Atualizações na terapêutica farmacológica para infertilidade na mulher diagnosticada com síndrome de ovários policísticos: revisão de literatura / Updates on pharmacological treatments for infertility in women diagnosed with polycystic ovary syndrome: a literature review

Objetivo: Abordar atualizações referentes à terapia medicamentosa para indução da ovulação nas mulheres diagnosticadas com síndrome dos ovários policísticos (SOP). Métodos: Revisão de literatura por meio de levantamento bibliográfico do período de 1975 a 2021, nas bases eletrônicas PubMed, SciELO e MedLine, complementado pela Diretriz Internacional Baseada em Evidências para a Avaliação e Manejo da SOP de 2018 e pelo manual da Febrasgo para SOP. Sete descritores que atendessem à finalidade da pesquisa foram utilizados. Resultados: A literatura aponta atualmente algumas drogas como opção na terapêutica para a indução de ovulação, como metformina, letrozol e citrato de clomifeno, evidenciando que o uso de letrozol isolado e em associação com a metformina apresentaram melhores taxas de ovulação, 71,5% e 75,4%, respectivamente. Conclusão: O uso do letrozol isolado ou combinado com a metformina apresentou os melhores resultados nas taxas de gravidez e ovulação, todavia o tratamento para indução ovulatória deve ser individualizado.(AU)

Objective: To address updates of medicinal therapy for ovulation induction in women diagnosed with polycystic ovary syndrome (PCOS). Methods: Reviewing Literature through a bibliographic survey from 1975 to 2021, on the electronic databases PubMed, SciELO and MedLine, complemented by the International Evidence-Based Guideline for the Evaluation and Management of PCOS 2018 and the Febrasgo guide for PCOS. Seven descriptors that matched to the purpose of the research were applied. Results: Some drugs are currently indicated in the literature as an option for ovulation induction therapy, such as: metformin, letrozole and clomiphene citrate, showing that the use of letrozole alone and in association with metformin had better ovulation rates, 71.5% and 75.4%, respectively. Conclusion: The use of letrozole alone or combined with metformin showed the best results in pregnancy and ovulation rates, however, treatment for ovulatory induction must be individualized.(AU)

Clinical efficacy of Bushen Huoxue Culuan Formula in treatment of infertility caused by diminished ovarian reserve due to kidney deficiency and blood stasis / 中国中药杂志

To study the clinical efficacy and safety of Bushen Huoxue Culuan Formula in treating infertility caused by diminished ovarian reserve(DOR) with kidney deficiency and blood stasis. A total of 100 DOR patients treated at Xiyuan Hospital, Acupuncture Hospital and Clinic of China Academy of Chinese Medical Sciences from 2017 to 2020 in line with the inclusion criteria were selected and randomly divided into experimental group and control group at the ratio of 1∶1. The experimental group was treated with Bushen Huoxue Culuan Formular, while the control group was treated with Climen and Clomiphene for 3 menstrual cycles. The ovulation rate, pregnancy rate, pregnancy success rate, serum hormone levels, and traditional Chinese medicine(TCM) symptom scores were observed in the 2 groups. The total effective rate was 92.00% in the experimental group and 72.00% in the control group, with a statistical difference between the two groups(P<0.01); the experimental group was superior to the control group in reducing FSH level, increasing AMH level, improving TCM symptoms, increasing pregnancy rate and pregnancy success rate, with a significant difference(P<0.05). There was no abnormal safety indicator and adverse reaction. Bushen Huoxue Culuan Formular is effective in treating infertility caused by DOR due to kidney deficiency and blood stasis, with a safety and reliability.

Effect of therapies for kidney-tonifying and blood-activating in treatment of anovulatory infertility in eugenics / 中国中药杂志

In the context of the new era, paying attention to maternal and child health and advocating prenatal and postnatal care can effectively improve the quality of the birth population. Traditional Chinese medicine has a long history of prenatal and postnatal healthcare with rich content, which is the theoretical basis of modern related services. With the social development and the improvement of people's awareness of prenatal and postnatal healthcare, people have gradually shifted the focus of prenatal and postnatal healthcare to the peri-pregnancy stage at present, namely that couples of childbearing age are guided to prepare for pregnancy under the premise of solving their basic diseases. Infertility is a common and refractory disease for women of childbearing age. Ovulation disorder is one of its common pathological mechanisms. Traditional Chinese medicine believes that kidney deficiency is the main cause and pa-thogenesis of anovulation infertility and blood stasis is an important factor throughout the disease course. In clinical practice, therapies for invigorating kidney and activating blood are safe and reliable to treat anovulatory infertility mainly by adjusting the hypothalamus-pituitary-ovarian axis, improving ovarian function, uterine environment and gamete quality and increasing endometrial volume. Under the guidance of the thought of prenatal and postnatal healthcare, the authors tried to explore the effect of therapies for kidney-tonifying and blood-activating in the treatment of anovulatory infertility in eugenics, with the purpose of providing ideas and basis for subsequent relevant clinical studies and contributing to prenatal and postnatal healthcare services.

Síndrome dos ovários policísticos: particularidades no manejo da infertilidade / Polycystic ovary syndrome: particularities in the management of infertility

A síndrome dos ovários policísticos (SOP) é responsável por cerca de 80% dos casos de infertilidade anovulatória. Não há na literatura evidências suficientes para a definição do tratamento ideal da infertilidade na SOP, mas repete-se que deve ser iniciado por mudanças no estilo de vida, e frequentemente envolve a indução farmacológica da ovulação e, em casos selecionados, as técnicas de reprodução assistida e o drilling ovariano laparoscópico. Este texto pretende reunir informações atuais sobre o manejo da infertilidade em mulheres com SOP e, dessa forma, permitir ao ginecologista a escolha da melhor abordagem, de forma Individualizada e baseada nas melhores evidências disponíveis.(AU)

Metformina e citrato de clomifeno no tratamento de fertilidade na síndrome dos ovários policísticos / Metformin and clomiphene citrate in polycystic ovary syndrome's treatment

A síndrome dos ovários policísticos (SOP) é uma complexa desordem endócrina caracterizada por distúrbios reprodutivos e metabólicos, sendo a causa mais comum de infertilidade ovariana. A prevalência é entre 5 e 10% em mulheres na idade reprodutiva. Sua etiologia permanece obscura e a variabilidade de expressão fenotípica continua a desafiar os cuidados clínicos e pesquisas sobre a heterogeneidade desta condição. Embora mudanças no estilo de vida bem como o uso de citrato de clomifeno (CC) serem o padrão para o tratamento da infertilidade nestas pacientes, o uso da metformina tem se destacado como tratamento para esse fim ante sua eficácia. Partindo deste princípio, esta revisão tem por objetivo avaliar a eficácia da metformina em melhorar as taxas de ovulação e de gravidez clínica, seja como tratamento isolado ou combinado ao CC.(AU)

The polycystic ovary syndrome (PCOS) is a complex endocrine disease characterized by reproductive and metabolic disorders. It is the most common cause of ovarian infertility and has a prevalence of 5-10% in reproductive age women. Its etiology remains unclear, and the variability of phenotypic expression continues to yield clinical care and research on the heterogeneity of this challenging condition. Although life style changes as well as the use of clomiphene citrate (CC) is a standard treatment of infertility in these patients; metformin use has been highlighted in recent years as a treatment for this purpose due its effectiveness in treating PCOS. Based on this principle, this review aims to assess the metformin effectiveness in improving ovulation rates and clinical pregnancy, either alone or in combination as the CC treatment.(AU)

Clomiphene citrate treatment cycle outcomes of polycystic ovary syndrome patients based on basal high sensitive C-reactive protein levels: a cross-sectional study

Background: Polycystic ovary syndrome [PCOS] is highly associated with an ovulatory infertility, features of the metabolic syndrome, including obesity, insulin resistance and dyslipidemia. Serum concentrations of high sensitive C-reactive protein [hs-CRP] were significantly higher in obese than in non-obese PCOS patients at baseline, suggesting a relationship between elevated hs-CRP levels and obesity. The aim of this study was to evaluate whether cycle day 3 hs-CRP levels before clomiphene citrate [CC] treatment would predict cycle outcomes in women with PCOS

Materials and Methods: This cross-sectional study was conducted among 84 infertile women with PCOS who were treated with CC at Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey, between January 2014 and January 2015. Based on the exclusion criteria, cycle outcomes of remaining 66 infertile women with PCOS treated with CC were analyzed. The hs-CRP levels and insulin resistance indexes were evaluated on day 3 of the CC treatment cycle. The primary outcome measures were number of preovulatory follicles measuring>/=17 mm and pregnancy rates

Results: The mean +/- SD age of the patients was 24.0 +/- 3.8 years [range 18-36]. The mean +/- SD body mass index [BMI] of the patients was 25.7 +/- 4.9 [range 17-43]. Fifty patients developed dominant follicle [75%] and 5 patients established clinical pregnancy during the study [clinical pregnancy rate: 7%]. The mean +/- SD baseline hs-CRP, fasting insulin and Homeostasis Model Assessment-Insulin Resistance [HOMA-IR] values of the patients with and without dominant follicle generation during treatment cycle were 6.42 +/- 7.05 and 4.41 +/- 2.95 [P=0.27], 11.61 +/- 6.94 and 10.95 +/- 5.65 [P=0.73], 2.68 +/- 1.79 and 2.41 +/- 1.30 [P=0.58], respectively. The mean +/- SD baseline hs-CRP, fasting insulin and HOMA-IR values of the patients with and without clinical pregnancy establishment following treatment cycle were 6.30 +/- 2.56 and 5.90 +/- 6.57 [P=0.89], 11.60 +/- 7.54 and 11.44 +/- 6.61 [P=0.95], 2.42 +/- 1.51 and 2.63 +/- 1.70 [P=0.79], respectively

Conclusion: In this study, we did not observe a predictive value of cycle day 3 hs-CRP levels on preovulatory follicle development and pregnancy rates among infertile PCOS patients treated with CC. Also, no relationship between HOMA-IR values and dominant follicle generation or clinical pregnancy establishment was demonstrated in our study, confirming the previous studies emphasizing the neutral effect of metformin utilization before and/or during ovulation induction to pregnancy rates

Significados de la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida / Meanings of lived experience of pregnancy and labor of a woman with infertility diagnosis who did conceive through assisted reproduction techniques

OBJETIVO: Develar la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida. MÉTODO: Se trata de un estudio de caso con diseño fenomenológico. Se seleccionó una mujer portadora del fenómeno en estudio que accedió a compartir su experiencia mediante una entrevista en profundidad. La pregunta que guió el estudio fue ¿Cómo se muestra la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida? El análisis fue realizado de acuerdo a Streubert(1). Los pasos a seguir fueron: obtener la descripción de la participante, separar los supuestos del investigador ("bracketing"), leer la transcripción hecha "verbatim", revelar esencias, comprender las unidades de significado, desarrollar las descripciones, devolver a la participante para su validación, revisar literatura relevante, y compartir los resultados con la comunidad de enfermería. RESULTADOS: Destacan unidades de significado sobre sufrimiento por el tratamiento y las múltiples pérdidas que enfrenta la entrevistada. Se contraponen felicidad y angustia durante el embarazo, y esperanza al lograr el objetivo de vida planteado con su pareja. Surge el fortalecimiento del vínculo con su esposo, y finalmente miedo ante el verse enfrentada a la maternidad. Como conclusión se permite comprender que las mujeres enfrentadas a TRA tienen necesidades de cuidado únicas, por lo que el rol de enfermería es fundamental, sobre todo de acompañamiento. Se debe seguir estudiando este fenómeno en mujeres chilenas, e involucrar la perspectiva del padre.

OBJECTIVE: Reveal the lived experience of pregnancy and delivery of a woman diagnosed with infertility who did conceive through assisted reproduction techniques. METHOD: This is a case study with a qualitative health research design of phenomenology. The participant was a woman who is carrier of the phenomenon understudy and that agreedto share her experience through an in-depth interview. The study base question was ¿How the pregnancy and delivery process lived experience of a woman with infertility diagnosis who did conceive through assisted reproduction techniques is shown?. According to Streubert(1),the phenomenological analysis process steps are: to obtain the participant's description, to separate the assumptions of the researcher ("bracketing"), to read the transcript made "verbatim". Reveal essences, understand the units of meaning, develop the descriptions, return the participant for validation, review relevant literature, and share the results with the nursing community. RESULTS: There are significant units of meaning of suffering due to the treatment and the multiple losses that the interviewee faces. There is also the contrast between happiness and anguish in the course of pregnancy, and hope for having achieved the goal of life raised with her partner. The strengthening of the bond with her husband arises, and finally fears of being confronted with motherhood. As a conclusion, it is possible to understand that women facing ART have unique care needs, so the role of nursing is fundamental, especially accompaniment. This phenomenon should continue to be studied in Chilean women, and involve the perspective of the father.

Minimal Stimulation Using Gonadotropin Combined with Clomiphene Citrate or Letrozole for Intrauterine Insemination

PURPOSE: To evaluate the efficacy of minimal stimulation using discretely administered gonadotropin combined with clomiphene citrate (CC) or letrozole (LTZ) for intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: Total 257 IUI cycles from 158 infertile couples were assessed. A CC dose of 100 mg/day (n=126 cycles) or a LTZ dose of 5 mg/day (n=131 cycles) was administered on days 3-5 of the menstrual cycle for 5 days. Each group received human menopausal gonadotropin at a dose of 150 IU by two or three alternative day: CC combined with alternate-day regimen for 2 or 3 days (CC+300, n=37; CC+450, n=89) and LTZ combined with alternate-day regimen for 2 or 3 days (LTZ+300, n=36; LTZ+450, n=95). RESULTS: The clinical pregnancy rate was comparable between the CC and LTZ groups (18.3% vs. 13.0%, p=0.243). The clinical pregnancy rate also showed no significant difference among the 4 groups (21.6% vs. 16.9% vs. 11.1% vs. 12.6%, p=0.507). The multiple pregnancy rate was significantly higher in LTZ compared to CC group (37.5% vs. 8.7%, p=0.028) and in the LTZ+450 compared to CC+450 group (50% vs. 13.3%, p=0.038). Overall, there were 15 cases of ovarian hyperstimulation syndrome (OHSS), with the prevalence being significantly lower in the LTZ compared to CC group (1.5% vs. 10.3%, p=0.003). OHSS was more prevalent in the CC+450 compared to the LTZ+450 group (12.4% vs. 1.1%, p=0.002). CONCLUSION: Our findings suggest that minimal stimulation using two alternate-day gonadotropin with LTZ decreases the development of OHSS and multiple pregnancies, while maintaining comparable pregnancy rates in IUI cycles.

Minimal Stimulation Using Gonadotropin Combined with Clomiphene Citrate or Letrozole for Intrauterine Insemination

PURPOSE: To evaluate the efficacy of minimal stimulation using discretely administered gonadotropin combined with clomiphene citrate (CC) or letrozole (LTZ) for intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: Total 257 IUI cycles from 158 infertile couples were assessed. A CC dose of 100 mg/day (n=126 cycles) or a LTZ dose of 5 mg/day (n=131 cycles) was administered on days 3-5 of the menstrual cycle for 5 days. Each group received human menopausal gonadotropin at a dose of 150 IU by two or three alternative day: CC combined with alternate-day regimen for 2 or 3 days (CC+300, n=37; CC+450, n=89) and LTZ combined with alternate-day regimen for 2 or 3 days (LTZ+300, n=36; LTZ+450, n=95). RESULTS: The clinical pregnancy rate was comparable between the CC and LTZ groups (18.3% vs. 13.0%, p=0.243). The clinical pregnancy rate also showed no significant difference among the 4 groups (21.6% vs. 16.9% vs. 11.1% vs. 12.6%, p=0.507). The multiple pregnancy rate was significantly higher in LTZ compared to CC group (37.5% vs. 8.7%, p=0.028) and in the LTZ+450 compared to CC+450 group (50% vs. 13.3%, p=0.038). Overall, there were 15 cases of ovarian hyperstimulation syndrome (OHSS), with the prevalence being significantly lower in the LTZ compared to CC group (1.5% vs. 10.3%, p=0.003). OHSS was more prevalent in the CC+450 compared to the LTZ+450 group (12.4% vs. 1.1%, p=0.002). CONCLUSION: Our findings suggest that minimal stimulation using two alternate-day gonadotropin with LTZ decreases the development of OHSS and multiple pregnancies, while maintaining comparable pregnancy rates in IUI cycles.

Os efeitos do desidroepiandrosterona na resposta ovariana de más respondedoras submetidas à reprodução humana assistida / Effects of dehydroepiandrosterone on ovarian response of poor responders undergoing assisted human reproduction

Os androgênios, por agirem de forma positiva no desenvolvimento folicular, estão sendo atualmente utilizados na reprodução humana assistida como uma alternativa para melhorar a resposta ovariana de mulheres consideradas más respondedoras. Esta revisão sistemática avalia o efeito do desidroepiandrosterona (DHEA) na resposta à estimulação ovariana de mulheres más respondedoras submetidas às técnicas de reprodução assistida. Os artigos para este estudo foram pesquisados no PubMed e publicados entre 1999 e 2013. Vinte e sete artigos foram avaliados e 18 deles foram selecionados, incluindo estudos experimentais e observacionais. O DHEA foi associado a um maior número de folículos recrutados, de oócitos selecionados e melhor qualidade embrionária, à diminuição do risco de aneuploidias e à maior taxa de gravidez clínica e nascidos vivos. Apesar de o DHEA apresentar efeito positivo na resposta ovariana de mulheres más respondedoras, os resultados obtidos foram pouco consistentes. Mais estudos controlados e randomizados devem ser realizados antes de se implantar o DHEA de rotina no tratamento de más respondedoras submetidas à reprodução humana assistida.(AU)

Androgens are currently being used in assisted human reproduction as an alternative to improve ovarian response of women considered poor responder by acting positively in follicular development. This systematic review evaluates the effects of dehydroepiandrosterone (DHEA) in response to ovarian stimulation of poor responder women undergoing assisted reproductive techniques. All articles for this study were searched in PubMed and published between 1999 and 2013. Twenty seven articles were evaluated and 18 of them were selected, including experimental and observational studies. DHEA was associated with a greater number of follicles, oocyte selected and better embryo quality, the decreased risk of aneuploidy and higher rates of clinical pregnancy and live birth. Although DHEA has positive effect on the ovarian response of poor responder women, the results were inconsistent. More randomized controlled trials should be conducted before using DHEA in routine treatment of poor responders undergoing assisted reproduction.(AU)

Pregnancies following the use of sequential treatment of metformin and incremental doses of letrozole in clomiphen-resistant women with polycystic ovary syndrome

Clomiphen citrate [CC] is the first line therapy for women with infertility and poly cystic ovary syndrome [PCOS]. However, 20-25% of women are resistant to CC and do not ovulate. The objective of this study was to evaluate the efficacy of sequential treatment of metformin and incremental doses of letrozole in induction of ovulation in cases of CC-resistant PCOS patients. In this prospective before-after study, we enrolled 106 anovulatory PCOS women who failed to ovulate with CC alone from Amir-Almomenin University Hospital in Semnan, Iran. After an initial 6-8 weeks of metformin treatment, they received 2.5 mg letrozole daily on days 3-7 after menes. If they did not ovulate with 2.5 mg letrozole, the doses were increased to 5 to 7.5 mg daily in subsequent cycles. The main outcomes were ovulatory rate, pregnancy rate and cumulative pregnancy rate. 13.33% of patients conceived with metformin alone. Ovulation occurred in 83 out of remaining 91 patients [91.2%]. 78.02% of patients responded to lower doses of letrozole. Cumulative pregnancy rate was 60/105 [57.14%]. We suggest that treatment in CC-resistant PCOS patients should begin at first with lower doses of letrozole and could increase to the higher dose depending on the patient response before considering more aggressive therapeutic alternatives such as gonadotropins

[Comparing two ovulation induction methods by brachial artery ultrasonography in infertile women with polycystic ovary syndrome]

Endothelial dysfunction can influence fertility rate in women with polycystic ovary syndrome [PCOS] as flow mediated dilatation [FMD] is impaired in patients with the disease. The aim of this study was to compare two methods of ovulation induction by letrozole or letrozole plus human menopausal gonadotropins [HMGs] in infertile women with PCOS who were resistant to clomiphene citrate based on brachial artery ultrasound findings. In this double -blind randomized clinical trial, 59 infertile women who had the inclusion criteria for PCOS were evaluated in the Infertility Clinic of Shariati Hospital in Tehran, Iran in 2010-2011. The patients were assigned to two letrozole and letrozole plus HMG groups and were evaluated for FMD in the brachial artery by transvaginal ultrasonography. Later, the values were recorded and analyzed statistically. In the letrozole group, infertility treatment was successful in 15 [57.7%] but it failed in 11 [42.3%] patients. In letrozole plus HMG group, the treatment was successful in 18 [54.5%] while it failed in 15 [45.5%] patients. The mean FMD values in the groups with successful and unsuccessful treatment results were 19.42 +/- 10% and 18.57 +/- 7.2%, respectively, but the difference was not statistically significant [P=0.712]. Moreover, the average endometrial thickness in groups with successful and unsuccessful treatment results were 8.4 +/- 1.3 mm and 9.8 +/- 3.9 mm, respectively but the difference was not significant either [P=0.06]. In infertile women with polycystic ovary syndrome that are resistant to clomiphene, letrozole or letrozole combined with gonadotropin can be equally effective for ovulation induction

Efficacy of combined clomiphene citrate and gonadotrophin therapy

To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Observational analytical study. June 2009 to June 2010. In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin [CC - hMG] regime and maximum of three treatment cycle were given. Out of 100 patients in our study, 74% [2/3 rd] patients were less than 30 years of age and 26% [1/3rd] were between 30 - 40 yrs of age. Primary infertility was seen also in 2/3rd of patients [73%] and secondary infertility in remaining 1/3rd [27%] of patients. Polycystic ovary [PCO] was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown [unexplained infertility]. on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day [12.41 day] of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8% of patients refused further treatment and 4% did not report back. Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients

A comparison of bromocriptine & cabergoline on fertility outcome of hyperprolactinemic infertile women undergoing intrauterine insemination.

Background & objectives: The aim of this study was to compare the effects of bromocriptine versus cabergoline on pregnancy in hyperprolactinaemic infertile women. Methods: A total of 183 infertile women with hyperprolactinemia undergoing intrauterine insemination (IUI) were randomly divided into two groups. Group A: 94 with bromocriptine and group B:89 with cabergoline. The efficacy and safety was evaluated on the basis of normalization of prolactin levels, normalization of menstrual cycle, disappearance of galactorrhea, occurrence of pregnancy and adverse effects with each of these medications. Results: The presence of galactorrhea and irregular menstruation were significantly lower in patients of group B than group A (P<0.001 and P=0.011, respectively) with a significant lower prevalence of side effects in cabergoline group. Pregnancy was significantly more achieved among the women with the treatment of cabergoline (82%) as compared to bromocriptine (56.4%) (P<0.001). Interpretation & conclusions: Our results suggest that cabergoline treatment in infertile women with prolactinemia is more effective. It lowers prolactin with better tolerability and much more effective in the achievement of pregnancy.

[Comparison of efficacy of letrozole and clomiphene citrate in the treatment of infertility induced by ovulation disorder in patients with polycystic ovarian syndrome]

According to side effects of clomiphen citrate [cc], especially on thendometrium, it was replaced with letrozole, an aromatase inhibitor, for induction of ovulation. In this study, effects of these drugs on ovulation and fertility were compared in patients with polycystic ovarian [PCO] syndrome. In a randomized clinical trial, women with PCO and history of infertility referred to gynecology clinic of Rasoul Akram hospital and private office between 2007 and 2008 were studied. Subjects were randomly assigned to two groups of clomiphen citrate and letrozole. In CC group, subjects were received 100 milligram per day clomiphen citrate between 3rd and 7th day of each cycle for 3 cycles. In letrozole group, women treated with letrozole 2.5 mg daily between 3 and 7 day of each for 3 cycles. Number of follicles in days of 12-16 of cycle, diameter of the greatest one, pregnancy and outcome of pregnancy were compared in two groups. 40 patients in each group were studied. Numbers of follicles, mean diameter of the greatest one were not significantly different in two groups. Pregnancy was occurred in 15 patients [37.5%] of letrozole group Vs 13 patients [32.5%] of CC group. There was no abortion in letrozole group Vs 3 abortion in CC group. Preterm labor was significantly lower in letrozole treated patients [p=0.04]. This study showed that letrozole could be proper substitution of clomiphen citrate for induction of ovulation in patients with PCO and infertility

role of metformin therapy in women with polycystic ovarian syndrome

To determine the efficacy of metformin therapy in women with PCOS in terms of ovulation induction and pregnancy. The study was carried out in Outpatient department Gynaecology Unit-1, Nishtar Hospital, Multan from January 2007 to March 2008. A total of 285 patients fulfilling the inclusion criteria [oligo/hypomenohorea, infertility, weight gain, hyperandrogenism] were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in one or both ovaries was the cut off number for positive ultrasound. Patients with other causes of infertility were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were evaluated for response to metformin therapy. At the start of the study, 78% women had menstrual irregularity, 54% had primary and 46% had secondary, ultrasound features were found in 94% patients, hirstism in 70% and weight gain was found in 64% of patients. After six months of metformin therapy, ovulation was observed in 66% of women while 52% of patients conceived on metformin, therapy alone. Metformin alone was an effective treatment for PCOS in terms of ovulation induction and pregnancy

Dexamethasone in unexplained infertility

To determine if dexamethasone could be a suitable option in the treatment of patients with unexplained infertility. This study was carried out in the Obstetrics Department of Amir University Hospital, Semnan, Iran, from April 2001 to May 2008. One hundred and twenty-four cases of unexplained infertility that underwent ovulation induction and intrauterine insemination [IUI] [only one cycle] were evaluated, and divided into 2 groups. Sixteen cases were excluded, as they were unresponsive to the induction ovulation regimen. Group I [n=42] received clomiphene citrate [CC] + dexamethasone, and the control group [group II, n=66] received CC alone. These groups were the same in age, duration of infertility, and body mass index. The clinical pregnancy rates were evaluated in 2 groups by using statistical tests. The clinical pregnancy rate was 21.4% in group I, and 4.5% in group II. There was a significant statistical difference between the groups [relative risk=4.71, 95% confidence interval=1.35-16.42, p=0.0085]. The pregnancy rate in women with unexplained infertility that underwent ovulation induction with CC + dexamethasone + IUI was significantly higher than those who underwent ovulation induction with CC alone + IUI

Tratamento da infertilidade em mulheres com síndrome dos ovários policísticos: [revisão] / Treatment of infertility in women with polycystic ovary syndrome: [review]

A síndrome dos ovários policísticos (SOP) é a principal endocrinopatia ginecológica na idade reprodutiva, com incidência de 6 a 10 por cento das mulheres no menacme. A resistência insulínica e a hiperinsulinemia compensatória permanecem como os elementos mais importantes na etiopatogenia da SOP. Esta revisão teve como objetivo discutir as controvérsias no tratamento de mulheres com SOP nos diferentes contextos da infertilidade feminina e gestação, à luz das evidências atuais, com ênfase no consenso de 2008 proposto pelas sociedades européia (European Society of Human Reproduction and Embryology, ESHRE) e americana (American Society for Reproductive Medicine, ASRM) de reprodução.

Polycystic ovary syndrome (PCOS) occurs in 6 to 10 percent of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.