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My Take on Role of IR & of IS
in Infertile Women with PCOS Planning IVF
•
•
Who to screen for IR?
– All meeting NIH criteria for PCOS overweight/obese
– Clinical suspicion
– Family history of DM
How to screen for IR in clinical practice?
– OGTT with Insulin levels
• Who to treat?
– Resistant to OI attempts
– High AMH
– Ovarian hyperandrogenemia/ High LH
– Dysmetabolic
• Treat with what ?? – Metformin
– Myoinositol
– Incretins
• How long to treat?
SLIDE 22
Meaningful Reads
• Sivalingam VN et al. Metformin in reproductive health, pregnancy and gynaecological cancer: established and emerging indications. Hum Reprod Update.. 2014 Nov-Dec;20(6):853-68.
• Nardo LG et al. British Fertility Society Policy and Practice Committee: adjuvants in IVF: evidence for good clinical practice. Hum Fertil (Camb). 2015 Mar;18(1):2-15. doi: 10.3109/14647273.2015.985454. Epub 2014 Dec 22.
• Mendoza N et al. Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial.. doi: 10.1080/09513590.2019.1576620. [Epub ahead of print]
• Mendoza N et al. Inositol supplementation in women with polycystic ovary syndrome undergoing intracytoplasmic sperm injection: a systematic review and meta-analysis of randomized controlled trials. Reprod Biomed Online. 2017 Nov;35(5):529-535. doi: 10.1016/j.rbmo.2017.07.005. Epub 2017 Jul 14.
• Leopoldo O. Tso Metformin treatment before and during in vitro fertilization or intracytoplasmic sperm injection in women with polycystic ovary syndrome: summary of a Cochrane review. 2015 Volume 104, Issue 3, Pages 542–544
• Palomba S, et al. Metformin reduces risk of ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome during gonadotropin- stimulated in vitro fertilization cycles: a randomized, controlled trial. Fertil Steril. 2011 Dec;96(6):1384-1390.e4.
• Palomba S et al. Effects of metformin in women with polycystic ovary syndrome treated with gonadotrophins for in vitro fertilisation and intracytoplasmic sperm injection cycles: a systematic review and meta-analysis of randomised controlled trials. BJOG. 2013 Feb;120(3):267-76.
• Rehman R et al. Metformin, Oxidative Stress, and Infertility: A Way Forward. Front Physiol. 2018 Nov 29;9:1722.
• Tso LO et al. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2014 Nov 18;(11):
• Løvvik TS et al. Use of metformin to treat pregnant women with polycystic ovary syndrome (PregMet2): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019 Apr;7(4):256-266. doi: 10.1016/S2213-8587(19)30002-6. Epub 2019 Feb 18.
• Gateva A et al. The use of inositol(s) isomers in the management of polycystic ovary syndrome: a comprehensive review. Gynecol Endocrinol. 2018 Jul;34(7):545-550.
• Gateva A et al. The use of inositol(s) isomers in the management of polycystic ovary syndrome: a comprehensive review. Gynecol Endocrinol. 2018 Jul;34(7):545-550. doi: 10.1080/09513590.2017.1421632.
• Salamun V et al. Liraglutide increases IVF pregnancy rates in obese PCOS women with poor response to first-line reproductive treatments: a pilot randomized study. Eur J Endocrinol. 2018 Jul;179(1):1-11.
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