Comparative Study between Pioglitazone, Pioglitazone Plus Clomiphene Citrate and Metformine Plus Clomephine Citrate in Treatment of Polycystic Ovarian Syndrome
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Keywords
PCOS, Pioglitazone, Metformine, Clomephine Citrate
Abstract
Polycystic ovarian syndrome (PCOS) is a prevalent metabolic & reproductive condition in females of reproductive age.
Aim and objectives: To assess the effectiveness of Pioglitazone, Pioglitazone plus Clomiphene citrate, Metformin plus Clomiphene citrate in treating infertility in PCOS.
Patients & methods: This was a randomized comparative study conducted on patients presented to the Outpatient Clinic of Gynecology of Om-Elmasrieen Hospital, complaining of infertility and diagnosed as having PCOS. Patients were divided into three groups.
Results: no significant variances in endometrial thickness, OHSS, and multiple pregnancies between three groups= 0.312, 0.360, 0.635 respectively. However, there were significant differences in drug-related complications, PRL before induction p=0.001, FSH, and Insulin levels p>0.05 before & after induction, but no significant differences in LH or Insulin levels p= 0.759, 0.377 respectively after 6 months.
Conclusion: pioglitazone is as effective as metformin without use of ovulation inducing drug. While metformin cannot be used alone. But it should combine with clomiphene citrate.pioglitazone can be used as an alternative to metformin as a single drug with the least side effects and complications and the same ovulation and pregnancy rates.
References
2. NIGAM, Aruna; DWIVEDI, Pooja; SAXENA, Pikee. Insulin Sensitising Agents and Infertility. Indian Journal of Medical Specialities, 2010, 1.2: 106-110.
3. AZZIZ, Ricardo, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. The Journal of Clinical Endocrinology & Metabolism, 2004, 89.6: 2745-2749.
4. IMANI, Babek, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. The Journal of Clinical Endocrinology & Metabolism, 1998, 83.7: 2361-2365.
5. The Practice Committee of the American Society for Reproductive Medicine: Use of insulin sensitizing agents in the treatment of PCOS. Fertil Steril 2004; 82(1): 5181-83.
6. WU, Yuanyuan, et al. Metformin and pioglitazone combination therapy ameliorate polycystic ovary syndrome through AMPK/PI3K/JNK pathway. Experimental and therapeutic medicine, 2018, 15.2: 2120-2127.
7. AZZIZ, Ricardo, et al. Polycystic ovary syndrome. Nature reviews Disease primers, 2016, 2.1: 1-18.
8. DU, Qiang, et al. A systematic review and meta-analysis of randomized controlled trials comparing pioglitazone versus metformin in the treatment of polycystic ovary syndrome. Current medical research and opinion, 2012, 28.5: 723-730.
9. ALLEMAND, Michael C., et al. Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound. Fertility and sterility, 2006, 85.1: 214-219.
10. GASIC, Slavisa, et al. Troglitazone is a competitive inhibitor of 3β-hydroxysteroid dehydrogenase enzyme in the ovary. American Journal of Obstetrics and Gynecology, 2001, 184.4: 575-579.
11. ORTEGA-GONZALEZ, C., et al. Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 2005, 90.3: 1360-1365.
12. SHAHEBRAHIMI, Karoon, et al. Comparison clinical and metabolic effects of metformin and pioglitazone in polycystic ovary syndrome. Indian journal of endocrinology and metabolism, 2016, 20.6: 805.
13. BRETTENTHALER, Nora, et al. Effect of the insulin sensitizer pioglitazone on insulin resistance, hyperandrogenism, and ovulatory dysfunction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 2004, 89.8: 3835-3840.
14. RAUTIO, K1, et al. Endocrine and metabolic effects of rosiglitazone in overweight women with PCOS: a randomized placebo-controlled study. Human Reproduction, 2006, 21.6: 1400-1407.
15. GHAZEERI, Ghina, et al. Effect of rosiglitazone on spontaneous and clomiphene citrate–induced ovulation in women with polycystic ovary syndrome. Fertility and sterility, 2003, 79.3: 562-566.
16. OTA, Hirotaka, et al. Successful pregnancies treated with pioglitazone in infertile patients with polycystic ovary syndrome. Fertility and sterility, 2008, 90.3: 709-713.
17. GLUECK, C. J., et al. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertility and sterility, 2001, 75.1: 46-52.
18. GLUECK, Charles J., et al. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Human Reproduction, 2002, 17.11: 2858-2864.
19. RICHARD, Pierre J., et al. Measuring organizational performance: Towards methodological best practice. Journal of management, 2009, 35.3: 718-804.
20. Ziaee A, Oveisi S, Abedini A, et al. Effect of metformin and piogleta zone treatment on cardiovascular risk profile in PCOS. Acta Med Indones; 2012, 44:16-22.
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