DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214580

Prospective observational study on prescribing pattern of infertility treatment options and their success rates in women with polycystic ovary syndrome at tertiary care teaching hospital

Rishitha Sanjana Abbagoni, Madhuri Mushan, Pooja Kosika, Prathyusha Vemula, Manognya Pattepura

Abstract


Background: Polycystic ovary syndrome or in shortcut PCOS previously called as Stein-Leventhal syndrome is a primary and major cause of anovulatory infertility in women of child bearing ages. 3 in every 5 women with PCOS have trouble getting pregnant. Various therapeutic options are available in managing several PCOS symptoms and in increasing chances of pregnancy. The aim of the study was to observe the prescribing pattern of infertility treatment options and their individual success rates.

Methods: The study was conducted in out-patient department of obstetrics and gynaecology, tertiary care teaching hospital, Telangana, India. The study included women aged between 18-37 years who were seeking treatment for infertility due to PCOS. Patients were divided into two categories based on their age and treatment they received which was further grouped accordingly.

Results: The frequency of infertility was found to be significantly higher among PCOS women of age group between 23-27 when compared to other age groups. Among infertility treatment options, ovulation induction drugs were mostly prescribed and among supplements folic acid and myo-inositol were widely prescribed as supplements as well as an adjuvant. Patients who received treatment with ovulation inducing drugs showed high success rate.

Conclusions: Lifestyle modifications were chosen as primary therapeutic option. Ovulation induction drugs among infertility treatment options, folic acid and myo-inositol among supplements were the mostly prescribed medicines to treat or improve infertility in PCOS women. Ovulation inducing drugs showed high success rate.


Keywords


PCOS, Stein-Leventhal syndrome, Infertility, Ovulation induction drugs, Supplements, Myo-inositol

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References


Pasquali R. Contemporary approaches to the management of polycystic ovary syndrome. Sage j. 2018;9(4):123-34.

Centers for Disease Control and Prevention. PCOS (Polycystic Ovary Syndrome) and Diabetes. Available at: https://www.cdc.gov/diabetes/basics/pcos.html. Accessed 24 March 2020.

U.S. Department of Health and Human Services. Polycystic ovary syndrome (PCOS). Available at: https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome. Accessed 27 May 2016.

Alessandro P, Delitala. Polycystic ovary syndrome, adipose tissue and metabolic syndrome. Arch Gynecol obstet. 2017;296(3):405-19.

Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.

Yvonne V, Louwers E. Characteristics of polycystic ovary syndrome throughout life. Ther Adv Reprod Health. 2020;14:2633494120911038.

Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Womens Health. 2015;24(4):299-307.

Healthline. How Polycystic Ovary Syndrome (PCOS) Affects Fertility and What to Do. Available at https://www.healthline.com/health/womens-health/pcos-and-fertility. Accessed 19 November 2020.

Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics. 2015;70(11);765-7.

Eunice Kennedy Shriver National Institute of Child Health and Human Development. Treatment for Infertility Resulting from PCOS. Available at: https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/treatments/infertility. Accessed 31 January 2017.

NHS. Polycystic ovary syndrome. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/. Accessed 1 February 2019.

Jean Hailes for Women’s Health. Fertility-management and treatment. Available at: https://www.jeanhailes.org.au/health-a-z/pcos/fertility-management-treatment#pcos-and-fertility. Accessed 1 September 2020.

Costelll MF, Ledger W. Evidence-Based Lifestyle and Pharmacological Management of Infertility in Women with Polycystic Ovary Syndrome. Sager J. 2012;8(3):277-90.

Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23(3):462-77.

Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab. 2008;93(11):4299-306.

Ornstein RM, Copperman NM, Jacobson MS. Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2011;24(3);161-5.

Lass N, Kleber M, Winkel K, Wunsch R, Reinehr T. Effect of lifestyle intervention on features of polycystic ovarian syndrome, metabolic syndrome, and intima-media thickness in obese adolescent girls. J Clin Endocrinol Metab. 2011;96(11);3533-40.

Lisa J Moran et al. Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. J Acad Nutr Diet. 2013;113(4):520.

Naderpoor N, Shorakae S, De Courten B, Misso ML, Moran LG, Teede HJ. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update. 2015;21(5):560-74.

Xi W, Liu S, Mao H, Yang Y, Xue X, Lu X. Use of letrozole and clomiphene citrate combined with gonadotropins in Clomiphene-resistant infertile women with polycystic ovary syndrome: a prospective study. Drug Des Devel Ther. 2015;9:6001-8.

Mejia RB, Summers KM, Kresowik JD, Van Voorhis BJ. A randomized controlled trial if combination letrozole and clomiphene citrate or letrozole alone for ovulation induction in women with polycystic ovary syndrome. Fertil Steril. 2019;111(3);571-8.

Legro RS, Brzyski RG, Diamond MP, Coutifaris C. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119-29.

Thomas S, Woo I, Bendikson K. Ovulation rates in a stair-step protocol with letrozole vs clomiphene citrate in patients with polycystic ovarian syndrome. Contracept Reprod Med. 2019;4:20.

Veltman-Verhulst SM, Hughes E, Ayeleke RO, Cohlen BJ. Intra-Uterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2012;(9):CD001838.

Huang S, Du X, Wang R, Li R, Wang H, Luo L, O'Leary S, Qiao J, Mol JB. Ovulation induction and intrauterine insemination in infertile women with polycystic ovary syndrome: A comparison of drugs. Eur J Obstet Gynecol Reprod Biol. 2018;231:117-21.

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);40-8.

Flyckt RL, Goldberg JM. Laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome. Semin Reprod Med. 2011;29(2);138-46.

University Reproductive Associates. Will IVF Work With PCOS| Success Rates of IVF and PCOS. Available at: https://www.uranj.com/blog/will-ivf-work-with-pcos-success-rates-of-ivf-and-pcos/. Accessed 4 April 2019.

Günalan E, Yaba A, Yilmaz B. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. J Turk Ger Gynecol Assoc. 2018;19(4):220-32.

Papaleo E, Unfer V, Baillargeon JB, De Santis L, Fusi F, Brigante C. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007;23(12);700-3.

Gerli S, Papaleo E, Ferrari A, Di Renzo GC. Randomized, double blind placebo-controlled trial:effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. Eur Rev Med Pharmacol Sci. 2007;11(5);347-54.

Regidor PA, Schindler AE, Lesoine B, Druckman R. Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Horm Mol Biol Clin Investig. 2018;34(2).

Selimoglu H, Duran C, Kiyici S, Ersoy C, Guclu M, Ozkaya G et al. The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome. J Endocrinol Invest. 2010;33(4):234-8.

Kotsa K, Yavropoulou MP, Anastasiou O, Yovos JG. Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome. Fertil Steril. 2009;92(3):1053-8.

Irani M, Minkoff H, Seifer DB, Merhi Z. Vitamin D increases serum levels of the soluble receptor for advanced glycation end products in women with PCOS. J Clin Endocrinol Metab. 2014;99(5):E886-90.Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2);362-70.

Asemi Z, Karamali M, Esmaillzadeh A. Metabolic response to folate supplementation in overweight women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial. Mol Nutr Food Res. 2014;58(7):1465-73.

Olaniyan OT, Femi A, Iliya G, Ayobami D, Godam E, Olugbenga E et al. Vitamin C suppresses ovarian pathophysiology in experimental polycystic ovarian syndrome. Pathophysiology. 2019;26(3-4):331-41.