Body Weight Key In Choice of PCOS Therapy.
Author/s: Nancy Walsh
Issue: Dec 15, 2000
WASHINGTON — Body weight is a crucial consideration in determining the choice of treatment for clomiphene-resistant women with polycystic ovary syndrome who wish to become pregnant, Dr. Alexander B. Mamonov said at the FIGO World Congress of Gynecology and Obstetrics.
Obese women showed a better response to laparoscopic electrocoagulation of the ovarian surface (LEOS), whereas lean women responded well to medical therapy with the follicle-stimulating hormone Metrodin in a study involving 128 women who had been infertile for a range of 2-8 years. The study cohort included 84 obese and 44 nonobese women, said Dr. Mamonov of Donetsk State Medical University, Donetsk, Ukraine.
After four failed trials of clomiphene to induce ovulation, women in both study groups were randomized to undergo LEOS or medical therapy with Metrodin. A total of 66 women underwent the laparoscopic procedure, while 62 were given Metrodin. All were followed for 18 months to determine rates of conception, pregnancy and miscarriage.
The highest conception rate (65%) among the obese women was seen in those treated with LEOS. Among the nonobese women, higher conception rates were seen in those treated with Metrodin than with LEOS (58% vs. 32%). The highest overall pregnancy rate (38%) was in the Metrodin-treated obese group, but a first-trimester spontaneous abortion rate of 20% also was seen in this group. The highest miscarriage rate (42%) was seen among the LEOS-treated nonobese women.
Lean women are better candidates for a medical approach when clomiphene-induced ovulation fails, Dr. Mamonov said at the meeting, also sponsored by the American College of Obstetricians and Gynecologists.
There actually may be two different forms of PCOS, Dr. Mamonov said. Obese women tend to have hyperinsulinemia, androgen excess, and coronary risks. They also tend to be anovulatory Lean women typically experience repeated miscarriages. “They do ovulate, but the oocytes are premature and characterized by abnormal meiosis.” he said.
COPYRIGHT 2000 International Medical News Group
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