scholarly journals GnRH Antagonist Versus Modified Prolonged GnRH Agonist Protocol in Polycystic Ovary Syndrome (PCOS): Analysis Using Propensity Score Matching

2020 ◽  
Author(s):  
Leizhen Xia ◽  
Lifeng Tian ◽  
Jun Tan ◽  
Shanshan Zhang ◽  
Qiong-Fang Wu
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Polycystic Ovary ◽  
Economic Cost ◽  
Live Birth Rate ◽  
Ovary Syndrome ◽  
The Cost ◽  
Severe Ohss

Abstract Background: Women with polycystic ovary syndrome (PCOS) have been reported with low pregnancy rate and high OHSS risk in in vitro fertilization (IVF) programs due to the decreased endometrial receptivity and high ovarian reserve. The aim of the study was to compare the effectiveness, safety and economic cost of GnRH antagonist (GnRH-ant) and modified prolonged GnRH agonist (mGnRH-a) protocol in PCOS patients.Methods: This study was a retrospective cohort study that included 2164 women with (PCOS) undergoing assisted reproductive technology (ART) treatment from January 2014 to April 2019. Among them, 2018 women received mGnRH-a treatment and 146 women received GnRH antagonist (GnRH-ant) treatment. The two groups were matched by propensity scores with a ratio of 1:4 (GnRH-ant versus mGnRH-a) accounting for potential confounding factors. The primary outcomes were the live birth rate (LBR), incidence of moderate-to-severe OHSS and the cost of controlled ovarian hyperstimulation (COH). LBR was defined as live birth per started treatment cycle after first fresh or frozen embryo transfer.Results: Women with the mGnRH-a protocol had an increased endometrial thickness on HCG injection day, compared with GnRH-ant protocol (10.84 vs. 9.62, P<0.001), furthermore, the number of transferable embryos on day 3 (7 vs. 5, P=0.022), clinical pregnancy rate (67.81% vs. 52.74%, P=0.0007), implantation rate (56.05%, vs. 43.44%, P<0.001) and live birth rate (58.22% vs. 41.78%, P=0.0004) were also significantly higher in the mGnRH-a protocol group. However, there were no significant differences in the incidence of moderate-to-severe OHSS (4.28% vs. 2.05%, P=0.333), the incidence of severe OHSS (0.17% vs. 0%, P=1) and the cost of COH (RMB: 7736.9 vs. 8046.54, P=0.113). Conclusion: The mGnRH-a protocol has a higher live birth rate than GnRH-ant protocol with the similar safety and economic cost among infertile women with PCOS.

Data Do Not Support Effectiveness of Acupuncture for Improving Live Birth Rate in Women with Polycystic Ovary Syndrome

2018 ◽  
Vol 24 (5) ◽  
pp. 399-400
Author(s):  
Hong-ying Kuang ◽  
Yan Li ◽  
He-ping Zhang ◽  
Richard S. Legro ◽  
Elisabet Stener-Victorin
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Birth Rate ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
Ovary Syndrome

scholarly journals Association between baseline LH/FSH and live-birth rate after fresh-embryo transfer in polycystic ovary syndrome women

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nian-jun Su ◽  
Cui-yu Huang ◽  
Jie Liu ◽  
De-ying Kang ◽  
Song-lu Wang ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
In Vitro Fertilisation ◽  
Fresh Embryo Transfer ◽  
Ovary Syndrome

AbstractThis study aimed to retrospectively analyse the effect of the baseline luteinising hormone/follicle-stimulating hormone ratio (bLH/FSH) on the live-birth rate per fresh-embryo transfer cycle (LBR/ET) in infertile women with polycystic ovary syndrome (PCOS) who received a fresh-embryo transfer. A total of 424 patients with PCOS who underwent the first cycle of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) fresh-embryo transfer at our hospital was enrolled. Univariate and multivariate logistic regression analyses, along with curve fitting and a threshold effect analysis, were performed. Baseline LH/FSH levels were a significant (P < 0.05) independent risk factor affecting live birth. In the first IVF/ICSI antagonist treatment cycles, LBR/ET after fresh-embryo transfer was relatively flat, until bLH/FSH was 1.0; thereafter, it started to decrease by 17% for every 0.1-unit bLH/FSH increase. Considering the decline in LBR/ET, it is recommended that PCOS women with bLH/FSH > 1.0 carefully consider fresh-embryo transfer during their first IVF/ICSI.

scholarly journals The Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome

2020 ◽  
Vol 36 (7) ◽  
Author(s):  
Mehmet Nafi Sakar ◽  
Süleyman Cemil Oğlak
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Ovulation Induction ◽  
Birth Rate ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Ovary Syndrome ◽  
Live Birth Rates

Objective: This study was aimed to compare the clinical outcomes of ovulation induction (OI) by timed intercourse with letrozole (LTZ) and clomiphene citrate (CC). Methods: Three hundred and twenty-three patients with polycystic ovary syndrome (PCOS) who underwent OI with LTZ or CC between February 2017 and November 2018 were included in this retrospective study. The patients were divided into two groups as the CC group (n=148) and the LTZ group (n=175). Endometrial thickness, follicular development, ovulation, clinical pregnancy, abortion, and live birth rates of the groups were analyzed. Results: The mean endometrium thickness of the CC group was 7.1±1.7 mm, and the LTZ group was 8.6±1.8 mm (p<0.001). The ovulation rate per cycle was higher in the LTZ group (93.1%) in comparison with the CC group (83.8%) (p=0.013). Clinical pregnancy rates were 52% in the LTZ group, and 41.2% in the CC group (p=0.047). LTZ with 44% of live birth rate was superior to CC with a 33% live birth rate (p=0.029). Conclusions: LTZ is an effective OI agent in PCOS patients. LTZ is superior to CC in terms of pregnancy rates and live birth rates. As a result, we recommend that LTZ should be the first-line treatment agent in patients with PCOS. doi: https://doi.org/10.12669/pjms.36.7.3345 How to cite this:Sakar MN, Oglak SC. Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome. Pak J Med Sci. 2020;36(7):1460-1465. doi: https://doi.org/10.12669/pjms.36.7.3345 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS

2016 ◽  
Vol 101 (7) ◽  
pp. 2658-2666 ◽  
Author(s):  
Richard S. Legro ◽  
William C. Dodson ◽  
Allen R. Kunselman ◽  
Christy M. Stetter ◽  
Penny M. Kris-Etherton ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Risk Ratio ◽  
Birth Rate ◽  
Lifestyle Modification ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
Infertility Treatment ◽  
Obese Women ◽  
Ovary Syndrome

Context: In overweight/obese women with polycystic ovary syndrome (PCOS), the relative benefit of delaying infertility treatment to lose weight vs seeking immediate treatment is unknown. Objective: We compared the results of two, multicenter, concurrent clinical trials treating infertility in women with PCOS. Design, Setting, and Participants: This was a secondary analysis of two randomized trials conducted at academic health centers studying women 18–40 years of age who were overweight/obese and infertile with PCOS. Intervention: We compared immediate treatment with clomiphene from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial (N = 187) to delayed treatment with clomiphene after preconception treatment with continuous oral contraceptives, lifestyle modification (Lifestyle: including caloric restriction, antiobesity medication, behavioral modification, and exercise) or the combination of both (combined) from the Treatment of Hyperandrogenism Versus Insulin Resistance in Infertile Polycystic Ovary Syndrome (OWL PCOS) trial (N = 142). Main Outcome Measures: Live birth, pregnancy loss, and ovulation were measured. Results: In PPCOS II, after four cycles of clomiphene, the cumulative per-cycle ovulation rate was 44.7% (277/619) and the cumulative live birth rate was 10.2% (19/187), nearly identical to that after oral contraceptive pretreatment in the OWL PCOS trial (ovulation 45% [67/149] and live birth: 8.5% [4/47]). In comparison, deferred clomiphene treatment preceded by lifestyle and combined treatment in OWL PCOS offered a significantly better cumulative ovulation rate compared to immediate treatment with clomiphene. (Lifestyle: 62.0% [80/129]; risk ratio compared to PPCOS II = 1.4; 95% confidence interval [CI], 1.1–1.7; P = .003; combined: 64.3% [83/129]; risk ratio compared to PPCOS II = 1.4; 95% CI, 1.2–1.8; P &lt; .001 and a significantly better live birth rate lifestyle: 25.0% [12/48]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3–4.7; P = .01 and combined: 25.5% [12/47]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3–4.8; P = .01). Conclusions: These data show the benefit of improved ovulation and live birth with delayed infertility treatment with clomiphene citrate when preceded by lifestyle modification with weight loss compared with immediate treatment. Pretreatment with oral contraceptives likely has little effect on the ovulation and live birth rate compared with immediate treatment.

scholarly journals Ovulation Rate after Metformin and Clomiphene vs Clomiphene Alone in Polycystic Ovary Syndrome (PCOS): A Randomized, Double-Blind, Placebo-Controlled Trial

2020 ◽  
Vol 02 (01) ◽  
pp. 32-36 ◽  
Author(s):  
Georgia Heathcote ◽  
Clare Boothroyd ◽  
Kevin Forbes ◽  
Alan Lee ◽  
Margaret Gregor ◽  
...  
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Polycystic Ovary ◽  
Controlled Trial ◽  
Live Birth Rate ◽  
Ovulation Rate ◽  
Miscarriage Rate ◽  
Ovary Syndrome ◽  
Double Blind ◽  
Double Blind Placebo

Background: Polycystic ovary syndrome (PCOS) affects 5%-15% of women of reproductive age and has a negative impact on their fertility. The primary outcome of this study is ovulation rate when standard (immediate release) metformin (MF) is added to clomiphene citrate (CC) in oligoovulatory and anovulatory women with PCOS. Methods: This is a randomized, double-blind, placebo-controlled trial. Twenty-seven women with PCOS (according to the Rotterdam consensus), desiring pregnancy and without another cause of subfertility were recruited from a public hospital outpatient gynecology clinic. Up to six cycles of CC (25-150 mg) plus either MF 500 mg tds (CC+MF) or placebo (CC+Pl) were offered. Student’s t-test, Chi-squared test, and Fisher’s exact test were used for analysis. Results: Thirteen women with up to six cycles each were included in the final analysis. The rate of ovulation and ovulation rate per cycle was similar between women in the CC+MF and CC+Pl groups RR 1.09 (95% CI 0.80-1.49) and RR 0.88 (95% CI 0.63-1.22), respectively as was chemical pregnancy rate RR 1.77 (95% CI 0.58-5.38). The live birth rate was higher in CC+MF RR 6.83 (95% CI 0.83-56.27) and miscarriage rate was lower RR 0.21 (95% CI 0.002-1.07). The number needed to treat for live birth was 10. Conclusion: Use of standard MF, 500 mg tds, when given with CC results in an increase in live birth rate, and a decrease in miscarriage rate.

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