Current methods to realize the reproductive function in patients with polycystic ovarian syndrome and chronic endometritis
DOI:
https://doi.org/10.12775/JEHS.2021.11.11.038Keywords
polycystic ovary syndrome, chronic endometritis, comorbidity, infertility, treatmentAbstract
Literature review indicates that both polycystic ovary syndrome (PCOS) and chronic endometritis (CE) have a significant role in implantation disorders, one of the main causes of infertility and unsuccessful outcomes of assisted reproductive technologies.
Study aim was to analyze the literature on current methods to recover reproductive function in patients with polycystic ovary syndrome and chronic endometritis.
Materials and methods. The review analyzed scientific literature published in the past decade, as well as relevant research publications available in the online databases, which were searched using the key words "polycystic ovary syndrome", "endometritis", "comorbidity", and "infertility".
Results. While the evidence of positive effects of lifestyle changes on fertility is inconclusive, weight loss is a first-line treatment option recommended for women with PCOS. International guidelines for women with anovulatory PCOS consistently recommendas a second-line option gonadotropin therapy to induce ovulation if oral first-line induction ovulatory therapy, including aromatase inhibitors and selective estrogen receptor modulators, fails. In regards to the treatment of CE, research supports the use of antibiotic therapy which increases the incidence of pregnancy in women with CE and repeated unsuccessful implantation, infertility of unknown ethoilogy or recurrent miscarriage.
Conclusions. Current methods of restoring reproductive function in patients with PCOS and chronic endometritis include a wide range of non-pharmacological and pharmacological treatments of PCOS in combination with antibiotic therapy of chronic endometritis, but their effectiveness remains low, which requires the use of assisted reproductive technologies.
References
Okoroh EM, Hooper WC, Atrash HK, Yusuf HR, Boulet SL Prevalence of polycystic ovary syndrome among privately insured, United States 2003–2008, Obstet. Gynecol. 2012; (4): 299. American.
Brassard, M., AinMelk, Y. and Baillargeon, JP Basic Infertility Including Polycystic Ovary Syndrome. The Medical Clinics of North America. 2008; (92): 1163-1192.American.
A review: Brief insight into Polycystic Ovarian syndrome. Jeshica Bulsara, Priyanshi Patel, Arun Soni, Sanjeev Acharya. Endocrine and Metabolic Science. 30 June 2021.Vol. 3: 100085. USA.
RV Bharathi, S. Swetha, J. Neerajaa, JV Madhavica, DM Janani, SN Rekha, S. Ramya, B. Usha. An epidemiological survey: Effect of predisposing factors for PCOS in Indian urban and rural population. Middle East Fertility Society Journal, 2017; (4): 313-316.
Kauffman RP, Baker VM, Dimarino P., Gimpel T., Castracane VD Polycystic ovarian syndrome and insulin resistance in white and Mexican American women: A comparison of two distinct populations. Am. J. Obstet. Gynecol. 2002; 187: 1362–1369.
Carvalho FM, Aguiar FN, Tomioka R, de Oliveira RM, Frantz N, et al. Functional endometrial polyps in infertile asymptomatic patients: a possible evolution of vascular changes secondary to endometritis. Eur J Obstet Gynecol Reprod Biol 2013; (170): 152-156.
Smith M, Hagerty KA, Skipper B, Bocklage T. Chronic endometritis: a combined histopathological and clinical review of cases from 2002 to 2007. Int J Gynecol Pathol. 2010; 29 (1): 44–50.
Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010; 93 (2): 437–441.
Bouet PE, El Hachem H, Monceau E, Gariepy G, Kadoch IJ, Sylvestre C. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril. 2016; 105 (1): 106–10.
Cicinelli E, Matteo M, Trojano G, Mitola PC, Tinelli R, Vitagliano A, et al. Chronic endometritis in patients with unexplained infertility: prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reprod Immunol. 2018; 79 (1): 12782.
Liu Y, Chen X, Huang J, Wang CC, Yu MY, Laird S, et al. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil Steril. 2018; 109 (5): 832–9.
Song D, Feng X, Zhang Q, Xia E, Xiao Y, Xie W, et al. Prevalence and confounders of chronic endometritis in premenopausal women with abnormal bleeding or reproductive failure. Reprod Biomed Online. 2018; 36 (1): 78–83.
Tersoglio AE, Salatino DR, Reinchisi G, Gonzalez A, Tersoglio S, Marlia C. Repeated implantation failure in oocyte donation. What to do to improve the endometrial receptivity? JBRA Assist Reprod. 2015; 19 (2): 44–52.
Moreno I, Cicinelli E, Garcia-Grau I, et al. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol; 218: 602. 1-16
Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018; 110: 364–379.
Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011; (2): 110 - 112. France.
Pasquali R, Casimirri F, Vicennati V. Weight control and its beneficial effect on fertility in women with obesity and polycystic ovary syndrome. Hum Reprod. 1997; (12): 82–87.
Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992; 36: 105–111.
Legro RS, Dodson WC, Kunselman AR, et al. Benefit of delayed fertility therapy with preconception weight loss over immediate therapy in obese women with PCOS. J Clin Endocrinol Metab. 2016; 101: 2658–2666.
Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril. 2009; 92: 1966–1982.
Hakimi O, Cameron LC. Effect of exercise on ovulation: a systematic review. Sports Med. 2017;47:1555–1567.
Homburg R. Clomiphene citrate—end of an era? A mini-review. Hum Reprod. 2005; 20: 2043–2051.
Close LK Dhaliwal, V. Suri, KR Gupta, S. Sahdev. Tamoxifen: An alternative to clomiphene in women with polycystic ovary syndrome. J.Hum.Reprod.Sci., 2020; 4 (2): 76
Tanbo T, Mellembakken J, Bjercke S, Ring E, Abyholm T, Fedorcsak P. Ovulation induction in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2018; 97: 1162–7.
Casper RF. Aromatase inhibitors in ovarian stimulation. J Steroid Biochem Mol Biol. 2007; 106: 71–75.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril. 2001;75:305–309.
Weiss NS, Kostova E, Nahuis M, Mol BWJ, van der Veen F, van Wely M.Gonadotrophins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019;1:CD010290.
Ikenaga H, Tanaka Y, Shiotani M, et al. Phase III trial comparing the efficacy and safety of recombinant- or urine-derived human chorionic gonadotropin for ovulation triggering in Japanese women diagnosed with anovulation or oligo-ovulation and undergoing ovulation induction with follitropin-alfa. Reprod Med Biol. 2017;16:45–51.
Bordewijk EM, Nahuis M, Costello MF, et al. Metformin during ovulation induction with gonadotrophins followed by timed intercourse or intrauterine insemination for subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev.2017; 1: 165 – 170.
Palomba S, Falbo A, La Sala GB. Metformin and gonadotropins for ovulation induction in patients with polycystic ovary syndrome: a systematic review with meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2014; 12: 3.
Nestler JE, Jakubowicz DJ. Decreases in ovarian cytochrome P450c17 alpha activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl J Med. 1996; 335: 617–623.
Attia GR, Rainey WE, Carr BR. Metformin directly inhibits androgen production in human thecal cells. Fertil Steril. 2001; 76: 517–524.
Utiger RD. Insulin and the polycystic ovary syndrome. N Engl J Med. 1996; 335: 657–658.
Panda SR, Jain M, Jain S, Saxena R, Hota S. Effect of orlistat versus metformin in various aspects of polycystic ovarian syndrome: a systematic review of randomized control trials. J Obstet Gynaecol 2018; 68: 336–343. India.
Han Y, Li Y, He B. GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis. Reprod Biomed Online. 2019; 39: 332–42.
Showell MG, Mackenzie-Proctor R, Jordan V, Hodgson R, Farquhar C. Inositol for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev .2018; 12: 128 -134.
Monastra G, Unfer V, Harrath AH, Bizzarri M. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecol Endocrinol. 2017; 33: 1–9.
Facchinetti F, Bizzarri M, Benvenga S, et al. Results from the international consensus conference on myo-inositol and D-chiro-inositol in obstetrics and gynecology: the link between metabolic syndrome and PCOS. Eur J Obstet Gynecol Reprod Biol.2015; 195: 72–76.
Pundir J, Sunkara SK, El-Toukhy T, Khalaf Y. Meta-analysis of GnRH antagonist protocols: do they reduce the risk of OHSS in PCOS. Reprod Biomed Online. 2012; 24: 6–22.
Cappelli V, Musacchio MC, Bulfoni A, Morgante G, De Leo V. Natural molecules for the therapy of hyperandrogenism and metabolic disorders in PCOS. Eur Rev Med Pharmacol Sci. 2017; 21(2): 15-29.
El Hayek S, Bitar L, Hamdar LH, et al. Polycystic ovarian syndrome: an updated overview. Front Physiol 2016; (7) :124.
Masharani U, Gjerde C, Evans JL, Youngren JF, Goldfine ID. Effects of controlled-release alpha lipoic acid in lean, nondiabetic patients with polycystic ovary syndrome. J Diabetes Sci Technol. 2010 ; 4(2): 359 - 364.
Di Tucci C, Di Feliciantonio M, Vena F, et al. Alpha lipoic acid in obstetrics and gynecology. Gynecol Endocrinol 2018; 34: 729–33.
Genazzani AD, Shefer K, Della Casa D, et al. Modulatory effects of alpha-lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. J Endocrinol Invest 2018; 41: 583–590.
Fruzzetti F, Capozzi A, Canu A, et al. Treatment with d-chiro-inositol and alpha lipoic acid in the management of polycystic ovary syndrome. Gynecol Endocrinol 2019; 35: 506–510.
Unfer V, Porcaro G. Updates on the myo-inositol plus D-chiro-inositol combined therapy in polycystic ovary syndrome. Expert Rev Clin Pharmacol 2014; 7: 623–31.
Nestler JE, Unfer V. Reflections on inositol(s) for PCOS therapy: steps toward success. Gynecol Endocrinol 2015; 31: 501–505.
Thomas MP, Mills SJ, Potter BV. The other” inositols and their phosphates: synthesis, biology, and medicine (with recent advances in myo-inositol chemistry). Angew Chem Int Ed Engl 2016; 55: 1614–1615.
Rago R, Marcucci I, Leto G, et al. Effect of myo-inositol and alpha-lipoic acid on oocyte quality in polycystic ovary syndrome non-obese women undergoing in vitro fertilization: a pilot study. J Biol Regulators Homeostatic Agents 2015; 29(4): 1-11.
Genazzani AD, Shefer K, Della Casa D, et al. Modulatory effects of alphalipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. J Endocrinol Invest 2018; 41: 583–590.
Carbonelli MG, Di Renzo L, Bigioni M, et al. α-Lipoic Acid Supplementation: A Tool for Obesity Therapy. Curr Pharmaceut Design 2010; 16: 840-846.
De Cicco S, Immediata V, Romualdi D, et al. Myoinositol combined with alpha-lipoic acid may improve the clinical and endocrine features of polycystic ovary syndrome through an insulin-independent action. Gynecol Endocrinol 2017; 33(9): 698–701.
De Leo V, Tosti C, Cappelli V, Morgante G, Cianci A. Valutazione dell'associazione inositolo-glucomannano nel trattamento di donne affette da PCOS. Minerva Ginecol 2014; 66: 527-533.
Mollace V, Sacco I, Janda E, Malara C, Ventrice D, Colica C, Visalli V, Muscoli S, Ragusa S, Muscoli C, Rotiroti D, Romeo F. Hypolipemic and hypoglycaemic activity of bergamot poyphenols: from animal models to human studies. Fitoterapia 2011; 82: 309-331.
Cappello AR, Dolce V, Iacopetta D, Martello M, Fiorillo M, Curcio R, Muto L, Dhanyalayam D. Bergamot (Citrus bergamia Risso) flavonoids and their potential benefits in human hyperlipidemia and atherosclerosis: an overview. Mini Rev Med Chem 2016; 16: 619-629.
Tosti C, Cappelli V, De Leo V. Role of a new oral formulation based on D-chiro-inositol / monacolin K / bergamot extract / methylfolate and Vitamin K2 in perimenopausal women with metabolic syndrome with a BMI >25 kg / m2. J Metab Syndrome 2016; 5: 3 - 4.
Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr. 2007; 137: 447–452.
Nesby-O'Dell S, Scanlon KS, Cogswell ME, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr.2002;76:187–192.
Butts SF, Seifer DB, Koelper N, et al. Vitamin D deficiency is associated with poor ovarian stimulation outcome in PCOS but not unexplained infertility. J Clin Endocrinol Metab. 2019; 104: 369–378.
Lips P, Eekhoff M, van Schoor N, et al. Vitamin D and type 2 diabetes. J Steroid Biochem Mol Biol. 2017; 173: 280–285.
Cicinelli E., Matteo M., Tinelli R., Lepera A., Alfonso R., Indraccolo U. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum. Reprod. 2015; 30: 323-330;
Kitaya K.,Matsubayashi H., Takaya Y., Nishiyama R., Yamaguchi K., Takeuchi T., Ishikawa T. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. Am. J. Reprod. Immunol. 2017; 78: 127- 129;
Vitagliano A., Saccardi C., Noventa M., Di Spiezio A., Saccone G., Cicinelli E., Pizzi S., Andrisani A., Litta PS Effects of chronic endometritis therapy on invitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil. Steril. 2018; 110: 103 - 105.
Cicinelli E., Matteo M., Trojano G., Mitola PC, Tinelli R., Vitagliano A., Crupano FM, Lepera A., Miragliotta G., Resta L. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception. Am. J. Reprod. Immunol. 2018; 79: 127- 182:
McQueen DB, Bernardi LA, Stephenson MD Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil. Steril. 2014; 101: 1026-1030
Tersoglio AE, Salatino DR, Reinchisi G., Gonzalez A., Tersoglio S., Marlia C. Repeated implantation failure in oocyte donation. What to do to improve the endometrial receptivity?. JBRA Assist. Reprod. 2015; 19: 44-52:
Lewis EI, Brower M, Shamonki M (2013) Treatment of chronic endometritis in women with implantation failure improves implantation in subsequent embryo transfers. Fertil Steril 100: 390.
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