Medical and surgical treatment of reproductive outcomes in polycystic ovary syndrome

an overview of systematic reviews

Moustafa A. Gadalla, Robert J. Norman, Chau Tay, Danielle S. Hiam, Angela M. Melder, Jyotsna Pundir, Shakila Thangaratinam, Helena J Teede, Ben Willem J. Mol, Lisa Moran

Research output: Contribution to journalReview ArticleOtherpeer-review

Abstract

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.
Original languageEnglish
JournalInternational Journal of Fertility and Sterility
Volume13
Issue number4
DOIs
Publication statusPublished - Jan 2020

Keywords

  • Therapeutics
  • Polycystic Ovary Syndrome
  • Treatment outcome
  • Infertility

Cite this

Gadalla, Moustafa A. ; Norman, Robert J. ; Tay, Chau ; Hiam, Danielle S. ; Melder, Angela M. ; Pundir, Jyotsna ; Thangaratinam, Shakila ; Teede, Helena J ; Mol, Ben Willem J. ; Moran, Lisa. / Medical and surgical treatment of reproductive outcomes in polycystic ovary syndrome : an overview of systematic reviews. In: International Journal of Fertility and Sterility. 2020 ; Vol. 13, No. 4.
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abstract = "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.",
keywords = "Therapeutics, Polycystic Ovary Syndrome, Treatment outcome, Infertility",
author = "Gadalla, {Moustafa A.} and Norman, {Robert J.} and Chau Tay and Hiam, {Danielle S.} and Melder, {Angela M.} and Jyotsna Pundir and Shakila Thangaratinam and Teede, {Helena J} and Mol, {Ben Willem J.} and Lisa Moran",
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Medical and surgical treatment of reproductive outcomes in polycystic ovary syndrome : an overview of systematic reviews. / Gadalla, Moustafa A.; Norman, Robert J.; Tay, Chau; Hiam, Danielle S.; Melder, Angela M.; Pundir, Jyotsna; Thangaratinam, Shakila; Teede, Helena J; Mol, Ben Willem J.; Moran, Lisa.

In: International Journal of Fertility and Sterility, Vol. 13, No. 4, 01.2020.

Research output: Contribution to journalReview ArticleOtherpeer-review

TY - JOUR

T1 - Medical and surgical treatment of reproductive outcomes in polycystic ovary syndrome

T2 - an overview of systematic reviews

AU - Gadalla, Moustafa A.

AU - Norman, Robert J.

AU - Tay, Chau

AU - Hiam, Danielle S.

AU - Melder, Angela M.

AU - Pundir, Jyotsna

AU - Thangaratinam, Shakila

AU - Teede, Helena J

AU - Mol, Ben Willem J.

AU - Moran, Lisa

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - Therapeutics

KW - Polycystic Ovary Syndrome

KW - Treatment outcome

KW - Infertility

UR - http://ijfs.ir/journal/article/abstract/5608

U2 - 10.22074/ijfs.2020.5608

DO - 10.22074/ijfs.2020.5608

M3 - Review Article

VL - 13

JO - International Journal of Fertility and Sterility

JF - International Journal of Fertility and Sterility

SN - 2008-076X

IS - 4

ER -