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Huyghe L, Robin C, Dumont A, Decanter C, Kyheng M, Dewailly D, Catteau-Jonard S, Robin G. How to Choose the Optimal Starting Dose of Clomiphene Citrate (50 or 100 mg per Day) for a First Cycle of Ovulation Induction in Anovulatory PCOS Women? J Clin Med 2023; 12:4943. [PMID: 37568345 PMCID: PMC10420149 DOI: 10.3390/jcm12154943] [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: 05/12/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
RESEARCH QUESTION Clomiphene citrate (CC) is one of the first-line treatments for ovulation induction in women with anovulatory polycystic ovary syndrome (PCOS). However, nearly 1 out of 2 women is resistant to 50 mg/day of CC. The objective of this study is to investigate the clinical, biological, and/or ultrasound factors that may predict the resistance to 50 mg/day of CC in the first cycle of treatment in women with anovulatory PCOS. This would make it possible to identify PCOS patients to whom the dose of 100 mg/day would be offered as of the first cycle. DESIGN A retrospective and monocentric study was conducted on 283 women with anovulatory PCOS who required the use of ovulation induction with CC (903 cycles). RESULTS During the first cycle of treatment, 104 patients (36.8%) were resistant to 50 mg/day of CC. Univariate regression analysis showed that patients who resisted 50 mg/day of CC had significantly higher BMI, waist circumference, serum levels of AMH, total testosterone, Δ4-androstenedione, 17-OHP, and insulin (p < 0.05), compared to patients ovulating with this dose. Serum levels of SHBG were significantly lower in patients resistant to 50 mg/day (p < 0.05). After multivariate analysis, only AMH and SHBG remained statistically significant (p = 0.01 and p = 0.001, respectively). However, areas under the ROC curves were weak (0.59 and 0.68, respectively). CONCLUSION AMH and SHBG are the only two parameters significantly associated with the risk of resistance to 50 mg/day of CC. However, no satisfactory thresholds have been established to predict resistance to 50 mg CC.
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Affiliation(s)
- Lucie Huyghe
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Camille Robin
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Agathe Dumont
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Christine Decanter
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Maeva Kyheng
- Department of Biostatistics, Lille University Hospital, 59000 Lille, France
- ULR 2694—METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, 59000 Lille, France
| | - Didier Dewailly
- Faculty of Medicine, University of Lille, 59000 Lille, France
- UMRS-1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, 59000 Lille, France
| | - Sophie Catteau-Jonard
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
- Faculty of Medicine, University of Lille, 59000 Lille, France
- UMRS-1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, 59000 Lille, France
- Department of Medical Gynecology and Sexology, Lille University Hospital, 59000 Lille, France
| | - Geoffroy Robin
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
- Faculty of Medicine, University of Lille, 59000 Lille, France
- UMRS-1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, 59000 Lille, France
- Department of Medical Gynecology and Sexology, Lille University Hospital, 59000 Lille, France
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Anti-Müllerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS. Int J Mol Sci 2021; 22:ijms222212507. [PMID: 34830389 PMCID: PMC8619458 DOI: 10.3390/ijms222212507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 01/19/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women. It is characterized by chronic anovulation, hyperandrogenism, and the presence of polycystic ovary in ultrasound examination. PCOS is specified by an increased number of follicles at all growing stages, mainly seen in the preantral and small antral follicles and an increased serum level of Anti-Müllerian Hormone (AMH). Because of the strong correlation between circulating AMH levels and antral follicle count on ultrasound, Anti-Müllerian Hormone has been proposed as an alternative marker of ovulatory dysfunction in PCOS. However, the results from the current literature are not homogeneous, and the specific threshold of AMH in PCOS and PCOM is, therefore, very challenging. This review aims to update the current knowledge about AMH, the pathophysiology of AMH in the pathogenesis of PCOS, and the role of Anti-Müllerian Hormone in the treatment of this syndrome.
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Bulletti C, Allegra A, Mignini Renzini M, Vaiarelli A. How fixed versus variable gonadotropin dose during controlled ovarian stimulation could influence the management of infertility patients undergoing IVF treatment: a national Delphi consensus. Gynecol Endocrinol 2021; 37:255-263. [PMID: 32588675 DOI: 10.1080/09513590.2020.1770214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIM Define how and when fixed starting gonadotropin doses can be used in current clinical ART practices in Italy. METHODS A Delphi conference consisting of three rounds was performed in order to define the ideal clinical conditions in which fixed-gonadotropin-dose during COS should be applied. During the conference, 19 statements about the current ART practice were provided to a panel of twenty-nine national experts. Median score was 5 (IQ:4-6) in all Delphi rounds. RESULTS Eleven statements (57.9%) were classified as shareable with high-degree of convergence, 2 (10.5%) as shareable with low convergence and 6 (31.6%) as un-shareable with high convergence. The panel reached high consensus regarding some statements: (i) fixed FSH-dose in normoresponders and poor-responder, (ii) importance of predicting ovarian response before COS, considering multiple markers to select the right stimulation protocol for each patient, (iii) importance of therapy simplification and standardization to improve efficiency during COS. Moreover, a low-convergence was reached about use of GnRH antagonist as first treatment line and drug storage at room temperature. However from these findings, the debate remains open regarding some other statements: (a) usefulness of Bologna-criteria to define poor-responders; (b) efficacy to change always stimulation protocol after a failure IVF; (c) utility of AMH-dosed with standardized automatic mode to define normo-responder patients; (d) usefulness to modify the dosage of 12.5 IU/die during COS to improve stimulation effectiveness. CONCLUSION Controlled ovarian stimulation remains a challenging clinical step in Assisted Reproductive Technique, especially in some specific patient groups for which no clinical consensus is available. This study is the first attempt to describe the shared clinical opinion regarding the fixed versus variable gonadotropin dose in the real IVF practice.
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Affiliation(s)
- Carlo Bulletti
- Ostetricia e Ginecologia, EXTRA OMNES Medicina e Salute Riproduttiva, Cattolica, Italy
| | | | | | - Alberto Vaiarelli
- GENERA Centers for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
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Li HWR, Nelson SM. Clinical Application of AMH Measurement in Assisted Reproduction. Front Endocrinol (Lausanne) 2020; 11:606744. [PMID: 33362720 PMCID: PMC7757755 DOI: 10.3389/fendo.2020.606744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022] Open
Abstract
Anti-Müllerian hormone reflects the continuum of the functional ovarian reserve, and as such can predict ovarian response to gonadotropin stimulation and be used to individualize treatment pathways to improve efficacy and safety. However, consistent with other biomarkers and age-based prediction models it has limited ability to predict live birth and should not be used to refuse treatment, but rather to inform counselling and shared decision making. The use of absolute clinical thresholds to stratify patient phenotypes, assess discordance and individualize treatment protocols in non-validated algorithms combined with the lack of standardization of assays may result in inappropriate classification and sub-optimal clinical decision making. We propose that holistic baseline phenotyping, incorporating antral follicle count and other patient characteristics is critical. Treatment decisions driven by validated algorithms that use ovarian reserve biomarkers as continuous measures, reducing the risk of misclassification, are likely to improve overall outcomes for our patients.
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Affiliation(s)
- Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
- *Correspondence: Hang Wun Raymond Li,
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
- The Fertility Partnership, Oxford, United Kingdom
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Brar PC, Dingle E, Ovadia D, Pivo S, Prasad V, David R. Interpretation of androgen and anti-Mullerian hormone profiles in a Hispanic cohort of 5- to 8-year-old girls with premature adrenarche. Ann Pediatr Endocrinol Metab 2018; 23:210-214. [PMID: 30599482 PMCID: PMC6312917 DOI: 10.6065/apem.2018.23.4.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/18/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Premature adrenarche (PA) often leads to polycystic ovary syndrome (PCOS). Higher anti-mullerian hormone (AMH) levels are reported in PCOS. We studied the androgen profile and AMH profiles in Hispanic girls with PA (aged 5-8 years) and age and body mass index (BMI) matched controls. METHODS Retrospective review of electronic medical records of girls who met the inclusion criteria for premature adrenarche were done. RESULTS PA girls (n=76) were matched to control girls (n=12) for age (mean±standard deviation) (6.7±1 years vs. 6.2±1.3 years) and BMI (20±10 kg/m2 vs. 17.8±2.7 kg/m2). Dehydroepiandrostenedione sulfate (63.3±51.3 μg/dL vs. 29.8±17.3 μg/dL, P<0.001) and testosterone levels (11.4±4.8 ng/dL vs. 8.2±2.9 ng/dL, P=0.001) were significantly higher in the PA group than controls. AMH values (<14 years: reference range, 0.49-3.15 ng/mL) were 3.2±2.2 ng/mL vs. 4.6± 3.2 ng/mL respectively in the PA and control groups and were not different (P=0.4). AMH did not show a correlation with bone age (P=0.1), and testosterone (P=0.9) in the PA group. 17-hydroxyprogesterone levels (17-OHP ng/dL) were 39.5±30.5 ng/dL vs. 36.8±19.8 ng/dL in PA versus control girls. The concentration of 17-OHP was not statistically different between the control and PA groups. CONCLUSION Higher AMH was not observed in PA girls and no correlation with BA and androgen levels was observed.
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Affiliation(s)
- Preneet Cheema Brar
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, NY, USA,Address for correspondence: Preneet Cheema Brar, MD Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, 160 East 3nd street, L3, New York 10016, New York, USA Tel: +1-212-263-5940 Fax: +1-212-263-5808 E-mail:
| | - Elena Dingle
- Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Daniela Ovadia
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
| | - Sarah Pivo
- Deparment of Surgery, New York University School of Medicine, New York, NY, USA
| | - Veeramac Prasad
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Raphael David
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, NY, USA
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