Wednesday 12 March 2008
Consensus: fertility treatment and PCOS
Issue 05: 10 Mar 2008
Source: Fertility and Sterility 2008;89:505-22
An international panel of specialists has produced a consensus report on fertility treatment related to polycystic ovarian syndrome (PCOS).
The report was drawn up following a 2-day meeting held in March 2007 in Thessaloniki, Greece, at which specialists reviewed and discussed published data with the aim of reaching agreement regarding the management of women with infertility and PCOS.
The meeting was sponsored by the European Society for Human Reproduction and Embryology (ESHRE), the American Society for Reproductive Medicine (ASRM), and pharmaceutical developer Organon.
The consensus report, published in the latest issue of the journal Fertility and Sterility, consists of seven sections covering: lifestyle modification, clomiphene citrate, insulin-sensitizing agents, gonadotropins/GnRH analogues, laparoscopic ovarian surgery, IVF, and ovulation induction/homologous artificial insemination. Each of these sections ends with a number of practical summary points.
The report then ends with a series of overall conclusions. These include the following:
- “Evaluation of women with presumed PCOS desiring pregnancy should exclude any other health issues in the woman or infertility problems in the couple.”
- Preconceptional counseling emphasizing the importance of lifestyle, “especially weight reduction and exercise in overweight women, smoking, and alcohol consumption,” should be provided before any intervention is initiated, the report states.
- “The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC).”
- “Recommended second-line intervention should CC fail to result in pregnancy is either exogenous gonadotropins or laparoscopic ovarian surgery (LOS).” It is pointed out that both have clear advantages and disadvantages, and that the choice must be made on an individual basis.
- “Recommended third-line treatment is IVF because this treatment is effective in women with PCOS.” More data on the use of single-embryo transfer in women with PCOS undergoing IVF are awaited, the report states.
- The report also identifies a clear need for the development of more patient-tailored approaches for ovulation induction, based on the initial screening characteristics of women with PCOS. It could be that, in certain well-defined subsets of patients, the first-, second-, and third-line treatment recommendations (above) would not apply.
Other conclusions are that the use of metformin in PCOS should be confined to women with glucose intolerance, and that routine use of metformin in ovulation induction is not recommended. In addition, there is currently insufficient evidence to recommend the use of aromatase inhibitors in routine ovulation induction.
The final overall conclusion states: “Even singleton pregnancies in PCOS are associated with increased health risks for both the mother and the fetus.”
The consensus report can be accessed in full via the journal’s website. For more on the role of obesity in PCOS and on IVF outcomes, see the recent ORGYN Online Magazine article PCOS, obesity, and fertility treatment, from the issue of 5 February 2008.
SOURCE:
http://www.orgyn.com/en//webzine/200...epageid=144104
Consensus: fertility treatment and PCOS 
