Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments.

[en] Infertility concerns 15% of the couples. Management of female infertility requires a complete history of the patient followed by a physical, gynecological and endocrine examination. Infertility etiology will be investigated thanks to different tests including ovarian function and reserve assessment, search for uterine abnormalities and evaluation of tubal permeability. Polycystic ovarian syndrome (PCOS) is a predominant cause of infertility and a common gyne-endocrine disorder affecting 7 to 15% of women in reproductive age. Behavioral, medical and surgical treatments have been evaluated in order to improve the fertility of women with PCOS. Lifestyle modifications (stop smoking, physical exercise and weight loss when necessary) are of the utmost importance. Clomiphene citrate remains the first line of medical treatment of infertility in women with PCOS in absence of other male or female causes of infertility. Use of metformin solely for infertility is not recommended in absence of metabolic anomaly and new treatment as myoinositol is emerging. Surgical techniques aiming to enhance ovulation and pregnancy rate are an option when medical treatment failed. Ovarian drilling by laparoscopy or by transvaginal hydrolaparoscopy is taking a larger place in the treatment of infertility. In vitro maturation and fertilization remain the third-line of treatment in PCOS.

Disciplines :

Reproductive medicine (gynecology, andrology, obstetrics)

Author, co-author :

Collée, Julie

Mawet, Marie

Tebache, Linda

Nisolle, Michelle ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie - Obstétrique

Brichant, Géraldine ; Centre Hospitalier Universitaire de Liège - CHU > Département de gynécologie-obstétrique > Service de gynécologie-obstétrique (CHR)

Language :

English

Title :

Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments.

Publication date :

2021

Journal title :

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology

ISSN :

0951-3590

eISSN :

1473-0766

Volume :

Issue :

Pages :

869-874

Peer reviewed :

Peer reviewed

Available on ORBi :

since 06 October 2021

Statistics

Number of views

1401 (14 by ULiège)

Number of downloads

832 (11 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013; 99 (1): 63.
Pasquali R, Antenucci D, Casimirri F, et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab. 1989; 68 (1): 173–179.
Tarlatzis BC, Fauser BCJM, Legro RS, et al. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Repro. 2008; 23 (3): 462–477.
Gibson-Helm ME, Lucas IM, Boyle JA, et al. Women’s experiences of polycystic ovary syndrome diagnosis. Fam Pract. 2014; 31 (5): 545–549.
Melo AS, Ferriani RA, Navarro PA., Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics. 2015; 11: 765–769.
Sahmay S, Aydogan Mathyk B, Sofiyeva N, et al. Serum AMH levels and insulin resistance in women with PCOS. Eur J Obstet Gynecol Reprod Biol. 2018; 224: 159–164.
Artini PG, Obino MER, Sergiampietri C, et al. PCOS and pregnancy: a review of available therapies to improve the outcome of pregnancy in women with polycystic ovary syndrome. Expert Rev Endocrinol Metabol. 2018; 13 (2): 87–98.
Kiddy DS, Hamilton‐Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol. 1992; 36 (1): 105–111.
Balen AH, Dresner M, Scott EM, et al. Should obese women with polycystic ovary syndrome receive treatment for infertility? BMJ. 2006; 332 (7539): 434–435.
Crosignani PG, Colombo M, Vegetti W, et al. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod. 2003; 18 (9): 1928–32.
Malik SM., Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012; 3 (4): 71–79.
Escobar-Morreale HF, Santacruz E, Luque-Ramírez M, et al. Prevalence of “obesity-associated gonadal dysfunction” in severely obese men and women and its resolution after bariatric surgery: A systematic review and meta-analysis. Hum Reprod Update. 2017; 23 (4): 390–408.
Mahawar KK, Parmar C, Graham Y., One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications. Minerva Chir. 2019; 74 (2): 126–136.
Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020; 324 (9): 879–887.
Morley LC, Tang T, Yasmin E, et al. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2017; 11 (11):CD003053.
Legro RS, Barnhart HX, Schlaff WD, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med. 2007; 356 (6): 551–566.
Johnson NP, Stewart AW, Falkiner J, et al. PCOSMIC: a multi-centre randomized trial in women with polycystic ovary syndrome evaluating metformin for infertility with clomiphene. Hum Reprod. 2010; 25 (7): 1675–1683.
Kettel LM, Roseff SJ, Berga SL, et al. Hypothalamic-pituitary-ovarian response to clomiphene citrate in women with polycystic ovary syndrome. Fertil Steril. 1993; 59 (3):532–538.
Kerin JF, Liu JH, Phillipou G, et al. Evidence for a hypothalamic site of action of clomiphene citrate in women. J Clin Endocrinol Metab. 1985; 61 (2): 265–268.
Kumar P, Sait S., Luteinizing hormone and its dilemma in ovulation induction. J Hum Reprod Sci. 2011; 4 (1): 2–7.
Dehbashi S, Parsanezhad ME, Alborzi S, et al. Effect of clomiphene citrate on endometrium thickness and echogenic patterns. Int J Gynecol Obstet. 2003; 80 (1): 49–53.
Zhao J, Zhang Q, Li Y., The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reprod Biol Endocrinol. 2012; 10 (1): 100.
Unfer V, Facchinetti F, Orrù B, et al. Myo-inositol. effects in women with PCOS: A meta-analysis of randomized controlled trials. Endocr Connect. 2017; 6 (8): 647–658.
Huang S, Du X, Wang R, et al. Ovulation induction and intrauterine insemination in infertile women with polycystic ovary syndrome: A comparison of drugs. Eur J Obstet Gynecol Reprod Biol. 2018; 231: 117–121.
Mejia RB, Summers KM, Kresowik JD, et al. A randomized controlled trial of combination letrozole and clomiphene citrate or letrozole alone for ovulation induction in women with polycystic ovary syndrome. Fertil Steril. 2019; 111 (3): 571–578.e1.
Casper RF., Letrozole versus clomiphene citrate: which is better for ovulation induction? Fertil Steril. 2009; 92 (3): 858–859.
Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016; 22 (6): 687–708.
Helmy M, Saleh S, El-Khouly N, et al. Transvaginal needle versus laparoscopic ovarian drilling in drug-resistant polycystic ovary syndrome: a randomized, controlled study. Menoufia Med J. 2019; 32(2): 436–440.
Weiss NS, Kostova E, Nahuis M, et al. Gonadotrophins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019; 1 (1): CD010290.
Gjønnaess H., Late endocrine effects of ovarian electrocautery in women with polycystic ovary syndrome. Fertil Steril. 1998; 69 (4): 697–701.
Walls ML, Hart RJ., In vitro maturation. Best Pract Res: Clin Obstetr Gynaec. 2018; 53: 60–72.
Fauser BCJM, Tarlatzis BC, Rebar RW, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012; 97 (1): 28–38.e25.
Laganà AS, Rossetti P, Sapia F, et al. Evidence-based and patient-oriented inositol treatment in polycystic ovary syndrome: changing the perspective of the disease. Int J Endocrinol Metab. 2017; 15 (1): e43695.
Atay V, Cam C, Muhcu M, et al. Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation. J Int Med Res. 2006; 34 (1): 73–76.
Baillargeon JP, Iuorno MJ, Jakubowicz DJ, et al. Metformin therapy increases insulin-stimulated release of D-Chiro-inositol-containing inositolphosphoglycan mediator in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004; 89 (1): 242–249.
Pundir J, Psaroudakis D, Savnur P, et al. Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials. BJOG. 2018; 125 (3): 299–308.
Laffargue P, Gares R, Luscan R, et al. Syndrome de Stein-Leventhal d’origine congénitale probable guéri par résection cunéiforme des ovaires et cortisone; hyperplasie fonctionnelle du stroma ovarien [Stein-Leventhal syndrome of probable congenital origin cured by cuneiform resection of ovaries & cortisone; functional hyperplasia of the ovarian stroma]. Bull Fed Soc Gynecol Obstet Lang Fr. 1957; 9 (3): 317–322.
Mitra S, Nayak PK, Agrawal S., Laparoscopic ovarian drilling: an alternative but not the ultimate in the management of polycystic ovary syndrome. J Nat Sci Biol Med. 2015; 6 (1): 40–48.
Ferraretti AP, Gianaroli L, Magli MC, et al. Transvaginal ovarian drilling: a new surgical treatment for improving the clinical outcome of assisted reproductive technologies in patients with polycystic ovary syndrome. Fertil Steril. 2001; 76 (4): 812–816.
Giampaolino P, Morra I, Tommaselli GA, et al. Post-operative ovarian adhesion formation after ovarian drilling: a randomized study comparing conventional laparoscopy and transvaginal hydrolaparoscopy. Arch Gynecol Obstet. 2016; 294 (4): 791–796.
Debras E, Fernandez H, Neveu ME, et al. Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate. Eur J Obstet Gynecol Reprod Biol X. 2019; 4: 100093.
Giampaolino P, De Rosa N, Della Corte L, et al. Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome. Gynecol Endocrinol. 2018; 34 (1): 32–35.
Ezedinma NA, Phelps JY., Transvaginal hydrolaparoscopy. JSLS. 2012; 16 (3): 461–465.
Lebbi I, Ben Temime R, Fadhlaoui A, et al. Ovarian drilling in PCOS: is it really useful? Front Surg. 2015; 2: 30.
Lemieux S, Lewis GF, Ben-Chetrit A, et al. Correction of hyperandrogenemia by laparoscopic ovarian cautery in women with polycystic ovarian syndrome is not accompanied by improved insulin sensitivity or lipid-lipoprotein levels. J Clin Endocrinol Metab. 1999; 84: 4278–4282.
Bordewijk EM, Ng KYB, Rakic L, et al. Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2020; 2: CD001122.
Seow KM, Juan CC, Hwang JL, et al. Laparoscopic surgery in polycystic ovary syndrome: reproductive and metabolic effects. Semin Reprod Med. 2008; 26 (1): 101–110.
Practice Committee of American Society For Reproductive M.Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2012; 98 (2): 302–307.