Status of clomiphene citrate and metformin for infertility in PCOS (original) (raw)
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European Journal of Obstetrics & Gynecology and Reproductive Biology, 2000
Polycystic ovary syndrome (PCOS) describes a convergence of chronic multisystem endocrine derangements, including irregular menses, hirsutism, obesity, hyperlipidemia, androgenization, large and cystic-appearing ovaries, insulin resistance and subfertility. Few PCOS patients exhibit all of these features, and often only one sign or symptom is evident. The sequelae of PCOS reach beyond reproductive health, as women affected with PCOS have increased relative risks for myocardial infarction, hypertension, ischemic heart disease, thromboembolic disease and diabetes. Although the adverse health consequences associated with PCOS are substantial, unfortunately most women are not aware of these risks. Indeed, in infertility practice such concerns are secondary as most patients are referred for treatment specifically to achieve a pregnancy. Impairments in insulin metabolism appear central to the physiologic cascade of PCOS, yet clomiphene therapy fails to remedy this defect. Several investigators have described satisfactory reproductive outcomes for PCOS patients treated with oral insulin-lowering agents. In this report, we outline a diagnostic and therapeutic approach for women with PCOS refractory to clomiphene with attention to the underlying insulin imbalance associated with impaired fertility.
2014
Polycystic Ovary Syndrome (PCOS) is characterized by ovulatory disturbances, hyperandrogenaemia and hyperinsulinemia secondary to increased insulin resistance. In PCOS, hyperinsulinemic insulin resistance is of interest because skeletal muscle may be resistant to insulin in terms of glucose metabolism, while the ovaries remain sensitive to insulin with regard to stimulation of testosterone biosynthesis. Insulin resistance and hyperinsulinemia are associated with reproductive failure such as early pregnancy loss, and cardiovascular risk and the development of diabetes mellitus later in life. Insulin-sensitizing agents such as metformin improve insulin sensitivity, thereby improving ovulatory cycles and fertility in women with PCOS. Metformin has also been shown to retard progression to type 2 diabetes in PCOS. This review addresses the effects of metformin on reproduction. Special Issue on Antidiabetic DrugMetformin
Infertility Riding on Polycystic Ovarian Syndrome (PCOS): A Review of Treatment Modalities
Journal of Pharmaceutical Research International, 2021
Polycystic ovarian syndrome (PCOS) is the commonest cause of anovulatory infertility. Depending on the population studied between 5 and 18% of women of reproductive age suffer from PCOS, however not all of them are anovulatory or experience subfertility. PCOS has been associated with numerous reproductive and metabolic abnormalities. Despite enormous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exerc...
Pediomaternal Nursing Journal, 2021
Introduction: Polycystic ovarian syndrome (PCOS) is characterized by infrequent or absent ovulation as well as elevated levels of androgens and insulin (hyperinsulinaemia). The purpose of this study was to determine the efficacy of endocrine treatment in improving reproductive and metabolic outcomes in women with PCOS.Methods: We searched the following databases from inception to Maret 2020: PubMed, Proquest, ScienceDirect, Scopus and CINAHL. We investigated at metformin, clomiphene citrate, metformin plus clomiphene citrate, D-chiro-inositol, statins, and resveratrol as treatments. We compared them to each other, as well as to a placebo or no therapy. The quality of the evidence ranged from extremely low to moderate. The risks of bias (poor reporting of technique and inadequate outcome data), imprecision, and inconsistency were the limitations.Results: Although the evidence quality was low, our latest evaluation indicated that metformin alone may be superior to placebo for live bir...
Human Reproduction Update, 2013
† Introduction † Methods † Results † Discussion background: Recent studies suggest that metformin may be more effective in women with polycystic ovary syndrome (PCOS) who are non-obese. The objective here is to determine and compare the effectiveness of metformin and clomiphene citrate for improving fertility outcomes in women with PCOS and a BMI , 32 kg/m 2 (BMI 32 kg/m 2 was used to allow for international differences in BMI values which determine access to infertility therapy through the public health system). methods: Databases were searched for English language articles until July 2011. Inclusion criteria: women of any age, ethnicity and weight with PCOS diagnosed by all current criteria, who are infertile; at least 1000 mg of any type of metformin at any frequency, including slow release and standard release, compared with any type, dose and frequency of clomiphene citrate. Outcomes: rates of ovulation, live birth, pregnancy, multiple pregnancies, miscarriage, adverse events, quality of life and cost effectiveness. Data were extracted and risk of bias assessed. A random effects model was used for meta-analyses of data, using risk ratios (relative risk).
Fertility and Sterility, 2006
To determine if short courses of metformin (MET) administration in patients with polycystic ovary syndrome (PCOS) would reduce fasting insulin and improve the efficacy of clomiphene citrate (CC) to induce ovulation. Design: A randomized prospective trial involving 31 subjects with PCOS and infertility. Setting: University-based medical center. Patient(s): Obese patients (body mass index Ͼ 29 kg/m 2 ) with PCOS. Intervention(s): Patients with PCOS were treated either with CC or CCϩMET for 2 weeks. Main Outcome Measure(s): Ovulation as determined by serum P, serum insulin, and total and free T.