Infertility in Women with Polycystic Ovary Syndrome: Pathogenesis and Management PDF
Preview Infertility in Women with Polycystic Ovary Syndrome: Pathogenesis and Management
Infertility in Women with Polycystic Ovary Syndrome Pathogenesis and Management Stefano Palomba Editor 123 Infertility in Women with Polycystic Ovary Syndrome Stefano Palomba Editor Infertility in Women with Polycystic Ovary Syndrome Pathogenesis and Management Editor Stefano Palomba Unit of Reproductive Medicine and Surgery ASMN-IRCCS of Reggio Emilia Reggio Emilia Italy ISBN 978-3-319-45533-4 ISBN 978-3-319-45534-1 (eBook) https://doi.org/10.1007/978-3-319-45534-1 Library of Congress Control Number: 2017955842 © Springer International Publishing Switzerland 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica- tion does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword Dr. Palomba has done an outstanding job assimilating an exceptionally well- qualified and talented cohort of authors to write on the subject of fertility in women with polycystic ovarian syndrome (PCOS), which constitutes one of the most com- mon endocrinopathies of reproductive aged women. The information provided is the most current evidence regarding the diagnosis and treatment of infertility in women with PCOS. In addition, there is in-depth discussion on new insights into the pathophysiology of this disease. As so eloquently stated by Dr. Hatem Abu Hashim, who authored a chapter of this book outlining the role of laparoscopic ovarian drilling in women with PCOS, “Science, practice, and evidence are dynamic processes. A marvelous progress in the understanding of the pathophysiology and metabolic features of PCOS has been witnessed in the last two decades.” As our understanding of this disease has evolved, so too has our clinical definitions and strategies for the treatment of infertility in patients affected with PCOS. The first several chapters of the book are focused on providing analysis of the diagnostic criteria and pathophysiology underlying infertility associated with PCOS. These chapters include “Diagnostic criteria for PCOS” by Dr. Francesco Orio; “Anovulation in women with PCOS” by Dr. Ujvala Rao; “Oocyte quality in PCOS” by Dr. Christine Decanter; “Endometrial receptivity in PCOS” by Dr. Giuseppe Benagiano; and “Infertility and subfertility cofactors in women with PCOS” by Dr. Tal Shavit. These chapters are comprehensive, very well written, and provide a wealth of knowledge to readers interested in gaining a better understand- ing of the complexity of mechanisms underlying infertility in PCOS as well as the health implications associated with it. The subsequent chapters are extremely thor- ough with in-depth discussions on medical, surgical, and alternative treatment strat- egies of infertility in women with PCOS. These in turn are followed by a chapter, prepared by Dr. Coghlan, which distills down all the important information men- tioned in the prior chapters. He does an excellent job describing evidence-based integrated strategies for enhancing fertility in PCOS. Another very interesting chapter, written by Dr. John Nestler, discusses current evidence of inositol treatment and its role in improving fertility outcomes in women with PCOS. Dr. Nestler begins this chapter by outlining the intricate mechanisms underlying dysregulation of inositols in PCOS and the resulting consequences on insulin resistance, glucose uptake, ovarian androgen production, and glycogen v vi Foreword synthesis. This is followed by a detailed discussion on the metabolic and reproduc- tive benefits of myo-inositol and d-Chiro-inositol treatment, alone or in combina- tion, in PCOS. Women with PCOS are at higher risk for developing ovarian hyperstimulation syndrome (OHSS). Dr. Melanie Walls, in her chapter “In vivo maturation” (IVM), introduces the utility of IVM for patients with PCOS, which can eliminate the potential risk of OHSS. She then very thoroughly summarizes different protocols and treatment regimens, as well as hormonal priming and culture conditions utilized in IVM, with a specific focus on their clinical outcomes. Once conception occurs, adverse pregnancy and perinatal outcomes are more common in women with PCOS. These complications and their underlying patho- physiology are discussed in the final chapter “Complications of pregnancy” by Dr. Palomba. To conclude, Dr. Palomba’s book is an excellent contribution to our understand- ing of the complexities underlying the pathophysiology, diagnosis, and treatment of infertility in women with PCOS. The text is well organized and will serve as an excellent resource for both clinician and researcher alike. Anthony M. DeAngelis Resident Physician in Obstetrics and Gynecology Danbury Hospital – Western Connecticut Health Network 24 Hospital Avenue, Danbury, CT, 06810, USA Alan H. DeCherney, MD Head Program in Reproductive and Adult Endocrinology Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health 10 Center Drive, Bldg10, CRC, Rm 1-3140 Bethesda, MD, 20892, USA Preface Although the study of polycystic ovary syndrome (PCOS) was “my topic” for more than 15 years, the idea to write a book about infertility in women with PCOS came to me during 2015 when, participating in many meetings, courses, and congresses on the treatment of infertility, I realized that there was a lack of awareness of the syndrome among medical staff specialized in reproductive medicine, particularly with regard to assisted reproduction technologies (ARTs). At first glance, the current book could be considered to consist merely of evidence-b ased guidance about the pathogenesis of infertility in women with PCOS and its treatment. However, it should not only be considered a technical tool to employ in clinical practice, but also as a cultural basis for approaching and under- standing the new and future basic and clinical studies on infertility related to PCOS. Anovulation, oocyte quality, and endometrial competence in women with PCOS are discussed in depth, along with almost all aspects of the infertility and subfertility cofactors potentially present in infertile patients with PCOS, including the impact and the interaction of PCOS phenotypes with regard to the reproductive outcome. From a therapeutic point of view, the book includes chapters on the classical medi- cal treatments for treating PCOS-related ovulatory dysfunction (such as clomiphene citrate, letrozole, metformin, and gonadotrophins), in addition to new and potential therapeutic approaches, such as natural insulin sensitizers (i.e., inositol), acupunc- ture, dietary supplements, and traditional Chinese medicine. Strong emphasis is placed on the nonpharmacological approach (i.e., diet and physical activity), which is crucial for obese and overweight patients, and on the use of a more invasive approach, including controlled ovarian stimulation for in vitro fertilization with or without in vitro maturation of oocytes. Significant effort has been made to clarify that reproductive success can be achieved not by evaluating the available treatments individually, but as a concert of options to modulate in specific strategies tailored to patient characteristics. Finally, the acknowledgements. I would like to thank all the authors who agreed to participate in the preparation of the chapters for the immeasurable help they gave me, for the many things they taught me, and for the patience they have had in fol- lowing my comments and suggestions. I would also like to thank my family, and especially my son Francesco, whom I have denied so much precious time. Reggio Emilia, Italy Stefano Palomba vii Contents Part I Diagnosis, Pathophysiology, and Pathogenesis 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Stefano Palomba 2 Diagnostic Criteria for PCOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Francesco Orio and Giovanna Muscogiuri 3 Anovulation in Women with PCOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Ujvala Rao and Roy Homburg 4 Oocyte Quality in PCOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Christine Decanter 5 Endometrial Receptivity in PCOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Giuseppe Benagiano, Paola Bianchi, and Ivo Brosens 6 Infertility and Subfertility Cofactors in Women with PCOS . . . . . . . 63 Tal Shavit and Togas Tulandi 7 PCOS Phenotypes: Impact on Fertility . . . . . . . . . . . . . . . . . . . . . . . . . 81 Enrico Carmina 8 Follicle Excess and Abnormalities in Women with PCOS: Pathophysiology, Assessment and Clinical Role . . . . . . . . . . . . . . . . . . 89 Agathe Dumont, Pauline Plouvier, and Didier Dewailly Part II Medical Treatments 9 Antiestrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Richard S. Legro 10 Aromatase Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Nivin Samara and Robert F. Casper 11 Insulin-Sensitising Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Stefano Palomba, Angela Falbo, and Giovanni Battista La Sala ix x Contents 12 Gonadotrophins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Sophie Christin-Maitre Part III Lifestyle Management and Other Treatment Approaches 13 Lifestyle Interventions and Natural and Assisted Reproduction in Patients with PCOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Renato Pasquali 14 Dietary Supplements, Phytotherapy and Chinese Herbal Medicine in PCOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Xiao-Ke Wu and Ernest HY Ng 15 Laparoscopic Ovarian Drilling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Hatem Abu Hashim 16 Inositols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 John E. Nestler and Antonio Simone Laganà 17 Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Elisabet Stener-Victorin, Anna Benrick, Romina Fornes, and Manuel Maliqueo Part IV Controlled Ovarian Stimulation and In Vitro Oocyte Maturation 18 Intrauterine Insemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Madelon van Wely 19 Controlled Ovarian Stimulation for In Vitro Fertilisation Cycles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Raoul Orvieto 20 In Vitro Oocyte Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Melanie L. Walls Part V Integrated Strategies, Complications of Pregnancy, and Outlook 21 Integrated Strategies for Enhancement of Fertility in PCOS . . . . . . . 289 Edwina Coghlan and Roger J. Hart 22 Complications of Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Stefano Palomba and Bart C.J.M. Fauser 23 Conclusive Remarks and Future Perspectives . . . . . . . . . . . . . . . . . . . 325 Stefano Palomba Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 Contributors Giuseppe Benagiano Department of Obstetrics, Gynaecology and Urology, Sapienza, University of Rome “La Sapienza”, Rome, Italy Anna Benrick Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden School of Health and Education, University of Skövde, Skövde, Sweden Paola Bianchi Department of Medico-Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy Ivo Brosens Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium Enrico Carmina Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy Robert F. Casper Division of Reproductive Sciences, University of Toronto, Toronto, ON, Canada Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada Toronto Centre for Advanced Reproductive Technology Fertility Partners, Toronto, ON, Canada Sophie Christin-Maitre Reproductive Endocrine Unit, Hôpital St. Antoine, AP-HP, University Pierre and Marie Curie, Paris, France Unité INSERM U933, Paris, France Edwina Coghlan King Edward Memorial Hospital, Perth, WA, Australia Christine Decanter Centre d’Assistance Médicale à la Procréation et de Préservation de la Fertilité, Hôpital Jeanne de Flandre, EA 4308 “Gamétogénèse et Qualité du Gamète”, Centre Hospitalier Universitaire de Lille, Lille, France Didier Dewailly Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Lille, France xi
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