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30 - Medical Management of Polycystic Ovary Syndrome

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

By
Kabli Nadia  and
Tulandi Togas
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Its prevalence among infertile women is 15–20 percent. The etiology of PCOS remains unclear; however, several studies have suggested that PCOS is an X-linked dominant condition (1). The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions. Women with PCOS are predisposed to type 2 diabetes or develop cardiovascular disease (2).

DEFINITION OF PCOS

In a workshop sponsored by ESHRE (European Society for Human Reproduction and Embryology) and ASRM (American Society for Reproductive Medicine) in Rotterdam in 2003, a new definition of PCOS was proposed (3). This consensus defined PCOS as a syndrome with two out of three of the following features: oligo- or anovulation, clinical and/or biochemical sign of hyperandrogenism, and/or sonographic finding of polycystic ovaries (after exclusion of other etiologies such as congenital adrenal hyperplasia, androgen-secreting tumors, or Cushing's syndrome) (Table 30.1).

Sonographic features of polycystic ovaries (PCO) include the presence of twelve or more follicles in each ovary measuring 2–9 mm in diameter and/or increased ovarian volume (>10 mL). This is regardless of follicle distribution, ovarian stromal echogenicity, or ovarian volume. One ovary fulfilling this definition is sufficient to define PCO (2, 4). It is recognized that some women with sonographic findings of PCO may have regular cycles without clinical or biochemical signs of hyperandrogenism.

Keywords

aromatase inhibitorsclomiphene citratedexamethazonegonadotropin-releasing hormone agonistinsulin resistancemenstrual dysfunctionmetformin treatmenthirsutismoral contraceptive pillspolycystic ovary syndrome
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 286 - 293
Publisher: Cambridge University Press
Print publication year: 2008

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References

Speroffl, Fritz M. Anovulation and polycystic ovary. In: Clinical Gynecologic Endocrinology and Infertility, 7th edn. Lippincott Williams and Wilkins, Baltimore, MA, 2005; pp. 470–83.Google Scholar
Azziz, R. Diagnostic criteria for polycystic ovary syndrome: a reappraisal. Fertil Steril 2005;83:1343–6.CrossRefGoogle ScholarPubMed
The Rotterdam ESHRE/ASRM Sponsored PCOS concensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41–7.
The Rotterdam ESHRE/ASRM Sponsored PCOS concensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Fertil Steril 2004;19–25.
Bucket, WM, Bouzayen, R, Watkin, KL, Tulandi, T, Tan, SL. Ovarian stromal echogenicity in women with normal and polycystic ovaries. Hum Reprod 2003;18:598–603.Google Scholar
Hardiman, P, Pillay, OC, Atiomo, W. Polycystic ovary syndrome and endometrial carcinoma. Lancet 2003;361:1810.Google Scholar
Ducluzeau, PH, Cousin, P, Malyoisin, E, Bornet, H, Vidal, H, Laville, M, Pugeat, M. Glucose-to-insulin ratio rather than sex hormone-binding globulin and adiponectin levels is the best predictor of insulin resistance in nonobese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003;88:3626–31.CrossRefGoogle ScholarPubMed
Ciampelli, M, Leoni, F, Cucinelli, F, Mancuso, S, Panunzi, S, Gaetano, A, Lanzone, A. Assessment of insulin sensitivity from measurements in the fasting state and during an oral glucose tolerance test in polycystic ovary syndrome and menopausal patients. J Clin Endocrinol Metab 2005;90:1398–406.CrossRefGoogle ScholarPubMed
Apridonidze, T, Essah, PA, Iuorno, MJ, Nestler, JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:1929–35.CrossRefGoogle ScholarPubMed
Patel, SM, Nestler, JE. Fertility in polycystic ovary syndrome. Endocrinol Metab Clin North Am 2006;35:137–55.CrossRefGoogle ScholarPubMed
Lakhani, K, Prelevic, GM, Seifalian, AM, Atiomo, WU, Hardiman, P. Polycystic ovary syndrome, diabetes and cardiovascular disease: risks and risk factors. J Obstet Gynaecol 2004;24:613–21.CrossRefGoogle ScholarPubMed
Tang, T, Glanville, J, Hayden, CJ, White, D, Barth, JH, Balen, AH. Combined life style modification and metformin in obese patients with polycystic ovary syndrome a randomized placebo- controlled, double-blinded multicentre study. Hum Reprod 2006;21:80–9.CrossRefGoogle ScholarPubMed
Moran, LJ, Noakes, M, Clifton, PM, et al. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003;88:812–19.CrossRefGoogle ScholarPubMed
Aziz, R. Use of combination oral contraceptives in the treatment of hyperandrogenism and hirsutism. UpToDate, Clinical Reference Library 2006. www.uptodate.comGoogle Scholar
Falsetti, L, Gambera, A, Tisi, G. Efficacy of the combination ethinyl estradiol and cyproterone acetate on endocrine, clinical and ultrasonographic profile in polycystic ovarian syndrome. Hum Reprod 2001;16:36–42.CrossRefGoogle ScholarPubMed
Falsetti, L, Gambra, A, Platto, C, Legrenzi, L. Management of hirsutism. Am J Clin Dermatol 2000;1:89–99.CrossRefGoogle ScholarPubMed
Rosenfield, RL. Clinical practice, hirsutism. N Engl J Med 2005;15;353:2578–88.CrossRefGoogle Scholar
Barbieri, R. Treatment of hirsutism. UpToDate, Clinical Reference Library 2006. www.uptodate.comGoogle Scholar
Ibáñez, L, Zegher, F. Low-dose flutamide-metformin therapy for hyperinsulinemic hyperandrogenism in non-obese adolescents and women. Hum Reprod Update 2006;10. 1093.Google Scholar
Beigi, A, Sobhi, A, Zarrinkoub, F. Finasteride versus cyproterone acetate-estrogen regimens in the treatment of hirsutism. Int J Gynaecol Obstet 2004;87:29–33.CrossRefGoogle ScholarPubMed
Vanky, E, Salvesen, KA, Carlsen, SM. Six-month treatment with low-dose dexamethasone further reduces androgen levels in PCOS women treated with diet and lifestyle advice, and metformin. Hum Reprod 2004;19:529–33.CrossRefGoogle ScholarPubMed
Parsanezhad, ME, Alborzi, S, Motazedian, S, Omrani, G. Use of dexamethasone and clomiphene citrate in the treatment of clomiphene citrate-resistant patients with polycystic ovary syndrome and normal dehydroepiandrosterone sulfate levels: a prospective, double-blind, placebo-controlled trial. Fertil Steril 2002;5:1001–4.CrossRefGoogle Scholar
Nugent, D, Vandekerckhove, P, Hughes, E, Arnot, M, Lilford, R. Gonadotropin therapy for ovulation induction in sub fertility associated with polycystic ovary syndrome (Cochrane Review). The Cochrane Library, (4):, CD000410. 2000. Oxfordupdate SoftwareGoogle Scholar
Cristello, F, Cela, V, Artini, PG, Genazzani, AR. Therapeutic strategies for ovulation induction in infertile women with polycystic ovary syndrome. Gynecol Endocrinol 2005;21:340–352.CrossRefGoogle ScholarPubMed
Mitwally, MF, Casper, RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776–80.CrossRefGoogle ScholarPubMed
Al-Omari, WR, Suliman, WR, Al-Hadithi, N. Comparison of two aromatase inhibitors in women with clomiphene-resistant polycystic ovary syndrome. Int J Gynaecol Obstet 2004;85:289–91.CrossRefGoogle ScholarPubMed
Al-Fozan, H, Al-Khadouri, M, Tan, SL, Tulandi, T. A randomized trial of letrozole versus clomiphene citrate in women undergoing super ovulation. Fertil Steril 2004;82:1561–1563.CrossRefGoogle Scholar
Healy, S, Tan, SL, Tulandi, T, Biljan, M. Effects of letrozole on superovulation with gonadotropins in women undergoing intrauterine insemination. Fertil Steril 2003;80:1325–9.CrossRefGoogle Scholar
Al-Fadhli, R, Sylvestre, C, Buckett, W, Tan, SL, Tulandi, T. A randomized trial of superovulation with two different doses of letrozole. Fertil Steril 2006;85:161–4.CrossRefGoogle ScholarPubMed
Grana-Barcia, M, Liz-Leston, J, Lado-Abeal, J. Subcutaneous administration of pulsatile gonadotropin-releasing hormone decreases serum follicle-stimulating hormone and luteinizing hormone levels in women with polycystic ovary syndrome: a preliminary study. Fertil Steril 2005;83:1466–72.CrossRefGoogle ScholarPubMed
Bahceci, M, Ulug, U, Ben-Shalomo, I, Erden, HF, Akman, MA. Use of a GnRH antagonist in controlled ovarian hyperstimulation for assisted conception in women with polycystic ovary disease: a randomized, prospective, pilot study. J Reprod Med 2005; 50:84–90.Google ScholarPubMed
Hwang, JL, Seow, KM, Lin, YH, Huang, LW, Hsieh, BC, Tsai, YL, Wu, GJ, Huang, SC, Chen, CY, Chen, PH, Tzeng, CR. Ovarian stimulation by concomitant administration of cetrorelix acetate and HMG following Diane-35 pre-treatment for patients with polycystic ovary syndrome: a prospective randomized study. Hum Reprod 2004;19:1993–2000.CrossRefGoogle ScholarPubMed
Cheang, KI, Nestler, JE. Should insulin-sensitizing drugs be used in the treatment of polycystic ovary syndrome?Reprod Biomed Online 2004;8:440–7.CrossRefGoogle ScholarPubMed
Harborne, LR, Sattar, N, Norman, JE, Fleming, R. Metformin and weight loss in obese women with polycystic ovary syndrome: comparison of doses. J Am Assoc Gynecol Laparosc 2005;90(8): 4593–8.Google ScholarPubMed
Lord, JM, Flight, IHK, Norman, RJ.Insulin-sensitizing drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev 2003;(2), Art. No: CD003053. DOI:10.1002/14651858.CD003053.Google Scholar
Yilmaz, M, Karakoc, A, Toruner, FB, Cakir, N, Tiras, B, Ayvaz, G, Arslan, M. The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome. Gynecol Endocrinol 2005;21:154–60.CrossRefGoogle ScholarPubMed
Moghetti, P, Castello, R, Negri, C, Tosi, F, Perrone, F, Caputo, M, et al. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double blinded, placebo controlled 6 month trial, followed by open, long term clinical evaluation. J Clin Endocrinol Metab 2000;85:139–46.Google ScholarPubMed
Eisenhardt, S, Schwarzmann, N, Henschel, V, Germeyer, A, Wolff, M, Hamann, A, Strowitzki, T. Early effects of metformin in women with polycystic ovary syndrome (PCOS): a prospective randomized double blind placebo controlled trial. J Clin Endocrinol Metab 2005;10:1210.Google Scholar
Glueck, CJ, Wang, P, Goldenberg, N, Sieve-Smith, L. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 2002;17:2858–64.CrossRefGoogle ScholarPubMed
Glueck, CJ, Goldenberg, N, Wang, P, Loftspring, M, Sherman, A. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and the development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Hum Reprod 2004;19:510–21.CrossRefGoogle ScholarPubMed
Baillargeon, JP, Jakubowicz, DJ, Iuorno, MJ, Jakubowicz, S, Nestler, JE: Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril 2004;82:893–902.CrossRefGoogle ScholarPubMed
Glueck, CJ, Moreira, A, Goldenberg, N, Sieve-Smith, L, Wang, P. Pioglitazone and metformin in obese women with polycystic ovary syndrome not primarily responsive to metformin. Hum Reprod 2003;18:1618–25.CrossRefGoogle ScholarPubMed
Maciel, GA, Junior, JM, deMaotta, EL, Abi Haidar, M, deLima, GR, Baracat, E. Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin. Fertil Steril 2004;81:355–60.CrossRefGoogle ScholarPubMed
Azziz, R, Ehrmann, D, Legro, RS, Whitcomb, RW, Hanley, R, Fereshetian, AG. PCOS/Troglitazone Study Group. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial. J Clin Endocrinol Metab 2001;86:1626–32.Google ScholarPubMed
Iuorno, MJ, Jakubowicz, DJ, Baillargeon, JP, Dillon, P, Gunn, RD, Allan, G, Nestler, JE. Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome. Endocrinol Pract 2002;8:417–23.CrossRefGoogle ScholarPubMed
Penna, IA, Canella, PR, Reis, RM, Silva de Sa, MF, Ferriani, RA. Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study. Hum Reprod 2005;20:2396–401.CrossRefGoogle ScholarPubMed
Ciotta, L, Calogero, AE, Farina, M, Leo, V, Marca, A, Cianci, A. Clinical, endocrine and metabolic effects of acarbose, an α-glucosidase inhibitor, in PCOS patients with increased insulin response and normal glucose tolerance. Hum Reprod 2001;16: 2066–72.CrossRefGoogle ScholarPubMed
Felemban, A, Tan, SL, Tulandi, T. Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril 2000;73:266–9.CrossRefGoogle ScholarPubMed
Palomba, S, Orio, F Jr., Falbo, A, Russo, T, Caterina, G, Manguso, F, Tolinos, A, Colao, A, Zullo, F. Metformin administration and laparoscopic ovarian drilling improve ovarian response to clomiphene citrate in oligo-anovulatory clomiphene citrate resistant women with polycystic ovary syndrome. Clin Endocrinol 2005;63:631–5.CrossRefGoogle ScholarPubMed
Al-Fadhli, R, Tulandi, T. Laparoscopic treatment of polycystic ovaries: is its place diminishing?Curr Opin Obstet Gynecol 2004; 16:295–8.CrossRefGoogle ScholarPubMed
Pirwany, I, Tulandi, T. Laparoscopic treatment of polycystic ovaries: is it time to relinquish the procedure. Fertil Steril 2003;80: 241–51.CrossRefGoogle ScholarPubMed

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