High dose of d-chiro-inositol improves oocyte quality in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial

Abstract

The aim of this study was to evaluate the effect of two doses of d-chiro-inositol (DCI) in combination with Myo-inositol (MYO) on the oocyte quality (OQ) of women with polycystic ovarian syndrome (PCOS) undergoing intracytoplasmic sperm injection (ICSI). Methods: This was a controlled, randomized, double-blind, parallel group study on 172 oocytes from 11 women. The study compared the effect of two MYO-DCI formulations given over 12?weeks on OQ. Five women received 550?mg of MYO + 300?mg of DCI daily (high DCI content group), while 6 women were given a daily dose of 550?mg of MYO with the only 27.6?mg of DCI (low DCI content group). Results: According to a multivariate analysis using linear mixed effect models, high doses of DCI have a positive influence on the quality of the cytoplasm of the oocyte (β?=?1.631, χ²?=?7.347, d.f.?=?1, p?=?.00672). Zona pellucida, plasma membrane, cytoplasm, and sperm reception have also been improved with any combination of MYO/DCI by decreasing testosterone or improving insulin sensitivity, regardless of age and body mass index. Conclusion: The combination of MYO with high doses of DCI improved oocyte cytoplasm quality in women with PCOS undergoing ICSI.     

Can AMH levels predict the need for increased medication during IVF/ICSI in PCOS women?

Purpose: To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles.

Methods: AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.

Results: The area under the curve (AUC) was 0.820 95%CI (0.792–0.848), and a cutoff value of 4.6?ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p?4.6?ng/ml). No difference in the mean age (p?=?0.147); BMI (p?=?0.411), basal FSH (p?=?0.221), and starting dose (p?=?0.195); however, the dose at which the first response occurred was higher in group (B) (p?p?p?=?0.026).

Conclusions: PCOS with AMH >4.6?ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.     

Dehydroepiandrosterone sulfate/free androgen index ratio predicts a favorable metabolic profile in patients with polycystic ovary syndrome

Potential effect of hyperandrogenemia on metabolic disturbances in polycystic ovary syndrome (PCOS) has always been a matter of interest. We analyzed the records of 125 patients with PCOS and 54 age-matched healthy women. All participants underwent biochemical and hormonal assessment and a 75?g oral glucose tolerance test was performed. PCOS and control groups were comparable in terms of age. Dehydroepiandrosterone sulfate/free androgen index (DHEAS/FAI) ratio was negatively correlated with body mass index (BMI) (p?<?.001), fasting glucose (p?=?.02), area under the curve (AUC) of glucose (p?=?.03), AUC of insulin (p?=?.001), homeostasis model assessment-estimated insulin resistance (HOMA-IR) (p?<?.001), and triglycerides (TG) (p?=?.009), and positively correlated with insulin sensitivity index (ISI) (p?<?.001) and high-density lipoprotein cholesterol (HDL-C) (p?<?.001) among PCOS patients. In logistic regression analysis, higher DHEAS/FAI ratio levels were associated with lower risk of low HDL-C [RR(95%CI); 0.97(0.95–0.98); p?<?.001] as well as atherogenic dyslipidemia (TG/HDL-C) [RR(95%CI); 0.97(0.94–0.99); p?=?.035] even after adjustment for BMI in the PCOS group. Androgens, DHEAS and FAI act differently on metabolic parameters. Our results demonstrate that high DHEA-S/FAI ratio levels are associated with a more favorable metabolic profile.     

TWEAK and monocyte to HDL ratio as a predictor of metabolic syndrome in patients with polycystic ovary syndrome

We aimed at analyzing serum TWEAK levels and monocyte/HDL ratio in polycystic ovary syndrome (PCOS) and their predictivity for metabolic syndrome (MS) in PCOS. We included 71 women with PCOS and 40 healthy controls without any cardiovascular risk factors in this cross-sectional study. Patient group was classified as MS positive (n?=?34) and negative (n?=?37). Study group had higher monocyte/HDL ratio and TWEAK levels (9.59?±?2.82 vs 8.2?±?2.46, p?=?.007 and 1085.54?±?780.95 vs 694.88?±?369.67?ng/ml, p?=?.009). Monocyte/HDL ratio and TWEAK levels were higher in MS positive group (10.47?±?2.81 vs 8.77?±?2.61, p?=?.01 and 1417.59?±?921.52 vs 780.41?±?455.67, p?=?.009). In multivariate regression analysis, monocyte/HDL ratio (>9.9, OR 3.42, 95%CI 1.41–5.78, p?=?.008) and TWEAK (>846.5?ng/ml, OR 5.49, 95%CI 3.14–7.59, p?=?.002) were found to be independent predictors of MS in study group. Discriminative value of monocyte/HDL ratio for MS in study group was evaluated by receiver operating curve. Area under curve for monocyte/HDL ratio was 0.669 with a sensitivity of 70.3% and specifity of 67.7%, cutoff value was >9.9. Receiver operating curve for TWEAK at >846.5?pg/ml threshold to diagnose MS in study group was performed and area under the curve was 0.769 with a sensitivity of 73% and specifity of 72%. TWEAK and monocyte/HDL ratio may be promising in predicting MS at early stages in PCOS to prevent future cardiovascular diseases by modifying life-style or giving pharmacotheraphy.     

The effect of myoinositol on ovarian blood flows in women with polycystic ovary syndrome

To evaluate whether 4 gram myoinositol and 400?mcg folic acid(MYO) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at 3?months follow-up period in polycystic ovary syndrome (PCOS). One-hundred eighty patients were designed into six groups; Group 1: PCOS patients that received OCP containing 30?mcg ethinyl estradiol (EE) plus 3?mg drospirenone (DRP); Group 2: PCOS patients that received MYO; Group 3: PCOS patients that received no medication. Group 4: Healthy patients that received OCP; Group 5: Healthy patients that received MYO; Group 6: Healthy patients that received no medication. Resistance index (RI) and pulsatility index (PI) of both ovaries were assessed. There was a significant increase in RI and PI of both ovarian stromal blood flow women with PCOS who received OCP (Group 1, p?<?.001) and MYO (Group 2, p?<?.001). The rate of increment in both RI and PI values were similar for OCP users (Group 1) and MYO users(Group2) in PCOS patients. MYO therapy reduced ovarian vascularization in both PCOS and healthy users after 3?months and this decrease is especially noticeable in women with PCOS compared to healthy women. OCP therapy also reduced ovarian vascularization just like MYO therapy.     

The effects of treatment with liraglutide on quality of life and depression in young obese women with PCOS and controls

Polycystic ovary syndrome (PCOS) is associated with reduced quality of life (QoL), though the role of associated obesity is unclear. In this study we examined the effects of six months treatment with liraglutide, 1.8?mg od, on obesity, depression and QoL in young women with PCOS and obesity compared to age- and weight-matched controls. In a cross-sectional study, 36 women were recruited (19 PCOS, 17 controls), age 33.9?±?6.7 vs. 33.5?±?7.1?yr, and weight 102.1?±?17.1 vs. 100.4?±?15.1?kg, respectively. PCOS was diagnosed according to the Rotterdam criteria. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). QoL was measured using the World Health Organization QoL questionnaire (WHOQOL-BREF). At baseline there was no difference in QoL or CES-D scores between the two groups. At six months, weight was reduced by 3.0?±?4.2?kg, p?=?.01, in the PCOS group and 3.8?±?3.4?kg, p?=?.001, in controls. Psychological health improved in the PCOS group (percentage change 11.3%, p?<?.02). Combining the two groups revealed significant improvement (p?<?.05) in physical (82.6?±?11.2 vs. 78.9?±?13.6), psychological (62.4?±?16.5 vs. 57.5?±?16.4) and social health (76.6?±?15.3 vs. 71?±?16.8) components of the WHOQOL-BREF at six months. Weight loss is associated with an improvement in QoL; and when matched for age and obesity, PCOS was not independently associated with reduced QoL or depression.     

Comparison of cabergoline versus calcium infusion in ovarian hyperstimulation syndrome prevention: A randomized clinical trial

Aim

To compare effectiveness of calcium infusion (CI) versus oral cabergoline (OC) in lowering the incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high risk women undergoing in vitro-fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles.

Fibroblast growth factor 23 and 25(OH)D levels are related to abdominal obesity and cardiovascular risk in patients with polycystic ovarian syndrome

Abstract

Fibroblast growth factor 23 (FGF23) and Klotho are extensively studied in relation to bone metabolism and progression of chronic kidney disease. There is very limited information about their role in polycystic ovarian syndrome (PCOS). The aim of the present study was to investigate some bone markers in women with PCOS in relation to obesity and cardiovascular risk. In the study were included 80 patients, divided into three age-matched groups –Non-obese PCOS (n?=?40); Obese PCOS (n?=?20) and Obese control group (n?=?20). Bone marker levels were measured by an enzyme-linked immunosorbent assay. Obese PCOS patients had higher levels of FGF23 and sRANKL, lower levels of 25(OH)D and higher prevalence of vitamin D deficiency compared to non-obese subjects. Patients with abdominal obesity (waist circumference >80?cm) independently of PCOS status had significantly higher levels of FGF23 (112.5?±?86.5 vs. 73.4?±?37.9?pg/ml; p?=?.023) and lower of 25(OH)D (35.8?±?21.4 vs 47.8?±?26.5?nmol/l; p?=?.034). Patients with PCOS at risk of cardiovascular diseases according to AE-PCOS consensus also had increased levels of FGF23 (111.6?±?84.5 vs. 66.5?±?35.1?pg/ml; p?=?.031) and decreased levels of 25(OH)D (31.9?±?16.8 vs. 47.1 vs 28.4?nmol/l; p?=?.017) compared to those not at risk. There was no correlation between bone markers and blood glucose levels, insulin resistance or hormonal levels.     

Risk factors associated with coronary artery calcification in midlife women: a population-based study

Abstract

The aim of this study was to investigate the association between individual risk factors and coronary artery calcification (CAC), as a marker of subclinical cardiovascular disease, in a population-based nested cross-sectional study of midlife women. Anthropometric and metabolic data from 295 women from the South of Brazil were analyzed. Habitual physical activity was assessed by pedometer. CAC was assessed by a multi-detector computed tomography system. Average Agatston score was used to stratify participants as CAC?>?0 and CAC?=?0. Women with CAC?>?0 (34.7%) were older (58.7?±?5.4 vs. 56.3?±?5.2?years, p?<?.001) and had higher prevalence of central adiposity (71 vs. 59%, p?=?.04) and hypertension (71 vs. 52%, p?=?.002) than women in the CAC?=?0 group. Hormone therapy (HT) was more prevalent in the group with CAC?=?0 (19.7 vs. 9.8%, p?=?.029). The prevalence ratios for CAC?>?0 were 0.545 (95%CI:0.309–0.962, p?=?.036) for HT and 1.752 (95%CI:1.207–2.541, p?=?.003) for hypertension, after adjustment for age, educational level, smoking, alcohol intake, and physical activity. The present data in a population-based sample of midlife women indicate that hypertension and age were positively associated with higher risk for CAC?>?0 and HT was related with CAC?=?0.     

Effect of sperm selection using hyaluronan on fertilization and quality of cleavage-stage embryos in intracytoplasmic sperm injection (ICSI) cycles of couples with severe teratozoospermia

Abstract

This study aimed to evaluate the effect of hyaluronan-selected/physiological intracytoplasmic sperm injection (PICSI) on fertilization and quality of cleavage-stage embryos in infertile couples with ≤1% of spermatozoa with normal strict morphology (severe teratozoospermia). Seventy-seven couples underwent PICSI between October 2017 and December 2018 (PICSI group), while 75 couples underwent conventional intracytoplasmic sperm injection (ICSI) between January 2016 and September 2017 (ICSI group). Good quality embryos (GQEs) were evaluated based on morphology. Patient and cycle characteristics were comparable between the PICSI and ICSI groups, except for age and anti-Müllerian hormone (AMH) level (38.4?±?3.9?years vs. 36.3?±?4.3?years, p?=?.002 and 2.06?±?1.99?ng/mL vs. 2.97?±?3.25?ng/mL, p?=?.040). The fertilization rate per oocyte inseminated and GQE rate were significantly higher in the PICSI group than in the ICSI group (82.7% vs. 71.7%, p ? .001 and 52.8% vs. 34.0%, p ? .001). Furthermore, the absence of GQEs was found to be lower in the PICSI group (13.0% vs. 30.7%, p?=?.008). Multivariate analysis adjusted for age and AMH level identified PICSI as an unfavorable and independent factor for the absence of GQEs (adjusted odds ratio, 0.333; 95% confidence interval, 0.125–0.890). PICSI seems to be superior to ICSI in terms of fertilization and embryo quality in couples with severe teratozoospermia.     

The effect of vitamin D supplementation on insulin resistance,visceral fat and adiponectin in vitamin D deficient women with polycystic ovary syndrome: a randomized placebo-controlled trial

Introduction: Low plasma 25-hydroxy-vitamin D (25OHD) is associated with polycystic ovary syndrome (PCOS). Vitamin D deficiency may contribute to the development of insulin resistance, visceral fat and low level of adiponectin which are common feature in PCOS women. This study aimed to evaluate the effect of vitamin D supplementation on insulin resistance, visceral fat, and adiponectin in hypovitaminosis D women with polycystic ovary syndrome.

Methods: In this randomized, placebo-controlled clinical trial, 44 PCOS women aged 20–38?years with plasma 25OHD?<20?ng/mL were randomized in the intervention or placebo groups and followed for 8?weeks. Participants received 50,000?IU of oral vitamin D3 once weekly in the intervention group or placebo. The visceral adipose tissue, Insulin resistance (HOMA-IR), HOMA-B, QUICKI, and circulating adiponectin were compared before and after the intervention within groups using paired tests and the mean changes were analyzed between two groups by independent t-test.

Results: Of 44 eligible participates, 36 patients (81.8%) completed the study. After 8?week intervention, vitamin D supplementation compared to the placebo group significantly decreased fasting plasma glucose (FPG) (7.67?±?7.66 versus 1.71?±?7.50?mg/dL, p?=?.001) and significantly increased homeostasis model of assessment-estimated B cell function (HOMA-B) (129.76?±?121.02 versus 48.32?±?128.35, p?=?.014), Adiponectin (5.17?±?8.09 versus ?5.29?±?8.64?mg/dL, p?=?.001), and serum vitamin D level (28.24?±?6.47 versus 3.55?±?4.25?ng/mL, p?=?.001).

Conclusion: Vitamin D supplementation in vitamin D deficient women with PCOS, improved the FPG, HOMA-B, Adiponectin, and serum vitamin D level.     

The efficacy of myo-inositol supplementation to prevent gestational diabetes onset: a meta-analysis of randomized controlled trials

Introduction: The efficacy of myo-inositol supplementation to prevent gestational diabetes onset remains controversial. We conducted a systematic review and meta-analysis to explore the influence of myo-inositol supplementation on the incidence of gestational diabetes.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of myo-inositol supplementation on gestational diabetes onset. This meta-analysis is performed using the random-effect model.

Results: Five randomized controlled trials (RCTs) are included in the meta-analysis. Compared with control group in pregnant women, myo-inositol supplementation is associated with significantly reduced incidence of gestational diabetes (risk ratio (RR)?=?0.43; 95%CI?=?0.21–0.89; p?=?.02), and preterm delivery (RR?=?0.36; 95%CI?=?0.17–0.73; p?=?.005), but has no substantial impact on 2-h glucose oral glucose tolerance test (OGTT) (mean difference (MD)?=??6.90; 95%CI?=??15.07 to 1.27; p?=?.10), gestational age at birth (MD?=?0.74; 95%CI?=??1.06 to 2.54; p?=?.42), birth weight (MD?=??5.50; 95%CI?=??116.99 to 105.99; p?=?.92), and macrosomia (RR?=?0.65; 95%CI?=?0.20–2.11; p?=?.47).

Conclusions: Myo-inositol supplementation has some ability to reduce the incidence of gestational diabetes and preterm delivery in pregnant women.     

Can dopamine agonist at a low dose reduce ovarian hyperstimulation syndrome in women at risk undergoing ICSI treatment cycles? A randomized controlled study

Objective

Dopamine agonists were proposed as a preventive strategy for severe ovarian. The aim of this randomized controlled study is to evaluate the role of dopamine agonist at lower doses (0.25 mg) as a preventive strategy of severe hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles.

Study design

Two hundred women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included; the study group received 0.25 mg of cabergoline for 8 days from the day of HCG administration versus no treatment for the prevention of OHSS. Reduction of the incidence OHSS was the primary outcome.

Results

The overall incidence of OHSS was significantly reduced, almost 50%, in cabergoline group in comparison with control group (RR: 0.5, 95% CI: 0.29–0.83), with absolute risk reduction following cabergoline administration 11% (ARR: 0.11, 95% CI: 1.09–20.91). The corresponding number needed to treat (NNT) was 9.

Conclusion

Prophylactic treatment with the dopamine agonist, cabergoline, at lower doses (0.25 mg) reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment.     

多囊卵巢综合征(PCOS)患者在IVF-ET中发生严重卵巢过度刺激综合征(OHSS)的特点分析

目的:通过总结IVF-ET中多囊卵巢综合征(PCOS)患者应用控制性超促排卵(COH)后发生卵巢过度刺激综合征(OHSS)的特点,提出防止中、重度OHSS发生的有效措施。方法:将IVF/ICSI治疗时出现中、重度OHSS的患者根据有无PCOS史分成PCOS组和对照组。比较分析PCOS组和非PCOS组在COH中的雌激素水平、卵泡数、取卵数及发生中、重度OHSS的时间等临床资料;分析妊娠对OHSS的影响。结果:PCOS组的Gn用药总量及hCG注射日的血清E2水平比对照组低,其总卵泡数、中小卵泡数明显高于对照组,发生中、重度OHSS的时间早,妊娠可能加重OHSS病情发展。结论:卵泡总数、中小卵泡数可作为PCOS患者预测中、重度OHSS独立的重要指标,建议即使取卵前E2水平不高、获卵数不多也考虑行全胚冷冻,以阻止严重的OHSS发生。     

Myoinositol combined with alpha-lipoic acid may improve the clinical and endocrine features of polycystic ovary syndrome through an insulin-independent action

The aim of our study was to investigate the effects of a combined treatment with alpha-lipoic acid (ALA) and myoinositol (MYO) on clinical, endocrine and metabolic features of women affected by polycystic ovary syndrome (PCOS). In this pilot cohort study, forty women with PCOS were enrolled and clinical, hormonal and metabolic parameters were evaluated before and after a six-months combined treatment with ALA and MYO daily. Studied patients experienced a significant increase in the number of cycles in six months (p?p?p?p?p?p相似文献   

The impact of unicornuate uterus on perinatal outcomes after IVF/ICSI cycles: a matched retrospective cohort study

Objective: To evaluate the impact of unicornuate uterus on perinatal outcomes after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) cycles.

Methods: We performed a retrospective cohort study including 160 women with unicornuate uterus and 1:1 matched controls with normally shaped uterus. They received IVF/ICSI treatment during January 2009 and December 2011. The perinatal outcomes were followed up till December 2014.

Results: There were no significant differences in pregnancy rate, clinical pregnancy rate or live birth rate (53.6 versus 52.7, 41.4 versus 43.5, 33.8% versus 31.8%) between unicornuate uterus group and controls. Their biochemical pregnancy rate (22.8 versus 17.5%) and miscarriage rate (16.0 versus 18.8%) were similar. No significant differences were identified in preterm birth rate (18.3 versus 11.8%), birthweight (3.24?±?0.60 versus 3.33?±?0.54?kg) or birth length (50.47?±?2.33 versus 50.06?±?2.40?cm) among the singletons. However, lower gestational age (35.56?±?2.68 versus 36.71?±?1.73, p?=?.019), higher preterm birth rate (55.0 versus 34.4%, p?=?.038), lower birthweight (2.33?±?0.58 versus 2.69?±?0.38?kg, p?=?.001), lower birth length (45.33?±?2.46 versus 48.88?±?2.06?cm, p?=?.000), as well as higher rate of very low birthweight (13.2% versus 0, p?=?.007) were found for the twins from unicornuate uterus group.

Conclusions: The results indicated unimpaired pregnancy and perinatal outcomes for women with unicornuate uterus conceiving one fetus. However, close attention should be paid to twin pregnancy in unicornuate uterus owing to increased risks of prematurity and low birthweight. Selected single embryo transfer is recommended for women with unicornuate uterus undergoing IVF/ICSI cycles.     

A novel modified ultra-long agonist protocol improves the outcome of high body mass index women with polycystic ovary syndrome undergoing IVF/ICSI

In an attempt to evaluate the effectiveness of a novel modified ultra-long agonist (ULA) protocol on polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI), a retrospective study of 499 women employed with either ULA or conventional long agonist (LA) protocol was analyzed. In high BMI group (>25?kg/m²), the ULA protocol yielded significant higher clinic pregnancy rate (PR) (70.2% versus 50.8%, p?p?p?2), the ULA protocol also demonstrated a higher clinic PR (70.8% versus 59.5%, p?p?相似文献   

Effect of metformin taken in the ‘fresh’ in vitro fertilization/intracytoplasmic sperm injection cycle upon subsequent frozen embryo replacement in women with polycystic ovary syndrome

Objective.?We aimed to determine whether metformin when taken during a fresh in?vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle affects live birth rate (LBR) in subsequent frozen embryo replacement cycles (FERC).

Design. A retrospective database analysis of women with polycystic ovary syndrome (PCOS) undergoing FERC at a university teaching hospital between 2002 and 2007 (n?=?142). The outcome of FERC in women who had taken metformin in the ‘fresh’ IVF/ICSI cycle (group A, n?=?28) and those who had not (group B, n?=?114) were compared.

Results.?In the first FERC there was a significantly higher LBR (A?=?28.6%, B?=?12.3%, OR 2.86 95% CI 1.06–7.71). Women who had elective cryopreservation due to ovarian hyperstimulation syndrome risk were found to have significantly higher LBRs if metformin was taken in the fresh IVF/ICSI cycle (A?=?44.4%, B?=?7.9%, OR 9.33 95% CI 1.60–54.58).

Conclusions.?Women with PCOS who take metformin during IVF/ICSI may have a higher LBR in subsequent FERC, especially in those who have elective cryopreservation for OHSS risk. The findings of this study are limited by its retrospective design and small sample size and require confirmation in an adequately powered prospective randomized controlled trial.     

Serum betatrophin levels are reduced in patients with full-blown polycystic ovary syndrome

Betatrophin is defined as a new marker in glucose homeostasis and lipid metabolism. We aimed to investigate the role of serum betatrophin in full-blown polycystic ovary syndrome (PCOS) patients and 47-aged healthy women, 51 full-blown PCOS patients were included in this cross-sectional study. Betatrophin concentrations were significantly lower in PCOS group and displayed a positive correlation only with serum tryglyceride in control group (p?<?.05). A cutoff level (464.5?ng/L) was determined for betatrophin according to Receiver Operating Characteristic curve. Using this value, 64.7% of PCOS patients were classified as below the cutoff and in this group betatrophin was found to correlate negatively with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (p?=?.038, p?=?.020, and p?=?.014, respectively), and positively with total testosterone (p?=?.041). In the rest of PCOS cases (35.3%) who had betatrophin higher than cutoff, positive correlation was found with low-density lipoprotein cholesterol (p?=?.009). In conclusion, betatrophin levels are reduced in full-blown PCOS patients who had worse metabolic phenotype.     

Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome

Objective: The aim of this work was to investigate the value of laparoscopic ovarian drilling (LOD) compared with GnRH antagonist flexible protocol combined with cabergoline (Cb), as a prophylaxis against the re-development of ovarian hyperstimulation syndrome (OHSS) in women with clomiphene citrate-resistant polycystic ovary disease (CCR-PCOD) who had severe OHSS before in a previous ICSI cycle.

Study design: It is a prospective controlled study, where 250 CCR-PCOD women (n?=?250) with a history of severe OHSS before, had been recruited for the study. LOD had been performed for 120 (n?=?120) of the recruited women before ovarian induction, and considered as group A. GnRH antagonist (Cetrotide 0.25?mg) was added when a leading follicle reaches 14–16?mm combined with oral Cb in a dose 0.5?mg a day before hCG, and for 8?d for another 130 (n?=?130) women, and considered as group B. Pregnancy was diagnosed with BhCG level ≥25?IU/L,?±?14?d after embryo transfer, followed with transvaginal ultrasound scanning (TVS) 2 weeks later to confirm intra-uterine pregnancy (IUP). Women were followed up weekly for 3?months for the possible development of any signs and symptoms of OHSS.

Results: None of the participants in group A developed severe OHSS, and only six women (5%) developed mild to moderate OHSS. The incidence of severe OHSS was significantly higher (n?=?3, 15%) in group B compared with group A (p?n?=?17, 13.3%) women in group B developed mild to moderate OHSS. The probability of developing severe OHSS was also significantly higher in group B as well (p?=?.031). Pregnancy rate (PR) was significantly higher in group A more than group B (67% versus 39%, respectively), and all were single intrauterine pregnancies (IUP) and all developed after fresh embryo transfer (ET), compared with frozen embryo transfer (FET) which was performed in 42 cases in group B after postponing ET due to significantly severe OHSS developed.

Conclusion: LOD could be considered a good prophylactic measure against OHSS, in addition to improving the total outcome of IVF cycles in women with CCR-PCOS.