Should clomiphene citrate (CC) or low-dose gonadotrophin therapy be the first-line treatment for anovulatory infertility associated with polycystic ovary syndrome (PCOS)? A multicentre, randomised, prospective study and cost effective analysis.

2013 ◽  
Author(s):  
R. Homburg
2005 ◽  
Vol 90 (7) ◽  
pp. 4068-4074 ◽  
Author(s):  
Stefano Palomba ◽  
Francesco Orio ◽  
Angela Falbo ◽  
Francesco Manguso ◽  
Tiziana Russo ◽  
...  

Abstract Context: Although metformin has been shown to be effective in the treatment of anovulation in women with polycystic ovary syndrome (PCOS), clomiphene citrate (CC) is still considered to be the first-line drug to induce ovulation in these patients. Objective: The goal of this study was to compare the effectiveness of metformin and CC administration as a first-line treatment in anovulatory women with PCOS. Design: We describe a prospective parallel randomized, double-blind, double-dummy controlled clinical trial. Setting: The study was conducted at the University “Magna Graecia” of Catanzaro, Catanzaro, Italy. Patients: One hundred nonobese primary infertile anovulatory women with PCOS participated. Interventions: We administered metformin cloridrate (850 mg twice daily) plus placebo (group A) or placebo plus CC (150 mg for 5 d from the third day of a progesterone withdrawal bleeding) (group B) for 6 months each. Mean outcome measures: The main outcome measures were ovulation, pregnancy, abortion, and live-birth rates. Results: The subjects of groups A (n = 45) and B (n = 47) were studied for a total of 205 and 221 cycles, respectively. The ovulation rate was not statistically different between either treatment group (62.9 vs. 67.0%, P = 0.38), whereas the pregnancy rate was significantly higher in group A than group B (15.1 vs. 7.2%, P = 0.009). The difference found between groups A and B regarding the abortion rate was significant (9.7 vs. 37.5%, P = 0.045), whereas a positive trend was observed for the live-birth rate (83.9 vs. 56.3%, P = 0.07). The cumulative pregnancy rate was significantly higher in group A than group B (68.9 vs. 34.0%, P < 0.001). Conclusions: Six-month metformin administration is significantly more effective than six-cycle CC treatment in improving fertility in anovulatory nonobese PCOS women.


2021 ◽  
Vol 11 (9) ◽  
pp. 131-136
Author(s):  
Anna Małgorzata Łopuszyńska ◽  
Mateusz Pawlicki ◽  
Magdalena Kozioł ◽  
Aleksandra Krasa ◽  
Ewa Piekarska ◽  
...  

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women in reproductive age. It is estimated that it affects about 5-10% of women aged 18-44. This disease is associated with reproductive dysfunction and metabolic disorders. According to the American Society for Reproductive Medicine (ASRM) 2018 guidelines, the first line treatment for PCOS are lifestyle adjustments, including dietary control and exercise. Hence a lot of research on the diet that is most appropriate for this group of people.  Material and methods: PubMed research base was searched using the following keywords: diet, pcos, policystic ovary syndrome in 2017-2021.  Results: The diet of women with PCOS is poorly composed, and dietary errors may affect the metabolic disorders occurring in these patients. Women with PCOS tend to have insufficient intakes of vitamin D, fiber, and vitamin B9, as well as excessive sodium intake. Mediterranean, ketogenic, low-carbohydrate, low-glycemic, low-AGE and pod-based diets positively affect this disease in   various ways.  Conclusions: PCOS is a very diverse disease that affects a large number of women around the world. Changing your lifestyle, including diet and exercise, is the first line treatment. This is why creating the best diet for these patients is extremely important. Current discoveries are very promising and give hope to create a model of nutrition that will be the best for these women. Large, multicentre randomized trials are still needed to develop diets that are appropriate for different patients because the disease picture is heterogeneous. 


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