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Insulin-Sensitizing Drugs for the Treatment of Infertility in Polycystic Ovary Syndrome

  • Chapter
Insulin Resistance and Polycystic Ovarian Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Infertility in polycystic ovary syndrome (PCOS) is characterized by anovulation and early pregnancy loss. A key component of PCOS is the presence of insulin resistance and compensatory hyperinsulinemia, which has an important role in the pathogenesis of infertility. As a result, insulinsensitizing agents such as metformin and thiazolinediones have been studied in women with PCOS with the goal of improving ovulation.

Multiple studies have demonstrated the effectiveness of metformin in improving ovulatory rates as a single agent and in combination with clomiphene citrate. Pregnancy rates are also increased when metformin is added to clomiphene. In addition, metformin with follicle-stimulating hormone induction may minimize ovarian hyperstimulation, although studies are limited. Recent data suggests metformin improves the endometrial environment during the peri-implantation period, thereby decreasing the rate of early miscarriage.

Rosiglitazone and pioglitazone monotherapy increase ovulatory rates, as well as the combination of clomiphene and rosiglitazone. Prelimary studies suggest that thiazolinediones may be more effective in obese women with PCOS compared with metformin in improving ovulation. However, with the thiazolinediones as category C pregnancy drugs, their use as fertility agents is less clear than metformin.

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Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

    Cynthia S. Ryan MD & John E. Nestler MD

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  1. Cynthia S. Ryan MD
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  2. John E. Nestler MD
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Editor information

Editors and Affiliations

  1. Endocrine Section of First Department of Internal Medicine, Athens University School of Medicine, Athens, Greece

    Evanthia Diamanti-Kandarakis MD, PhD

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

    John E. Nestler MD

  3. Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios Panidis MD, PhD

  4. Endocrinology Unit, Department of Internal Medicine and Gastroenterology and C.R.B.A., S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Renato Pasquali MD

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Ryan, C.S., Nestler, J.E. (2007). Insulin-Sensitizing Drugs for the Treatment of Infertility in Polycystic Ovary Syndrome. In: Diamanti-Kandarakis, E., Nestler, J.E., Panidis, D., Pasquali, R. (eds) Insulin Resistance and Polycystic Ovarian Syndrome. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-310-3_10

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  • DOI: https://doi.org/10.1007/978-1-59745-310-3_10

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-763-1

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