Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지
DOI QR코드

DOI QR Code

The impact of hyperandrogenism on the outcomes of ovulation induction using gonadotropin and intrauterine insemination in women with polycystic ovary syndrome

  • Received : 2022.01.03
  • Accepted : 2022.04.04
  • Published : 2022.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: This study aimed to investigate the impact of hyperandrogenism (HA) on the outcomes of ovulation induction (OI) using gonadotropin and intrauterine insemination (IUI) in patients with polycystic ovary syndrome (PCOS). Methods: This was a retrospective cohort study including 415 patients undergoing OI using gonadotropin and IUI treatment between January 2018 and December 2020 at a single infertility center. Baseline characteristics, clinical and laboratory parameters, and pregnancy outcomes were investigated. Results: Among the study population, there were 105 hyperandrogenic (25.3%) and 310 non-hyperandrogenic patients (74.7%). The live birth rate was lower in the HA group than in the non-HA group, but this difference did not reach statistical significance due to the limited sample size (14.3% vs. 21.0%, relative risk=0.68; 95% CI, 0.41-1.14, p=0.153). No predictive factors for live birth were identified through logistic regression analysis. Conclusion: HA did not negatively affect the outcomes of OI using gonadotropin and IUI cycles in Vietnamese women with PCOS. The result may not be applicable elsewhere due to the large variation in the characteristics of women with PCOS across races and populations.

Keywords

References

  1. Kim JJ, Choi YM. Phenotype and genotype of polycystic ovary syndrome in Asia: ethnic differences. J Obstet Gynaecol Res 2019;45:2330-7. https://doi.org/10.1111/jog.14132
  2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
  3. Bellver J, Rodriguez-Tabernero L, Robles A, Munoz E, Martinez F, Landeras J, et al. Polycystic ovary syndrome throughout a woman's life. J Assist Reprod Genet 2018;35:25-39. https://doi.org/10.1007/s10815-017-1047-7
  4. Mumusoglu S, Yildiz BO. Polycystic ovary syndrome phenotypes and prevalence: Differential impact of diagnostic criteria and clinical versus unselected population. Curr Opin Endocr Metab Res 2020;12:66-71. https://doi.org/10.1016/j.coemr.2020.03.004
  5. Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011;(7):CD007506.
  6. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018;33:1602-18. https://doi.org/10.1093/humrep/dey256
  7. Kim YJ, Park CW, Ku SY. Indications of intrauterine insemination for male and non-male factor infertility. Semin Reprod Med 2014;32:306-12. https://doi.org/10.1055/s-0034-1375183
  8. Atalay E, Ozaksit MG, Tokmak A, Engin-Ustun Y. Intrauterine insemination versus timed intercourse in ovulation induction cycles with clomiphene citrate for polycystic ovary syndrome: a retrospective cohort study. J Gynecol Obstet Hum Reprod 2019;48: 805-9. https://doi.org/10.1016/j.jogoh.2019.07.002
  9. Walters KA, Bertoldo MJ, Handelsman DJ. Evidence from animal models on the pathogenesis of PCOS. Best Pract Res Clin Endocrinol Metab 2018;32:271-81. https://doi.org/10.1016/j.beem.2018.03.008
  10. Gleicher N, Weghofer A, Barad DH. The role of androgens in follicle maturation and ovulation induction: friend or foe of infertility treatment? Reprod Biol Endocrinol 2011;9:116. https://doi.org/10.1186/1477-7827-9-116
  11. Ma L, Cao Y, Ma Y, Zhai J. Association between hyperandrogenism and adverse pregnancy outcomes in patients with different polycystic ovary syndrome phenotypes undergoing in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Gynecol Endocrinol 2021;37:694-701. https://doi.org/10.1080/09513590.2021.1897096
  12. de Wilde MA, Lamain-de Ruiter M, Veltman-Verhulst SM, Kwee A, Laven JS, Lambalk CB, et al. Increased rates of complications in singleton pregnancies of women previously diagnosed with polycystic ovary syndrome predominantly in the hyperandrogenic phenotype. Fertil Steril 2017;108:333-40. https://doi.org/10.1016/j.fertnstert.2017.06.015
  13. Christ JP, Gunning MN, Meun C, Eijkemans M, van Rijn BB, Bonsel GJ, et al. Pre-conception characteristics predict obstetrical and neonatal outcomes in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2019;104:809-18. https://doi.org/10.1210/jc.2018-01787
  14. Mackens S, Pareyn S, Drakopoulos P, Deckers T, Mostinckx L, Blockeel C, et al. Outcome of in-vitro oocyte maturation in patients with PCOS: does phenotype have an impact? Hum Reprod 2020;35:2272-9. https://doi.org/10.1093/humrep/deaa190
  15. Cheewadhanaraks S, Peeyananjarassri K, Choksuchat C. Clinical diagnosis of hirsutism in Thai women. J Med Assoc Thai 2004;87: 459-63.
  16. Zhou Z, Li R, Qiao J. Androgen profile in Chinese women with polycystic ovary syndrome in their reproductive years. Reprod Biomed Online 2017;35:331-9. https://doi.org/10.1016/j.rbmo.2017.05.019
  17. Boteju WM, Karunarathna GD, Udayangani SA, Silva KG, Wijeyaratne CN. Markers of hyperandrogenism in South Asians with polycystic ovary syndrome. Sri Lanka J Diabetes Endocrinol Metab 2014;4:3-8. https://doi.org/10.4038/sjdem.v4i1.7240
  18. World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 1992.
  19. Huang S, Du X, Wang R, Li R, Wang H, Luo L, et al. Ovulation induction and intrauterine insemination in infertile women with polycystic ovary syndrome: a comparison of drugs. Eur J Obstet Gynecol Reprod Biol 2018;231:117-21. https://doi.org/10.1016/j.ejogrb.2018.08.002
  20. Weiss NS, Kostova E, Nahuis M, Mol BW, van der Veen F, van Wely M. Gonadotrophins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019;1:CD010290.
  21. Ozcan P, Takmaz T. Identification of predictive factors for the probability of pregnancy following ovulation stimulation-intra-uterine insemination cycles in terms of female and male. J Obstet Gynaecol Res 2021;47:893-9. https://doi.org/10.1111/jog.14594
  22. Guan HJ, Pan LQ, Song H, Tang HY, Tang LS. Predictors of pregnancy after intrauterine insemination in women with polycystic ovary syndrome. J Int Med Res 2021;49:3000605211018600.
  23. Oduola OO, Ryan GA, Umana E, Conway U, Purandare N. Ovulation induction: comparing success rates between anovulatory and ovulatory cycles using different treatment protocols. Gynecol Endocrinol 2019;35:978-80. https://doi.org/10.1080/09513590.2019.1613642
  24. Zhang K, Shi Y, Wang E, Wang L, Hu Q, Dai Y, et al. Ovarian stimulated cycle: not a better alternative for women without ovulation disorder in intrauterine insemination. Oncotarget 2017;8: 100773-80. https://doi.org/10.18632/oncotarget.22052
  25. Erdem M, Erdem A, Guler I, Atmaca S. Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility. Fertil Steril 2008;90:360-6. https://doi.org/10.1016/j.fertnstert.2007.06.028
  26. Wang MH, Chen CH, Wang CW, Hsu MI, Tzeng CR. A higher anti-Mullerian hormone level is associated with an increased chance of pregnancy in patients undergoing controlled ovarian stimulation and intrauterine insemination. J Obstet Gynaecol 2015;35: 64-8. https://doi.org/10.3109/01443615.2014.935718
  27. Tiegs AW, Sun L, Scott RT Jr, Goodman LR. Comparison of pregnancy outcomes following intrauterine insemination in young women with decreased versus normal ovarian reserve. Fertil Steril 2020;113:788-96.e4. https://doi.org/10.1016/j.fertnstert.2019.12.006
  28. Pan JX, Zhang JY, Ke ZH, Wang FF, Barry JA, Hardiman PJ, et al. Androgens as double-edged swords: induction and suppression of follicular development. Hormones (Athens) 2015;14:190-200.
  29. De Vos M, Pareyn S, Drakopoulos P, Raimundo JM, Anckaert E, Santos-Ribeiro S, et al. Cumulative live birth rates after IVF in patients with polycystic ovaries: phenotype matters. Reprod Biomed Online 2018;37:163-71. https://doi.org/10.1016/j.rbmo.2018.05.003
  30. Cao NT, Le MT, Nguyen V, Pilgrim J, Le V, Le DD, et al. Defining polycystic ovary syndrome phenotype in Vietnamese women. J Obstet Gynaecol Res 2019;45:2209-19. https://doi.org/10.1111/jog.14097
  31. Romanski PA, Bortoletto P, Magaoay B, Chung A, Rosenwaks Z, Spandorfer SD. Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer. J Assist Reprod Genet 2021;38:347-55. https://doi.org/10.1007/s10815-020-02011-1
  32. Toosy S, Sodi R, Pappachan JM. Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. J Diabetes Metab Disord 2018;17:277-85. https://doi.org/10.1007/s40200-018-0371-5
  33. Dahan MH, Reaven G. Relationship among obesity, insulin resistance, and hyperinsulinemia in the polycystic ovary syndrome. Endocrine 2019;64:685-9. https://doi.org/10.1007/s12020-019-01899-9
  34. Lee MS, Lanes A, Dolinko AV, Bailin A, Ginsburg E. The impact of polycystic ovary syndrome and body mass index on the absorption of recombinant human follicle stimulating hormone. J Assist Reprod Genet 2020;37:2293-304. https://doi.org/10.1007/s10815-020-01865-9
  35. He Y, Lu Y, Zhu Q, Wang Y, Lindheim SR, Qi J, et al. Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women. Am J Obstet Gynecol 2019;221:138e1-e12. https://doi.org/10.1016/j.ajog.2019.03.011
  36. Bahri Khomami M, Joham AE, Boyle JA, Piltonen T, Arora C, Silagy M, et al. The role of maternal obesity in infant outcomes in polycystic ovary syndrome: a systematic review, meta-analysis, and meta-regression. Obes Rev 2019;20:842-58. https://doi.org/10.1111/obr.12832
  37. Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis. Am J Obstet Gynecol 2011;204:558e1-6. https://doi.org/10.1016/j.ajog.2011.03.021
  38. Moran C, Arriaga M, Rodriguez G, Moran S. Obesity differentially affects phenotypes of polycystic ovary syndrome. Int J Endocrinol 2012;2012:317241. https://doi.org/10.1155/2012/317241
  39. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2012; 18:618-37. https://doi.org/10.1093/humupd/dms030
  40. Mani H, Davies MJ, Bodicoat DH, Levy MJ, Gray LJ, Howlett TA, et al. Clinical characteristics of polycystic ovary syndrome: investigating differences in White and South Asian women. Clin Endocrinol (Oxf) 2015;83:542-9. https://doi.org/10.1111/cen.12784
  41. Gambineri A, Patton L, Altieri P, Pagotto U, Pizzi C, Manzoli L, et al. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes 2012;61: 2369-74. https://doi.org/10.2337/db11-1360
  42. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992;167:1807-12. https://doi.org/10.1016/0002-9378(92)91779-a