P884 Improvement of the ovarian function, follicular growth and ovulation rate using Metformin in patients with polycystic ovarian syndrome

2009 ◽  
Vol 107 ◽  
pp. S663-S663
Author(s):  
E. Trajkovska ◽  
G. Dimitrov ◽  
E. Dzikova ◽  
I. Andonova ◽  
L. Hodza
1999 ◽  
Vol 68 (2) ◽  
pp. 257-284 ◽  
Author(s):  
R. Webb ◽  
R. G. Gosden ◽  
E. E. Telfer ◽  
R. M. Moor

AbstractThis review addresses the reasons for the lack of progress in the control of superovulation and highlights the importance of understanding the mechanisms underlying follicular development. The present inability to provide large numbers of viable embryos from selected females still restricts genetic improvement, whilst variability in ovarian response to hormones limit the present capacity for increasing reproductive efficiency.Females are born with a large store of eggs which rapidly declines as puberty approaches. If these oocytes are normal then there is scope for increasing the reproductive potential of selected females. Oocytes must reach a certain size before they can complete all stages of development and the final changes that occur late in follicular development. It is likely that oocytes that do not produce specific factors at precise stages of development will not be viable. Hence, it is important to characterize oocyte secreted factors since there are potential indicators of oocyte quality.The mechanisms that determine ovulation rate have still not been fully elucidated. Indeed follicular atresia, the process whereby follicles regress, is still not known. A better understanding of these processes should prove pivotal for the synchronization of follicular growth, for more precise oestrous synchronization and improved superovulatory response.Nutrition can influence a whole range of reproductive parameters however, the pathways through which nutrition acts have not been fully elucidated. Metabolic hormones, particularly insulin and IGFs, appear to interact with gonadotrophins at the level of the gonads. Certainly gonadotropins provide the primary drive for the growth of follicles in the later stages of development and both insulin and IGF-1, possibly IGF-2, synergize with gonadotrophins to stimulate cell proliferation and hormone production. More research is required to determine the effects of other growth factors and their interaction with gonadotropins.There is evidence, particularly from studies with rodents, that steroids can also modulate follicular growth and development, although information is very limited for ruminants. There may be a rôle for oestrogens in synchronizing follicular waves, to aid in oestrous synchronization regimes and for removing the dominant follicle to achieve improved superovulatory responses. However more information is required to determine whether these are feasible approaches.Heritability for litter size is higher in sheep than in cattle. Exogenous gonadotropins are a commercially ineffective means of inducing twinning in sheep and cattle. Although there are differences in circulating gonadotropin concentrations, the mechanism(s) responsible for the high ovulation appear to reside essentially within the ovaries. The locus of the Booroola gene, a major gene for ovulation rate, has been established but not specifically identified. However sheep possessing major genes do provide extremely valuable models for investigating the mechanisms controlling ovulation rate, including a direct contrast to mono-ovulatory species such as cattle.In conclusion, the relationship between oocyte quality, in both healthy follicles and those follicles destined for atresia, must be resolved before the future potential for increasing embryo yield can be predicted. In addition, a greater understanding of the factors affecting folliculogenesis in ruminants should ensure that the full benefits ensuing from the precise control of ovarian function are achieved. The improved use of artificial insemination and embryo transfer that would ensue from a greater understanding of the processes of folliculo genesis, coupled with the new technologies of genome and linkage mapping, should ensure a more rapid rate of genetic gain.


2015 ◽  
Vol 3 (4) ◽  
pp. 335-349
Author(s):  
Basima Al Ghazali

The objective of this study is to evaluate the efficacy of the clomiphene stair-step protocol to induce ovulation in women with polycystic ovarian syndrome (PCOS) compared to traditional protocol. This single center randomized controlled trial was undertaken. A 140-patients who met all of the inclusion criteria were divided into two main groups and induction of ovulation for both protocols was performed. Follow up of follicular maturation is done by transvaginal ultrasound. The time to ovulation with the stair step protocol was 21-28 days as compared with the traditional protocol which was 42-70 days. The dose dependent ovulation rate was 43% at 100 mg with the stair step protocol compared with 25.3% with the traditional regimen and the ovulation rate at 150 mg was 21.6% with the stair step protocol compared with 14.7% with the traditional protocol while the clomiphene citrate resistance rate was higher with the traditional protocol 38.7% as compared to the stair step method which was 20% which are statistically significant. This randomized controlled trial suggests that clomiphene stair step protocol decreases the time to ovulation and may improve ovulation rates in clomiphene-resistant women.


2020 ◽  
Vol p4 (05) ◽  
pp. 2450-2452
Author(s):  
Sushma 1 ◽  
Shivani Chaudhary ◽  
Satish Jalihal

Due to sedentary lifestyle and stress, the incidence of metabolic disorders is increasing day by day. Among these, polycystic ovarian syndrome (PCOS) is one of them. PCOS is a disease, which is related to cystic changes in the ovary. The follicles develop from primordial follicle, but the development stops at an early antral stage due to disturbed ovarian function. Women with PCOS have irregular menstrual cycle, excess of androgen, anovulation, acne, hirsutism and infertility. According to Ayurveda, this type of clinical features is found in Pushpagni, Jataharni and Artavakshaya. It can be considered as rasa Medodhatuvikara and has to be managed depending on Doshadushya vitiation. Ayurvedic management principles as Amaha-rachikitsa, Shodhana and Samana therapies along with Vata-Kaphahara Dravyas. Diet and lifestyle modi-fications are also proving to be beneficial in PCOS. The present study highlights the effect of Samana ther-apy in PCOS.


2012 ◽  
Vol 87 (Suppl_1) ◽  
pp. 502-502
Author(s):  
Qi Wang ◽  
Ji Young Kim ◽  
Kai Xue ◽  
Jia-Yin Liu ◽  
Arthur Leader ◽  
...  

Author(s):  
Swapna Y. ◽  
V. Srilakshmi

Background: It has been estimated that prevalence of PCOS ranges from 5-10% in reproductive females. Thus, it becomes most common endocrinopathy in this age group. Lack of ovulation and androgen over activity are key features of PCOS. The objective of this study was to patients with polycystic ovarian syndrome at a tertiary care center.Methods: Present study was following up study with 200 cases of PCOS. Rotterdam criteria were used for the diagnosis of the PCOS. This criterion includes three things. First is woman having in last year <6 periods of menstruation. Second is testosterone value >0.6 ng/ml and third is each ovary having >12 follicles with increased size and volume. Those cases with hypothyroidism, adrenal tumors, congenital adrenal hyperplasia etc were excluded from the present study. Those on steroid therapy were also excluded. Detailed history and clinical examination were carried out for included cases as well as required investigations.Results: Overall incidence of infertility was found as 27.9%. Out of these 200 cases, 44 (22%) had PCOS. Majority cases belonged to 20-24 years of age. Hirsutism was most common findings in clinical hyperandrogenism. Risk of insulin resistance syndrome was 4.79 times higher in obesity compared to not obese. Age, BMI, duration of infertility, ovarian volume, and menstrual pattern had effect on ovulation rate following laparoscopic ovarian drilling. Increasing duration of infertility and BMI had lower ovulation rate. Ovulation rate was highest when treated with clomiphene citrate alone than the combination therapy.Conclusions: Women with obesity have more chances of having PCOS as seen from the present study.


2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Muhammad Arshad Chohan ◽  
Fauzia Butt ◽  
Humaira Mansoor ◽  
Tanzeela Falak

Objective: To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Design: Observational study. Place and duration of study: Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Intervention: Clomiphene citrate (50-150mg) was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Main outcome measures: Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Results: Forty-six patients (54.76%) ovulated in six cycles while twenty-seven (32.14%) remained anovulatory. Sixteen women (34.79%) conceived during the study period. Out of which ten women (62.5%) miscarried. Endometerial thickness did not differ (P>.50) between the conceived and non-conceived group but echogenic grade A pattern (75%) was observed during the conceived cycles (P<. 001). Conclusion: Clomiphene citrate (CC) is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome.


2018 ◽  
Vol 5 (10) ◽  
pp. 3230
Author(s):  
M. Sridhar ◽  
Chillamherla Susmitha

Background: Polycystic ovarian disease (PCOD) or polycystic ovarian syndrome (PCOS) is a common endocrine disorder which commonly affects women in their reproductive age, often leading to anovulatory infertility. There has been a resurgence of surgical intervention with the advent of ovarian drilling. This study was performed to assess the surgical management for patients with PCOS resistant to hormonal therapy.Methods: A thorough history and demographic details were taken from all the patients. A detailed clinical examination, along with transvaginal sonography was done. Laparoscopic ovarian drilling was performed on the patients under general anesthesia.Results: Most of the women were in the 3rd decade of their life and majority of the women had attained menarche at 13 years. The chief complaint of the patients was irregular periods experienced by 80%. 44.4% of the patents had normal BMI, while 31.5% were underweight. Most of the patients (6.7%) showed no evidence of hyperandrogenism, while 20% had hirsutism, 11% had acne.Conclusions: Polycystic ovarian syndrome is quite prevalent among the women of reproductive age. The effective treatment for PCOS which are resistant to hormonal therapy is laparoscopic drilling of the ovaries which results in ovarian function.


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