In the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II)¹ clinical trial, the aromatase inhibitor letrozole (Femara) demonstrated significantly greater rates of ovulation, conception, pregnancy, and live birth, compared with the selective estrogen receptor modulator clomiphene citrate (Clomid) when given for up to five menstrual cycles in women with PCOS (Figure). The main findings of PPCOS II were published in the New England Journal of Medicine last summer (2014).¹ The trial, initiated and led by Richard Legro, M.D., of Penn State Hershey Obstetrics and Gynecology, sought to identify and compare safer, more cost-effective, oral infertility treatments that could be used as first-line options for women with PCOS. Both treatments were fairly well tolerated; the most common adverse events were hot flushes (clomiphene), dizziness, and fatigue (letrozole). Continue reading
Category Archives: Research
There are multiple surgical and nonsurgical approaches for treating pelvic organ prolapse (POP), and deciding which one best fits a given patient is often based on care provider preference and experience with certain techniques. With POP stages >2, marked by the vaginal wall protruding to varying degrees through the vaginal opening, many urogynecologists intervene surgically.
“In addition to conventional colporrhaphy, transvaginal mesh-based repairs had gained acceptance as a treatment option for POP over the last ten years, only to see the pendulum swing the other way secondary to fanfare surrounding postoperative complications,” explains Matthew Davies, M.D., of Penn State Hershey Obstetrics and Gynecology.
The Food and Drug Administration (FDA) issued a safety warning for mesh repair of POP, noting that mesh erosion is the most common complication, potentially requiring hospitalization and secondary re-operation.
“In addition to the risk for erosion, another complication seen with mesh-based repair is dyspareunia; unlike erosion or infection, dyspareunia may not resolve when the mesh is explanted and may be permanent. Because of these reported risks, many patients with POP are fearful and refuse to undergo a mesh-based repair,” says Davies. Continue reading
Advancing Safer, More Cost-effective Fertility Treatment Options for Women with Polycystic Ovary Syndrome (PCOS) and Couples with Unexplained Infertility
For infertile women with polycystic ovary syndrome (PCOS) or couples with unexplained infertility who wish to become pregnant, fertility treatment is often expensive and invasive, and holds greater risks. Increasingly, couples are being advised to consider in vitro fertilization (IVF) as a front line treatment. “Even though we have effective strategies for inducing ovulation and achieving pregnancy in women with PCOS or unexplained infertility, going straight to IVF for infertility treatment results in high cost and in risky multiple gestation pregnancies,“ explains Richard Legro, M.D., Penn State Hershey Obstetrics and Gynecology. Multiple gestation pregnancies are associated with risks to the mother, as well as the infant, including preterm labor and delivery, infant morbidity, and ensuing financial and personal burden to the parents. Worldwide, rates of twin pregnancies have increased nearly 60 percent, and rates of higher-order multiple pregnancies have increased a staggering 400 percent since 1980, largely ascribed to infertility therapy, including injectable gonadotropins and IVF. Gonadotropin regimens are also associated with increased risk of ovarian hyperstimulation syndrome which can be life-threatening. Continue reading