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Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice

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Abstract

Purpose

Polycystic ovary syndrome (PCOS) is an endocrine, metabolic, and reproductive disorder which, according to the Rotterdam criteria, affects up to 24% of women of childbearing age. Although the prevalence of infertility in this subpopulation of women is high, the optimal treatment has not been fully established yet. Insulin resistance is considered to be an important mechanism involved in the development of PCOS; hence, the aim of this narrative review is to present an overview of the current pharmacological insulin-sensitizing treatment modalities for infertile women with PCOS.

Methods

A MEDLINE and PubMed search for the years 1990–2023 was performed using a combination of keywords. Clinical trials with insulin sensitizers used for infertility treatment as well as analyses of systematic reviews and meta-analyses were evaluated. When deemed necessary, additional articles referenced in the retrieved papers were included in this narrative review.

Results

Several insulin-sensitizing compounds and various therapeutical protocols are available for infertility treatment of women with PCOS. Metformin is the most common adjuvant medication to induce ovulation in infertile women with PCOS and is more frequently administered in combination with clomiphene citrate than on its own. Recently, inositol and glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as possible options for infertility treatment in PCOS.

Conclusion

The future of medical treatment of PCOS women with infertility lies in a personalized pharmacological approach, which involves various compounds with different mechanisms of action that could modify ovarian function and endometrial receptivity, ultimately leading to better overall reproductive outcomes in these women.

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Authors and Affiliations

  1. University of Belgrade Faculty of Medicine, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia

    Radmila Sparić & Olivera Kontić-Vučinić

  2. Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia

    Mladen Andjić

  3. Clinic for Gynecology and Obstetrics Narodni front, Belgrade, Serbia

    Aleksandar Rakić

  4. Department of Endocrinology, UMC Bežanijska Kosa, University of Belgrade Faculty of Medicine, Belgrade, Serbia

    Jelica Bjekić-Macut

  5. Endocrine Unit, Athens Medical Centre, Athens, Greece

    Sarantis Livadas

  6. Unit of Endocrine Diseases, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    George Mastorakos

  7. University of Belgrade Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotića 13, Belgrade, 11000, Serbia

    Djuro Macut

Authors
  1. Radmila Sparić
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  2. Mladen Andjić
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  3. Aleksandar Rakić
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  4. Jelica Bjekić-Macut
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  5. Sarantis Livadas
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  6. Olivera Kontić-Vučinić
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  7. George Mastorakos
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  8. Djuro Macut
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Contributions

R.S. and D.M. conceived and designed the study. M.A., A.R., D.M., R.S., J.B-M., S.L., and G.M. performed initial and final literature searches and analyses. The initial manuscript draft was prepared by R.S. and M.A. and subsequently revised by D.M., A.R., J.B-M., S.L., O.K-V., and GM. The final submitted version was approved by all the authors.

Corresponding author

Correspondence to Djuro Macut.

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Sparić, R., Andjić, M., Rakić, A. et al. Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice. Hormones 23, 49–58 (2024). https://doi.org/10.1007/s42000-023-00494-y

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  • DOI: https://doi.org/10.1007/s42000-023-00494-y

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