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Chapter 15 - Ovulation Induction for Anovulatory Infertility

Published online by Cambridge University Press:  03 June 2019

Jane A. Stewart
Affiliation:
Newcastle Hospitals NHS Foundation Trust
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Summary

Folic acid should be taken at a daily dose of 400 mcg or, in those who are obese, 5 mg. There is debate about the restriction of fertility treatment to women who are overweight, although there is no doubt that obesity has a significant adverse impact on reproductive outcome. It influences not only the chance of conception but also the response to fertility treatment and increases the risk of miscarriage, congenital anomalies and pregnancy complications [1]. The British Fertility Society guidance suggests that treatment should be deferred until the BMI is less than 35 kg/m2, although in those with more time (e.g. less than 37 years, normal ovarian reserve) a weight reduction to a BMI of less than 30 kg/m2 is preferable [2]. Even a moderate weight loss of 5–10% of body weight can be sufficient to restore fertility and improve metabolic parameters.

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Publisher: Cambridge University Press
Print publication year: 2019

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References

Balen, AH, Dresner, M, Scott, EM, Drife, JO. Should obese women with polycystic ovary syndrome (PCOS) receive treatment for infertility? BMJ 2006: 332: 434435Google Scholar
Balen, AH, Anderson, R. Impact of obesity on female reproductive health: British Fertility Society, Police and Practice Guidelines. Hum Fertil 2007; 10: 195206.Google Scholar
Shoham, Z, Balen, AH, Patel, A, Jacobs, HS. Results of ovulation induction using human menopausal gonadotropins or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients. Fertil Steril 1991; 56: 1048–53.CrossRefGoogle ScholarPubMed
White, DM, Polson, DW, Kiddy, D et al. Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women. J Clin Endocrinol Metab 1996; 81: 3821–4.Google Scholar
European and Australian Multicentre Study. Co-treatment with growth hormone and gonadotrophin for ovulation induction in hypogonadotrophic patients: a prospective randomized, placebo controlled, dose response study. Fertil Steril 1995; 64: 917–23.Google Scholar
Colao, A, Abs, R, Bárcena, DG, Chanso, P, Paulus, W, Kleinberg, DL. Pregnancy outcomes following cabergoline treatment: extended results from a 12-year observational study. Clin Endocrinol 2008; 68: 6671.Google Scholar
Balen, AH, Morley, LC, Misso, M, Franks, S, Legro, RS, Wijeyaratne, CN, Stener-Victorin, E, Norman, RJ, Fauser, BJCM, Teede, H. WHO recommendations for the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS). Hum Reprod Update 2016; doi: 10.1093/humupd/dmw025.CrossRefGoogle Scholar
Current Management of Polycystic Ovary Syndrome. Edited by Balen, Adam, Franks, Steve, Homburg, Roy and Kehoe, Sean. Proceedings of 59th RCOG Study Group, RCOG Press, London 2010.CrossRefGoogle Scholar
Moran, LJ, Hutchison, SK, Norman, RJ, Teede, HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011; Issue 2. Art. No.: CD007506.CrossRefGoogle Scholar
Scholtz, S, Le Roux, C, Balen, AH. The role of bariatric surgery in the management of female fertility. RCOG Scientific Impact Paper number 17, October 2015. www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_17.pdfGoogle Scholar
Beck, JI, Boothroyd, C, Proctor, M, Farquhar, C, Hughes, E. Oral anti-oestrogens and medical adjuncts for subfertility associated with anovulation. Cochrane Database Syst Rev 2005; Issue 1. Art. No.: CD002249; doi: 10.1002/14651858.CD002249.pub3.Google Scholar
Kousta, E, White, DM, Franks, S. Modern use of clomifene citrate in induction of ovulation. Hum Reprod Update 1997; 3: 359–65.Google Scholar
Shoham, Z, Borenstein, R, Lunenfeld, B, Pariente, C. Hormonal profiles following clomifene citrate therapy in conception and non-conception cycles. Clin Endocrinol 1990; 33: 271–8.Google Scholar
Casper, RF, Mitwally, MF. 2006 Review: aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab 2006 Mar; 91(3): 760–71CrossRefGoogle ScholarPubMed
Legro, RS, Brzyski, RG, Diamond, MP, Coutifaris, C, Schlaff, WD, Casson, P, Christman, GM, Huang, H, Yan, Q, Alvero, R, Haisenleder, DJ, Barnhart, KT, Bates, GW, Usadi, R, Lucidi, S, Baker, V, Trussell, JC, Krawetz, SA, Snyder, P, Ohl, D, Santoro, N, Eisenberg, E, Zhang, H, Network, NRM. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014; 371: 119–29.Google Scholar
Franik, S, Kremer, JA, Nelen, WL, Farquhar, C. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2014; Issue 2. Art. No.: CD010287. doi: 10.1002/14651858.CD010287.pub2.Google Scholar
Morley, LC, Tang, T, Yasmin, E, Lord, JM, Norman, RJ, Balen, AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2015; Issue 9. Art. No.: CD003053. doi: 10.1002/14651858.CD003053.pub6.Google Scholar
Morin-papunen, L, Rantala, AS, Unkila-Kallio, L, Tiitinen, A, Hippeläinen, M, Perheentupa, A, Tinkanen, H, Bloigu, R, Puukka, K, Ruokonen, A, Tapanainen, JS. Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): a multicenter, double-blind, placebo-controlled randomized trial. J Clin Endocrinol Metab 2012; 97: 1492–500.Google Scholar
Naderpoor, N, Shorakae, S, de Courten, B, Misso, ML, Moran, LJ, Teede, HJ. Metformin and lifestyle modification in PCOS: systematic review and meta-analysis. Human Reprod Update 2015; 21: 560574.Google Scholar
Bayram, N, van Wely, M, Kaaijk, EM, Bossuyt, PMM, van der Veen, F. Using an electrocautery strategy or recombinant FSH to induce ovulation in polycystic ovary syndrome: a randomised controlled trial. BMJ 2004; 328: 192–5.Google Scholar
Boomsma, CM, Eijkemans, MJ, Hughes, EG, Visser, GH, Fauser, BC, Macklon, NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006; 12, 673–83.Google Scholar

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