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La infertilidad por anovulación es una complicación común asociada al síndrome de ovario poliquístico. La optimización de la salud constituye el primer paso en el abordaje de esta patología, principalmente con cambios en estilo de vida e índice de masa corporal óptimo. En lo referente a farmacoterapia, el citrato de clomifeno es ampliamente utilizado a nivel mundial como primera línea para inducir la ovulación. No obstante, el letrozol y la metformina en combinación con citrato de clomifeno, son terapias con evidencia prometedora que han demostrado ser superiores al citrato de clomifeno en monoterapia, en lo que respecta a fertilidad. Sin embargo, no existe consenso, y se siguen considerando terapias de segunda línea. Las gonadotropinas exógenas y la perforación laparoscópica del ovario son utilizadas cuando hay resistencia a la primera línea. La fertilización in vitro es una opción cuando tanto la primera, como la segunda línea, no son exitosas. Otros medicamentos se encuentran en estudio para determinar su eficacia en esta patología, como los agonistas del receptor del péptido similar al glucagón tipo 1 y esteroisómeros del inositol, empero, aún requieren estudios de mejor calidad.
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Wang R, Li W, Bordewijk EM, Legro RS, Zhang H, Wu X, et al. First-line ovula- tion induction for polycystic ovary syndrome: an individual participant data meta-analysis. Hum Reprod Update. 2019;25:717–32. https://doi.org/10.1093/humupd/dmz029
Bergh C, Moore M, Gundell C. Evidence-Based Management of Infertility in Women With Polycystic Ovary Syndrome. JOGNN. 2016;45:111-122. http://dx.doi.org/10.1016/j.jogn.2015.10.001
Zhang J, Si Q, Li J. Therapeutic effects of metformin and clomiphene in combination with lifestyle intervention on infertility in women with obese polycystic ovary syndrome. Pak J Med Sci. 2017;33(1):8-12. doi: https://doi.org/10.12669/pjms.331.11764
Giviziez C, Sanchez E, Approbato M, Maia M, Fleury E et al. Obesity and anovulatory infertility: A review. JBRA Assisted Reproduction. 2016;20(4):240-245. https://doi.org/10.5935/1518-0557.20160046
Mascarenhas M, Balen A. Treatment update for anovulation and subfertility in polycystic ovary syndrome. Current Opinion in Endocrine and Metabolic Research. 2020;12:53–58. https://doi.org/10.1016/j.coemr.2020.03.003
Khan A, Karim N, Ainuddin J. The Triad Of PCOS, Infertility And Metformin. JBUMDC. 2019;9(1):67-71.
Foroozanfard F, Samimi M, Almadani K, Sehat M. Effect of metformin on the anti-Müllerian hormone level in infertile women with polycystic ovarian syndrome. Electronic Physician. 2017;9(12):5969-5973. https://doi.org/10.19082/5969
Balen A, Morley L, Misso M, Franks S, Legro R, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22(6):687-708. https://doi.org/10.1093/humupd/dmw025
Sánchez C. Factores que influyen en la tasa de embarazo en mujeres obesas en tratamiento con inseminación artificial. NURE Inv. 2013;10(62).
Obirikorang C, Owiredu W, Adu-Afram S, Acheampong E, Asamoah E,et al. Assessing the variability and predictability of adipokines (adiponectin, leptin, resistin and their ratios) in non obese and obese women with anovulatory polycystic ovary syndrome. BMC Res Notes. 2019;12:513. https://doi.org/10.1186/s13104-019-4546-z.
Vivas C, Calderón C, Pulido E. Adiponectina y Reproducción. Rev Desafíos. 2013;1(7). Accesado el 24 de setiembre 2020, en: http://revistas.ut.edu.co/index.php/desafios/article/view/439
Fichman V, Costa RS, Miglioli TC, Marinheiro LP. Association of obesity and anovulatory infertility. Einstein (São Paulo). 2020;18:eAO5150. http://dx.doi.org/10.31744/einstein_journal/2020AO5150
Kar S. Clomiphene citrate or letrozole as first-line ovulation induction drug in infertile PCOS women: a prospective randomized trial. J Hum Reprod Sci. 2012;5:262–265. https://doi.org/10.4103/0974-1208.106338
Franik S, Eltrop SM, Kremer JAM, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome.TheCochrane database of systematic reviews.2018;5(5). https://doi.org/10.1002/14651858.CD010287.pub3
Wang R, Kim BV, van Wely M, Johnson NP, Costello M, et al. Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis. BMJ. 2017;356:j138. https://doi.org/10.1136/bmj.j138
Debras E, Fernandez H, Neveu ME, Deffieux X, Capmas P. Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate. Eur J Obstet Gynecol Reprod Biol X. 2019;4:100093. https://doi.org/10.1016/j.eurox.2019.100093
Yu Q, Hu S, Wang Y, Cheng G, Xia W, et al. Letrozole versus laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2019;17:17. https://doi.org/10.1186/s12958-019-0461-3
Costello M, Garad R, Hart R, Homer H, Johnson L,et al. A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med Sci. 2019;7,75. https://doi.org/10.3390/medsci7070075
Practice Committee of the American Society for Reproductive Medicine. Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Fertil Steril. 2017;108:426–441. https://doi.org/10.1016/j.fertnstert.2017.06.026
Sam S, Ehrmann D. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome. Diabetologia. 2017;60:1656–1661. https://doi.org/10.1007/s00125-017-4306-3
Zeng XL, Zhang YF, Quan T, Xue Y, An RF. Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome. Medicine. 2016;95(36). https://doi.org/10.1097/MD.0000000000004526
Practice Committee of the American Society for Reproductive Medicine. Use of exogenous gonadotropins for ovulation induction in anovulatory women: a committe opinion. Fertil Steril. 2020;113(1):66-69. https://doi.org/10.1016/j.fertnstert.2019.09.020
Weiss NS, Kostova E, Nahuis M, Mol BWJ, van der Veen F, et al.Gonadotrophins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2019;1:CD010290. https://doi.org/10.1002/14651858.CD010290.pub3
Hong K, Franasiak J, Werner M, Patounakis G, Juneau C, et al. Embryonic aneuploidy rates are equivalent in natural cycles and gonadotropin-stimulated cycles. Fertil Steril. 2020;112(4):670-676.
https://doi.org/10.1016/j.fertnstert.2019.05.039
Bordewijk EM, Ng KYB, Rakic L, Mol BWJ, Brown J, Crawford TJ, et al. Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2020;2:CD001122. https://doi.org/10.1002/14651858.CD001122.pub5
Abu Hatem, Foda O, Rakhawy M. Unilateral or bilateral laparoscopic ovarian drilling in polycystic ovary syndrome: a meta analysis of randomized trials. Arch Gynecol Obstet. 2018;297:859-870. https://doi.org/10.1007/s00404-018-4680-1
Elshewy N, Ji D, Zhang Z, Chen D, Chen B, et al. Association between mild stimulated IVF/M cycle and early embryo arrest in sub fertile women with/without PCOS. Reprod Biol Endocrinol. 2020;18:71. https://doi.org/10.1186/s12958-020-00622-y
Walls M, Junk S, Ryan JP, Hart R. IVF versus ICSI for the fertilization of in-vitro matured human oocytes. rBMO. 2012;25:603-607.https://doi.org/10.1016/j.rbmo.2012.08.001
29. Swanton A, Storey L, McVeigh E, Child T. IVF outcome in women with PCOS, PCO and normal ovarian morphology.Eur J Obstet Gynecol Reprod Biol. 2010;149:68-71
https://doi.org/10.1016/j.ejogrb.2009.11.017
Mateo HA, Rentería GA, Frausto JA, Mateo M y col. Administración de metformina en mujeres con síndrome de ovario poliquístico y su efecto en fertilización in vitro. Reproducción (México). 2018;9(2):31-37.
Zhou H, Zhang D, Luo Z, Yang A, Cui N, et al. Association between Body Mass Index and Reproductive Outcome in Women with Polycystic Ovary Syndrome Receiving IVF/ICSI-ET. BioMed Research International. 2020;2020:6434080. https://doi.org/10.1155/2020/6434080
Salamun V, Jensterle M, Janez A, Bokal E. Liraglutide increases IVF pregnancy rates in obese PCOS women with poor response to first-line reproductive treatments: a pilot randomized study. Eur J Endocrinol. 2018;179(1):1-11. https://doi.org/10.1530/EJE-18-0175
Cena H, Chiovato L, Nappi Rossella. Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists. Clin Endocrinol Metab. 2020;105(8):e2695-e2709.
https://doi.org/10.1210/clinem/dgaa285
Han Y, Li Y, He B. GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis. rBMO. 2019;39(2):332-342. https://doi.org/10.1016/j.rbmo.2019.04.017
Carmona IO, Saucedo E, Moraga MR, Romeu A. Mioinositol en combinación con D-chiro-inositol: resultados preliminares en el tratamiento de primera línea de pacientes con síndrome de ovario poliquístico. Ginecol Obstet Mex. 2017;85(3):141-151.
Showell MG, Mackenzie-Proctor R, Jordan V, Hodgson R, Farquhar C. Inositol for subfertile women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2018;12:CD012378. https://doi.org/10.1002/14651858.CD012378.pub2
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