Medical and Surgical Treatment of Reproductive Outcomes in Polycystic Ovary Syndrome: An Overview of Systematic Reviews
نویسندگان
چکیده مقاله:
Background Polycystic ovary syndrome (PCOS) is a common and complex condition affecting up to 18% of reproductive-aged women with reproductive, metabolic and psychological dysfunction. We performed an overview and appraisal of methodological quality of systematic reviews assessing medical and surgical treatments for reproductive outcomes in women with PCOS. Methods This was an overview of systematic reviews. Databases (MEDLINE, EMBASE, CINAHL PLUS and PROSPERO) were searched on the 15th of September 2017. We included any systematic review assessing the effect of medical or surgical management of PCOS on reproductive, pregnancy and neonatal outcomes. Eligibility assessment, data extraction and quality assessment (by the AMSTAR tool) were performed in duplicate. Results We identified 53 reviews comprising 44 reviews included in this overview; the majority being moderate to high quality. In unselected women with PCOS, letrozole was associated with a higher live birth rate than clomiphene citrate (CC), while CC was better than metformin or placebo. In women with CC-resistant PCOS, gonadotrophins were associated with a higher live birth rate than CC plus metformin, which was again better than laparoscopic ovarian drilling (LOD). LOD was associated with lower multiple pregnancy rates than other medical treatments. In women with PCOS undergoing in vitro fertilization / intra-cytoplasmic sperm injection (IVF/ICSI), adding metformin to gonadotrophins resulted in less ovarian hyperstimulation syndrome (OHSS), higher pregnancy and live birth rate than gonadotrophins alone. Gonadotrophin releasing hormone (GnRH) antagonist was associated with less OHSS, gonadotrophins units and shorter stimulation length than GnRH agonist. Conclusion Letrozole appears to be a good first line treatment and gonadotrophins as second line treatment for anovulatory women with PCOS. LOD results in lower multiple pregnancy rates. However, due to the heterogeneous nature of included populations of women with PCOS, further larger scale trials are needed with more precise assessment of treatments according to heterogeneous variants of PCOS.
منابع مشابه
The Role of Polycystic Ovary Syndrome in Reproductive and Metabolic Health: Overview and Approaches for Treatment
Polycystic ovary syndrome (PCOS) is a condition with a range of reproductive and metabolic features that affects 4–18% of reproductive-age women, depending on the diagnostic criteria used (1,2). PCOS typically involves hormonal imbalances, insulin resistance, and metabolic abnormalities, which significantly increase the risk of infertility, type 2 diabetes, and cardiovascular disease (CVD) (3) ...
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Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects between 5 - 10% of women who are of reproductive age. The most common symptoms of PCOS are obesity/difficulty losing weight, acne, amenorrhea (absence of menstrual cycles), irregular menstrual cycles, hirsutism (increased growth of corporal hair), insulin resistance, and high cholesterol. One of the treatments for PCOS is the ...
متن کاملSurgical Ovulation Induction in Women with Polycystic Ovary Syndrome: A Systematic Review
Background: Currently clomiphene citrate is the first-line treatment to induce ovulation in women with polycystic ovarian syndrome (PCOS). Surgical therapy with laparoscopic ovarian drilling (LOD) may avoid or reduce the need for gonadotropins. Objective: To determine the effectiveness and safety of LOD compared with ovulation induction in subfertile women with clomiphene-resistant PCOS. Search...
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چکیده ندارد.
15 صفحه اولDiagnosis and Treatment of Polycystic Ovary Syndrome.
Polycystic ovary syndrome is the most common endocrinopathy among reproductive-aged women in the United States, affecting approximately 7% of female patients. Although the pathophysiology of the syndrome is complex and there is no single defect from which it is known to result, it is hypothesized that insulin resistance is a key factor. Metabolic syndrome is twice as common in patients with pol...
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عنوان ژورنال
دوره 13 شماره 4
صفحات 257- 270
تاریخ انتشار 2020-01-01
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