Until recently, specialists treating obese women with polycystic ovary syndrome (PCOS) have lacked research-based evidence to support the theory that weight-loss prior to fertility treatments may improve ovulation and, ultimately, live births. The topic had not been extensively studied, and most advice was from clinicians’ “common knowledge” that weight-loss prior to conception is beneficial. However, a recent study published in The Journal of Clinical Endocrinology & Metabolism1 now provides the clinical evidence to support that guidance. Richard S. Legro, MD, reproductive endocrinologist, Penn State Health Milton S. Hershey Medical Center, led the team that conducted a secondary analysis of two randomized trials to evaluate various approaches.1 They compared outcomes from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial (n=187 women) of immediate treatment with clomiphene to outcomes from the treatment of Hyperandrogenism versus Insulin Resistance in Infertile PCOS Women (OWL PCOS) trial (n=142 women) of delayed treatment with clomiphene after preconception treatment with oral contraceptives, lifestyle modification or the combination of both.1 Continue reading
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The OWL-PCOS study provided physicians with a detailed weight-loss strategy to share with their patients.1 Patients are instructed to take the following action:
- Orlistat: (available OTC under the brand name Alli) to be taken as recommended + meal replacements contributing to a hypocaloric diet (~1200kcal/d) + lifestyle modification. To ensure adequate vitamin effects, take a vitamin supplement once a day, at least two hours before or after Orlistat. Institute Orlistat at a dose of 60 mg to be taken three times a day with meals. The dose may be skipped if the patient anticipates eating a high-fat meal to avoid the occurrence of unwelcome gastrointestinal side-effects.
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
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