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Guixue G, Yifu P, Yuan G, Xialei L, Fan S, Qian S, Jinjin X, Linna Z, Xiaozuo Z, Wen F, Wen Y. Progress of the application clinical prediction model in polycystic ovary syndrome. J Ovarian Res 2023; 16:230. [PMID: 38007488 PMCID: PMC10675861 DOI: 10.1186/s13048-023-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/05/2023] [Indexed: 11/27/2023] Open
Abstract
Clinical prediction models play an important role in the field of medicine. These can help predict the probability of an individual suffering from disease, complications, and treatment outcomes by applying specific methodologies. Polycystic ovary syndrome (PCOS) is a common disease with a high incidence rate, huge heterogeneity, short- and long-term complications, and complex treatments. In this systematic review study, we reviewed the progress of clinical prediction models in PCOS patients, including diagnosis and prediction models for PCOS complications and treatment outcomes. We aimed to provide ideas for medical researchers and clues for the management of PCOS. In the future, models with poor accuracy can be greatly improved by adding well-known parameters and validations, which will further expand our understanding of PCOS in terms of precision medicine. By developing a series of predictive models, we can make the definition of PCOS more accurate, which can improve the diagnosis of PCOS and reduce the likelihood of false positives and false negatives. It will also help discover complications earlier and treatment outcomes being known earlier, which can result in better outcomes for women with PCOS.
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Affiliation(s)
- Guan Guixue
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Pu Yifu
- Laboratory of Genetic Disease and Perinatal Medicine, Key laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Gao Yuan
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Liu Xialei
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Shi Fan
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Sun Qian
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Xu Jinjin
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Zhang Linna
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Zhang Xiaozuo
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Feng Wen
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China
| | - Yang Wen
- The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China.
- Xuzhou Medical University affiliated hospital of Lianyungang, Lianyungang, Jiangsu, 222002, China.
- The first affiliated hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222002, China.
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Bordewijk EM, Jannink TI, Weiss NS, de Vries T, Nahuis M, Hoek A, Goddijn M, Mol BW, van Wely M. Long-term outcomes of switching to gonadotrophins versus continuing with clomiphene citrate, with or without intrauterine insemination, in women with normogonadotropic anovulation and clomiphene failure: follow-up study of a factorial randomized clinical trial. Hum Reprod 2023; 38:421-429. [PMID: 36622200 PMCID: PMC9977112 DOI: 10.1093/humrep/deac268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/01/2022] [Indexed: 01/10/2023] Open
Abstract
STUDY QUESTION What are the long-term outcomes after allocation to use of gonadotrophins versus clomiphene citrate (CC) with or without IUI in women with normogonadotropic anovulation and clomiphene failure? SUMMARY ANSWER About four in five women with normogonadotropic anovulation and CC failure had a live birth, with no evidence of a difference in pregnancy outcomes between the allocated groups. WHAT IS KNOWN ALREADY CC has long been used as first line treatment for ovulation induction in women with normogonadotropic anovulation. Between 2009 and 2015, a two-by-two factorial multicentre randomized clinical trial in 666 women with normogonadotropic anovulation and six cycles of CC failure was performed (M-ovin trial). This study compared a switch to gonadotrophins with continued treatment with CC for another six cycles, with or without IUI within 8 months. Switching to gonadotrophins increased the chance of conception leading to live birth by 11% over continued treatment with CC after six failed ovulatory cycles, at a cost of €15 258 per additional live birth. The addition of IUI did not significantly increase live birth rates. STUDY DESIGN, SIZE, DURATION In order to investigate the long-term outcomes of switching to gonadotrophins versus continuing treatment with CC, and undergoing IUI versus continuing with intercourse, we conducted a follow-up study. The study population comprised all women who participated in the M-ovin trial. PARTICIPANTS/MATERIALS, SETTING, METHODS The participating women were asked to complete a web-based questionnaire. The primary outcome of this study was cumulative live birth. Secondary outcomes included clinical pregnancies, multiple pregnancies, miscarriage, stillbirth, ectopic pregnancy, fertility treatments, neonatal outcomes and pregnancy complications. MAIN RESULTS AND THE ROLE OF CHANCE We approached 564 women (85%), of whom 374 (66%) responded (184 allocated to gonadotrophins; 190 to CC). After a median follow-up time of 8 years, 154 women in the gonadotrophin group had a live birth (83.7%) versus 150 women in the CC group (78.9%) (relative risk (RR) 1.06, 95% CI 0.96-1.17). A second live birth occurred in 85 of 184 women (49.0%) in the gonadotrophin group and in 85 of 190 women (44.7%) in the CC group (RR 1.03, 95% CI 0.83-1.29). Women allocated to gonadotrophins had a third live birth in 6 of 184 women (3.3%) and women allocated to CC had a third live birth in 14 of 190 women (7.4%). There were respectively 12 and 11 twins in the gonadotrophin and CC groups. The use of fertility treatments in the follow-up period was comparable between both groups. In the IUI group, a first live birth occurred in 158 of 192 women (82.3%) and while in the intercourse group, 146 of 182 women (80.2%) reached at least one live birth (RR: 1.03 95% CI 0.93-1.13; 2.13%, 95% CI -5.95, 10.21). LIMITATIONS, REASONS FOR CAUTION We have complete follow-up results for 57% of the women.There were 185 women who did not respond to the questionnaire, while 102 women had not been approached due to missing contact details. Five women had not started the original trial. WIDER IMPLICATIONS OF THE FINDINGS Women with normogonadotropic anovulation and CC failure have a high chance of reaching at least one live birth. In terms of pregnancy rates, the long-term differences between initially switching to gonadotrophins are small compared to continuing treatment with CC. STUDY FUNDING/COMPETING INTEREST(S) The original study received funding from the Dutch Organization for Health Research and Development (ZonMw number: 80-82310-97-12067). A.H. reports consultancy for development and implementation of a lifestyle App, MyFertiCoach, developed by Ferring Pharmaceutical Company. M.G. receives unrestricted grants for scientific research and education from Ferring, Merck and Guerbet. B.W.M. is supported by an NHMRC Investigatorgrant (GNT1176437). B.W.M. reports consultancy for ObsEva and Merck and travel support from Merck. All other authors have nothing to declare. TRIAL REGISTRATION NUMBER This follow-up study was registered in the OSF Register, https://osf.io/pf24m. The original M-ovin trial was registered in the Netherlands Trial Register, number NTR1449.
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Affiliation(s)
- E M Bordewijk
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - T I Jannink
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - N S Weiss
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Centre for Reproductive Medicine Amsterdam UMC, VU University, Amsterdam, Netherlands
| | - T de Vries
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - M Nahuis
- Department of Obstetrics and Gynecology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - A Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - B W Mol
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - M van Wely
- Centre for Reproductive Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Ovulation induction in anovulatory infertility is obsolete. Reprod Biomed Online 2023; 46:221-224. [PMID: 36167631 DOI: 10.1016/j.rbmo.2022.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
Women with polycystic ovary syndrome make up the vast majority of patients with anovulatory infertility. The commonly accepted treatment guidelines recommend ovulation induction for timed intercourse as the first-line treatment. After a 2-year treatment period, the cumulative pregnancy rates with a singleton live-born baby reached 71% and 78% in two prospective studies. Despite aiming for monofollicular growth, multifollicular responses with subsequent multiple/higher order multiple pregnancies are a dreaded risk associated with ovarian induction. However, the lengthy treatment, the increase of maternal age and the psychological effects of 'obligatory intercourse' are also factors challenging the concept of ovarian induction as the first treatment approach in anovulatory infertility. Nowadays, individualized IVF treatment with cycle segmentation, freeze-all strategies and single-embryo transfers in frozen embryo transfer cycles dramatically reduces the risk of multiple pregnancies, and a cumulative pregnancy rate of 83% can be achieved over three complete cycles, thereby reducing exposure to fertility medication and time to pregnancy. Although on first sight ovarian induction might present the easier and less costly approach, efficient and individualized IVF treatments with low complication rates and the chance of preventing multiple pregnancies challenge this concept, and it seems that the time has come to abandon ovarian induction in anovulatory infertility.
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Gunning MN, Christ JP, van Rijn BB, Koster MPH, Bonsel GJ, Laven JSE, Eijkemans MJC, Fauser BCJM. Predicting pregnancy chances leading to term live birth in oligo/anovulatory women diagnosed with PCOS. Reprod Biomed Online 2023; 46:156-163. [PMID: 36411204 DOI: 10.1016/j.rbmo.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
RESEARCH QUESTION Which patient features predict the time to pregnancy (TTP) leading to term live birth in infertile women diagnosed with polycystic ovary syndrome (PCOS)? DESIGN Prospective cohort follow-up study was completed, in which initial standardized phenotyping was conducted at two Dutch university medical centres from January 2004 to January 2014. Data were linked to the Netherlands Perinatal Registry to obtain pregnancy outcomes for each participant. All women underwent treatment according to a standardized protocol, starting with ovulation induction as first-line treatment. Predictors of pregnancies (leading to term live births) during the first year after PCOS diagnosis were evaluated. RESULTS A total of 1779 consecutive women diagnosed with PCOS between January 2004 and January 2014 were included. In the first year following screening, 659 (37%) women with PCOS attained a pregnancy leading to term birth (≥37 weeks of gestational age). A higher chance of pregnancy was associated with race, smoking, body mass index (BMI), insulin, total testosterone and sex hormone-binding globulin (SHBG) concentrations (c-statistic = 0.59). CONCLUSIONS Predictors of an increased chance of a live birth include White race, no current smoking, lower BMI, insulin and total testosterone concentrations, and higher SHBG concentrations. This study presents a nomogram to predict the chances of achieving a pregnancy (leading to a term live birth) within 1 year of treatment.
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Affiliation(s)
- Marlise N Gunning
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands
| | - Jacob P Christ
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands; Cleveland Clinic Lerner College of Medicine, Cleveland Ohio, USA; Department of Obstetrics & Gynecology, University of Washington Medical Center, SeattleWashington, USA.
| | - Bas B van Rijn
- Department of Obstetrics, University Medical Center Utrecht Utrecht, the Netherlands; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maria P H Koster
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics, University Medical Center Utrecht Utrecht, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marinus J C Eijkemans
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands; Julius Center for Health Sciences and Primary care, University Medical Center Utrecht Utrecht, the Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht Utrecht, the Netherlands
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Bulsara J, Patel P, Soni A, Acharya S. A review: Brief insight into Polycystic Ovarian syndrome. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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6
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Garthwaite H, Stewart J, Wilkes S. Multiple pregnancy rate in patients undergoing treatment with clomifene citrate for WHO group II ovulatory disorders: a systematic review. HUM FERTIL 2021; 25:618-624. [PMID: 33451262 DOI: 10.1080/14647273.2021.1872803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clomifene citrate has long been associated with a multiple pregnancy rate of up to 8-10%. Studies from which these figures originated have largely included patients who received clomifene outside of current national and international treatment guidelines. In January 2020, a systematic review of MEDLINE and relevant reference lists was conducted. Studies were included that reported multiple pregnancy rate in a cohort of patients undergoing treatment with single agent clomifene citrate for WHO group II dysovulatory subfertility. Twelve studies were included in the analysis, with a total sample size of 1,387 patients. The overall multiple pregnancy rate was 3.8% (3.6% twins/0.2% triplets); this dropped to 2.4% (all twins) when studies with a mean BMI ≥35kg/m2 were excluded. This review suggests that contemporary single agent clomifene use following current guidelines in terms of indication, results in a lower than expected multiple pregnancy rate. Further evidence from clinical practice is required to ensure that patients are adequately informed.
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Affiliation(s)
- Heather Garthwaite
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Jane Stewart
- Newcastle Fertility Centre at Life, Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Scott Wilkes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Pundir J, Achilli C, Bhide P, Sabatini L, Legro RS, Rombauts L, Teede H, Coomarasamy A, Zamora J, Thangaratinam S. Risk of foetal harm with letrozole use in fertility treatment: a systematic review and meta-analysis. Hum Reprod Update 2020; 27:474-485. [PMID: 33374012 DOI: 10.1093/humupd/dmaa055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aromatase inhibitor letrozole is increasingly recommended for ovulation induction, as it is more effective with fewer side-effects than other agents. But many clinicians are reluctant to use the drug for fertility treatment due to a strong-label warning against its use, which warns about congenital malformation risk to the foetus in women seeking pregnancy. OBJECTIVE AND RATIONALE The aim of this study was to determine the risks of congenital malformations and pregnancy loss with letrozole compared with clomiphene primarily, and with other fertility drugs and natural conception. SEARCH METHODS A systematic review and meta-analysis using PRISMA harms guidelines. We searched MEDLINE, EMBASE and other sources from inception until January 2020, with the MeSH words for 'letrozole' and pregnancy OR foetal/neonatal outcome. We included studies reported on congenital malformations in foetuses born to mothers conceived after fertility treatment, with letrozole versus clomiphene, placebo, gonadotrophins, metformin, natural conception or other agents, from randomised trials, comparative cohort studies and non-comparative observational cohorts. Quality of the studies was assessed using Cochrane risk of bias tool and Newcastle Ottawa Scale. The McMaster tool was used to assess the quality of reported harm for foetal congenital malformations in the studies. We compared the absolute risk of events using risk difference measures and pooled the findings using a fixed-effect model. We evaluated the statistical heterogeneity using forest plots and the I2 statistic and funnel plot to assess publication bias. We assessed the strength of evidence for congenital malformation and pregnancy loss as per the GRADE recommendations and with the Fragility index. OUTCOMES We included 46 studies (18 randomised trials; 21 comparative cohorts; 7 non-comparative cohorts). Overall 2.15% (101/4697; 95% CI 1.7 to 2.5) of babies conceived on letrozole for fertility treatment had congenital foetal malformations. We did not observe a significant increase in congenital malformations with letrozole versus clomiphene in the randomised trials (risk difference (RD) 0.01, 95% CI -0.02, 0.03; I2 = 0%; 14 studies) and found a significant reduction in the cohort studies (RD -0.02, 95% CI -0.04, -0.01; I2 = 0%, 11 studies). The fragility index was 44% (7/16) (either an increase in the intervention arm or a decrease in control arm was needed to alter the results). The risks of pregnancy loss were not increased with letrozole versus clomiphene in the 14 randomised trials (RD -0.01, 95% CI -0.06, 0.04; I2 = 0%), and the risks were reduced in the six cohort studies (RD -0.09, 95% CI -0.17, -0.00; I2 = 68%). The GRADE quality of evidence was low to moderate for congenital malformations and pregnancy loss. We did not find any increased congenital malformation risk with letrozole versus gonadotrophins, natural conception or natural cycle ART, but the number of studies was small. WIDER IMPLICATIONS There is no evidence that letrozole increases the risk of congenital foetal malformation or pregnancy loss compared with clomiphene, natural conception or other fertility agents, to warrant warning against its use. Given its therapeutic benefits and lack of evidence of harm to the foetus, clinicians should consider letrozole as first-line agent for ovulation induction.
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Affiliation(s)
- Jyotsna Pundir
- Queen Mary University, London E1 4NS, UK.,Centre for Reproductive Medicine, St. Bartholomew's Hospital, London EC1A 7BE, UK
| | - Chiara Achilli
- Hewitt Fertility Centre, Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Priya Bhide
- Centre for Women's Health, Queen Mary University of London, E1 2AB, UK.,Homerton University Hospital, London E9 6SR, UK
| | - Luca Sabatini
- Centre for Reproductive Medicine, St. Bartholomew's Hospital, London EC1A 7BE, UK
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, USA
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3800, Australia
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Javier Zamora
- CIBER Epidemiology and Public Health, Clinical Biostatistics Unit, Hospital Ramon y Cajal Ctra, Madrid 28034, Spain.,Women's Health Research Unit, Queen Mary University of London
| | - Shakila Thangaratinam
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
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Obirikorang C, Owiredu WKBA, Adu-Afram S, Acheampong E, Asamoah EA, Antwi-Boasiakoh EK, Owiredu EW. Assessing the variability and predictability of adipokines (adiponectin, leptin, resistin and their ratios) in non-obese and obese women with anovulatory polycystic ovary syndrome. BMC Res Notes 2019; 12:513. [PMID: 31416473 PMCID: PMC6696689 DOI: 10.1186/s13104-019-4546-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the variability and predictability of adiponectin, leptin, resistin and their ratios in non-obese and obese women with anovulatory polycystic ovary syndrome (aPCOS). Results A total of 52 ovulatory controls (mean age = 31.63 ± 4.88 years, BMI = 25.33 ± 2.68 kg/m2); 54 non-obese (mean age = 32.11 ± 4.25 years, BMI = 25.72 ± 2.95 kg/m2) and 50 obese women with aPCOS (mean age = 33.64 ± 4.14 years, BMI = 39.19 ± 2.99 kg/m2) were recruited. The aPCOS group had lower adiponectin [13.0 (10.49–16.59) vs 18.42 (15.72–19.92) µg/ml, p < 0.0001], adiponectin: leptin ratio (A:L) [0.60 (0.35–0.88) vs 1.19 (0.92–1.37), p < 0.0001], and adiponectin: resistin ratio (A:R) [0.30 (0.21–0.43) vs 0.42 (0.32–0.62), p < 0.0001] but a higher leptin [20.02 (14.54–26.80) vs 16.17 (14.51–18.36) ng/ml, p < 0.0001] and leptin: resistin ratio (L:R) [0.53 (0.37–0.82) vs 0.40 (0.27–0.48), p < 0.0001] compared to the controls. The obese aPCOS group had lower adiponectin [11.04 (5.66–13.25) vs 14.18 (11.04–18.02), p < 0.0001 and 18.42 (15.72–19.92) µg/ml, p < 0.0001], A:L [0.36 (0.27–0.44) vs 0.78 (0.61–1.16), p < 0.0001 and 1.19 (0.92–1.37), p < 0.0001], and A:R [0.24 (0.17–0.38) vs 0.40 (0.23–0.58), p < 0.0001 and 0.42 (0.32–0.62), p < 0.0001] but a higher leptin [26.80 (14.28–32.09) vs 17.95 (14.86–21.26), p < 0.05 and 16.17 (14.51–18.36) ng/ml, p < 0.0001] and L:R [0.63 (0.46–1.03) vs 0.41 (0.30–0.61), p < 0.0001 and 0.40 (0.27–0.48), p < 0.0001] compared to the non-obese aPCOS and control group, respectively. A:L showed the best discriminatory power in predicting aPCOS (AUC = 0.83), followed by adiponectin alone (AUC = 0.79), L:R and leptin alone (both AUC = 0.69). Resistin alone had the poorest discriminatory power (AUC = 0.48). Electronic supplementary material The online version of this article (10.1186/s13104-019-4546-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Obirikorang
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - William K B A Owiredu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sandra Adu-Afram
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Acheampong
- School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Evans Adu Asamoah
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Bovet J. Evolutionary Theories and Men's Preferences for Women's Waist-to-Hip Ratio: Which Hypotheses Remain? A Systematic Review. Front Psychol 2019; 10:1221. [PMID: 31244708 PMCID: PMC6563790 DOI: 10.3389/fpsyg.2019.01221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/08/2019] [Indexed: 01/20/2023] Open
Abstract
Over the last 25 years, a large amount of research has been dedicated to identifying men's preferences for women's physical features, and the evolutionary benefits associated with such preferences. Today, this area of research generates substantial controversy and criticism. I argue that part of the crisis is due to inaccuracies in the evolutionary hypotheses used in the field. For this review, I focus on the extensive literature regarding men's adaptive preferences for women's waist-to-hip ratio (WHR), which has become a classic example of the just-so storytelling contributing to the general mistrust toward evolutionary explanations of human behavior. The issues in this literature originate in the vagueness and incompleteness of the theorizing of the evolutionary mechanisms leading to mate preferences. Authors seem to have rushed into testing and debating the effects of WHR on women's attractiveness under various conditions and using different stimuli, without first establishing (a) clear definitions of the central evolution concepts (e.g., female mate value is often reduced to an imprecise concept of "health-and-fertility"), and (b) a complete overview of the distinct evolutionary paths potentially at work (e.g., focusing on fecundability while omitting descendants' quality). Unsound theoretical foundations will lead to imprecise predictions which cannot properly be tested, thus ultimately resulting in the premature rejection of an evolutionary explanation to human mate preferences. This paper provides the first comprehensive review of the existing hypotheses on why men's preferences for a certain WHR in women might be adaptive, as well as an analysis of the theoretical credibility of these hypotheses. By dissecting the evolutionary reasoning behind each hypothesis, I show which hypotheses are plausible and which are unfit to account for men's preferences for female WHR. Moreover, the most cited hypotheses (e.g., WHR as a cue of health or fecundity) are found to not necessarily be the ones with the strongest theoretical support, and some promising hypotheses (e.g., WHR as a cue of parity or current pregnancy) have seemingly been mostly overlooked. Finally, I suggest some directions for future studies on human mate choice, to move this evolutionary psychology literature toward a stronger theoretical foundation.
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Affiliation(s)
- Jeanne Bovet
- Stony Brook University, Stony Brook, NY, United States
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10
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Braam SC, de Bruin JP, Buisman ETIA, Brandes M, Nelen WLDM, Smeenk JMJ, van der Steeg JW, Mol BWJ, Hamilton CJCM. Treatment strategies and cumulative live birth rates in WHO-II ovulation disorders. Eur J Obstet Gynecol Reprod Biol 2018; 225:84-89. [PMID: 29680465 DOI: 10.1016/j.ejogrb.2018.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/12/2018] [Accepted: 04/07/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the live birth rate in women with WHO II anovulation and the proportion of women that need second or third line treatments if the initial therapy fails. STUDY DESIGN In this multicenter cohort study we included couples with unfulfilled child wish who were referred to three fertility clinics in the Netherlands and selected women with a WHO II ovulation disorder as the only final infertility diagnosis (n = 468). RESULTS The cumulative live birth rate of the total group was 82% (383/468). The majority started with clomiphene-citrate as first-line treatment (n = 378) resulting in 180 (48%) live births. There were 153 couples (40%) who underwent a second-line treatment (recombinant-FSH or laparoscopic electrocoagulation of the ovaries, LEO) and 52 couples (14%) a third-line treatment (IVF/ICSI), resulting in 44% and 63% treatment dependent live births rates, respectively. Of all couples, 92 (20%) conceived naturally, 186 (40%) after clomiphene-citrate, 60 (13%) after recombinant-FSH, nine (2%) after LEO and 36 (8%) after IVF. CONCLUSION Subfertile women with a WHO II ovulation disorder have a good prognosis on live birth, and most did so after ovulation induction with clomiphene-citrate. If first-line ovulation induction has failed ovulation induction with gonadotrophins or IVF still result in a live birth in about half of the cases.
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Affiliation(s)
- Sanne C Braam
- Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Erato T I A Buisman
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Monique Brandes
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jesper M J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Jan Willem van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Ben Willem J Mol
- School of Paediatrics and Reproductive Health, University of Adelaide, 5000, SA, Australia
| | - Carl J C M Hamilton
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
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Righarts A, Gray A, Dickson N, Parkin L, Gillett W. Resolution of infertility and number of children: 1386 couples followed for a median of 13 years. Hum Reprod 2017; 32:2042-2048. [DOI: 10.1093/humrep/dex271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- A.A. Righarts
- Women's and Children's Health, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - A. Gray
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - N.P. Dickson
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - L. Parkin
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - W.R. Gillett
- Women's and Children's Health, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
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de Wilde MA, Lamain-de Ruiter M, Veltman-Verhulst SM, Kwee A, Laven JS, Lambalk CB, Eijkemans MJ, Franx A, Fauser BC, Koster MP. Increased rates of complications in singleton pregnancies of women previously diagnosed with polycystic ovary syndrome predominantly in the hyperandrogenic phenotype. Fertil Steril 2017; 108:333-340. [DOI: 10.1016/j.fertnstert.2017.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/28/2017] [Accepted: 06/09/2017] [Indexed: 01/26/2023]
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13
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Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, Coomarasamy A, Thangaratinam S. Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials. BJOG 2017; 125:299-308. [DOI: 10.1111/1471-0528.14754] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 02/07/2023]
Affiliation(s)
- J Pundir
- Centre for Reproductive Medicine; St. Bartholomew's Hospital; London UK
| | - D Psaroudakis
- Centre for Reproductive Medicine; St. Bartholomew's Hospital; London UK
| | - P Savnur
- Centre for Reproductive Medicine; St. Bartholomew's Hospital; London UK
| | - P Bhide
- Fertility and Assisted Reproduction; Homerton University Hospital; Queen Mary University of London; London UK
| | - L Sabatini
- Centre for Reproductive Medicine; St. Bartholomew's Hospital; London UK
| | - H Teede
- Monash Centre for Health Research and Implementation; Monash University; Clayton Vic. Australia
| | - A Coomarasamy
- Tommy's National Centre for Miscarriage Research; University of Birmingham; Birmingham UK
| | - S Thangaratinam
- Women's Health Research Unit; The Blizard Institute; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
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Brouwer J, Fleurbaaij R, Hazes JMW, Dolhain RJEM, Laven JSE. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care Res (Hoboken) 2017; 69:1142-1149. [PMID: 27723275 PMCID: PMC5575464 DOI: 10.1002/acr.23124] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022]
Abstract
Objective Subfertility is frequently encountered among female rheumatoid arthritis (RA) patients and has been associated with disease activity and antirheumatic drugs. However, little is known about the results of the fertility assessments in these women. Our aim was to study the outcome of fertility assessments in subfertile women with RA. Methods A cross‐sectional study was performed in a nationwide cohort of female RA patients who were pregnant or trying to conceive between 2002 and 2010 (Pregnancy‐Induced Amelioration of Rheumatoid Arthritis Study). Patients who had given consent for future contact (n = 260) received a questionnaire on reproductive history, fertility examinations, and fertility treatments. Medical files were obtained from attending gynecologists. Results A completed questionnaire was returned by 178 women (68%), of whom 96% had ended their efforts to conceive. Eighty‐two subjects (46%) had at least 1 subfertile episode, and for 61 women a diagnosis for subfertility was available. Unexplained subfertility (48%) and anovulation (28%) were the most common gynecologic diagnoses, and both occurred more often in RA patients than reported in the general population. Women with unexplained subfertility more often used nonsteroidal antiinflammatory drugs (NSAIDs) during the periconceptional period. Seventeen percent of all pregnancies were conceived after fertility treatments. Fertility treatments had equal or higher pregnancy rates in RA compared to other subfertile populations. Conclusion Unexplained subfertility is more often diagnosed in subfertile female RA patients than in the general population, and is related to periconceptional NSAID use. Despite the higher incidence of subfertility in women with RA, the outcome of fertility treatments in these women appears favorable.
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Affiliation(s)
- Jenny Brouwer
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rosalie Fleurbaaij
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johanna M W Hazes
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Joop S E Laven
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Use of clomiphene or letrozole for treating women with polycystic ovary syndrome related subfertility in Hilla city. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Romanski P, Stanic AK. Practical Approach to the PCOS Patient. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goeckenjan M, Reisenbüchler C. Kinderwunschtherapie in der gynäkologischen Praxis. GYNAKOLOGISCHE ENDOKRINOLOGIE 2016. [DOI: 10.1007/s10304-016-0069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Birch Petersen K, Pedersen NG, Pedersen AT, Lauritsen MP, la Cour Freiesleben N. Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction. Reprod Biomed Online 2016; 32:563-83. [PMID: 27151490 DOI: 10.1016/j.rbmo.2016.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 12/26/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects 5-10% of women of reproductive age and is the most common cause of anovulatory infertility. The treatment approaches to ovulation induction vary in efficacy, treatment duration and patient friendliness. The aim was to determine the most efficient, evidence-based method to achieve mono-ovulation in women diagnosed with PCOS. Publications in English providing information on treatment, efficacy and complication rates were included until September 2015. Systematic reviews, meta-analyses and randomized controlled trials were favoured over cohort and retrospective studies. Clomiphene citrate is recommended as primary treatment for PCOS-related infertility. It induces ovulation in three out of four patients, the risk of multiple pregnancies is modest and the treatment is simple and inexpensive. Gonadotrophins are highly efficient in a low-dose step-up regimen. Ovulation rates are improved by lifestyle interventions in overweight women. Metformin may improve the menstrual cycle within 1-3 months, but does not improve the live birth rate. Letrozole is effective for ovulation induction, but is an off-label drug in many countries. Ovulation induction in women with PCOS should be individualized with regard to weight, treatment efficacy and patient preferences with the aim of achieving mono-ovulation and subsequently the birth of a singleton baby.
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Affiliation(s)
- Kathrine Birch Petersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Nina Gros Pedersen
- Department of Gynecology/Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Anette Tønnes Pedersen
- Fertility Clinic and Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mette Petri Lauritsen
- Department of Gynecology/Obstetrics, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Nina la Cour Freiesleben
- Fertility Clinic and Department of Gynecology/Obstetrics, Holbæk Hospital, Copenhagen University Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark
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Hestiantoro A, Negoro YS, Afrita Y, Wiweko B, Sumapradja K, Natadisastra M. Anti-Müllerian hormone as a predictor of polycystic ovary syndrome treated with clomiphene citrate. Clin Exp Reprod Med 2016; 43:207-214. [PMID: 28090459 PMCID: PMC5234282 DOI: 10.5653/cerm.2016.43.4.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to determine the threshold of anti-Müllerian hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods Fifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed. Results The AMH levels of patients with successful follicular growth were significantly lower (p=0.001) than those with unsuccessful follicular growth (6.10±3.52 vs. 10.43±4.78 ng/mL). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p=0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y=–2.35+(–0.312×AMH level)+(0.464×fiber intake) (area under the curve, 0.88; 95% confidence interval, 0.79–0.98; p<0.001). Conclusion The optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.
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Affiliation(s)
- Andon Hestiantoro
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yuwono Sri Negoro
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yohana Afrita
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Budi Wiweko
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kanadi Sumapradja
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Muharam Natadisastra
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Mahran A, Abdelmeged A, Shawki H, Moheyelden A, Ahmed AM. Nitric oxide donors improve the ovulation and pregnancy rates in anovulatory women with polycystic ovary syndrome treated with clomiphene citrate: A RCT. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Messinis IE, Messini CI, Anifandis G, Dafopoulos K. Polycystic ovaries and obesity. Best Pract Res Clin Obstet Gynaecol 2015; 29:479-88. [DOI: 10.1016/j.bpobgyn.2014.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 01/29/2023]
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Follicle-stimulating hormone receptor polymorphism affects the outcome of ovulation induction in normogonadotropic (World Health Organization class 2) anovulatory subfertility. Fertil Steril 2015; 103:1081-1088.e3. [PMID: 25721191 DOI: 10.1016/j.fertnstert.2015.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 01/02/2015] [Accepted: 01/02/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess whether an FSH receptor polymorphism (Asn680Ser, rs6166) can affect the outcome of ovulation induction in normogonadotropic (World Health Organization class 2 [WHO2]) anovulatory subfertile women. DESIGN Prospective, longitudinal, cohort study. SETTING University-based fertility unit. PATIENT(S) A total of 240 consecutive women diagnosed with WHO2 anovulatory subfertility who underwent ovulation induction therapy. Results were replicated in a retrospective cohort of 185 patients with polycystic ovary syndrome (PCOS) (Rotterdam criteria). INTERVENTION(S) Ovulation induction using clomiphene citrate (CC) as first-line and exogenous gonadotropins (exFSH) as second-line therapy. MAIN OUTCOME MEASURE(S) Clomiphene-resistant anovulation (CRA), clomiphene failure (CCF), and ongoing pregnancy rate. RESULT(S) Genotyped patients (n = 159) were similar to nongenotyped women (n = 81) regarding clinical characteristics and outcomes of ovulation induction. The 680(Ser) allele was associated with CRA. A pooled analysis of both cohorts showed an 89% higher chance of CRA after CC treatment (odds ratio 1.9 [95% confidence interval 1.1-3.3]) in homozygous carriers of the FSH receptor variant (680(Ser/Ser)). A lower chance of ongoing pregnancy (hazard ratio 0.51 [95% confidence interval 0.27-0.98]) was observed among these patients during CC treatment in the prospective cohort. CONCLUSION(S) An FSH receptor polymorphism is associated with CRA during treatment with clomiphene citrate. These data may be used to design a treatment algorithm that is more efficacious and better tailored to the individual patient.
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Weiss NS, Braam S, König TE, Hendriks ML, Hamilton CJ, Smeenk JMJ, Koks CAM, Kaaijk EM, Hompes PGA, Lambalk CB, van der Veen F, Mol BWJ, van Wely M. How long should we continue clomiphene citrate in anovulatory women? Hum Reprod 2014; 29:2482-6. [PMID: 25164024 DOI: 10.1093/humrep/deu215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What is the effectiveness of continued treatment with clomiphene citrate (CC) in women with World Health Organization (WHO) type II anovulation who have had at least six ovulatory cycles with CC but did not conceive? SUMMARY ANSWER When women continued CC after six treatment cycles, the cumulative incidence rate of the ongoing pregnancy rate was 54% (95% CI 37-78%) for cycles 7-12. WHAT IS KNOWN ALREADY If women with WHO type II anovulation fail to conceive with CC within six ovulatory cycles, guidelines advise switching to gonadotrophins, which have a high risk of multiple gestation and are expensive. It is however not clear what success rate could be achieved by continued treatment with CC. STUDY DESIGN, SIZE, DURATION We performed a retrospective cohort study of women with WHO II anovulation who visited the fertility clinics of five hospitals in the Netherlands between 1994 and 2010. We included women treated with CC who had had at least six ovulatory cycles without successful conception (n = 114) after which CC was continued using dosages varying from 50 to 150 mg per day for 5 days. PARTICIPANTS/MATERIALS, SETTING, METHODS Follow-up was a total of 12 treatment cycles. Primary outcome was the cumulative incidence rate of an ongoing pregnancy at the end of treatment. MAIN RESULTS AND THE ROLE OF CHANCE We recruited 114 women that had ovulated on CC for at least six cycles but had not conceived. Of these 114 women, 35 (31%) had an ongoing pregnancy resulting in a cumulative incidence rate of an ongoing pregnancy of 54% after 7-12 treatment cycles with CC. LIMITATIONS, REASONS FOR CAUTION Limitations of our study are its retrospective approach. WIDER IMPLICATIONS OF THE FINDINGS Randomized trials comparing continued treatment with CC with the relatively established second line treatment with gonadotrophins are justified. In the meantime, we suggest to only begin this less convenient and more expensive treatment for women who do not conceive after 12 ovulatory cycles with CC. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- N S Weiss
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, the Netherlands
| | - S Braam
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands Center for Reproductive Medicine, Jeroen Bosch Hospital, 5223 GZ Den Bosch, the Netherlands
| | - T E König
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - M L Hendriks
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - C J Hamilton
- Center for Reproductive Medicine, Jeroen Bosch Hospital, 5223 GZ Den Bosch, the Netherlands
| | - J M J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital, 5000 LC Tilburg, the Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Máxima Medical Center, 5504 DB Veldhoven, the Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, the Netherlands
| | - P G A Hompes
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - C B Lambalk
- Center for Reproductive Medicine, Free University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - B W J Mol
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
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Takahashi T, Igarashi H, Hara S, Amita M, Matsuo K, Hasegawa A, Kurachi H. Brachial-to-ankle pulse wave velocity as an independent prognostic factor for ovulatory response to clomiphene citrate in women with polycystic ovary syndrome. J Ovarian Res 2014; 7:74. [PMID: 25024746 PMCID: PMC4096545 DOI: 10.1186/1757-2215-7-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) has a risk for cardiovascular disease. Increased arterial stiffness has been observed in women with PCOS. The purpose of the present study was to investigate whether the brachial-to-ankle pulse wave velocity (baPWV) is a prognostic factor for ovulatory response to clomiphene citrate (CC) in women with PCOS. Methods This study was a retrospective cohort study of 62 women with PCOS conducted from January 2009 to December 2012 at the university hospital, Yamagata, Japan. We analyzed 62 infertile PCOS patients who received CC. Ovulation was induced by 100 mg CC for 5 days. CC non-responder was defined as failure to ovulate for at least 2 consecutive CC-treatment cycles. The endocrine, metabolic, and cardiovascular parameters between CC responder (38 patients) and non-responder (24 patients) groups were analyzed. Results In univariate analysis, waist-to-hip ratio, level of free testosterone, percentages of patients with dyslipidemia, impaired glucose tolerance, and diabetes mellitus, blood glucose and insulin levels at 60 min and 120 min, the area under the curve of glucose and insulin after 75-g oral glucose intolerance test, and baPWV were significantly higher in CC non-responders compared with responders. In multivariate logistic regression analysis, both waist-to-hip ratio (odds ratio, 1.77; 95% confidence interval, 2.2–14.1; P = 0.04) and baPWV (odds ratio, 1.71; 95% confidence interval, 1.1–2.8; P = 0.03) were independent predictors of ovulation induction by CC in PCOS patients. The predictive values of waist-to-hip ratio and baPWV for the CC resistance in PCOS patients were determined by the receiver operating characteristic curves. The area under the curves for waist-to-hip ratio and baPWV were 0.76 and 0.77, respectively. Setting the threshold at 0.83 for waist-to-hip ratio offered the best compromise between specificity (0.65) and sensitivity (0.84), while the setting the threshold at 1,182 cm/s for baPWV offered the best compromise between specificity (0.80) and sensitivity (0.71). Conclusions Both metabolic and cardiovascular parameters were predictive for CC resistance in PCOS patients. The measurement of baPWV may be a useful tool to predict ovulation in PCOS patients who receive CC.
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Affiliation(s)
- Toshifumi Takahashi
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Hideki Igarashi
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Shuichiro Hara
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Mitsuyoshi Amita
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Koki Matsuo
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Ayumi Hasegawa
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Hirohisa Kurachi
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
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Abstract
The purpose of this paper is to provide a stepwise approach to treating the infertility/subfertility associated with polycystic ovary syndrome. Defining polycystic ovary syndrome in a patient requires first investigating other possible causes for polycystic ovary morphology, acne, hirsutism, obesity, and the metabolic derangements that often accompany polycystic ovary syndrome. Beginning with lifestyle modification and use of metformin, the progressive inclusion of more intensive therapies for induction of ovulation is described. Second-line treatments are discussed and the new findings from a large multicenter trial are discussed in the context of evidence-based treatment strategies for first-line agents. Finally, monofollicular development as a treatment goal and in vitro fertilization are discussed for those with recalcitrant disease.
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Affiliation(s)
- Joshua J Berger
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Birmingham, AL, USA
| | - G Wright Bates
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Birmingham, AL, USA
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Moolenaar LM, Nahuis MJ, Hompes PG, van der Veen F, Mol BWJ. Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate. Reprod Biomed Online 2014; 28:606-13. [DOI: 10.1016/j.rbmo.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 01/15/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
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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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28
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Massicotte MH, Langlois F, Baillargeon JP. Current procedures for managing polycystic ovary syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol 2013; 11:56. [PMID: 23800002 PMCID: PMC3737012 DOI: 10.1186/1477-7827-11-56] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/13/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age. The risk of pregnancy and neonatal complications in women with PCOS is debatable. In order to determine the risk of pregnancy and neonatal complications, evidence regarding these risks was examined. METHODS Literature searches were performed in the electronic databases MEDLINE, EMBASE, and CENTRAL based on the established strategy and eligible tries were included according to inclusion and exclusion criteria. A systematic literature review looking at rates of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, premature delivery, neonatal birth weight, caesarean section and admission to a neonatal intensive care unit (NICU) was conducted in women with PCOS. Pregnancy outcomes between women with PCOS versus controls were included. Sensitivity analyses were performed to determine the reliability of the available evidence and to validate the results. The study was performed with the approval of the ethics committee of the First Affiliated Hospital of Guangxi Medical University. RESULTS A total of 27studies, involving 4982 women with PCOS and 119692 controls were eligible for the meta-analysis. Women with PCOS demonstrated a significantly higher risk of developing GDM (OR3.43; 95% CI: 2.49-4.74), PIH (OR3.43; 95% CI: 2.49-4.74), preeclampsia (OR2.17; 95% CI: 1.91-2.46), preterm birth (OR1.93; 95%CI: 1.45-2.57), caesarean section (OR 1.74; 95% CI: 1.38-2.11) compared to controls. Their babies had a marginally significant lower birth weight (WMD -0.11g; 95%CI: -0.19 - -0.03), and higher risk of admission to NICU (OR 2.32; 95% CI: 1.40-3.85) compared to controls. CONCLUSIONS Women with PCOS have increased risk of adverse pregnancy and neonatal complications. It is necessary to establish guidelines for supervision during pregnancy and parturition to prevent these complications.
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Affiliation(s)
- Jun Z Qin
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li H Pang
- Department of Prenatal Diagnosis Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mu J Li
- Department of Reproductive Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao J Fan
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ru D Huang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hong Y Chen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Nahuis MJ, Oosterhuis GJE, Hompes PGA, van Wely M, Mol BWJ, van der Veen F. The basic fertility workup in women with polycystic ovary syndrome: a systematic review. Fertil Steril 2013; 100:219-25. [PMID: 23582439 DOI: 10.1016/j.fertnstert.2013.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 02/26/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems. DESIGN Systematic review. SETTING Not applicable. PATIENT(S) The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant). INTERVENTION(S) Performance of a semen analysis or tubal patency test before or during treatment. MAIN OUTCOME MEASURE(S) Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests. RESULT(S) Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available. CONCLUSION(S) Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.
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Affiliation(s)
- Marleen J Nahuis
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
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Oates J, Casikar I, Campain A, Müller S, Yang J, Reid S, Condous G. A prediction model for viability at the end of the first trimester after a single early pregnancy evaluation. Aust N Z J Obstet Gynaecol 2013; 53:51-7. [DOI: 10.1111/ajo.12046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/27/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Jennifer Oates
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
| | - Ishwari Casikar
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
| | - Anna Campain
- School of Mathematics and Statistics; University of Sydney; Sydney; Australia
| | - Samuel Müller
- School of Mathematics and Statistics; University of Sydney; Sydney; Australia
| | - Jean Yang
- School of Mathematics and Statistics; University of Sydney; Sydney; Australia
| | - Shannon Reid
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
| | - George Condous
- Early Pregnancy and Advanced Endosurgery Unit; Acute Gynaecology; Nepean Centre for Perinatal Care; Nepean Clinical School; Nepean Hospital; University of Sydney; Kingswood; Australia
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Does ovulation induction with follicle-stimulating hormone still have a future in polycystic ovary syndrome? Fertil Steril 2012; 98:599. [DOI: 10.1016/j.fertnstert.2012.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 04/18/2012] [Indexed: 11/21/2022]
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Veltman-Verhulst SM, Fauser BC, Eijkemans MJ. High singleton live birth rate confirmed after ovulation induction in women with anovulatory polycystic ovary syndrome: validation of a prediction model for clinical practice. Fertil Steril 2012; 98:761-768.e1. [DOI: 10.1016/j.fertnstert.2012.04.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 11/26/2022]
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Moll E, van Wely M, Lambalk CB, Bossuyt PMM, van der Veen F. Health-related quality of life in women with newly diagnosed polycystic ovary syndrome randomized between clomifene citrate plus metformin or clomifene citrate plus placebo. Hum Reprod 2012; 27:3273-8. [PMID: 22926838 DOI: 10.1093/humrep/des310] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the health-related quality of life (HRQoL) in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction with clomifene citrate (CC) combined with metformin compared with those using CC combined with placebo? SUMMARY ANSWER Overall quality of life in women with PCOS treated with CC plus metformin was significantly lower than in women treated with CC plus placebo. WHAT IS KNOWN ALREADY There are no data on HRQoL in adult women who receive ovulation induction with the purpose of conceiving. Women with PCOS have higher scores on depression and anxiety scales and lower QoL scores than women without PCOS. STUDY DESIGN, SIZE AND DURATION This study was a secondary analysis of a multi-centre RCT completed between June 2001 and May 2004. The randomization was stratified per centre, and the centres received blinded, numbered containers with medication. There were172 women available for the HRQoL assessment: 85 were allocated to metformin and 87 were allocated to placebo. PARTICIPANTS, SETTING AND METHODS The Rotterdam Symptom Checklist (RSCL), a standard self-administered questionnaire, was used to assess physical symptoms, psychological distress, activity levels and overall HRQoL. MAIN RESULTS AND THE ROLE OF CHANCE In the intention to treat analysis, we found differences between the treatment groups with respect to physical symptoms and overall HRQoL. Physical well-being was significantly impaired in women allocated to metformin but not in women allocated to placebo. The increase in physical symptoms in the metformin group was caused by side-effects typical of metformin, and was most pronounced at Week 1 (mean difference 12 [95% confidence interval (CI): 8-16] and still apparent at Week 16 [mean difference 7 (95% CI 2-12]. Overall well-being was significantly impaired in the metformin group compared with the placebo group [mean difference 13 (95% CI 6-20)]. LIMITATIONS AND REASONS FOR CAUTION RSCL measurements were available only for three quarters of the participants. Although the number of missing questionnaires and the baseline measurements, were comparable between the treatment groups, some form of selection bias cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS Our finding that metformin was more burdensome than placebo, strengthens the recommendation that CC only and not CC plus metformin should be the drug of choice in this patient population. STUDY FUNDING/COMPETING INTEREST(S) None of the authors declared a conflict of interest. There was no study funding. TRIAL REGISTRATION NUMBER ISRCTN55906981.
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Affiliation(s)
- E Moll
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Amsterdam, The Netherlands.
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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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Serum anti-Müllerian hormone and inhibin B concentrations are not useful predictors of ovarian response during ovulation induction treatment with recombinant follicle-stimulating hormone in women with polycystic ovary syndrome. Fertil Steril 2011; 96:459-63. [PMID: 21719005 DOI: 10.1016/j.fertnstert.2011.05.084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 05/17/2011] [Accepted: 05/25/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe changes of anti-Müllerian hormone (AMH) and inhibin B during low-dose gonadotropin ovulation induction (OI) treatment in women with polycystic ovary syndrome (PCOS), and thus disturbed selection of the dominant follicle. DESIGN Observational study. SETTING A referral fertility clinic. PATIENT(S) Women with PCOS (n = 48) and normo-ovulatory women (n = 23). INTERVENTION(S) AND MAIN OUTCOME MEASURE(S) Serum AMH, inhibin B, FSH, and E(2) concentrations were measured at start of stimulation, on the day of follicle selection, and at administration of hCG during OI cycles and were compared with concentration measured during the normal menstrual cycle. RESULT(S) Development of a single dominant follicle was observed in 92% of all OI cycles, reflected by similar E(2) concentrations compared with those in spontaneous cycles. AMH concentrations were constant during low-dose ovarian stimulation. Inhibin B concentrations remained elevated in patients with PCOS, suggesting prolonged survival of small antral follicles, whereas in controls inhibin B concentrations declined during the late follicular phase. CONCLUSION(S) The lack of change in AMH and inhibin B concentrations suggest that follicle dynamics during low-dose stimulation seem different from those during controlled ovarian hyperstimulation. In addition, constant AMH and inhibin B levels suggest that neither AMH nor inhibin B is an accurate marker of ovarian response after low-dose gonadotropin OI in patients with PCOS.
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Sarhan A, Beydoun H, Jones HW, Bocca S, Oehninger S, Stadtmauer L. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles. Reprod Biomed Online 2011; 23:220-6. [PMID: 21665547 DOI: 10.1016/j.rbmo.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
Ovulation induction (OI) or ovulation enhancement (OE) with gonadotrophins can be a reasonable treatment option for patients with a variety of infertility diagnoses. It must be used with extensive monitoring and management given the risk of multiple pregnancy,especially high-order multiples. This retrospective study evaluated per cycle outcomes of a large cohort of 1452 gonadotrophin OI/OE cycles at an academic infertility centre, and the efficacy of specific guidelines in limiting multiple pregnancy. The lowest possible gonadotrophin doses were used and cycle cancellation was recommended if more than three dominant follicles were present, and/or ifserum oestradiol was above 1500 pg/ml. Overall, pregnancy rate (PR) was 12% and live birth rate was 7.7%, with an increasing trend in younger patients (P = 0.0002 and <0.0001, respectively). Multiple clinical PR was 2.6% with 1.9% twins and 0.7% triplets and above.The birthweight of a singleton from a vanishing twin pregnancy (n = 8)was significantly lower than other singletons (2882 g versus 3250 g,P = 0.013). Reducing multiple pregnancies from OI/OE cycles remains an important and challenging goal. In this large cohort, high-order multiple clinical PR was limited to 0.7% per cycle by using specific management strategies while maintaining a reasonable PR.
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Affiliation(s)
- Abbaa Sarhan
- The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, VA 23507, USA.
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Abstract
During the last years, numerous consensuses have been held in different countries in order to review the data concerning diagnosis and treatment and their relationship with the ethnic origin, social status and lifestyle of women with Polycystic Ovary Syndrome (PCOS). This study describes the conclusions concerning diagnostic criteria and the appropriate treatment of women with PCOS reached during the International Symposium Polycystic Ovary Syndrome, First Latin-American Consensus held in Buenos Aires, Argentina on 4th and 5th May 2009 to be applied in South American.
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Wallwiener LM, Rösner S, Goeckenjan M, Strowitzki T, Toth B. Therapieoptionen bei polyzystischem Ovarsyndrom mit oder ohne Kinderwunsch. GYNAKOLOGISCHE ENDOKRINOLOGIE 2011. [DOI: 10.1007/s10304-010-0399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kuivasaari-Pirinen P, Hippeläinen M, Hakkarainen H, Randell K, Heinonen S. Cumulative baby take-home rate among women with PCOS treated by IVF. Gynecol Endocrinol 2010; 26:582-9. [PMID: 20175706 DOI: 10.3109/09513591003632043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was designed to evaluate cumulative live birth rates after an in vitro fertilisation (IVF) programme in polycystic ovary syndrome (PCOS) women. SUBJECTS AND METHODS IVF outcomes of 66 women with PCOS diagnosed via Rotterdam criteria, who failed to conceive after ovulation induction, were compared with 106 women with tubal factor infertility. One hundred and twenty-five cycles were analysed in the PCOS group and 225 cycles in the control group (1-4 cycles per woman). Results of frozen-thawed cycles, occurrence of ovarian hyperstimulation syndrome (OHSS) and drop-outs were also included. RESULTS Despite a lower pregnancy rate among women with PCOS versus controls, the cumulative baby take-home rate did not differ between the groups (48.5% and 44.3%). The first cycle was the most successful cycle for living birth rate in PCOS group. One-third of PCOS women, who did not continue after unsuccessful treatment, had more miscarriage but not more OHSS compared to those who continued. CONCLUSIONS Although the baby take-home rate was similar among women with PCOS, and controls, the outcomes of consecutive cycles were not equal. Cumulative data give more realistic information than pooled cycles.
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Nyboe Andersen A, Balen AH, Platteau P, Pettersson G, Arce JC. Prestimulation parameters predicting live birth in anovulatory WHO Group II patients undergoing ovulation induction with gonadotrophins. Hum Reprod 2010; 25:1988-95. [PMID: 20522443 PMCID: PMC2907229 DOI: 10.1093/humrep/deq142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study was to identify baseline predictors of live birth in anovulatory patients undergoing ovulation induction, and based on these predictors, develop nomograms for estimation of the probability of live birth in a single cycle. METHODS Univariate and multivariate logistic regression were used for retrospective analysis of clinical, sonographic and endocrinological parameters collected prior to the start of ovarian stimulation in a cohort of anovulatory World Health Organization (WHO) Group II patients (n = 335), who were resistant to clomiphene citrate (CC) and therefore stimulated with gonadotrophins using a low-dose step-up protocol. RESULTS The univariate analysis identified age [OR = 0.91 (95% CI: 0.84-0.98), P = 0.015], duration of infertility [OR = 0.71 (95% CI: 0.56-0.91), P = 0.007], serum follicle stimulating hormone (FSH) concentration at the start of stimulation [OR = 0.83 (95% CI: 0.69-0.99), P = 0.034] and menstrual cycle pattern (P = 0.022) as significant predictors of live birth. Baseline concentrations of luteinizing hormone, androgens, glucose and insulin, as well as body mass index, were not predictors of live birth. In the multivariate analysis, duration of infertility, FSH and menstrual cycle pattern were independent predictors, and nomograms were designed with these three parameters for individual prediction of the probability of live birth. CONCLUSIONS The chances of live birth in women with WHO Group II anovulatory infertility resistant to CC undergoing ovulation induction with gonadotrophins is highly influenced by the menstrual cycle pattern. Increases in duration of infertility and concentration of FSH (within the normal range) before the start of stimulation have negative influences on the likelihood of achieving a live birth.
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Affiliation(s)
- A Nyboe Andersen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Eckmann KR, Kockler DR. Aromatase Inhibitors for Ovulation and Pregnancy in Polycystic Ovary Syndrome. Ann Pharmacother 2009; 43:1338-46. [DOI: 10.1345/aph.1m096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate evidence for use of aromatase inhibitors for ovulation induction and pregnancy in patients with polycystic ovary syndrome (PCOS). Data Sources: A MEDLINE search (1966–May 2009) was conducted using the search terms anastrozole, aromatase inhibitors, axemestane, letrozole, ovulation, and polycystic ovary syndrome to identify relevant studies. Study Selection and Data Extraction: Prospective clinical trials published in English and conducted in humans were identified. Trials using intrauterine insemination methods for pregnancy were excluded. The resulting articles were separated into 2 groups: aromatase inhibitor use in clomiphene-resistant patients and use in treatment-naive patients. Eleven trials were reviewed. Data Synthesis: Accepted pharmacologic treatments for women with PCOS and infertility include clomiphene citrate, gonadotropins, and gonadotropin-releasing hormone (GnRH) analogs. Each medication has variable efficacy rates and adverse effects. Therefore, other treatments are needed for a subset of women with PCOS and infertility. Evidence suggests that nonsteroidal aromatase inhibitors, specifically letrozole and anastrozole, may have ovulation-inducing effects by inhibiting androgen-to-estrogen conversion. Select trials with aromatase inhibitors have demonstrated efficacy for increased endometrium thickness, ovulation rates, and pregnancy rates when used in clomiphene citrate–resistant or treatment-naïve patients. Conclusions: Further trials comparing aromatase inhibitors with clomiphene citrate are necessary before aromatase inhibitors can be recommended routinely for ovulation induction in women with PCOS and infertility. However, aromatase inhibitors may be considered in a subset of this population, specifically women who are clomiphene citrate resistant or those who, after discussion of risks and benefits, are not candidates for clomiphene citrate, gonadotropins, or GnRH analogs.
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Affiliation(s)
- Karen R Eckmann
- Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond
| | - Denise R Kockler
- Drug Information Services, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals; Associate Clinical Professor, School of Pharmacy, Virginia Commonwealth University
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Sastre ME, Prat MO, Checa MA, Carreras RC. Current trends in the treatment of polycystic ovary syndrome with desire for children. Ther Clin Risk Manag 2009; 5:353-60. [PMID: 19536311 PMCID: PMC2697533 DOI: 10.2147/tcrm.s3779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS), one of the most frequent endocrine diseases, affects approximately 5%–10% of women of childbearing age and constitutes the most common cause of female sterility regardless of the need or not for treatment, a change in lifestyle is essential for the treatment to work and ovulation to be restored. Obesity is the principal reason for modifying lifestyle since its reduction improves ovulation and the capacity for pregnancy and lowers the risk of miscarriage and later complications that may occur during pregnancy (gestational diabetes, pre-eclampsia, etc). When lifestyle modification is not sufficient, the first step in ovulation induction is clomiphene citrate. The second-step recommendation is either exogenous gonadotrophins or laparoscopic ovarian surgery. Recommended third-line treatment is in vitro fertilization. Metformin use in PCOS should be restricted to women with glucose intolerance.
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Dickey RP. Strategies to reduce multiple pregnancies due to ovulation stimulation. Fertil Steril 2008; 91:1-17. [PMID: 18973894 DOI: 10.1016/j.fertnstert.2008.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 08/05/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review factors associated with high-order multiple births (HOMB) due to ovulation induction (OI) and the efficacy of strategies to reduce their occurrence. DESIGN Retrospective analysis of published studies of OI with intrauterine insemination (IUI) where patient and cycle characteristics were fully documented. RESULT(S) High-order multiple pregnancies (HOMP) were positively related to use of high doses of gonadotropin, number of 7-10 mm preovulatory follicles, and E(2), and inversely related to age and number of treatment cycles. Strategies successful in reducing HOMP include: use of clomiphene (CC) before gonadotropins, minimal gonadotropin doses, cancellation for more than three follicles >10-15 mm, and aspiration of excess follicles. Depending on the strategy used, 5%-20% of cycles may be canceled but HOMP rates can be less than 2% and pregnancy rates can average 10%-20% per cycle. Pregnancy rates per patient need not be reduced if low doses are continued for 4-6 cycles. CONCLUSION(S) High-order multiple pregnancies due to OI can be reduced to 2% or less by less aggressive stimulation without reducing overall chances of pregnancy for most patients.
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Affiliation(s)
- Richard Palmer Dickey
- Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA.
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Requena A, Herrero J, Landeras J, Navarro E, Neyro JL, Salvador C, Tur R, Callejo J, Checa MA, Farré M, Espinós JJ, Fábregues F, Graña-Barcia M. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Hum Reprod Update 2008; 14:571-82. [PMID: 18812422 PMCID: PMC2569859 DOI: 10.1093/humupd/dmn033] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Letrozole is the third-generation aromatase inhibitor (AI) most widely used in assisted reproduction. AIs induce ovulation by inhibiting estrogen production; the consequent hypoestrogenic state increases GnRH release and pituitary follicle-stimulating hormone (FSH) synthesis. METHODS A systematic search of the literature was performed for both prospective and retrospective studies. Meta-analyses of randomized clinical trials (RCTs) were performed for three comparisons: letrozole versus clomiphene citrate (CC), letrozole + FSH versus FSH in intrauterine insemination (IUI) and letrozole + FSH versus FSH in IVF. In the absence of RCTs, non-randomized studies were pooled. RESULTS Nine studies were included in the meta-analysis. Four RCTs compared the overall effect of letrozole with CC in patients with polycystic ovary syndrome. The pooled result was not significant for ovulatory cycles (OR = 1.17; 95% CI 0.66–2.09), or for pregnancy rate per cycle (OR = 1.47; 95% CI 0.73–2.96) or for pregnancy rate per patient (OR = 1.37; 95% CI 0.70–2.71). In three retrospective studies which compared L + FSH with FSH in ovarian stimulation for IUI, the pooled OR was 1.15 (95% CI 0.78−1.71). A final meta-analysis included one RCT and one cohort study that compared letrozole + gonadotrophin versus gonadotrophin alone: the pooled pregnancy rate per patient was not significantly different (OR = 1.40; 95% CI 0.67–2.91). CONCLUSIONS Letrozole is as effective as other methods of ovulation induction. Further randomized-controlled studies are warranted to define more clearly the efficacy and safety of letrozole in human reproduction.
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Affiliation(s)
- Antonio Requena
- IVI-Madrid, Santiago de Compostela 88, E-28035 Madrid, Spain.
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Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 2008; 89:505-22. [DOI: 10.1016/j.fertnstert.2007.09.041] [Citation(s) in RCA: 563] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 09/18/2007] [Accepted: 09/18/2007] [Indexed: 12/16/2022]
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MOHIUDDIN S, BESSELLINK D, FARQUHAR C. Long-term follow up of women with laparoscopic ovarian diathermy for women with clomiphene-resistant polycystic ovarian syndrome. Aust N Z J Obstet Gynaecol 2007; 47:508-11. [DOI: 10.1111/j.1479-828x.2007.00789.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fauser BCJM, Diedrich K, Devroey P. Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2007; 14:1-14. [PMID: 18006561 DOI: 10.1093/humupd/dmm034] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian stimulation is applied in the clinic to restore mono-ovulatory cycles in anovulatory women (ovulation induction) or to induce the development of multiple dominant follicles for assisted reproduction. Ovarian response is the endocrine and follicular reaction of the ovaries to stimulation. Achieving an appropriate ovarian response to anti-estrogens or exogenous gonadotrophins is central to ovulation induction and ovarian stimulation protocols. However, achieving an adequate response, without cycle cancellation or adverse events related to under- or over-stimulation, is complicated by high intra- and inter-individual variability. To predict each patient's ovarian response to medication for ovarian stimulation and to individualize the starting dose of exogenous gonadotrophin or the need for exogenous luteinizing hormone, various clinical, endocrine, ovarian ultrasonographic and genetic characteristics have been explored. Some of these features have been incorporated into prediction models. In this review, the methodology behind predictive factors and prediction models and their potential clinical applicability across ovulation induction and ovarian stimulation are explored.
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Affiliation(s)
- B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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van Wely M, Fauser BC, Laven JS, Eijkemans MJ, van der Veen F. Validation of a prediction model for the follicle-stimulating hormone response dose in women with polycystic ovary syndrome. Fertil Steril 2006; 86:1710-5. [DOI: 10.1016/j.fertnstert.2006.05.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
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