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Medical and Surgical Treatment of Reproductive Outcomes in Polycystic Ovary Syndrome: An Overview of Systematic Reviews
Polycystic ovary syndrome (PCOS) is a common, complex condition that affects up to 18% of reproductive- aged women, causing reproductive, metabolic and psychological dysfunctions. We performed an overview and appraisal of methodological quality of systematic reviews that assessed medical and surgica...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Royan Institute
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875858/ https://www.ncbi.nlm.nih.gov/pubmed/31710185 http://dx.doi.org/10.22074/ijfs.2020.5608 |
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author | Gadalla, Moustafa A. Norman, Robert J. Tay, Chau T Hiam, Danielle S. Melder, Angela Pundir, Jyotsna Thangaratinam, Shakila Teede, Helena J Mol, Ben W. J. Moran, Lisa J. |
author_facet | Gadalla, Moustafa A. Norman, Robert J. Tay, Chau T Hiam, Danielle S. Melder, Angela Pundir, Jyotsna Thangaratinam, Shakila Teede, Helena J Mol, Ben W. J. Moran, Lisa J. |
author_sort | Gadalla, Moustafa A. |
collection | PubMed |
description | Polycystic ovary syndrome (PCOS) is a common, complex condition that affects up to 18% of reproductive- aged women, causing reproductive, metabolic and psychological dysfunctions. We performed an overview and appraisal of methodological quality of systematic reviews that assessed medical and surgical treatments for reproductive outcomes in women with PCOS. Databases (MEDLINE, EMBASE, CINAHL PLUS and PROSPERO) were searched on the 15th of September 2017. We included any systematic review that assessed the effect of medical or surgical management of PCOS on reproductive, pregnancy and neonatal outcomes. Eligibility assessment, data extraction and quality assessment by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. We identified 53 reviews comprising 44 reviews included in this overview; the majority were 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 better than laparoscopic ovarian drilling (LOD). LOD was associated with lower multiple pregnancy rates than other medical treatments. In women with PCOS undergo- ing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), the addition of metformin to gonadotro- phins resulted in less ovarian hyperstimulation syndrome (OHSS), and higher pregnancy and live birth rates than gonadotrophins alone. Gonadotrophin releasing hormone (GnRH) antagonist was associated with less OHSS, gonadotrophin units and shorter stimulation length than GnRH agonist. Letrozole appears to be a good first line treatment and gonadotrophins, as a second line treatment, for anovulatory women with PCOS. LOD results in lower multiple pregnancy rates. However, due to the heterogeneous nature of the included popula- tions of women with PCOS, further larger scale trials are needed with more precise assessment of treatments according to heterogeneous variants of PCOS. |
format | Online Article Text |
id | pubmed-6875858 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Royan Institute |
record_format | MEDLINE/PubMed |
spelling | pubmed-68758582020-01-01 Medical and Surgical Treatment of Reproductive Outcomes in Polycystic Ovary Syndrome: An Overview of Systematic Reviews Gadalla, Moustafa A. Norman, Robert J. Tay, Chau T Hiam, Danielle S. Melder, Angela Pundir, Jyotsna Thangaratinam, Shakila Teede, Helena J Mol, Ben W. J. Moran, Lisa J. Int J Fertil Steril Systematic Review Polycystic ovary syndrome (PCOS) is a common, complex condition that affects up to 18% of reproductive- aged women, causing reproductive, metabolic and psychological dysfunctions. We performed an overview and appraisal of methodological quality of systematic reviews that assessed medical and surgical treatments for reproductive outcomes in women with PCOS. Databases (MEDLINE, EMBASE, CINAHL PLUS and PROSPERO) were searched on the 15th of September 2017. We included any systematic review that assessed the effect of medical or surgical management of PCOS on reproductive, pregnancy and neonatal outcomes. Eligibility assessment, data extraction and quality assessment by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. We identified 53 reviews comprising 44 reviews included in this overview; the majority were 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 better than laparoscopic ovarian drilling (LOD). LOD was associated with lower multiple pregnancy rates than other medical treatments. In women with PCOS undergo- ing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), the addition of metformin to gonadotro- phins resulted in less ovarian hyperstimulation syndrome (OHSS), and higher pregnancy and live birth rates than gonadotrophins alone. Gonadotrophin releasing hormone (GnRH) antagonist was associated with less OHSS, gonadotrophin units and shorter stimulation length than GnRH agonist. Letrozole appears to be a good first line treatment and gonadotrophins, as a second line treatment, for anovulatory women with PCOS. LOD results in lower multiple pregnancy rates. However, due to the heterogeneous nature of the included popula- tions of women with PCOS, further larger scale trials are needed with more precise assessment of treatments according to heterogeneous variants of PCOS. Royan Institute 2020 2019-11-11 /pmc/articles/PMC6875858/ /pubmed/31710185 http://dx.doi.org/10.22074/ijfs.2020.5608 Text en The Cell Journal (Yakhteh) is an open access journal which means the articles are freely available online for any individual author to download and use the providing address. The journal is licensed under a Creative Commons Attribution-Non Commercial 3.0 Unported License which allows the author(s) to hold the copyright without restrictions that is permitting unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited. http://creativecommons.org/licenses/by/3/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Systematic Review Gadalla, Moustafa A. Norman, Robert J. Tay, Chau T Hiam, Danielle S. Melder, Angela Pundir, Jyotsna Thangaratinam, Shakila Teede, Helena J Mol, Ben W. J. Moran, Lisa J. Medical and Surgical Treatment of Reproductive Outcomes in Polycystic Ovary Syndrome: An Overview of Systematic Reviews |
title | Medical and Surgical Treatment of Reproductive
Outcomes in Polycystic Ovary Syndrome:
An Overview of Systematic Reviews |
title_full | Medical and Surgical Treatment of Reproductive
Outcomes in Polycystic Ovary Syndrome:
An Overview of Systematic Reviews |
title_fullStr | Medical and Surgical Treatment of Reproductive
Outcomes in Polycystic Ovary Syndrome:
An Overview of Systematic Reviews |
title_full_unstemmed | Medical and Surgical Treatment of Reproductive
Outcomes in Polycystic Ovary Syndrome:
An Overview of Systematic Reviews |
title_short | Medical and Surgical Treatment of Reproductive
Outcomes in Polycystic Ovary Syndrome:
An Overview of Systematic Reviews |
title_sort | medical and surgical treatment of reproductive
outcomes in polycystic ovary syndrome:
an overview of systematic reviews |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875858/ https://www.ncbi.nlm.nih.gov/pubmed/31710185 http://dx.doi.org/10.22074/ijfs.2020.5608 |
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