New concepts in the management of polycystic ovary syndrome

Roy Homburg
In: Human Assisted Reproductive Technology · 2011 · pp. 110–118 · doi:10.1017/cbo9780511734755.012 · W1542774135
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Abstract

Ovarian endometriomas are a common and specific manifestation of the disease endometriosis. In vitro fertilization (IVF) treatment in the words of the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group (SIG) on Endometriosis appears to be appropriate in patients with advanced endometriosis, which is frequently associated with adhesions, ovarian endometriomas, and tubal obstruction. Ovarian responsiveness to hyperstimulation plays a crucial role in determining the success rate of IVF. There are currently insufficient data to clarify whether the endometrioma-related damage to ovarian responsiveness precedes or follows surgery. Elucidation of this point is of utmost interest since it would strongly impact on the decision of whether to operate on women with endometriomas and who are selected for IVF. At present, there appears to be evidence supporting both an endometrioma-related injury and a surgery-mediated damage. The physiological mechanisms leading to ovulation are abnormal in ovaries with endometriomas.
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Human Assisted Reproductive Technology Buy print or eBook [Opens in a new window] Future Trends in Laboratory and Clinical Practice - Human Assisted Reproductive Technology - Human Assisted Reproductive Technology - Copyright page - Dedication - Contents - Contributors - Preface - Acknowledgments - Chapter 1 Use of robotics in reproductive surgery - Chapter 2 Removal of hydrosalpinges and uterine leiomyoma to improve IVF outcome - Chapter 3 Ovarian endometriomas: - Chapter 4 Impact of uterine cavity abnormalities on IVF and pretreatment cavity evaluation - Chapter 5 Sperm retrieval techniques - Chapter 6 New concepts in ovarian stimulation - Chapter 7 GnRH antagonists in ART - Chapter 8 Pharmacogenetics of ovarian stimulation in the twenty-first century - Chapter 9 Non-invasive diagnosis of endometriosis with proteomic technologies - Chapter 10 Antiangiogenic agents for endometriosis - Chapter 11 New concepts in the management of polycystic ovary syndrome - Chapter 12 Adjuvant therapy to increase implantation rates - Chapter 13 Ovarian hyperstimulation syndrome - Chapter 14 The evidence-based practice of assisted reproduction - Chapter 15 Three-dimensional in vitro ovarian follicle culture - Chapter 16 Artificial gametes - Chapter 17 Current status and future trends of the clinical practice of human oocyte in vitro maturation - Chapter 18 Oocyte and zona imaging - Chapter 19 Granulosa cells and their impact on human ART - Chapter 20 Sperm diagnosis: - Chapter 21 Embryo culture in the twenty-first century - Chapter 22 Morphometric analyses of embryos - Chapter 23 Embryo biopsy: - Chapter 24 Analysis of the embryonic transcriptome - Chapter 25 Analysis of embryo-derived factors as markers of developmental potential and viability - Chapter 26 Proteomics analysis of the endometrium and embryo. Can we improve IVF outcome? - Chapter 27 Analysis of embryo metabolism and the metabolome to identify the most viable embryo within a cohort - Chapter 28 Oocyte and embryo cryopreservation - Index Published online by Cambridge University Press: 16 May 2011 By Book contents - Human Assisted Reproductive Technology - Human Assisted Reproductive Technology - Copyright page - Dedication - Contents - Contributors - Preface - Acknowledgments - Chapter 1 Use of robotics in reproductive surgery - Chapter 2 Removal of hydrosalpinges and uterine leiomyoma to improve IVF outcome - Chapter 3 Ovarian endometriomas: - Chapter 4 Impact of uterine cavity abnormalities on IVF and pretreatment cavity evaluation - Chapter 5 Sperm retrieval techniques - Chapter 6 New concepts in ovarian stimulation - Chapter 7 GnRH antagonists in ART - Chapter 8 Pharmacogenetics of ovarian stimulation in the twenty-first century - Chapter 9 Non-invasive diagnosis of endometriosis with proteomic technologies - Chapter 10 Antiangiogenic agents for endometriosis - Chapter 11 New concepts in the management of polycystic ovary syndrome - Chapter 12 Adjuvant therapy to increase implantation rates - Chapter 13 Ovarian hyperstimulation syndrome - Chapter 14 The evidence-based practice of assisted reproduction - Chapter 15 Three-dimensional in vitro ovarian follicle culture - Chapter 16 Artificial gametes - Chapter 17 Current status and future trends of the clinical practice of human oocyte in vitro maturation - Chapter 18 Oocyte and zona imaging - Chapter 19 Granulosa cells and their impact on human ART - Chapter 20 Sperm diagnosis: - Chapter 21 Embryo culture in the twenty-first century - Chapter 22 Morphometric analyses of embryos - Chapter 23 Embryo biopsy: - Chapter 24 Analysis of the embryonic transcriptome - Chapter 25 Analysis of embryo-derived factors as markers of developmental potential and viability - Chapter 26 Proteomics analysis of the endometrium and embryo. Can we improve IVF outcome? - Chapter 27 Analysis of embryo metabolism and the metabolome to identify the most viable embryo within a cohort - Chapter 28 Oocyte and embryo cryopreservation - Index The majority of women with anovulation or oligoovulation due to polycystic ovary syndrome (PCOS) often have clinical and/or biochemical evidence of hyperandrogenism. This chapter describes the treatment with clomiphene citrate (CC), aromatase inhibitors (AIs), gonadotropins, and metformin followed by a discussion on the management of women with PCOS undergoing in vitro fertilization (IVF). It deals with the combined treatment of clomiphene with metformin. In women with PCOS, metformin is said to lower fasting insulin concentrations but also probably acts directly on theca cells and attenuates androgen production. The aim of the chronic low-dose step-up protocol is to obtain the ovulation of a single follicle. While results of IVF for women with PCOS are generally satisfactory compared with those with normal ovaries, ovarian stimulation protocols must be adapted accordingly to avoid the major pitfall of ovarian hyperstimulation syndrome (OHSS) in these women. - Type - Chapter - Information - Human Assisted Reproductive TechnologyFuture Trends in Laboratory and Clinical Practice, pp. 110 - 118Publisher: Cambridge University PressPrint publication year: 2011 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. 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