Saw Palmetto (Serenoa repens, Sabal serrulata) This herb has anti estrogenic effects and also has been found to decrease the testosterone levels in the blood. Both effects are very positive for women with PCOS .9 The herb has properties that can block the process of testosterone turning into DHT (dihydrotestosterone, a by-product of testosterone) which in turn lowers male hormones in the body.
Although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals[74]), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking or shaving. Individuals vary in their response to different therapies. It is usually worth trying other medications if one does not work, but medications do not work well for all individuals.
hi doc bru ! ask ko lng po 7 years na po kami nagsasama ng asawa ko nagpafertility check naman po kami 2 years ago . ok nman po sperm count nia at ok nman din po ung ultrasound ko may nakita lng po na maliliit na bukol sa uterus ko . niresetahan po ako ng metmorfin fertyl at folic acid. regular nman po 28 days ung cycle ko! pero until now ndi pa din po kami nakakabuo . ano po ba the best way na gawin namin para magkababy na? i hope po na masagot nio .. thankyou en godbless po
During a transvaginal ultrasound, your doctor or a medical technician inserts a wandlike device (transducer) into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs, including your ovaries. On an ultrasound image (inset), a polycystic ovary shows many follicles. Each dark circle on the ultrasound image represents a fluid-filled follicle in the ovary. Your doctor may suspect PCOS if you have 20 or more follicles in each ovary.
Second-line therapy, when clomiphene citrate fails to lead to pregnancy, is either exogenous gonadotropins or laparoscopic ovarian surgery. [2, 3] If gonadotropins are used, a low-dose regimen is recommended, [3] and patients must be monitored with ultrasonography and laboratory studies. [2] Note that gonadotropin therapy is expensive and is associated with an increased risk of multiple pregnancy and ovarian hyperstimulation syndrome. [2]
Análisis de sangre. Los análisis de sangre sirven para realizar un conteo de los niveles de andrógeno, a veces conocido como "hormona masculina". El médico también buscará otros problemas de salud comunes relacionados con las hormonas que se pueden confundir con el SOP, como la enfermedad de la tiroides. El médico también puede controlar tus niveles de colesterol y hacerte pruebas para detectar o descartar diabetes.
“In addition to supplements, I recommend getting to the root cause of the condition,” says FLOLiving.com founder and One Medical patient Alisa Vitti. After suffering with PCOS symptoms for years, the best-selling author of “WomanCode” developed an online program that targets hormonal imbalances through nutrition. “I help women eat in a way that supports the endocrine system as a whole,” Vitti says. “Supplements are an important way to expedite healing, but nutrition and the mind-body connection are the basis of my practice.”
there is no "trial" lmao. you would have flown out for nothing. it's a two minute thing, TOPS. he probably got appointed a public defender today. or maybe not even appointed one, just applied to be appointed one. the first or second time they just ask you to bring in paperwork proving you're poor and need a public defender. when you do get one, the lawyer just keeps adjourning it, like six or more times usually. then you're asked to get into a program or a detox or whatever. at the end he might get probation. each court appearance is less than 5 minutes long.
Two important things to note are that the long term safety effects of use are not known (but the drug has been in use for decades already) and spironolactone IS NOT SAFE in pregnancy, so it is commonly used in conjunction with birth control pills. This use of birth control pills also protects against abnormal growth of the lining of the uterus. Some women cannot take birth control pills, in which case it is important to use other means of birth control if you are sexually active while taking spironolactone.

Hola, hace unos 6 años me detectaron SOP, me mandaron la píldora ya que no habia otro tipo de tratamiento, me lo diagnosticaron por mi falta de regla y exceso de bello. Hace como unos 6 meses deje la píldora para ver como reaccionaba mi cuerpo, no reacciono bien, volvi a las reglas irregulares y ahora llevo 3 meses sin que me baje. vi vuestra pag de casualidad, y quisiera saber si tomando vuestras pastillas se regulara de forma natural la regla y si hay posiblidad de que baje.
Women who do not wish to become pregnant can be effectively treated for hirsutism with oral contraceptives. [77] Oral contraceptives slow hair growth in 60-100% of women with hyperandrogenemia. Therapy can be started with a preparation that has a low dose of estrogen and a nonandrogenic progestin. Preparations that have norgestrel and levonorgestrel should be avoided because of their androgenic activity. There is also a risk of thrombotic events in obese women who use oral contraceptives; therefore, the proper precautions should be exercised to prevent such events. Oral contraceptives containing cyproterone acetate are also very effective in the treatment of more severe hirsutism [78] ; however, this combination of agents has not been approved by the FDA for use in the United States.
Combination oral contraceptives, especially those with progestins of norgestimate, desogestrel, or drospirenone (because of their low androgenic effects), are among the most commonly used medications for hirsutism in women with PCOS.2 However, they are not approved by the U.S. Food and Drug Administration (FDA) for this use. One study found that women taking desogestrel/ethinyl estradiol (Apri) had lower hirsutism scores on a standardized scale (i.e., the Ferriman-Gallwey hirsutism score).34 Finasteride (Propecia) and flutamide (formerly Eulexin) are effective, but are FDA pregnancy categories X and D, respectively; the use of these agents for hirsutism is strictly off-label.2
PCOS is a heterogeneous disorder of uncertain cause.[23][24] There is some evidence that it is a genetic disease. Such evidence includes the familial clustering of cases, greater concordance in monozygotic compared with dizygotic twins and heritability of endocrine and metabolic features of PCOS.[7][23][24] There is some evidence that exposure to higher than typical levels of androgens in utero increases the risk of developing PCOS in later life.[25]
Diagnosis of PCOS may be difficult because the signs and symptoms can be subtle and varied. The most common manifestations include hirsutism, infertility, insulin resistance, and menstrual irregularities.2 Physicians can diagnose PCOS when other causes of the symptoms or laboratory abnormalities are excluded; when oligo-ovulation or anovulation, usually manifested as oligomenorrhea or amenorrhea, is present; and when there is clinically confirmed hyperandrogenism (e.g., hirsutism, acne). Although the ovaries may be polycystic, this is usually not necessary for diagnosis. There is debate over which criteria should be used (e.g., 1990 National Institutes of Health criteria,3 2003 Rotterdam consensus workshop criteria4). Guidelines suggest screening women with PCOS for other disorders, such as hyperlipidemia, and treating accordingly.5
Polycystic Ovarian Syndrome is a condition that affects a woman's hormonal levels. Women with PCOS produce higher than normal male hormones which cause them to skip their monthly periods and make it harder for them to get pregnant. PCOS also causes hair growth on the face and body, and baldness. So basically, women with PCOS have dense hair growth on those areas of their bodies where they're not supposed to have excess hair. But they start losing hair from their scalps, leading to baldness. PCOS can contribute to long-term health problems like diabetes and heart disorders.
Shahin et al. [65] Randomised controlled trial using with an active control arm for comparative effectiveness. One menstrual cycle. 147 women aged less than 35 years with un-explained infertility and recurrent clomiphene resistance for ovulation induction. Anovulatory participants were excluded (n = 28). Anovulation was diagnosed by serum oestradiol < 200 ng/ml and absence of a dominant ovarian follicle on day 9 of the menstrual cycle. Complete data sets available for 119 women. All women received Clomiphene citrate (clomiphene) 150 mg on menstrual cycle days 3–7. A randomised group also took Cimicifuga racemosa 20 mg per day between days 1–12. Cimicifuga racemosa described as ‘phytoestrogens’ was provided in the commercial preparation Klimadynon®, manufactured by Norica in Germany. A trigger injection (human chorionic gonadotropin, 10 000 IU) and timed intercourse was recommended when a dominant follicle > 17 mm was observed. Pregnancy rate measured as increasing serum human chorionic gonadotropin (HCG) over two days. Clinical pregnancy defined as detection of gestational sac with embryonic heart-beat. Endometrial thickness measured by ultrasound concurrent with follicle maturation monitoring. Number of days to ovulation (trigger injection) Serum concentration for FSH oestradiol and LH. Luteal progesterone measured on days 21–23 of the menstrual cycle. Miscarriage and multiple pregnancy rates. Pregnancy rate in clomiphene alone group was 20.3% and 43.3% in the clomiphene plus Cimicifuga racemosa group (P < 0.01). Clinical pregnancy rate in the combination group was 36.7% versus 13.6% in the clomiphene alone group (P < 0.01). Endometrial thickness in combination group was 8.9 (±1.4) versus 7.5 (±1.3) (p < 0.001). Days to ovulation in clomiphene alone group was 13.0 ± 1.1 and in the clomiphene plus Cimicifuga racemosa group 14.2 ± 1.3 (n.s.). Luteal progesterone peak (ng/ml) in combination group was 13.3 (±3.1) versus 9.3 (±2.0) in clomiphene alone group (p < 0.01). All other hormone measures were not significantly different No detailed current baseline criteria for other causes of infertility. Confounding factors include current male fertility status. This may have caused an imbalance between the two groups. There is no description of the distribution of excluded (anovulatory) participants between groups.
This is a great place for any event: there is a restaurant area for lunches and dinners, small tables for romantic evenings, a lounge area equipped with comfortable sofas and low tables, as well as a huge bar and a dance floor. AQUA LUNA’s summer terrace offers a splendid view onto the yacht club, the spires and roofs of the medieval Old Town, Vanšu Bridge, and modern business buildings – it is the ideal place to enjoy sunshine during the day, sunsets in evenings, and moonlight. In colder weather, AQUA LUNA warms hearts with its cosy atmosphere during long dinners by the fireplace and cheerful weekend parties.
PCOS es un complemento que ayuda a equilibrar los niveles hormonales (exceso de testosterona) en las mujeres con SOP. Esos desequilibrios hormonales provocan en la mayoría de los casos signos externos de hiperandrogenismo como exceso de vello, caída excesiva del cabello y acné. Al regular tus niveles hormonales, conseguirás suavizar y mejorar esos signos externos 🙂
PCOS's principal signs and symptoms are related to menstrual disturbances and elevated levels of male hormones (androgens). Menstrual disturbances can include delay of normal menstruation (primary amenorrhea), the presence of fewer than normal menstrual periods (oligomenorrhea), or the absence of menstruation for more than three months (secondary amenorrhea ). Menstrual cycles may not be associated with ovulation (anovulatory cycles) and may result in heavy bleeding.
Ang oral contraceptive pills (magkasamang estrogen at progestin) ay binibigay para maging regular ang regla ng babaeng may PCOS. Kapag nagreregla buwan buwan ang babaeng may PCOS ay hindi kumakapal ang lining ng matres at nakakatulong maiwasan ang kanser sa lining ng matres (endometrial cancer). Ang pag-inom ng contraceptive pills ay makakatulong din sa taghiyawat at sobrang buhok (bigote o sa dibdib at ibang parte ng katawan). Hindi rin mabubuntis habang umiinom ng pills.
Los andrógenos son un tipo de hormona (mensajero químico del cuerpo); a menudo se denominan hormonas “masculinas”, pero el cuerpo de la mujer también produce y usa algunas de estas hormonas. Las niñas y las mujeres con PCOS generalmente tienen niveles más elevados de andrógenos de lo normal. Estas elevaciones pueden ocasionar ciertos cambios en el cuerpo como:
Treatment of PCOS is individualized and depends on whether or not pregnancy is being sought. Dietary modifications, weight management and regular exercise are important factors in the management of this condition in all women with PCOS, regardless of whether they are trying to conceive or not. Cosmetic treatment options to treat excess body hair, particularly facial hair, include electrolysis, laser treatment and typical medication which act at the hair follicle. There are medical and surgical options to treat the hormone abnormalities associated with PCOS. For women who are not trying to conceive, medical treatment options include oral contraceptives, progestational agents (that induce periods), and drugs that block the production or action of androgens. In some cases, surgery is performed to cauterize the cysts, which results in a decrease in male hormone levels and return of ovulation in some women. Insulin modifiers are useful in those women with high insulin levels and insulin resistance but do not benefit all women with PCOS. The safety of these medications in pregnancy has not been established.
La metformina, un medicamento que se utiliza para tratar la diabetes, puede reducir la concentración de la insulina en sangre. A algunas chicas con síndrome de ovario poliquístico, les puede ayudar a controlar la ovulación y la concentración de andrógenos, lo que puede contribuir a regularizar el ciclo menstrual. Algunas adolescentes y mujeres de más edad tratadas con metformina también experimentan pérdida de peso y reducción de la hipertensión.
Although aromatase inhibitors have been used in women with PCOS as an alternative method to avoid the anti-estrogenic effect of CC on the endometrium, these compounds are not typically used in clinical practice to treat infertility in these patients. Their mechanism of action is based on reducing the peripheral conversion of androgens to estrogens in ovarian granulosa cells by blocking aromatase. Consequently, a decrease in estrogen serum levels and in its negative feedback in the hypothalamus and pituitary gland is noted, resulting in increased endogenous gonadotropin release 41.
Skin Conditions: Very frustrating for many women with this disorder, skin conditions are difficult to hide and can on occasion be painful. From mild to severe acne to the development of skin tags, skin conditions caused by Polycystic Ovarian Syndrome (PCOS) can be both a nuisance and an embarrassment. Additionally, women with PCOS can experience acanthosis nigricans, which is the development of dark, thick, almost velvet-like skin in several places on the body.2
Metformin has been studied specifically in adolescent PCOS women. Metformin therapy for 10 mo decreased fasting serum insulin levels in obese girls with PCOS[74].The positive effects of metformin in adolescents wore off within 3 mo of medication discontinuation[75]. Metformin in obese PCOS adolescents has shown improvements in IR by clamp studies, fasting measurements and OGTT after just 3 mo of therapy[76,77]. Other studies have found non-significant trends to improved IR by HOMA and OGTT-AUC in adolescent PCOS patients[78]. Metformin has also been shown to effectively contribute to BMI reduction in PCOS adolescents[79].

The unfortunate truth is that there is no cure for PCOS. But because the disorder can have a profound effect on your health and well-being, treatment is a must. There is one important thing to know about your options: Because the cause of PCOS is still unknown, appropriate therapies are based on a woman’s individual concerns. Is she bothered most about excess hair growth? Does she want to have a baby? Does she need to get her periods back on track?
Píldoras anticonceptivas orales. Contienen una combinación de hormonas femeninas. Estas pastillas pueden ayudar a normalizar el equilibrio de las hormonas y reducir o eliminar los síntomas. Esto reduce el riesgo de cáncer de endometrio para cuando la joven sea mayor. (No es necesario que una adolescente mantenga relaciones sexuales activas para tomar anticonceptivos orales).
Removing or slowing the growth of excess hair.  Shaving, bleaching, plucking, waxing, and applying over-the-counter hair-removal creams are effective, albeit temporarily methods to get rid of unwanted excess hair. For more permanent results, you might try laser hair removal or electrolysis but these are expensive, require repeated treatments, and are not guaranteed to be successful.
Maliban sa genes, ang isa pa sa mga posibleng PCOS causes ang insulin resistance. Ang insulin ay hormone na ginagawa sa pancreas, na pinaninigurado na nagagamit ng katawan ang sugar o asukal bilang enerhiya. Maaring mangyari na hindi tama ang paggamit ng katawan sa insulin, at dahil sa misuse na ito lalakas lalo ang demand para sa nasabing hormone. Ang masyadong maraming insulin ay magpapataas ng androgen production, kaya mahihirapan ang obaryo sa tamang ovulation process.
Ang potent antioxidants naroroon sa green tea, lalo catechins, ikaw ang mananagot para sa nagdadala down ang antas ng mga hormones na nagiging sanhi ng ovarian cysts at mga kaugnay na mga sintomas. Insulin mga antas ay din nagdala sa ilalim ng control sa pamamagitan ng green tea antioxidants. Pag-inom green tea araw-araw na epekto din ang bigat ng nakuha na ay karaniwang nakikita sa PCOS at tumutulong sa iyo upang malaglag ang labis na timbang (10, 11).

hello po nabasa kopo itong blog nyo. almost 1yr napo ako nag tetake ng Pills na nirekomenda po saken ng OBgyne doctor kopo. kase mo may PCOS po ako, kaso wala pong nangyayare, lalo pa po akong tumataba 🙁 eh samantalang 17 palang po ako. ano po ba magandang gawen? meron po ba akong pwedeng inumin na herbal medicine? Masydo napo kse akong matagal umiinom ng gamot baka po naman mag ka MAYOMA po ako tulad po ng lola ko 🙁 natatakot po ako, please help po doc-. thanks po
Same, anon. I'm pretty sedated always I don't remember what it feels like not be on it but it took me literal years to get here I can't imagine taking 400 off the bat and not be able to sleep. One of the 500 drugs in her system must make it less effective but it's a very heavy sedative. It's not fun tho either. Idk why someone would abuse it. She probably thinks it's the same thing ambien but it is definitely not. She's so dumb it's amazing.
Bilang kababaihan edad, iba't-ibang mga genetic at hormonal disorder nakakaapekto sa kanilang buhay at kalusugan. Isa tulad ng hormonal kawalan ng timbang na may kaugnayan disorder na nakakaapekto sa mga kababaihan ay Polycystic Ovarian Syndrome (PCOS). Sa ganitong syndrome, dahil sa isang kawalan ng timbang sa mga reproductive hormones, likido-punong cysts punan ang obaryo. Ang mga obaryo makakuha pinalaki at itigil ang gumagana nang normal (1, 2).
Have you all forgotten that she has her own fucking name tattooed on herself? She's a vain bitch, she just says that she finds herself ugly to get compliments. Also, she doesn't really want your advice, she just wants your pity and money. I have no sympathy for her, and even though I don't actively participate in the nitpicking most times, I think it's fair game. If she really wanted to get better, she wouldn't have dropped that therapy group as soon as she realized that it isn't fun to go through therapy.

PCOS-related hormonal dysfunction can result in irregular or absent ovulation (anovulation). A variety of drugs can be used to treat this, enhancing the quality of both the egg (oocyte) and ovulation. Typical, first-line treatments include the fertility drugs Clomid (clomiphene citrate) and Femara (letrozole). While Clomid is commonly used to enhance ovulation, Femara may work better in women with PCOS as it neither raises estrogen levels nor increases the risk of multiple births to the same degree as Clomid.
Given the conditions associated with PCOS, the Endocrine Society, the Androgen Excess and PCOS Society, and the American College of Obstetricians and Gynecologists recommend that clinicians evaluate patients' blood pressure at every visit and lipid levels at the time of diagnosis, and screen for type 2 diabetes with a two-hour oral glucose tolerance test regardless of a patient's body mass index. Patients should have repeat diabetes screening every three to five years, or more often if other indications for screening are present.19–21 The Endocrine Society further recommends depression screening, as well as screening for symptoms of obstructive sleep apnea in overweight and obese patients with PCOS.19 However, routine screening for nonalcoholic fatty liver disease or endometrial cancer (using ultrasonography) is not recommended.19
Studies have attempted for years to show an advantage to metformin for ovulation induction and as an adjunct to more advanced fertility treatments. In ovulatory PCOS women metformin was associated with improved serum and follicular fluid AMH levels as well as insulin values; these changes were not seen in anovulatory PCOS women[71]. Despite the demonstration of negative effects of IR on reproductive outcome, the vast majority of evidence does not show improvement in live birth rates when metformin is used strictly for fertility[72], although treatment does improve ovulatory status[72,73].
Habang remedyo sa bahay ay maaaring maging isang mahusay na pagpipilian para sa paggamot ng PCOS, naghahanap ng medikal na tulong ay din napakahalaga sa karamihan ng mga oras. Makipag-usap sa iyong doktor tungkol sa iyong mga plano upang bigyan ng bahay remedyong subukan mo upang ang mga pinakamahusay na posibleng mga kumbinasyon ng paggamot ay maaaring devised para sa iyo. Gayundin, PCOS ay madalas na nauugnay sa isang hindi malusog lifestyle at diyeta. Para sa ito, kami ay compiled ng isang listahan ng mga maingat mga panukala na maaari mong sundin upang labanan ang kundisyong ito.
Palm jaggery o palm asukal ay itinuturing na isang malusog na pagpipilian kaysa sa regular na puting asukal dahil sa pagmamay-ari nito upang kontrolin insulin at asukal sa dugo antas. Ito rin ay nagtataglay ng isang mababang glycemic index at magpapalaki enerhiya na antas. Ang mas mataas na mga antas ng insulin ay karaniwan sa mga PCOS pasyente, at ito hindi nilinis uri ng jaggery (o asukal) ay maaaring makabuluhang epekto sa iyong kalusugan kapag isinama sa iyong diyeta.
i wonder if luna's dad knows about how much she complains about him. all he would have to do is google her name to see how much she hates him. if i were her dad and i saw the shit she says about me, i'd kick her to the curb. poor dude is letting her have what she wants, when she wants it, and she STILL talks about him like he's a monster. maybe he's a piece of shit but damn, at least he's trying. what an ungrateful brat

About Blog Verity is the UK charity for women with PCOS and supports thousands of women living with polycystic ovary syndrome. Verity's mission is to improve the lives of women with polycystic ovary syndrome (PCOS) which we aim to do by: - Supporting and empowering women with PCOS - Improving the quality of, access to, and choice of treatments available.


she's mentioned before that "healthy foods" are "rich people foods" which is just total bullshit to anyone who's gone grocery shopping. she used to post cvs hauls of frozen pizzas and candy she'd get for herself and lurch and it would be one nights worth of food. cvs is overpriced as fuck but even at a normal store, buying exclusively prepackaged junk food is expensive as fuuuccck. buy some rice and beans.
Another study, a double-blind trial by Legro et al, found that letrozole is more effective than clomiphene in the treatment of infertility in PCOS. Based on treatment periods of up to five cycles, the study, which involved 750 anovulatory women with PCOS, found that the birth rates for letrozole and clomiphene were 27.5% and 19.1%, respectively. The rate of congenital abnormalities and the risk of pregnancy loss in the letrozole and clomiphene groups were found to be comparable, although the likelihood of twin births was lower with letrozole. [53, 54]
In some cases, a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small cysts. These cysts make hormones called androgens. Women with PCOS often have high levels of androgens. This can cause more problems with a woman’s menstrual cycle. And it can cause many of the symptoms of PCOS.

Oldfag from up top. Just saying yes, thank you and agreed. On all my medical paperwork it says that I have benzodiazepine dependency. I am physically dependent but I also function–I can work, I can manage my life. The thing that upsets me is that these days, I would never have been given benzos as the first med for my illness, I would have been given something that's less physically addictive and potentially dangerous. In the long term I believe benzos aren't good for you at all, and I'm certainly long term.
Some have tried to utilize ultrasound to detect IR. Of note, normoglycemic women often have the phenotypic criteria for polycystic ovaries on ultrasound[54], consistent with other data in young adolescents showing that polycystic ovaries by ultrasound appearance often does not correlate with either anovulatory menstrual cycles or metabolic abnormalities[55]. Therefore ultrasound is too non-specific to use with any reliability in measuring IR.

Algunas chicas que padecen un síndrome de ovario poliquístico se deprimen; en estos casos, puede serles de ayuda hablar con un terapeuta u otro profesional de la salud mental. Hablar con otras adolescentes y con mujeres de más edad que padecen la misma afección es una buena forma de compartir información sobre su tratamiento y de obtener apoyo. Tu médico te puede recomendar un grupo de apoyo en tu localidad.
Selection of herbal medicines for the management of PCOS often includes the combined prescription of Glycyrrhiza spp. and Paeonia lactiflora[72–75]. We found preliminary evidence for this combination for hyperandrogenism only, and the evidence was more robust for Glycyrrhiza spp. alone than when combined with Paeonia lactiflora. Comparatively, our findings for the combination of Peaonia lactiflora and Cinnamomum cassia demonstrated no change in androgen concentration, suggesting that the anti-androgen activity in the Glycyrrhiza spp. and Paeonia lactiflora combination more likely attributable to Glycyrrhiza spp. However our findings may be complicated by the aqueous extraction methods used in the Paeonia lactiflora and Cinnamomum cassia combination and the preclinical studies into the Glycorrhizza spp and Paeonia lactiflora combination. More research into the anti-androgen effects of the combination Glycyrrhiza spp. and Paeonia lactiflora is needed to clarify the anti-androgen mechanism particularly if this herbal combination remains cornerstone herbal management for hyperandrogenism.
The effectiveness of aromatase inhibitors in the treatment of PCOS remains controversial. A meta-analysis investigated 78 studies on the use of these medications in the infertility treatment of women with PCOS. Of these studies, 13 RCTs met the inclusion criteria. Six studies compared the use of letrozole versus CC and found that letrozole presented with a higher ovulation rate/patient (OR 2.90; 95% CI: 1.72- 4.88; p<0.0001); however, no significant differences in the rate of ovulation per cycle or better pregnancy, live birth, multiple pregnancy or miscarriages rates were noted. Letrozole also did not obtain better results regarding clinical pregnancy or live birth rates compared with placebo or CC + metformin in women with CC-resistant PCOS. The results of the comparison of the effects of letrozole and anastrozole on ovulation and pregnancy rates in women with CC-resistant PCOS are controversial 41.
The second-line pharmacological treatment of infertility in anovulatory women with PCOS includes the use of gonadotropins [recombinant follicle-stimulating hormone (FSHr) or human menopausal gonadotropin (HMG)] for timed intercourse or intrauterine insemination (IUI) 9. Due to the higher cost of this therapeutic modality, an evaluation of the tubal patency is recommended prior to initiating the ovarian stimulation with gonadotropins if this procedure was not performed prior to initiating CC treatment. If the fallopian tube is opened and the sperm concentration is suitable for in vivo fertilization, the ovarian stimulation begins with low doses of gonadotropins (37.5 to 75 IU/day or every other day) to achieve monofollicular growth and reduce the risk of complications (OHSS and multiple gestation) 25. US monitoring of the follicular growth (follicular diameter measurement) is mandatory in this case and the endogenous secretion of gonadotropins does not need to be inhibited with gonadotropin-releasing hormone analogues (GnRH-a) during the timed intercourse cycles. The administration of hCG (used to simulate the endogenous peak of luteinizing hormone for final oocyte maturation and ovulation triggering) is unnecessary because it does not increase the probability of conception during ovulation induction cycles for timed intercourse 21. It is important to note that if gonadotropin is chosen as the treatment option, the IUI has a higher likelihood of successful pregnancy compared with timed intercourse in patients with subfertility 26.
Regardless of what reasons women have for seeking diagnosis and treatment of PCOS, it is imperative for practitioners to assess a woman’s risk for CAD. Assessment should probably be made in all PCOS patients regardless of BMI. Especially in young women or adolescents, IR may be the first identifiable risk factor. Practitioners must recognize that no universal test for IR exists and must use good clinical judgment to assess metabolic status in women. Stimulated testing with OGTT may be more sensitive than fasting measurements. Women who demonstrate IR should be counseled on lifestyle modifications. Physicians should discuss with their patients a target BMI that is realistically obtainable. It is often advisable for patients to seek nutritional assessment and counseling to help with this goal. In many individuals, consideration should be given to pharmacological treatment. Although the most commonly used medication is metformin, other medications may be appropriate first line therapy, especially in women not actively seeking pregnancy.
Although metformin is associated with better clinical pregnancy rates (positive beta hCG) (pooled OR 2.31; 95% CI: 1.52 to 3.51; 8 trials; 707 women), there is no evidence of better live birth rates (the main variable used to evaluate the effectiveness of a treatment for infertility) when this drug is used alone (pooled OR 1.80, 95% CI: 0.52 to 6.16; 3 trials; 115 women) or in combination with CC (pooled OR 1.16; 95% CI: 0.85 to 1.56; 7 trials; 907 women) 36. From a reproduction standpoint, there is also no benefit for its use in short (less than four weeks) or long (more than four weeks) periods prior to starting CC treatment in women with PCOS. Therefore, the use of metformin should be restricted to the treatment of glucose intolerance or type 2 diabetes in women with PCOS and should not be used to induce ovulation 9,36.
PCOS is the most common cause of anovulatory (pronounced an-OV-yuh-luh-tawr-ee) infertility, meaning that the infertility results from the absence of ovulation, the process that releases a mature egg from the ovary every month. Many women don't find out that they have PCOS until they have trouble getting pregnant...Read more about PCOS NIH - National Institute of Child Health and Human Development
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