Infertility in Polycystic Ovary Syndrome: Focus on Low-dose Gonadotropin Treatment

Overview

Journal Endocrine

Specialty Endocrinology

Date 2006 Dec 23

PMID 17185789

Citations 34

Authors

Anwen Gorry

Davinia M White

Stephen Franks

Affiliations

Soon will be listed here.

Abstract

Polycystic ovary syndrome accounts for more than 75% of cases of anovulatory infertility. The mechanism of anovulation is uncertain but there is evidence that arrested antral follicle development is associated with the abnormal endocrine profile, in particular the interaction of insulin and LH on granulosa cell differentiation. In terms of management, induction of ovulation can be achieved in most cases by the use of antiestrogens. Treatment of clomiphene-resistant subjects is difficult; conventional doses of gonadotropins are associated with high rates of ovarian hyperstimulation syndrome and multiple pregnancy. On the other hand, low-dose gonadotropin therapy has proven effective in inducing unifollicular ovulation and, in this review, we present, in detail, a recent analysis the results from this center. The cumulative conception rate after six cycles was more than 50% and, importantly, the multiple pregnancy rate was only 3%. Weight reduction in obese subjects with PCOS not only increases the chance of fertility but may also improve the long-term prognosis with regard to development of diabetes. Insulin-sensitizing drugs such as metformin may also have a place in treatment of PCOS.

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References

Balen A, Braat D, West C, Patel A, Jacobs H . Cumulative conception and live birth rates after the treatment of anovulatory infertility: safety and efficacy of ovulation induction in 200 patients. Hum Reprod. 1994; 9(8):1563-70. DOI: 10.1093/oxfordjournals.humrep.a138750. View

Franks S . Polycystic ovary syndrome: a changing perspective. Clin Endocrinol (Oxf). 1989; 31(1):87-120. DOI: 10.1111/j.1365-2265.1989.tb00457.x. View

Hughes E, Collins J, Vandekerckhove P . Ovulation induction with urinary follicle stimulating hormone versus human menopausal gonadotropin for clomiphene-resistant polycystic ovary syndrome. Cochrane Database Syst Rev. 2000; (2):CD000087. PMC: 10866112. DOI: 10.1002/14651858.CD000087. View

Farquhar C, Williamson K, Gudex G, Johnson N, Garland J, Sadler L . A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate-resistant polycystic ovary syndrome. Fertil Steril. 2002; 78(2):404-11. DOI: 10.1016/s0015-0282(02)03225-9. View

Franks S . Polycystic ovary syndrome. N Engl J Med. 1995; 333(13):853-61. DOI: 10.1056/NEJM199509283331307. View

Sagle M, Kiddy D, Franks S . A comparative, randomized study of low-dose human menopausal gonadotropin and follicle-stimulating hormone in women with polycystic ovarian syndrome. Fertil Steril. 1991; 55(1):56-60. DOI: 10.1016/s0015-0282(16)54059-x. View

Palomba S, Orio Jr F, Falbo A, Manguso F, Russo T, Cascella T . Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005; 90(7):4068-74. DOI: 10.1210/jc.2005-0110. View

Franks S, Mason H, Willis D . Follicular dynamics in the polycystic ovary syndrome. Mol Cell Endocrinol. 2000; 163(1-2):49-52. DOI: 10.1016/s0303-7207(99)00239-7. View

Robinson S, Kiddy D, Gelding S, Willis D, Niththyananthan R, Bush A . The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin Endocrinol (Oxf). 1993; 39(3):351-5. DOI: 10.1111/j.1365-2265.1993.tb02376.x. View

10.

Willis D, Watson H, Mason H, Galea R, Brincat M, Franks S . Premature response to luteinizing hormone of granulosa cells from anovulatory women with polycystic ovary syndrome: relevance to mechanism of anovulation. J Clin Endocrinol Metab. 1998; 83(11):3984-91. DOI: 10.1210/jcem.83.11.5232. View

11.

van Santbrink E, Donderwinkel P, van Dessel T, Fauser B . Gonadotrophin induction of ovulation using a step-down dose regimen: single-centre clinical experience in 82 patients. Hum Reprod. 1995; 10(5):1048-53. DOI: 10.1093/oxfordjournals.humrep.a136092. View

12.

Fulghesu A, Apa R, Belosi C, Ciampelli M, Selvaggi Jr L, Cucinelli F . Recombinant versus urinary follicle-stimulating hormone in the low-dose regimen in anovulatory patients with polycystic ovary syndrome: a safer and more effective treatment. Horm Res. 2001; 55(5):224-8. DOI: 10.1159/000050000. View

13.

Polson D, Kiddy D, Mason H, Franks S . Induction of ovulation with clomiphene citrate in women with polycystic ovary syndrome: the difference between responders and nonresponders. Fertil Steril. 1989; 51(1):30-4. DOI: 10.1016/s0015-0282(16)60423-5. View

14.

Stubbs S, Hardy K, da Silva-Buttkus P, Stark J, Webber L, Flanagan A . Anti-müllerian hormone protein expression is reduced during the initial stages of follicle development in human polycystic ovaries. J Clin Endocrinol Metab. 2005; 90(10):5536-43. DOI: 10.1210/jc.2005-0907. View

15.

Kamrava M, Seibel M, Berger M, Thompson I, TAYMOR M . Reversal of persistent anovulation in polycystic ovarian disease by administration of chronic low-dose follicle-stimulating hormone. Fertil Steril. 1982; 37(4):520-3. DOI: 10.1016/s0015-0282(16)46159-5. View

16.

Brown J . Pituitary control of ovarian function--concepts derived from gonadotrophin therapy. Aust N Z J Obstet Gynaecol. 1978; 18(1):46-54. DOI: 10.1111/j.1479-828x.1978.tb00011.x. View

17.

Bayram N, van Wely M, van der Veen F . Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. 2001; (2):CD002121. DOI: 10.1002/14651858.CD002121. View

18.

Kiddy D, Bush A, Short F, Anyaoku V, Reed M, Franks S . Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992; 36(1):105-11. DOI: 10.1111/j.1365-2265.1992.tb02909.x. View

19.

Imani B, Eijkemans M, Te Velde E, Habbema J, Fauser B . Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab. 1998; 83(7):2361-5. DOI: 10.1210/jcem.83.7.4919. View

20.

White D, Polson D, Kiddy D, Sagle P, Watson H, Gilling-Smith C . Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women. J Clin Endocrinol Metab. 1996; 81(11):3821-4. DOI: 10.1210/jcem.81.11.8923819. View