scholarly journals A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

2019 ◽  
Vol 7 (9) ◽  
pp. 95 ◽  
Author(s):  
Michael Costello ◽  
Rhonda Garad ◽  
Roger Hart ◽  
Hayden Homer ◽  
Louise Johnson ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Supporting Evidence ◽  
First Line ◽  
Ovary Syndrome ◽  
Ultrasound Monitoring

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.

Advances in Treatment Options for Polycystic Ovary Syndrome

2012 ◽  
Vol 08 (01) ◽  
pp. 57 ◽  
Author(s):  
Sanam Lathief ◽  
Lubna Pal ◽  
◽  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Assisted Reproductive Technologies ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Comparable Efficacy ◽  
Hormonal Contraceptives ◽  
Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy seen in women of reproductive age. Clinical concerns relating to PCOS range from ovulatory infertility and menstrual disorders to risk of diabetes and cardiovascular disease. Hormonal contraceptives have been the mainstay of the management of common PCOS symptoms, such as menstrual irregularity and clinical stigmata of androgen excess (i.e., hirsutism and acne). An appreciation of the relevance of metabolic pathways in the pathophysiology of PCOS is relatively recent, and has translated into an expansion of the therapeutic strategies available for the management of PCOS. Insulin sensitizers were one of the first metabolic modulators to be incorporated in the clinical management paradigm, albeit with mixed results. Recognizing that insulin resistance is central to the pathophysiology of PCOS, newer agents—e.g., thiazolidinediones— followed, with almost comparable efficacy to metformin. Statins and most recently incretins constitute novel therapies with distinct metabolic targets that seem to hold promise in the management of PCOS. In tandem with the expansion in pharmaceuticals, a host of complementary and alternative medical therapies have generated interest for purported promise in the management of PCOS, including vitamin D, acarbose, and myo-inositol. The therapeutic options for managing PCOS-related infertility have also expanded. Clomiphene citrate (CC) has long been the first-line strategy for ovulation induction in the setting of anovulatory infertility; however, aromatase inhibitors are fast gaining acceptance as an ovulation induction strategy, with results comparable or even better than those seen with CC. An increasing level of therapeutic sophistication is reflected in ovarian stimulation protocols judiciously using gonadotropins, gonadotropin-releasing hormone antagonists, the procedure of ovarian drilling, and assisted reproductive technologies within vitrooocyte maturation.

scholarly journals Evidence-Based Lifestyle and Pharmacological Management of Infertility in Women with Polycystic Ovary Syndrome

2012 ◽  
Vol 8 (3) ◽  
pp. 277-290 ◽  
Author(s):  
Michael F Costello ◽  
William L Ledger
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Pharmacological Therapy ◽  
Reproductive Age ◽  
First Line ◽  
Ovary Syndrome ◽  
Pharmacological Management ◽  
Medical Treatments ◽  
Laparoscopic Ovarian Drilling

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age and by far the most common cause of anovulatory infertility. Lifestyle change alone, and not in combination with pharmacological ovulation induction such as clomifene citrate or metformin, is generally considered the first-line treatment for the management of infertile anovulatory women with PCOS who are overweight or obese. Clomifene citrate should be considered as a first-line pharmacological therapy to improve fertility outcomes. Second-line medical treatments may include ovulation induction with gonadotropins (in clomifene citrate-resistant or clomifene citrate failure women) or laparoscopic ovarian drilling (in clomifene citrate-resistant women) or possibly with metformin combined with clomifene citrate (in clomifene citrate-resistant women). There is currently insufficient evidence to recommend aromatase inhibitors over that of clomifene citrate in infertile anovulatory women with PCOS in general or specifically in therapy-naive or clomifene citrate-resistant women with PCOS.

scholarly journals Comparative study of clomiphene citrate versus letrozole as first-line ovulation induction drug in infertile polycystic ovary syndrome women

2020 ◽  
Vol 9 (7) ◽  
pp. 2948
Author(s):  
Mahija Sahu ◽  
Nihar Ranjan Rout
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Ovulation Rate ◽  
First Line ◽  
Ovary Syndrome ◽  
Standard Drug

Background: Polycystic ovary syndrome is the commonest endocrinopathy resulting in anovulatory infertile young women. Clomifene citrate (clomiphene) is a long-standing standard drug for ovulation induction, and is still considered as first line option in PCOS women. However, clomiphene has certain disadvantage letrozole an aromatase inhibitor acts by reducing estrogen production and has no adverse effects on endometrium and cervical mucous. Indian PCOS women have high prevalence of insulin resistance and thus are likely to have high clomiphene resistance. So letrozole could prove to be a good alternative for ovulation induction in such women.Methods: This was a prospective randomized, parallel, comparative clinical trial of two ovulation induction drugs letrozole 5 mg versus clomiphene citrate 100 mg as first-line ovulation induction drug in infertile polycystic ovarian syndrome women. The target population of the study was one hundred infertile women with PCO (taking at least 2 Rotterdam’s parameters). 50 women were allocated to clomifene citrate and 50 were allocated to Letrozole for ovulation induction. Parameters like age, duration of infertility, B MI, ovulation rate, number of follicles, pregnancy rate, endometrial thickness were noted and analyzed.Results: In letrozole group, the ovulation rate, mono-follicular development, mean endometrial thickness and pregnancy rate was better in comparison to clomifene citrate group.Conclusions: The result of this study suggests that letrozole may replace clomiphene as the first line drug for ovulation induction in infertile PCOS women.

scholarly journals LUARAN PEMBERIAN KLOMIFEN SITRAT BERUPA ANGKA KEBERHASILAN KEHAMILAN PADA WANITA SINDROM OVARIUM POLIKISTIK

e-CliniC ◽  
2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Irwan Syah ◽  
Maria Loho ◽  
Freddt Wagey
Keyword(s):  
Polycystic Ovary Syndrome ◽  
General Hospital ◽  
Medical Therapy ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Reproductive Age ◽  
Ovary Syndrome ◽  
Descriptive Data ◽  
First Choice

Abstract: Polycystic ovary syndrome is the most common endocrinopathy in woman of reproductive age with an incidence that causes infertility. Woman who want to have children recomended to use ovulation induction is clomiphene citrate. Expected with the use of clomiphene citrate as first choice therapy has significcant numbers so that the use of drugs is always preffered. Purpose of this research to determine the number of pregnancies in patient with polycystic ovary syndrome with clomiphene citrate. Method used a retrospective descriptive, data of patient who treatment polycystic ovary syndrome in Prof. Dr. R. D. Kandou General Hospital Manado and practice clinical doctor conducted in the form medical therapy with clomiphene citrate. Polycystic ovary syndorme found 35 cases in the year 2012-2014 with 2 cases in Prof. Dr. R. D. Kandou General Hospital Manado and 33 cases in practice clinical doctor. Conceive with clomiphene citrate therapy were 9 people. Available data show clomiphene citrate still as the first choice drug for ovulation induction of polycystic ovary syndrome.Keywords: polycystic ovary syndrome, clomiphene citrate, succsesful, pregnancyAbstrak: Sindrom ovarium polikistik merupakan salah satu endokrinopati paling umum pada wanita usia reproduksi dengan angka kejadian yang menyebabkan infertilitas. Wanita yang ingin mempunyai anak direkomendasikan untuk induksi ovulasi adalah klomifen sitrat. Diharapkan dengan pemberian klomifen sitrat sebagai terapi pilihan pertama mempunyai angka bermakna sehingga penggunaan obat selalu diutamakan. Tujuan Penilitian ini untuk mengetahui jumlah kehamilan pada penderita sindrom ovarium polikistik dengan terapi klomifen sitrat. Metode yang digunakan bersifat retrosepktif deskriptif, data penderita sindrom ovarium polikistik yang berobat di RSUP Prof. Dr. R. D. Kandou Manado dan dokter praktek klinik yang dilakukan terapi berupa klomifen sitrat. Ditemukan 35 kasus sindrom ovarium polikistik dari tahun 2012-2014 dengan 2 kasus terdapat di RSUP Prof Dr. R. D. Kandou dan 33 kasus di dokter praktek klinik. Berhasil hamil dengan terapi klomifen sitrat sebanyak 9 orang. Data yang ada menunjukan klomifen sitrat masih sebagai pilihan pertama obat induksi ovulasi bagi penderita sindrom ovarium polikistik.Kata kunci: sindrom ovarium polikistik, klomifen sitrat, keberhasilan, kehamilan

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