Abstract
Polycystic ovarian syndrome is the most well-known endocrine condition among women of this generation (PCOS). Symptoms of hyperandrogenism, irregular menstrual periods, and insulin resistance are all traits associated with PCOS. In women with PCOS, the chance of having problems including infertility, insulin resistance, and type 2 diabetes increases. The PCOS board hopes to reduce body weight and insulin levels, restore fertility, control excessive hair growth on the body or scalp, re-establish the regular feminine cycle, and avoid misunderstandings. Insulin sensitizers have been one of the most common metabolic modulators, but their effectiveness has been sporadic. Insulin resistance, followed by thiazolidinediones, is central to the pathophysiology of PCOS, with metformin having nearly similar efficacy. In the management of PCOS, statins and incretins are newer therapies with obvious metabolic targets. Vitamin D, acarbose, and myoinositol are just a few of the reciprocal and optional clinical treatments that have been proved to be useful in the treatment of PCOS. The number of viable methods for dealing with PCOS-related infertility has increased as well. Despite the fact that clomiphene citrate (CC) has long been the gold standard for ovulation induction in the event of ovulatory infertility, aromatase inhibitors can induce ovulation with results that are nearly identical to or better than those reported with CC, aromatase inhibitors can cause ovulation with results that are nearly identical to or better than those reported with CC. Ovarian incitement conventions that intelligently utilize gonadotropins, gonadotropin-delivering hormone rivals, the approach of ovarian boring, and assisted conceptive advancements with in vitro oocyte development indicate an expanding level of therapeutic progress.
Acknowledgement
Authors would like to thank all the authors whose work has been reviewed while preparing this manuscript.
-
Research funding: None.
-
Author contribution: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
-
Conflict of interest: None.
References
1. El-Sharkawy, AA, Abdelmotaleb, GS, Aly, MK, Kabel, AM. Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome. J Pediatr Adolesc Gynecol 2014;27:347–52. https://doi.org/10.1016/j.jpag.2014.01.004.Search in Google Scholar
2. Nafiye, Y, Sevtap, K, Muammer, D, Emre, O, Senol, K, Leyla, M. The effect of serum and intrafollicular insulin resistance parameters and homocysteine levels of nonobese, nonhyperandrogenemic polycystic ovary syndrome patients on in vitro fertilization outcome. Fertil Steril 2010;93:1864–9. https://doi.org/10.1016/j.fertnstert.2008.12.024.Search in Google Scholar
3. Louwers, YV, Laven, JS. Characteristics of polycystic ovary syndrome throughout life. Ther Adv Reprod Health 2020;14:2633494120911038. https://doi.org/10.1177/2633494120911038.Search in Google Scholar
4. Maqbool, M, Khan, M, Mohammad, M, Adesina, MA, Fekadu, G. Awareness about reproductive health in adolescents and youth: a review. Int Res J Pharmaceut Appl Sci 2019:1–5. https://doi.org/10.31069/japsr.v2i3.1.Search in Google Scholar
5. Allahbadia, GN, Merchant, R. Polycystic ovary syndrome and impact on health. Middle East Fertil Soc J 2011;16:19–37. https://doi.org/10.1016/j.mefs.2010.10.002.Search in Google Scholar
6. Sheehan, MT. Polycystic ovarian syndrome: diagnosis and management. Clin Med Res 2004;2:13–27. https://doi.org/10.3121/cmr.2.1.13.Search in Google Scholar
7. Teede, H, Deeks, A, Moran, L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010;8:1–10. https://doi.org/10.1186/1741-7015-8-41.Search in Google Scholar
8. Palomba, S, Santagni, S, Falbo, A, La Sala, GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Wom Health 2015;7:745. https://doi.org/10.2147/ijwh.s70314.Search in Google Scholar
9. Nestler, JE. Metformin in the treatment of infertility in polycystic ovarian syndrome: an alternative perspective. Fertil Steril 2008:14–6. https://doi.org/10.1016/j.fertnstert.2008.04.073.Search in Google Scholar
10. Maqbool, M, Gani, I, Geer, MI. Polycystic ovarian syndrome-a multifaceted disease: a review. Int J Pharm Sci Res 2019;10:1072–79.Search in Google Scholar
11. Nidhi, R, Padmalatha, V, Nagarathna, R, Amritanshu, R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol 2011;24:223–7. https://doi.org/10.1016/j.jpag.2011.03.002.Search in Google Scholar
12. Legro, RS, Strauss, JFIII. Molecular progress in infertility: polycystic ovary syndrome. Fertil Steril 2002;78:569–76. https://doi.org/10.1016/s0015-0282(02)03275-2.Search in Google Scholar
13. Doi, SA, Al-Zaid, M, Towers, P, Scott, C, Al-Shoumer, KA. Ovarian steroids modulate neuroendocrine dysfunction in polycystic ovary syndrome. J Endocrinol Invest 2005;28:882–92. https://doi.org/10.1007/bf03345319.Search in Google Scholar
14. Legro, RS, Castracane, VD, Kauffman, RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv 2004;59:141–54. https://doi.org/10.1097/01.ogx.0000109523.25076.e2.Search in Google Scholar
15. Balen, AH, Conway, GS, Kaltsas, G, Techatraisak, K, Manning, PJ, West, C, et al.. Andrology: polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995;10:2107–11. https://doi.org/10.1093/oxfordjournals.humrep.a136243.Search in Google Scholar
16. Kiddy, D, Sharp, P, White, D, Scanlon, M, Mason, H, Bray, C, et al.. Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol 1990;32:213–20. https://doi.org/10.1111/j.1365-2265.1990.tb00857.x.Search in Google Scholar
17. Shaw, LJ, Bairey Merz, CN, Azziz, R, Stanczyk, FZ, Sopko, G, Braunstein, GD, et al.. Withdrawn: postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health—National heart, lung, and blood institute sponsored women’s ischemia syndrome evaluation. J Clin Endocrinol Metab 2008;93:1276–84. https://doi.org/10.1210/jc.2007-0425.Search in Google Scholar
18. Maqbool, M, Dar, MA, Gani, I, Geer, MI. Insulin resistance and polycystic ovary syndrome: a review. J Drug Deliv Therapeut 2019;9:433–6. https://doi.org/10.22270/jddt.v9i1-s.2275.Search in Google Scholar
19. Strauss, JFIII. Some new thoughts on the pathophysiology and genetics of polycystic ovary syndrome. Ann N Y Acad Sci 2003;997:42–8. https://doi.org/10.1196/annals.1290.005.Search in Google Scholar
20. Lee, TT, Rausch, ME. Polycystic ovarian syndrome: role of imaging in diagnosis. Radiographics 2012;32:1643–57. https://doi.org/10.1148/rg.326125503.Search in Google Scholar
21. Sharquie, KE, Al-Bayatti, AA, Al-Ajeel, AI, Al-Bahar, AJ, Al-Nuaimy, AA. Free testosterone, luteinizing hormone/follicle stimulating hormone ratio and pelvic sonography in relation to skin manifestations in patients with polycystic ovary syndrome. Saudi Med J 2007;28:1039.Search in Google Scholar
22. Pasquali, R, Gambineri, A. Insulin-sensitizing agents in polycystic ovary syndrome. Eur J Endocrinol 2006;154:763–75. https://doi.org/10.1530/eje.1.02156.Search in Google Scholar
23. Repaci, A, Gambineri, A, Pasquali, R. The role of low-grade inflammation in the polycystic ovary syndrome. Mol Cell Endocrinol 2011;335:30–41. https://doi.org/10.1016/j.mce.2010.08.002.Search in Google Scholar
24. González, F, Rote, NS, Minium, J, Kirwan, JP. Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:336–40. https://doi.org/10.1210/jc.2005-1696.Search in Google Scholar
25. Gleicher, N, Weghofer, A, Lee, IH, Barad, DH. FMR1 genotype with autoimmunity-associated polycystic ovary-like phenotype and decreased pregnancy chance. PloS One 2010;5:e15303. https://doi.org/10.1371/journal.pone.0015303.Search in Google Scholar
26. Kelly, C, Stenton, S, Lashen, H. Insulin-like growth factor binding protein-1 in PCOS: a systematic review and meta-analysis. Hum Reprod Update 2011;17:4–16. https://doi.org/10.1093/humupd/dmq027.Search in Google Scholar
27. Mohd, M, Maqbool, M, Dar, MA, Mushtaq, I. Polycystic ovary syndrome, a modern epidemic: an overview. J Drug Deliv Therapeut 2019;9:641–4.10.22270/jddt.v9i1-s.2275Search in Google Scholar
28. Schorge, J, Schaffer, J, Halvorson, L. Williams Gynecology. Mc Graw-Hill Professional: NY; 2008.Search in Google Scholar
29. Maqbool, M, Nasir, N, Mustafa, S. Polycystic in ovarian syndrome and its various treatment strategies. Indo Am J Pharmaceut Sci 2018;5:8470–8.Search in Google Scholar
30. Moll, E, van der Veen, F, van Wely, M. The role of metformin in polycystic ovary syndrome: a systematic review. Hum Reprod Update 2007;13:527–37. https://doi.org/10.1093/humupd/dmm026.Search in Google Scholar
31. Singh, B, Panda, S, Nanda, R, Pati, S, Mangaraj, M, Sahu, PK, et al.. Effect of metformin on hormonal and biochemical profile in PCOS before and after therapy. Indian J Clin Biochem 2010;25:367–70. https://doi.org/10.1007/s12291-010-0090-2.Search in Google Scholar
32. Chhabra, S, Gautam, RK, Kulshreshtha, B, Prasad, A, Sharma, N. Hirsutism: a clinico-investigative study. Int J Trichol 2012;4:246. https://doi.org/10.4103/0974-7753.111204.Search in Google Scholar
33. Khattab, S, Mohsen, IA, Foutouh, IA, Ramadan, A, Moaz, M, Al-Inany, H. Metformin reduces abortion in pregnant women with polycystic ovary syndrome. Gynecol Endocrinol 2006;22:680–4. https://doi.org/10.1080/09513590601010508.Search in Google Scholar
34. Amer, SAK. Polycystic ovarian syndrome: diagnosis and management of related infertility. Obstet Gynaecol Reprod Med 2009;19:263–70. https://doi.org/10.1016/j.ogrm.2009.06.006.Search in Google Scholar
35. Legro, RS, Arslanian, SA, Ehrmann, DA, Hoeger, KM, Murad, MH, Pasquali, R, et al.. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98:4565–92. https://doi.org/10.1210/jc.2013-2350.Search in Google Scholar
36. Carmina, E. PCOS: metabolic impact and long-term management. Minerva Ginecol 2012;64:501–5.Search in Google Scholar
37. Azziz, R. Diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab 2006;91:781–5. https://doi.org/10.1210/jc.2005-2153.Search in Google Scholar
38. Moran, LJ, Pasquali, R, Teede, HJ, Hoeger, KM, Norman, RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 2009;92:1966–82. https://doi.org/10.1016/j.fertnstert.2008.09.018.Search in Google Scholar
39. Hiam, D, Patten, R, Gibson-Helm, M, Moreno-Asso, A, McIlvenna, L, Levinger, I, et al.. The effectiveness of high intensity intermittent training on metabolic, reproductive and mental health in women with polycystic ovary syndrome: study protocol for the iHIT-randomised controlled trial. Trials 2019;20:1–9. https://doi.org/10.1186/s13063-019-3313-8.Search in Google Scholar
40. Barbosa, G, de Sá, LBPC, Rocha, DRTW, Arbex, AK. Polycystic ovary syndrome (PCOS) and fertility. Open J Endocr Metab Dis 2016;6:58–65. https://doi.org/10.4236/ojemd.2016.61008.Search in Google Scholar
41. Rachoń, D, Teede, H. Ovarian function and obesity—interrelationship, impact on women's reproductive lifespan and treatment options. Mol Cell Endocrinol 2010;316:172–9. https://doi.org/10.1016/j.mce.2009.09.026.Search in Google Scholar
42. Acién, P, Quereda, F, Matallı́n, P, Villarroya, E, López-Fernández, JA, Acién, M, et al.. Insulin, androgens, and obesity in women with and without polycystic ovary syndrome: a heterogeneous group of disorders. Fertil Steril 1999;72:32–40. https://doi.org/10.1016/s0015-0282(99)00184-3.Search in Google Scholar
43. Alchami, A, O'Donovan, O, Davies, M. PCOS diagnosis and management of related infertility. Obstet Gynaecol Reprod Med 2015;25:279–82. https://doi.org/10.1016/j.ogrm.2015.07.005.Search in Google Scholar
44. Ehrmann, DA, Liljenquist, DR, Kasza, K, Azziz, R, Legro, RS, Ghazzi, MN, et al.. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:48–53. https://doi.org/10.1210/jc.2005-1329.Search in Google Scholar
45. Mohammad, MB, Seghinsara, AM. Polycystic ovary syndrome (PCOS), diagnostic criteria, and AMH. Asian Pac J Cancer Prev APJCP 2017;18:17. https://doi.org/10.22034/APJCP.2017.18.1.17.Search in Google Scholar
46. Legro, RS, Kunselman, AR, Dodson, WC, Dunaif, A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165–9. https://doi.org/10.1210/jcem.84.1.5393.Search in Google Scholar
47. Clark, A, Thornley, B, Tomlinson, L, Galletley, C, Norman, R. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998;13:1502–5. https://doi.org/10.1093/humrep/13.6.1502.Search in Google Scholar
48. Huber-Buchholz, M-M, Carey, D, Norman, R. Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 1999;84:1470–4. https://doi.org/10.1210/jcem.84.4.5596.Search in Google Scholar
49. Wahrenberg, H, Ek, I, Reynisdottir, S, Carlström, K, Bergqvist, A, Arner, P. Divergent effects of weight reduction and oral anticonception treatment on adrenergic lipolysis regulation in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1999;84:2182–7. https://doi.org/10.1210/jcem.84.6.5794.Search in Google Scholar
50. Hutchison, SK, Stepto, NK, Harrison, CL, Moran, LJ, Strauss, BJ, Teede, HJ. Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. J Clin Endocrinol Metab 2011;96:E48–56. https://doi.org/10.1210/jc.2010-0828.Search in Google Scholar
51. Poehlman, ET, Dvorak, RV, DeNino, WF, Brochu, M, Ades, PA. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. J Clin Endocrinol Metab 2000;85:2463–8. https://doi.org/10.1210/jc.85.7.2463.Search in Google Scholar
52. Ross, R, Dagnone, D, Jones, PJ, Smith, H, Paddags, A, Hudson, R, et al.. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men: a randomized, controlled trial. Ann Intern Med 2000;133:92–103. https://doi.org/10.7326/0003-4819-133-2-200007180-00008.Search in Google Scholar
53. Greenblatt, RB. Chemical induction of ovulation. Fertil Steril 1961;12:402–4. https://doi.org/10.1016/s0015-0282(16)34261-3.Search in Google Scholar
54. Clark, JH, Markaverich, BM. The agonistic-antagonistic properties of clomiphene: a review. Pharmacol Therapeut 1981;15:467–519. https://doi.org/10.1016/0163-7258(81)90055-3.Search in Google Scholar
55. Mikkelson, TJ, Kroboth, PD, Cameron, WJ, Dittert, LW, Chungi, V, Manberg, PJ. Single-dose pharmacokinetics of clomiphene citrate in normal volunteers. Fertil Steril 1986;46:392–6. https://doi.org/10.1016/s0015-0282(16)49574-9.Search in Google Scholar
56. Corsan, G, Trias, A, Trout, S, Kemmann, E. Ovulation induction combined with intrauterine insemination in women 40 years of age and older: is it worthwhile? Hum Reprod 1996;11:1109–12. https://doi.org/10.1093/oxfordjournals.humrep.a019306.Search in Google Scholar
57. Kerin, JF, Liu, JH, Phillipou, G, Yen, SS. Evidence for a hypothalamic site of action of clomiphene citrate in women. J Clin Endocrinol Metab 1985;61:265–8. https://doi.org/10.1210/jcem-61-2-265.Search in Google Scholar
58. Kettel, LM, Roseff, SJ, Berga, SL, Mortola, JF, Yen, SS. Hypothalamic-pituitary-ovarian response to clomiphene citrate in women with polycystic ovary syndrome. Fertil Steril 1993;59:532–8. https://doi.org/10.1016/s0015-0282(16)55795-1.Search in Google Scholar
59. Rebar, R, Judd, H, Yen, S, Rakoff, J, Vandenberg, G, Naftolin, F. Characterization of the inappropriate gonadotropin secretion in polycystic ovary syndrome. J Clin Invest 1976;57:1320–9. https://doi.org/10.1172/jci108400.Search in Google Scholar
60. Mitwally, MF, Casper, RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305–9. https://doi.org/10.1016/s0015-0282(00)01705-2.Search in Google Scholar
61. Fisher, SA, Reid, RL, Van Vugt, DA, Casper, RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280–5. https://doi.org/10.1016/s0015-0282(02)03241-7.Search in Google Scholar
62. Wu, CH, Winkel, CA. The effect of therapy initiation day on clomiphene citrate therapy. Fertil Steril 1989;52:564–8. https://doi.org/10.1016/s0015-0282(16)60964-0.Search in Google Scholar
63. Lobo, RA, Granger, LR, Davajan, V, Mishell, DRJr. An extended regimen of clomiphene citrate in women unresponsive to standard therapy. Fertil Steril 1982;37:762–6. https://doi.org/10.1016/s0015-0282(16)46335-1.Search in Google Scholar
64. Dodge, ST, Strickler, RC, Keller, DW. Ovulation induction with low doses of clomiphene citrate. Obstet Gynecol 1986;67:63S–5S. https://doi.org/10.1097/00006250-198603001-00019.Search in Google Scholar
65. Gysler, M, March, CM, Mishell, DRJr, Bailey, EJ. A decade’s experience with an individualized clomiphene treatment regimen including its effect on the postcoital test. Fertil Steril 1982;37:161–7. https://doi.org/10.1016/s0015-0282(16)46033-4.Search in Google Scholar
66. Bizzarri, M, Carlomagno, G. Inositol: history of an effective therapy for polycystic ovary syndrome. Eur Rev Med Pharmacol Sci 2014;18:1896–903.Search in Google Scholar
67. Heard, MJ, Pierce, A, Carson, SA, Buster, JE. Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome. Fertil Steril 2002;77:669–73. https://doi.org/10.1016/s0015-0282(01)03266-6.Search in Google Scholar
68. Nestler, JE, Jakubowicz, DJ, Evans, WS, Pasquali, R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 1998;338:1876–80. https://doi.org/10.1056/nejm199806253382603.Search in Google Scholar
69. Velázquez, E, Acosta, A, Mendoza, SG. Menstrual cyclicity after metformin therapy in polycystic ovary syndrome. Obstet Gynecol 1997;90:392–5. https://doi.org/10.1016/s0029-7844(97)00296-2.Search in Google Scholar
70. Glueck, C, Phillips, H, Cameron, D, Sieve-Smith, L, Wang, P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertil Steril 2001;75:46–52. https://doi.org/10.1016/s0015-0282(00)01666-6.Search in Google Scholar
71. Glueck, C, Wang, P, Kobayashi, S, Phillips, H, Sieve-Smith, L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002;77:520–5. https://doi.org/10.1016/s0015-0282(01)03202-2.Search in Google Scholar
72. Opsahl, MS, Robins, ED, O’Connor, DM, Scott, RT, Fritz, MA. Characteristics of gonadotropin response, follicular development, and endometrial growth and maturation across consecutive cycles of clomiphene citrate treatment. Fertil Steril 1996;66:533–9. https://doi.org/10.1016/s0015-0282(16)58564-1.Search in Google Scholar
73. Deaton, JL, Clark, RR, Pittaway, DE, Herbst, P, Bauguess, P. Clomiphene citrate ovulation induction in combination with a timed intrauterine insemination: the value of urinary luteinizing hormone versus human chorionic gonadotropin timing. Fertil Steril 1997;68:43–7. https://doi.org/10.1016/s0015-0282(97)81473-2.Search in Google Scholar
74. Zreik, TG, Garcı́a-Velasco, JA, Habboosh, MS, Olive, DL, Arici, A. Prospective, randomized, crossover study to evaluate the benefit of human chorionic gonadotropin–timed versus urinary luteinizing hormone–timed intrauterine inseminations in clomiphene citrate–stimulated treatment cycles. Fertil Steril 1999;71:1070–4. https://doi.org/10.1016/s0015-0282(99)00116-8.Search in Google Scholar
75. Daly, DC, Walters, CA, Soto-Albors, CE, Tohan, N, Riddick, DH. A randomized study of dexamethasone in ovulation induction with clomiphene citrate. Fertil Steril 1984;41:844–8. https://doi.org/10.1016/s0015-0282(16)47896-9.Search in Google Scholar
76. March, CM, Tredway, DR, Mishell, DRJr. Effect of clomiphene citrate upon amount and duration of human menopausal gonadotropin therapy. Am J Obstet Gynecol 1976;125:699–704. https://doi.org/10.1016/0002-9378(76)90797-3.Search in Google Scholar
77. Lebbi, I, Ben Temime, R, Fadhlaoui, A, Feki, A. Ovarian drilling in PCOS: is it really useful? Front Surg 2015;2:30. https://doi.org/10.3389/fsurg.2015.00030.Search in Google Scholar
© 2021 Walter de Gruyter GmbH, Berlin/Boston
