by Shannon Bartlett
A recent study by the NIHCD could revolutionize the treatment for polycystic ovarian syndrome. Women with PCOS often have irregular menstrual cycles and difficulty getting pregnant.
While the cause of PCOS is unknown, medical experts know that the syndrome is driven by a hormonal imbalance. Women with PCOS make too much androgen, a male hormone that is similar to testosterone.
Infertility treatment for polycystic ovary syndrome involves drugs to stimulate ovulation and the release of an egg. Until now, many doctors have chosen to first administer a course of the hormone progestin to thicken the lining of the uterus and jumpstart the patient's period.
Once the progestin treatment ends, the uterine lining sloughs off and bleeding begins. The idea is to enable a woman with PCOS to resume normal ovulation and monthly cycle to allow them to have a baby.
Progestin Could Decrease Pregnant Rate
Recent findings might send physicians scrambling for alternative treatment options for their PCOS patients. Progestin appears to decrease the odds of conception and of giving birth, according to a study by a National Institutes of Health research network.
"Our results indicate that a treatment with progestin before ovulation induction is counterproductive in helping women with PCOS achieve pregnancy," said Esther Eisenberg, M.D., of the Reproductive Sciences Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, one of the study authors.
The researchers found that women who skipped the progestin treatment were much more likly to get pregnant -- almost four times more.
Twenty percent of the women who did not receive progestin gave birth, compared with about 5 percent of the women who received progestin.
Progestin appears to raise the rate of ovulation slightly, but decreases the rate of conception. Women who received a dose of progestin, followed by ovulation induction, ovulated in 30 percent of the cases. Nearly 7 percent of these women conceived.
Those who did not receive progestin ovulated 27 percent of the time, but nearly 28 percent of these women conceived.
Future Fertility Treatments
While starting at the beginning of a menstrual cycle seems intuitive, the study results suggest that we might need to rethink progestin fertility treatments for women with menstrual irregularity.
Do you or someone you know have PCOS? Let us know if this is a topic that you'll be raising with your personal caregiver. We'd love to hear your feedback!
About the NIHCD study: The study was conducted by Michael P. Diamond, M.D., of Wayne State University in Detroit, Richard S. Legro, M.D., of the Penn State College of Medicine in Hershey, and researchers at 16 institutions in the NICHD Cooperative Reproductive Medicine Network (RMN). It analysed data from a 2007 RMN study comparing two fertility treatments for women with PCOS: the standard drug therapy clomiphene, which stimulates ovulation, and the diabetes treatment drug metformin. The study will conclude in May 2013.
Diamond, M et al. Pregnancy in Polycystic Ovary Syndrome II (PPCOSII). U.S. National Institutes of Health.
Schlaff, W et al. The Reproductive Medicine Network experience with the Pregnancy in Polycystic Ovary Syndrome (PPCOS) I and II studies. Fertil Steril. 2011 Jul;96(1):15-8. Epub 2011 Jun 8.