Treatment of Infertility in Women with Polycystic Ovary Syndrome in a Single Center Study

Background: Anovulatory infertility is caused by polycystic ovarian syndrome in 80 percent of patients. Preconception guidelines, such as lifestyle modification (weight loss) to avoid fetal neural tube abnormalities, and quitting smoking and drinking alcohol, are all part of the early treatment. A clomiphene citrate medication for timed intercourse is the first-line pharmacological treatment for producing ovulation. Exogenous gonadotropins or laparoscopic ovarian surgery are two options for second-line pharmaceutical treatment (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective, with a 70 % cumulative live birth rate. When laparoscopy is necessary, ovarian drilling should be done; this operation is usually successful in around half of the instances. Finally, when the previous interventions have failed, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is recommended. There is no evidence that metformin should be used routinely in the treatment of infertility in anovulatory women with polycystic ovary syndrome. Aromatase inhibitors show promise, but more research is needed to confirm their safety.Methods:This study was conducted in Department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, from January 2019 to December 2019. A total number of 100 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 24.0.Conclusion:PCOS is a frequent syndrome and the most frequent cause of infertility. PCOS is defined as a syndrome with at least two of three of the Rotterdam criteria. A complete evaluation of the infertility is needed to exclude other causes of infertility..

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Faculty Opinions recommendation of An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate-metformin in patients with polycystic ovary syndrome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4423956.4263054 ◽

2010 ◽

Author(s):

Robert Rebar ◽

Katherine McKnight

Keyword(s):

Polycystic Ovary Syndrome ◽

Medical Treatment ◽

Lifestyle Modification ◽

Polycystic Ovary ◽

Clomiphene Citrate ◽

Ovary Syndrome

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Randomized controlled trial comparing letrozole with laparoscopic ovarian drilling in women with clomiphene citrate-resistant polycystic ovary syndrome

Experimental and Therapeutic Medicine ◽

10.3892/etm.2015.2690 ◽

2015 ◽

Vol 10 (4) ◽

pp. 1297-1302 ◽

Cited By ~ 10

Author(s):

WEI LIU ◽

SHENGNAN DONG ◽

YUMEI LI ◽

LIHONG SHI ◽

WEI ZHOU ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Controlled Trial ◽

Clomiphene Citrate ◽

Ovary Syndrome ◽

Randomized Controlled ◽

Laparoscopic Ovarian Drilling ◽

Ovarian Drilling

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Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?

Fertility and Sterility ◽

10.1016/j.fertnstert.2009.06.024 ◽

2009 ◽

Vol 92 (6) ◽

pp. 2039-2040 ◽

Cited By ~ 8

Author(s):

Murat Api

Keyword(s):

Polycystic Ovary Syndrome ◽

Laser Treatment ◽

Polycystic Ovary ◽

Transvaginal Ultrasound ◽

Clomiphene Citrate ◽

Ultrasound Guided ◽

Ovary Syndrome ◽

Laparoscopic Ovarian Drilling ◽

Ovarian Drilling ◽

Interstitial Laser

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Evaluation of Anti-Mullerian Hormone Predictive Value and Antral Follicle Count in the Success Rate of Ovarian Drilling in Polycystic Ovary Syndrome

Shiraz E-Medical Journal ◽

10.5812/semj.92162 ◽

2020 ◽

Vol 21 (6) ◽

Author(s):

Leili Hafizi ◽

Akram Behrouznia ◽

Maliheh Amirian ◽

Mina Baradaran ◽

Seyedeh Azam Pourhoseini

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Clomiphene Citrate ◽

Antral Follicle ◽

Serum Levels ◽

Antral Follicle Count ◽

Ovary Syndrome ◽

Antral Follicles ◽

Laparoscopic Ovarian Drilling ◽

Ovarian Drilling

Background: Laparoscopic ovarian drilling (LOD) is recommended for the treatment of women with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate. Objectives: This study aimed to evaluate the effect of ovarian drilling on the serum levels of anti-mullerian hormone (AMH), androgens, and the number of antral follicles. Methods: This was a pre- and post-clinical trial performed on 30 infertile women with PCOS resistant to clomiphene citrate. Patients underwent standard laparoscopic ovarian drilling. Serum levels of AMH and androgens and antral follicle count (AFC) were surveyed before LOD and three and six months after LOD. The ovarian ovulation rate in each month was also monitored for six months. Then, the association between changes in these parameters, especially the level of AMH, and postoperative ovulation was investigated. A P < 0.05 was considered statistically significant. Results: The number of antral follicles three (3.00 ± 8.00) and six months (7.73 ± 4.14) after ovarian drilling showed a significant decrease compared to preoperative values (12.40 ± 4.02) (repeated-measures ANOVA, P < 0.001). The mean AMH (6.78 ± 1.08 versus 12.25 ± 1.35; P = 0.005) and the antral follicle count (7.71 ± 0.54 versus 12.29 ± 0.67 and P < 0.001) were lower in ovulation than in non-ovulation patients. The significantly more AMH reductions were seen in pregnant women (3.63 ± 5.61) than in non-pregnant women (3.63 ± 1.24) (P = 0.01). Conclusions: It may be possible to use the changes in AMH and AFC to predict the success rate of LOD.

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The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8081210 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1210 ◽

Cited By ~ 7

Author(s):

Marlene Hager ◽

René Wenzl ◽

Sonja Riesenhuber ◽

Julian Marschalek ◽

Lorenz Kuessel ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Meta Analysis ◽

Clomiphene Citrate ◽

Ovary Syndrome ◽

Mild Disease ◽

Laparoscopic Ovarian Drilling ◽

Vitamin D Levels ◽

Ovarian Drilling ◽

25 Hydroxy Vitamin D

To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did not present with any endometriosis symptoms and underwent laparoscopic ovarian drilling (LOD) for clomiphene citrate (CC) resistance, 225 and 630 women with CC-resistant PCOS without classic endometriosis symptoms were included in a retrospective study and a meta-analysis, respectively. All women underwent LOD. The main outcome parameter was the prevalence of incidental endometriosis. Laparoscopy revealed endometriosis in 38/225 (16.9%) women (revised American Fertility Society (rAFS) stage I: 33/38, 86.8%; rAFS stage II: 5/38, 13.2%). When women with CC-resistant PCOS without endometriosis were compared, lower body mass index (BMI) and lower 25-hydroxy-vitamin D levels were associated with the presence of endometriosis at laparoscopy (odds ratios (OR): 0.872, 95% confidence intervals (95%CI): 0.792–0.960; p = 0.005 and OR: 0.980, 95%CI: 0.962–0.999; p = 0.036; respectively). The inclusion criteria for the meta-analysis were fulfilled by 4/230 reports about LOD. After correction for study heterogeneity, the pooled prevalence of incidental endometriosis was 7.7% in women with CC-resistant PCOS. In conclusion, the rate of incidental endometriosis in women with CC-resistant PCOS might reflect the prevalence of asymptomatic endometriosis. All cases were affected by minimal or mild disease. Since the literature lacks reports on associated clinical outcomes, the relevance of this entity in such patients should be the subject of further studies.

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