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Comparative Study between Metformin and Laparoscopic Ovarian Drilling for Ovulation Induction, Achievement of Pregnancy and Live Birth in Asian Women with Polycystic Ovarian Syndrome: A Prospective Trial

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DOI: 10.4236/oalib.1100645    1,367 Downloads   1,666 Views  

ABSTRACT

Objective: To compare the efficacy of metformin and laparoscopic ovarian drilling to be used in anovulatory patients with polycystic ovarian syndrome (PCOS) for ovulation induction and pregnancy achievement. Materials and Methods: Setting and Design: A prospective clinical trial conducted in the outpatient department of Gynaecology and Obstetrics of BIRDEM hospital from August 2008 to August 2013. Patient(s): Three hundred and eight newly diagnosed patients with PCOS based on ESHRE/ASRM criteria. These patients were assigned to two groups: Group 1 (152 patients) received 500 mg of metformin three times a day; Group 2 (156 patients) received laparoscopic ovarian drilling. Main Outcome Measure(s): Rate of ovulation, pregnancy rate (PR), and live birth. Ovulation was monitored by serum progesterone, transvaginal sonography up to six cycles or till pregnancy occurred upto six months. Result(s): The ovulation rate was 68.4% in the metformin group, 59% in the laparoscopy treatment group. The pregnancy rate was (20.1% and 16.6%) and live birth rate was (18.4% and 15.4%) in metformin and laparoscopy treatment groups, respectively. The rate of spontaneous first trimester loss was three and two in metformin and laparoscopy group respectively. There were no ectopic pregnancies in metformin group and two in laparoscopy group. There was no second trimester pregnancy loss in metformin group, three in laparoscopy group. There were no multiple pregnancies in metformin group, two in laparoscopy group.

Conflicts of Interest

The authors declare no conflicts of interest.

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Jahan, S. , Nayer, R. , Habib, S. , Khan, M. , Jahan, A. and Sharmin, F. (2014) Comparative Study between Metformin and Laparoscopic Ovarian Drilling for Ovulation Induction, Achievement of Pregnancy and Live Birth in Asian Women with Polycystic Ovarian Syndrome: A Prospective Trial. Open Access Library Journal, 1, 1-7. doi: 10.4236/oalib.1100645.

References

[1] Frank, S. (1995) Polycystic Ovary Syndrome. New England Journal of Medicine, 333, 833-861.
[2] Stein, I.F. and Leventhal, M.L. (1934) Amenorrhea Associated with Bilateral Polycystic Ovaries. American Journal of Obstetrics & Gynecology, 29, 181-191.
[3] Wild, R.A. (2002) Long-Term Health Consequences of PCOS. Human Reproduction Update, 8, 231-241.
http://dx.doi.org/10.1093/humupd/8.3.231
[4] The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome. Human Reproduction, 19, 41-47.
[5] Hull, M.G. (1987) Epidemiology of Infertility and Polycystic Ovarian Disease: Endocrinological and Demographic Studies. Gynecological Endocrinology, 1, 235-245.
http://dx.doi.org/10.3109/09513598709023610
[6] Homburg, R., Armar, N.A., Eshel, A., Adams, J. and Jacobs, H.S. (1988) Influence of Serum Luteinizing Hormone Concentrations on Ovulation, Conception and Early Pregnancy Loss in Polycystic Ovary Syndrome. BMJ, 297, 1024-1026.
http://dx.doi.org/10.1136/bmj.297.6655.1024
[7] Boomsma, C.M., Eijkemans, M.J., Hughes, E.G., Visser, G.H., Fauser, B.C. and Macklon, N.S. (2006) A Meta-Analysis of Pregnancy Outcomes in Women with Polycystic Ovary Syndrome. Human Reproduction Update, 12, 673-683.
http://dx.doi.org/10.1093/humupd/dml036
[8] Kim, H., Taylor, A.E. and Barbieri, R.L. (2000) Insulin Sensitizers and Polycystic Ovary Syndrome: Can a Diabetes Medication Treat Infertility? Fertility and Sterility, 73, 1097-1098.
http://dx.doi.org/10.1016/S0015-0282(00)00540-9
[9] Velazquez, E.M., Mendoza, S., Hamer, T., Sosa, F. and Glueck, C.J. (1994) Metformin Therapy in Polycystic Ovary Syndrome Reduces Hyperinsulinemia, Insulin Resistance, Hyperandrogenemia, and Systolic Blood Pressure, While Facilitating Normal Menses and Pregnancy. Metabolism, 43, 647-654.
http://dx.doi.org/10.1016/0026-0495(94)90209-7
[10] Bailey, C.S. and Turner, R.C. (1996) Metformin Drug Therapy. New England Journal of Medicine, 334, 574-579.
http://dx.doi.org/10.1056/NEJM199602293340906
[11] De Fronzo, R.A., Barzilai, N. and Simonson, D.C. (1991) Mechanism of Metformin Action in Obese and Lean Noninsulin-Dependent Diabetic Subjects. Journal of Clinical Endocrinology and Metabolism, 73, 1294-1301.
http://dx.doi.org/10.1210/jcem-73-6-1294
[12] Attia, G.R., Rainey, W.E. and Carr, B.R. (2001) Metformin Directly Inhibits Androgen Production in Human Theca Cells. Fertility and Sterility, 76, 517-524.
http://dx.doi.org/10.1016/S0015-0282(01)01975-6
[13] Nestler, J.E., Jakubowicz, D.J., Evans, W.S. and Pasquali, R. (1998) Effects of Metformin on Spontaneous and Clomiphene Induced Ovulation in the Polycystic Ovary Syndrome. New England Journal of Medicine, 338, 1876-1880.
http://dx.doi.org/10.1056/NEJM199806253382603
[14] Velazquez, E.M., Acosta, A. and Mendoza, S.G. (1997) Menstrual Cyclicity after Metformin Therapy in Polycystic Ovary Syndrome. Obstetrics & Gynecology, 90, 392-395.
http://dx.doi.org/10.1016/S0029-7844(97)00296-2
[15] Moghetti, P., Castello, R., Negri, C., Tosi, F., Perrone, F., Caputo, M., et al. (2000) Metformin Effects on Clinical Features, Endocrine and Metabolic Profiles, and Insulin Sensitivity in Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled 6 Month Trial, Followed by Open, Long-Term Clinical Evaluation. Journal of Clinical Endocrinology and Metabolism, 85, 139-146.
[16] Ehrmann, D.A., Cavaghan, M.K., Imperial, J., Sturis, J., Rosenfield, R.L. and Polonsky, K.S. (1997) Effects of Metformin on Insulin Secretion, Insulin Action, and Ovarian Steroidogenesis in Women with Polycystic Ovary Syndrome. Journal of Clinical Endocrinology and Metabolism, 82, 524-530.
[17] Sahin, Y., Yirmibes, U., Kelestimur, F. and Aygen, E. (2004) The Effects of Metformin on Insulin Resistance, Clomiphene-Induced Ovulation and Pregnancy Rates in Women with Polycystic Ovary Syndrome. European Journal of Obstetrics, Gynecology and Reproductive Biology, 113, 214-220.
[18] Norman, R.J. (2004) Metformin—Comparison with Other Therapies in Ovulation Induction in Polycystic Ovary Syndrome. Journal of Clinical Endocrinology & Metabolism, 89, 4797-4800.
http://dx.doi.org/10.1210/jc.2004-1658
[19] Badawy, A., Mosbah, A., Tharwat, A. and Eid, M. (2009) Extended Letrozole Therapy for Ovulation Induction in Clomiphene-Resistant Women with Polycystic Ovary Syndrome: A Novel Protocol. Fertility and Sterility, 92, 236-239.
http://dx.doi.org/10.1016/j.fertnstert.2008.04.065
[20] Kar, S. (2012) Clomiphene Citrate or Letrozole as First-Line Ovulation Induction Drug in Infertile PCOS Women: A Prospective Randomized Trial. Journal of Human Reproductive Sciences, 5, 262-265.
http://dx.doi.org/10.4103/0974-1208.106338
[21] Elizur, S.E. and Tulandi, T. (2008) Drugs in Infertility and Fetal Safety. Fertility and Sterility, 89, 1595-1602.
http://dx.doi.org/10.1016/j.fertnstert.2008.02.092
[22] Buttram Jr., V.C. and Vacquero, C. (1975) Postovarian Wedge Resection Adhesive Disease. Fertility and Sterility, 26, 874-876.
[23] Gjonnaess, H. (1984) Polycystic Ovarian Syndrome Treated by Ovarian Electrocautery through the Laparoscope. Fertility and Sterility, 41, 20-25.
[24] Keckstein, J. (1989) Laparoscopic Treatment of Polycystic Ovarian Syndrome in Laparoscopic Surgery. Baillière’s Clinical Obstetrics and Gynaecology, 3, 563-581.
http://dx.doi.org/10.1016/S0950-3552(89)80009-4
[25] Lord, J.M., Flight, I.H.K. and Norman, R.J. (2003) Metformin in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis. British Medical Journal, 327, 951-953.
http://dx.doi.org/10.1136/bmj.327.7421.951
[26] Lord, J.M., Flight, I.H.K. and Norman, R.J. (2003) Insulin-Sensitising Drugs (Metformin, Troglitazone, Rosiglitazone, Pioglitazone, D-Chiro-Inositol) for Polycystic Ovarian Syndrome. Cochrane Database of Systematic Reviews, 2003, Article ID: CD003053.
[27] Mitwally, M.F.M. and Casper, R.F. (2002) Aromatase Inhibition for Ovarian Stimulation: Future Avenues for Infertility Management. Current Opinion in Obstetrics & Gynecology, 14, 255-263.
http://dx.doi.org/10.1097/00001703-200206000-00003
[28] Hsu, M.I., Liou, T.H., Chou, S.Y., Chang, C.Y. and Hsu, C.S. (2007) Diagnostic Criteria for Polycystic Ovary Syndrome in Taiwanese Chinese Women: Comparison between Rotterdam 2003 and NIH 1990. Fertility and Sterility, 88, 727-729.
http://dx.doi.org/10.1016/j.fertnstert.2006.11.149
[29] Aruna, J., Mittal, S., Kumar, S., Misra, R., Dadhwal, V. and Vimala, N. (2004) Metformin Therapy in Women with Polycystic Ovary Syndrome. International Journal of Gynaecology and Obstetrics, 87, 237-241.
[30] Sugimoto, O. and Aono (1993) The Committee for Reproductive and Endocrine in Japan Society of Obstetrics and Gynaecology. Annual Report (1991-1992) for the Determination of Diagnostic Criteria for PCOS. Acta Obstetrica et Gynaecologica Japonica, 45, 1359-1367.
[31] Nestler, J.E. and Jakubowicz, D.J. (1996) Decreases in Ovarian Cytochrome P450c17α Activity and Serum Free Testosterone after Reduction of Insulin Secretion in Polycystic Ovary Syndrome. New England Journal of Medicine, 335, 617-623.
http://dx.doi.org/10.1056/NEJM199608293350902
[32] Fleming, R., Hopkinson, Z.E., Wallace, A.M., Greer, I.A. and Sattar, N. (2002) Ovarian Function and Metabolic Factors in Women with Oligomenorrhea Treated with Metformin in a Randomized Double Blind Placebo-Controlled Trial. Journal of Clinical Endocrinology & Metabolism, 87, 569-574.
http://dx.doi.org/10.1210/jcem.87.2.8261
[33] Balen, A. (2000) Ovulation Induction for Polycystic Ovary Syndrome. Fertility and Sterility, 3, 106-111.

  
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