboptimal for another. Increasing nutrition or adding CoQ10 to increase ATP production (Yang et al., Stem Cell Rev 13:454-464, 2017), managing stress enzyme levels with inhibitors (Xie et al., Mol Hum Reprod 12:217-224, 2006), or adding growth factors such as GM-CSF (Robertson et al., J Reprod Immunol 125:80-88, 2018); Chin et al., Hum Reprod 24:2997-3009, 2009) may increase survival and health of cultured embryos during different stress exposure contexts (Puscheck et al., Adv Exp Med Biol 843:77-128, 2015). We define "stress" as negative stimuli which decrease normal magnitude and speed of development, and these can be stress hormones, reactive oxygen species, inflammatory cytokines, or physical stimuli such as hypoxia. AMPK is normally activated by high AMP, commensurate with low ATP, but it was recently shown that if glucose is present inside the cell, AMPK activation by low ATP/high AMP is suppressed (Zhang et al., Nature 548:112-116, 2017). As we discuss in more detail below, this may also lead to greater AMPK agonist toxicity observed in two-cell embryos that do not import glucose. Stress in embryos and stem cells increases AMPK in large stimulation indexes but also direness indexes; the fastest AMPK activation occurs when stem cells are shifted from optimal oxygen to lower or high levels (Yang et al., J Reprod Dev 63:87-94, 2017). CoQ10 use may be better than risking AMPK-dependent metabolic and developmental toxicity when ATP is depleted and AMPK activated. Second, the use of AMPK agonists, DS, and drugs may best be rationalized when insulin resistance or obesity leads to aberrant hyperglycemia and hypertriglyceridemia, and obesity that negatively affect fertility. Under these conditions, beneficial effects of AMPK on increasing triglyceride and fatty acid and glucose uptake are important, as long as AMPK agonist exposures are not too high or do not occur during developmental windows of sensitivity. During these windows of sensitivity suppression of anabolism, proliferation, and stemness/potency due to AMPK activity, or overexposure may stunt or kill embryos or cause deleterious epigenetic changes.
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Affiliation(s)
- Elizabeth E Puscheck
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Alan Bolnick
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
- Department of Obstetrics and Gynecology, Kaleida Women's and Children's Hospital Buffalo New York, Buffalo, NY, USA
| | - Awoniyi Awonuga
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Yu Yang
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Mohammed Abdulhasan
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Quanwen Li
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Eric Secor
- Department of Medicine, Integrative Medicine, Hartford Hospital and University of Connecticut, Hartford, CT, 06102, USA
| | - Erica Louden
- Augusta University of Health Sciences, Augusta, GA, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daniel A Rappolee
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA.
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA.
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
- Institutes for Environmental Health Science, Wayne State University School of Medicine, Detroit, MI, USA.
- Department of Biology, University of Windsor, Windsor, ON, N9B 3P4, Canada.
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Abstract
Polycystic ovary syndrome (PCOS) is a commonly occurring endocrine disorder characterized by hirsutism, anovulation, and polycystic ovaries. Often comorbid with insulin resistance, dyslipidemia, and obesity, it also carries significant risk for the development of cardiovascular and metabolic sequelae, including diabetes and metabolic syndrome. Traditionally, the treatment of patients with PCOS has focused on relief of symptoms. Here, the criteria for the diagnosis of PCOS are reviewed with an emphasis on the stratification of subtypes by metabolic features. Then treatment options are reviewed according to the management goal: relief of hyperandrogenic symptoms, regulation of menstruation, and restoration of fertility.
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Affiliation(s)
- Renate K Meier
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
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15
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Gadalla MA, Huang S, Wang R, Norman RJ, Abdullah SA, El Saman AM, Ismail AM, van Wely M, Mol BWJ. Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:64-76. [PMID: 29055102 DOI: 10.1002/uog.18933] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the impact of clomiphene citrate (CC) vs other drug regimens on mid-cycle endometrial thickness (EMT), ovulation, pregnancy and live birth rates in women with World Health Organization (WHO) group II ovulatory disorders. METHODS We searched MEDLINE, EMBASE, Scopus, Web of Science, The Cochrane Central Register of Clinical Trials (CENTRAL) and the non-MEDLINE subset of PubMed from inception to December 2016 and cross-checked references of relevant articles. We included only randomized controlled trials (RCTs) comparing CC used alone vs other drug regimens for ovulation induction in women with WHO group II anovulation. Outcomes were mid-cycle EMT, ovulation, pregnancy and live birth rates. We pooled weighted mean differences (WMD) with 95% confidence intervals (CI) for continuous variables (EMT) and risk ratios (RR) with 95% CI for binary variables (ovulation, pregnancy and live birth rates). RESULTS We retrieved 1718 articles of which 33 RCTs (4349 women, 7210 ovulation induction cycles) were included. In 15 RCTs that compared CC with letrozole, EMT was lower in the CC group (1957 women, 3892 cycles; WMD, -1.39; 95% CI, -2.27 to -0.51; I2 = 100%), ovulation rates after CC and letrozole were comparable (1710 women, 3217 cycles; RR, 0.97; 95% CI, 0.90-1.04; I2 = 47%), while CC led to a lower pregnancy rate (1957 women, 3892 cycles; RR, 0.78; 95% CI, 0.63-0.95; I2 = 43%) and a lower live birth rate (RR, 0.70; 95% CI, 0.49-0.98; I2 = 35%). In two RCTs that compared CC with CC plus metformin, EMT, ovulation and pregnancy rates were comparable (101 women, 140 cycles; WMD, -0.23; 95% CI, -0.92 to 0.45; I2 = 78%; RR, 0.84; 95% CI, 0.67-1.06; I2 = 0%; and RR, 0.79; 95% CI, 0.33-1.87; I2 = 0%). In three studies that compared CC with CC plus N-acetyl cysteine (NAC), EMT was lower in the CC group (340 women, 300 cycles; WMD, -1.51; 95% CI, -1.98 to -1.04; I2 = 45%). In two studies that compared CC with CC + nitric oxide (NO) donor, EMT was lower in the CC group (120 women, 304 cycles; WMD, -1.75; 95% CI, -2.08 to -1.41; I2 = 0%). Compared with CC plus NO donor or NAC, CC showed statistically significant lower ovulation and pregnancy rates. Compared with tamoxifen in three studies, CC showed a tendency towards lower EMT (571 women, 844 cycles; WMD, -1.34; 95% CI, -2.70 to 0.01; I2 = 96%) with comparable ovulation and pregnancy rates. CONCLUSIONS In women with WHO group II ovulatory disorders, ovulation induction with CC might result in lower EMT than other ovulation induction regimens. Whether the lower EMT caused the lower pregnancy and live birth rates remains to be elucidated. Letrozole seems to be beneficial for these women. However, our findings should be interpreted with caution as the quality of evidence was very low. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M A Gadalla
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - S Huang
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Reproductive Medicine Centre, Peking University Third Hospital, Beijing, China
| | - R Wang
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - R J Norman
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - S A Abdullah
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - A M El Saman
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - A M Ismail
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - B W J Mol
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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16
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Salem MN, Ahmed SR, Abbas AM, Salem AN, Sabala AERM. Short term effects of laparoscopic ovarian drilling in clomiphene citrate resistant patients with polycystic ovary syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Bolnick A, Abdulhasan M, Kilburn B, Xie Y, Howard M, Andresen P, Shamir AM, Dai J, Puscheck EE, Secor E, Rappolee DA. Two-cell embryos are more sensitive than blastocysts to AMPK-dependent suppression of anabolism and stemness by commonly used fertility drugs, a diet supplement, and stress. J Assist Reprod Genet 2017; 34:1609-1617. [PMID: 28913567 DOI: 10.1007/s10815-017-1028-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/22/2017] [Indexed: 01/14/2023] Open
Abstract
PURPOSE This study tests whether metformin or diet supplement BR-DIM-induced AMP-activated protein kinase (AMPK) mediated effects on development are more pronounced in blastocysts or 2-cell mouse embryos. METHODS Culture mouse zygotes to two-cell embryos and test effects after 0.5-1 h AMPK agonists' (e.g., Met, BR-DIM) exposure on AMPK-dependent ACCser79P phosphorylation and/or Oct4 by immunofluorescence. Culture morulae to blastocysts and test for increased ACCser79P, decreased Oct4 and for AMPK dependence by coculture with AMPK inhibitor compound C (CC). Test whether Met or BR-DIM decrease growth rates of morulae cultured to blastocyst by counting cells. RESULT(S) Aspirin, metformin, and hyperosmotic sorbitol increased pACC ser79P ~ 20-fold, and BR-DIM caused a ~ 30-fold increase over two-cell embryos cultured for 1 h in KSOMaa but only 3- to 6-fold increase in blastocysts. We previously showed that these stimuli decreased Oct4 40-85% in two-cell embryos that was ~ 60-90% reversible by coculture with AMPK inhibitor CC. However, Oct4 decreased only 30-50% in blastocysts, although reversibility of loss by CC was similar at both embryo stages. Met and BR-DIM previously caused a near-complete cell proliferation arrest in two-cell embryos and here Met caused lower CC-reversible growth decrease and AMPK-independent BR-DIM-induced blastocyst growth decrease. CONCLUSION Inducing drug or diet supplements decreased anabolism, growth, and stemness have a greater impact on AMPK-dependent processes in two-cell embryos compared to blastocysts.
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Affiliation(s)
- Alan Bolnick
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA.
| | - Mohammed Abdulhasan
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Brian Kilburn
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Yufen Xie
- Fertility and Surgical Associates of California, Thousand Oaks, CA, 91361, USA
| | - Mindie Howard
- EmbryoTech Laboratories, 140 Hale Street, Haverhill, MA, 01830, USA
| | - Paul Andresen
- Wayne State University School of Medicine, Ob/Gyn, IVF Clinic, University Physician Group, 26400 W 12 Mile Road, Suite 140, Southfield, MI, 48034, USA
| | - Alexandra M Shamir
- University of Utah, 201 Presidents Circle, Salt Lake City, UT, 84112, USA
| | - Jing Dai
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Elizabeth E Puscheck
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA.,Department of Medicine, Hartford Hospital and University of Connecticut, Hartford, CT, USA
| | - Eric Secor
- Program for Reproductive Sciences and Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Daniel A Rappolee
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA.,Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.,Institutes for Environmental Health Science, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Biology, University of Windsor, Windsor, ON, N9B 3P4, Canada
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18
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Wang R, Kim BV, van Wely M, Johnson NP, Costello MF, Zhang H, Ng EHY, Legro RS, Bhattacharya S, Norman RJ, Mol BWJ. Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis. BMJ 2017; 356:j138. [PMID: 28143834 PMCID: PMC5421445 DOI: 10.1136/bmj.j138] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the effectiveness of alternative first line treatment options for women with WHO group II anovulation wishing to conceive. DESIGN Systematic review and network meta-analysis. DATA SOURCES Cochrane Central Register of Controlled Trials, Medline, and Embase, up to 11 April 2016. STUDY SELECTION Randomised controlled trials comparing eight ovulation induction treatments in women with WHO group II anovulation: clomiphene, letrozole, metformin, clomiphene and metformin combined, tamoxifen, gonadotropins, laparoscopic ovarian drilling, and placebo or no treatment. Study quality was measured on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Pregnancy, defined preferably as clinical pregnancy, was the primary outcome; live birth, ovulation, miscarriage, and multiple pregnancy were secondary outcomes. RESULTS Of 2631 titles and abstracts initially identified, 54 trials reporting on 7173 women were included. All pharmacological treatments were superior to placebo or no intervention in terms of pregnancy and ovulation. Compared with clomiphene alone, both letrozole and the combination of clomiphene and metformin showed higher pregnancy rates (odds ratio 1.69, 95% confidence interval 1.33 to 2.14; 1.71, 1.28 to 2.27; respectively). Letrozole led to higher live birth rates when compared with clomiphene alone (1.67, 1.11 to 2.49). Metformin led to lower multiple pregnancy rates compared with clomiphene alone (0.22, 0.05 to 0.93). CONCLUSIONS In women with WHO group II anovulation, letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of pregnancy. Compared with clomiphene alone, letrozole is the only treatment showing a significantly higher rate of live birth. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015027579. READERS' NOTE This is the second version of this paper. The original version was corrected following the retraction of two studies and removal of another which were ineligible (references 40, 41, and 75 of the original paper). These studies are not shown in this version. A tracked changes version of the original version is attached as a supplementary file to the correction notice, which explains the issue further.
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Affiliation(s)
- Rui Wang
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, North Adelaide, Australia
- Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bobae V Kim
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, North Adelaide, Australia
| | - Madelon van Wely
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Neil P Johnson
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, North Adelaide, Australia
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Michael F Costello
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Hanwang Zhang
- Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, China
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, USA
| | | | - Robert J Norman
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, North Adelaide, Australia
- FertilitySA, Adelaide, Australia
- NHMRC (National Health and Medical Research Council) Centre for Research Excellence in Polycystic Ovary Syndrome, Adelaide, Australia
| | - Ben Willem J Mol
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, North Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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19
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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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20
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Wang R, Mol BWJ. The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria? Hum Reprod 2016; 32:261-264. [PMID: 28119448 DOI: 10.1093/humrep/dew287] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/05/2016] [Accepted: 10/27/2016] [Indexed: 01/06/2023] Open
Abstract
The Rotterdam criteria for polycystic ovary syndrome (PCOS) are used by a wide range of medical professionals and researchers. However, the development of these criteria was based on expert meetings and not on evidence-based treatment guidance. Over the last decade, the Rotterdam criteria have been useful in guiding research, and a number of clinical studies on PCOS have been published consequently. We plead to revisit the Rotterdam criteria based on the available evidence in prognostic studies and randomized controlled trials. In this opinion paper, we provide arguments of the strengths and limitations of the Rotterdam criteria in guiding treatment selections and predicting prognoses in women with infertility. While the Rotterdam criteria have shown their advantages in predicting reproductive prognosis, the next step is to evaluate whether they can guide treatment choices in infertility as well as other health aspects of the syndrome. Based on available data in clinical studies, we should be able to determine whether the Rotterdam criteria are evidence-based criteria.
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Affiliation(s)
- Rui Wang
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, SA 5006, Australia.,Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei 430030, China
| | - Ben Willem J Mol
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, SA 5006, Australia.,The South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
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21
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Pal L, Zhang H, Williams J, Santoro NF, Diamond MP, Schlaff WD, Coutifaris C, Carson SA, Steinkampf MP, Carr BR, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Myers E, Legro RS. Vitamin D Status Relates to Reproductive Outcome in Women With Polycystic Ovary Syndrome: Secondary Analysis of a Multicenter Randomized Controlled Trial. J Clin Endocrinol Metab 2016; 101:3027-35. [PMID: 27186859 PMCID: PMC4971341 DOI: 10.1210/jc.2015-4352] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/10/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Experimental evidence supports a relevance of vitamin D (VitD) for reproduction; however, data in humans are sparse and inconsistent. OBJECTIVE To assess the relationship of VitD status with ovulation induction (OI) outcomes in women with polycystic ovary syndrome (PCOS). DESIGN A retrospective cohort. SETTING Secondary analysis of randomized controlled trial data. PARTICIPANTS Participants in the Pregnancy in PCOS I (PPCOS I) randomized controlled trial (n = 540) met the National Institutes of Health diagnostic criteria for PCOS. INTERVENTIONS Serum 25OHD levels were measured in stored sera. MAIN OUTCOME MEASURES Primary, live birth (LB); secondary, ovulation and pregnancy loss after OI. RESULTS Likelihood for LB was reduced by 44% for women if the 25OHD level was < 30 ng/mL (<75 nmol/L; odds ratio [OR], 0.58 [0.35-0.92]). Progressive improvement in the odds for LB was noted at thresholds of ≥38 ng/mL (≥95 nmol/L; OR, 1.42 [1.08-1.8]), ≥40 ng/mL (≥100 nmol/L; OR, 1.51 [1.05-2.17]), and ≥45 ng/mL (≥112.5 nmol/L; OR, 4.46 [1.27-15.72]). On adjusted analyses, VitD status was an independent predictor of LB and ovulation after OI. CONCLUSIONS In women with PCOS, serum 25OHD was an independent predictor of measures of reproductive success after OI. Our data identify reproductive thresholds for serum 25OHD that are higher than recommended for the nonpregnant population.
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Affiliation(s)
- Lubna Pal
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Heping Zhang
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Joanne Williams
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Nanette F Santoro
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Michael P Diamond
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - William D Schlaff
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Christos Coutifaris
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Sandra A Carson
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Michael P Steinkampf
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Bruce R Carr
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Peter G McGovern
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Nicholas A Cataldo
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Gabriella G Gosman
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - John E Nestler
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Evan Myers
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Richard S Legro
- Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
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Bolnick A, Abdulhasan M, Kilburn B, Xie Y, Howard M, Andresen P, Shamir AM, Dai J, Puscheck EE, Rappolee DA. Commonly used fertility drugs, a diet supplement, and stress force AMPK-dependent block of stemness and development in cultured mammalian embryos. J Assist Reprod Genet 2016; 33:1027-39. [PMID: 27230877 PMCID: PMC4974229 DOI: 10.1007/s10815-016-0735-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/13/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of the present study is to test whether metformin, aspirin, or diet supplement (DS) BioResponse-3,3'-Diindolylmethane (BR-DIM) can induce AMP-activated protein kinase (AMPK)-dependent potency loss in cultured embryos and whether metformin (Met) + Aspirin (Asa) or BR-DIM causes an AMPK-dependent decrease in embryonic development. METHODS The methods used were as follows: culture post-thaw mouse zygotes to the two-cell embryo stage and test effects after 1-h AMPK agonists' (e.g., Met, Asa, BR-DIM, control hyperosmotic stress) exposure on AMPK-dependent loss of Oct4 and/or Rex1 nuclear potency factors, confirm AMPK dependence by reversing potency loss in two-cell-stage embryos with AMPK inhibitor compound C (CC), test whether Met + Asa (i.e., co-added) or DS BR-DIM decreases development of two-cell to blastocyst stage in an AMPK-dependent (CC-sensitive) manner, and evaluate the level of Rex1 and Oct4 nuclear fluorescence in two-cell-stage embryos and rate of two-cell-stage embryo development to blastocysts. RESULT(S) Met, Asa, BR-DIM, or hyperosmotic sorbitol stress induces rapid ~50-85 % Rex1 and/or Oct4 protein loss in two-cell embryos. This loss is ~60-90 % reversible by co-culture with AMPK inhibitor CC. Embryo development from two-cell to blastocyst stage is decreased in culture with either Met + Asa or BR-DIM, and this is either >90 or ~60 % reversible with CC, respectively. CONCLUSION These experimental designs here showed that Met-, Asa-, BR-DIM-, or sorbitol stress-induced rapid potency loss in two-cell embryos is AMPK dependent as suggested by inhibition of Rex1 and/or Oct4 protein loss with an AMPK inhibitor. The DS BR-DIM or fertility drugs (e.g., Met + Asa) that are used to enhance maternal metabolism to support fertility can also chronically slow embryo growth and block development in an AMPK-dependent manner.
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Affiliation(s)
- Alan Bolnick
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA.
| | - Mohammed Abdulhasan
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Brian Kilburn
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Yufen Xie
- Fertility and Surgical Associates of California, Thousand Oaks, CA, 91361, USA
| | - Mindie Howard
- EmbryoTech Laboratories, 140 Hale Street, Haverhill, MA, 01830, USA
| | - Paul Andresen
- Ob/Gyn, IVF Clinic, University Physician Group, Wayne State University School of Medicine, 26400 W 12 Mile Road, Suite 140, Southfield, MI, 48034, USA
| | - Alexandra M Shamir
- University of Utah, 201 Presidents Circle, Salt Lake City, UT, 84112, USA
| | - Jing Dai
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Elizabeth E Puscheck
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
| | - Daniel A Rappolee
- CS Mott Center for Human Growth and Development, Department of Ob/Gyn, Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 275 East Hancock, Detroit, MI, 48201, USA
- Program for Reproductive Sciences and Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA
- Institutes for Environmental Health Science, Wayne State University School of Medicine, Detroit, MI, 48201, USA
- Department of Biology, University of Windsor, Windsor, ON, N9B 3P4, Canada
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O’Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, Gray-Donald K, Rossiter M, Adamo K, Brett K, Khatri N, Robinson N, Tumback L, Cheung A. Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:555-609.e19. [DOI: 10.1016/j.jogc.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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O'Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, Gray-Donald K, Rossiter M, Adamo K, Brett K, Khatri N, Robinson N, Tumback L, Cheung A. Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:508-554.e18. [PMID: 27368135 DOI: 10.1016/j.jogc.2016.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle. OUTCOMES Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter. EVIDENCE Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document. VALUES The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.
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Pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization. Fertil Steril 2016; 105:791-797.e2. [DOI: 10.1016/j.fertnstert.2015.11.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
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Huang X, Wang P, Tal R, Lv F, Li Y, Zhang X. A systematic review and meta-analysis of metformin among patients with polycystic ovary syndrome undergoing assisted reproductive technology procedures. Int J Gynaecol Obstet 2015; 131:111-6. [PMID: 26304048 DOI: 10.1016/j.ijgo.2015.04.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/10/2015] [Accepted: 07/10/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Metformin is used among patients with polycystic ovary syndrome (PCOS), but findings for its effects on outcomes of assisted reproductive technology (ART) have been conflicting. OBJECTIVES To compare ART outcomes among women with PCOS who were and were not given metformin. SEARCH STRATEGY Databases were searched for reports published in English between 2002 and 2013, using combinations of the terms "polycystic ovary syndrome," "PCOS," "insulin-sensitizing," and "metformin." SELECTION CRITERIA Randomized controlled trials of metformin versus placebo among women with PCOS undergoing ART were included if they assessed rates of pregnancy, live birth, spontaneous abortion, multiple pregnancy, and/or ovarian hyperstimulation syndrome (OHSS). DATA COLLECTION AND ANALYSIS Data were extracted from included studies. The Mantel-Haenzel random-effects model was used for meta-analyses. MAIN RESULTS Twelve studies (1516 participants) were included. No significant differences were recorded between metformin and placebo groups for rates of pregnancy (risk ratio [RR] 1.11, 95% CI 0.92-1.33), live birth (RR 1.12, 0.92-1.36), spontaneous abortion (RR 1.00, 0.60-1.67), or multiple pregnancy (RR 0.96, 0.47-1.96). However, OHSS rate was significantly lower among patients who received metformin than among those who received placebo (RR 0.44, 0.26-0.77). CONCLUSIONS Metformin does not improve ART outcomes among patients with PCOS, but does significantly reduce their risk of OHSS.
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Affiliation(s)
- Xiaman Huang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical School of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Pin Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical School of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Reshef Tal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Fang Lv
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical School of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yuanyuan Li
- Maternity and Child Care Center, Yangzhou, China
| | - Xiaomei Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical School of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China.
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Arain F, Arif N, Halepota H. Frequency and outcome of treatment in polycystic ovaries related infertility. Pak J Med Sci 2015; 31:694-9. [PMID: 26150870 PMCID: PMC4485297 DOI: 10.12669/pjms.313.8003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 11/20/2014] [Accepted: 03/21/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Infertility is defined as inability of couple to conceive after one year of unprotected intercourse. The prevalence of infertility in Pakistan is 21.9%. The most common cause of medically treatable infertility is polycystic ovarian syndrome (PCO). This study was conducted to see the frequency and outcome of treatment in PCOs related infertility in infertile couples coming to Mohammad Medical College Hospital, Mirpurkhas, Sindh. METHODS This prospective observational study was conducted at Muhammad Medical College for three years from 2005 to 2008. Total 1289 infertile couples were included in this study. RESULT The frequency of PCOs in female related infertility was 38.5%. Other causes of female infertility were in the frequency of 44% pelvic inflammatory disease, 12.3% endometriosis, 2.9% hyperprolactenemia, and 1.35% hypothyroidism. Patients with PCOS were given different treatment modalities. One hundred fifty patients with PCO were given ovulation induction with clomephene citrate and out of them 109 (72%) conceived. Sixty three women were given combination of clomephene citrate and Metformin. Out of them 50 (79%) conceived. Five patients were given gonadotrophins, Out of them 2 (40%) patients conceived. Five patients had laparoscopic drilling out of them 3 (60%) conceived. CONCLUSION In contrast to the literature review Polycystic Ovarian Syndrome turned out to be the second most common cause of female related infertility. But as the international literature shows it had very good out come after medical and /or surgical treatment.
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Affiliation(s)
- Farzana Arain
- Dr. Farzana Arain, Associate Professor, Taif Medical College, Taif, Saudi Arabia
| | - Nesreen Arif
- Dr. Nesreen Arif, Assistant Professor, Taif Medical College, Taif, Saudi Arabia
| | - Hafeez Halepota
- Dr. Hafeez Halepota, Professor of Gynae & Obstetric Department, Muhammad Medical College Hospital, Mirpurkhas, Sindh, Pakistan
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The Role of Metformin in Metabolic Disturbances during Pregnancy: Polycystic Ovary Syndrome and Gestational Diabetes Mellitus. Int J Reprod Med 2014; 2014:797681. [PMID: 25763406 PMCID: PMC4334060 DOI: 10.1155/2014/797681] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 02/07/2023] Open
Abstract
Maintenance of gestation implicates complex function of multiple endocrine mechanisms, and disruptions of the global metabolic environment prompt profound consequences on fetomaternal well-being during pregnancy and postpartum. Polycystic Ovary Syndrome (PCOS) and gestational diabetes mellitus (GDM) are very frequent conditions which increase risk for pregnancy complications, including early pregnancy loss, pregnancy-induced hypertensive disorders, and preterm labor, among many others. Insulin resistance (IR) plays a pivotal role in the pathogenesis of both PCOS and GDM, representing an important therapeutic target, with metformin being the most widely prescribed insulin-sensitizing antidiabetic drug. Although traditional views neglect use of oral antidiabetic agents during pregnancy, increasing evidence of safety during gestation has led to metformin now being recognized as a valuable tool in prevention of IR-related pregnancy complications and management of GDM. Metformin has been demonstrated to reduce rates of early pregnancy loss and onset of GDM in women with PCOS, and it appears to offer better metabolic control than insulin and other oral antidiabetic drugs during pregnancy. This review aims to summarize key aspects of current evidence concerning molecular and epidemiological knowledge on metformin use during pregnancy in the setting of PCOS and GDM.
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Coexistence of Polycystic Ovary Syndrome and Endometriosis in Women with Infertility. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose The aim of this study was to investigate if there is a higher incidence of endometriosis in patients with polycystic ovary syndrome (PCOS), compared with normal fertile controls. Material and methods Women with PCOS according to Rotterdam criteria, with infertility and/or pelvic pain, were identified (n = 104), and together with fertile women seeking bilateral tubal ligation (n = 111), they were submitted to laparoscopy at the Greenville Hospital System or the University of North Carolina at Chapel Hill. A biopsy was performed in 40 patients with PCOS to confirm or not endometriosis. Results Age was similar in both groups (control: 29.7 ± 0.5 years; PCOS: 29.6 ± 0.4). The incidence of suspected endometriotic lesions in controls and PCOS patients was 12.6% (95% confidence interval [95% CI], 7.6%-20%) and 74% (95% CI, 64.8%-81.5%), respectively; with an odds ratio of 19.7 (95% CI, 9.6-40.2) of finding endometriosis in PCOS (p<0.0001). Our results were similar when endometriosis was confirmed by pathology report. Of the PCOS patients with endometriosis, 76% had endometriosis stage I or II, according to the revised American Society for Reproductive Medicine criteria. Conclusions In this case-control study, a significant association between endometriosis and women with PCOS with pelvic pain and/or infertility was found. The majority of endometriotic lesions (76%) were stage I or II.
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Orief YI, Darwish EAE, Elsamra MA, Ragab DHA. Gestagen versus oral contraceptive pills to induce withdrawal bleeding before induction of ovulation by clomiphene citrate in polycystic ovary syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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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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The efficacy of converting high response – Ovulation induction cycles to in vitro fertilization in patients with PCOS. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2013.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Grigorescu V, Zhang Y, Kissin DM, Sauber-Schatz E, Sunderam M, Kirby RS, Diop H, McKane P, Jamieson DJ. Maternal characteristics and pregnancy outcomes after assisted reproductive technology by infertility diagnosis: ovulatory dysfunction versus tubal obstruction. Fertil Steril 2014; 101:1019-25. [PMID: 24484993 DOI: 10.1016/j.fertnstert.2013.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine differences in maternal characteristics and pregnancy outcomes between women with ovulatory dysfunction (OD) and women with tubal obstruction (TO) who underwent assisted reproductive technology (ART). DESIGN Retrospective cohort study. SETTING Centers for Disease Control and Prevention. PATIENT(S) Exposed and nonexposed groups were selected from the 2000-2006 National ART Surveillance System linked with live-birth certificates from three states: Florida, Massachusetts, and Michigan. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Maternal characteristics and pregnancy outcomes, including newborn's health status right after delivery (Apgar score, <7 vs. ≥ 7) as the study outcome of interest, were assessed among women with OD/polycystic ovary syndrome (PCOS) and TO who used ART. RESULT(S) A significantly higher prevalence of women with OD/PCOS were younger (<35 years of age; 65.7% vs. 48.9%), were white (85.4% vs. 74.4%), had higher education (29.4% vs. 15.6%), and experienced diabetes (8.8% vs. 5.3%) compared with those having TO. The odds of having a lower (<7) Apgar score at 5 minutes were almost twice as high among newborns of women with OD/PCOS compared with those with TO (crude odds ratio, 1.86; 95% confidence interval [CI], 1.31, 2.64; adjusted odds ratio, 1.90; 95% CI, 1.30, 2.77). CONCLUSION(S) Women with OD/PCOS who underwent ART have different characteristics and health issues (higher prevalence of diabetes) and infant outcomes (lower Apgar score) compared with women with TO.
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Affiliation(s)
| | - Yujia Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dmitry M Kissin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mithi Sunderam
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, Florida
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
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de Ziegler D, Streuli I, Gayet V, Frydman N, Bajouh O, Chapron C. Retrieving oocytes from small non-stimulated follicles in polycystic ovary syndrome (PCOS): in vitro maturation (IVM) is not indicated in the new GnRH antagonist era. Fertil Steril 2012; 98:290-3. [DOI: 10.1016/j.fertnstert.2012.06.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/18/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
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Baird DT, Balen A, Escobar-Morreale HF, Evers JLH, Fauser BCJM, Franks S, Glasier A, Homburg R, La Vecchia C, Devroey P, Diedrich K, Fraser L, Gianaroli L, Liebaers I, Sunde A, Tapanainen JS, Tarlatzis B, Van Steirteghem A, Veiga A, Crosignani PG, Evers JLH. Health and fertility in World Health Organization group 2 anovulatory women. Hum Reprod Update 2012; 18:586-99. [DOI: 10.1093/humupd/dms019] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Lisonkova S, Joseph K. Temporal trends in clomiphene citrate use: a population-based study. Fertil Steril 2012; 97:639-44. [DOI: 10.1016/j.fertnstert.2011.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/01/2011] [Accepted: 12/20/2011] [Indexed: 11/28/2022]
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Insulin-sensitizing agents in the treatment of polycystic ovary syndrome: an update. Curr Opin Obstet Gynecol 2011; 22:466-76. [PMID: 20724929 DOI: 10.1097/gco.0b013e32833e1264] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is the most frequent endocrinopathy in reproductive-aged women, mainly characterized by oligoanovulation and hyperandrogenism. Insulin resistance represents a major pathophysiological feature of the syndrome and, therefore, insulin-sensitizing agents (metformin and thiazolidinediones) have been applied in PCOS women. However, the clinical use of insulin sensitizers in PCOS has been debated. The aim of the current review was to update the knowledge regarding the role of metformin and thiazolidinediones in PCOS treatment, focusing on recently published studies. RECENT FINDINGS Several clinical trials examined metformin effectiveness on lipids, atherosclerosis and inflammatory markers, hormone levels, menstrual irregularities, ovulation induction, fertility, hirsutism, obesity parameters and quality of life in PCOS women. Metformin treatment was shown to improve these features, although conflicting results were also reported. Only one study investigated pioglitazone effect on PCOS, reporting an improved IVF outcome in clomiphene citrate-resistant PCOS patients. Finally, both metformin and pioglitazone, as a part of a low-dose polytherapy, exerted beneficial effects on lipids, androgen levels, hirsutism and markers of atherosclerosis in nonobese PCOS women. SUMMARY Further research, including larger randomized controlled trials and meta-analyses, is needed to clarify the role of metformin and thiazolidinediones in the treatment of clinical and biochemical PCOS characteristics.
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Saha L, Kaur S, Saha PK. Pharmacotherapy of polycystic ovary syndrome - an update. Fundam Clin Pharmacol 2011; 26:54-62. [DOI: 10.1111/j.1472-8206.2010.00916.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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