The present chapter will discuss on the potential uses of metformin in the treatment of infertility associated with anovulatory patients with polycystic ovary syndrome (PCOS) using data from randomised controlled trials and systematic reviews with meta-analysis.

Anovulation

10.1017/9781108986373.091

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Use of leuprolide acetate plus tibolone in the treatment of severe premenstrual syndrome

Fertility and Sterility (2001)

Costantino Di Carlo Stefano Palomba Giovanni A. Tommaselli Maurizio Guida Attilio Di Spiezio Sardo

Tibolone

10.1016/s0015-0282(00)01707-6

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Is the era of the endometrial scratching finished?

Fertility and Sterility (2022)

Stefano Palomba Amerigo Vitagliano

Unexplained infertility

Live birth

Scratching

10.1016/j.fertnstert.2022.06.019

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Citations (3)

Structured exercise training plus hypocaloric diet improves ovarian sensitivity to clomiphene citrate in polycystic ovary syndrome (PCOS) patients

12th European Congress of Endocrinology (2010)

Stefano Palomba Francesco Giallauria Angela Falbo Tiziana Russo A Grieco

Source

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Retrospective Cohort Study on Acute Care in Obstetrics and Gynecology: Analogies and Differences When Compared to Emergency Medicine

Open Journal of Obstetrics and Gynecology (2017)

Giuseppe Chiossi Stefano Palomba Sara Balduzzi Maged M. Costantine Angela Falbo

Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI; 24.5 - 38.4; >12 weeks’ gestation, OR 81.2, 95%CI; 64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI; 82.7 - 294.4), diurnal (night access OR 0.87, 95% CI; 0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI; 0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI; 0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI; 1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.

Triage

10.4236/ojog.2017.74049

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Predictors of success and optimization of treatment in infertile PCOS patients

Stefano Palomba Angela Falbo Giovanni Battista La Sala

The first successful assisted reproduction in humans performed in 1978 by Steptoe and Edwards was carried out in an unstimulated cycle. Gonadotropins for ovarian stimulation became the standard procedure in the subsequent decades, yielding a higher number of oocytes and an improved pregnancy rate. However, ovarian stimulation with gonadotropins requires strict management due to several side effects, (i.e., multiple pregnancies and the risk of ovarian hyperstimulation syndrome [OHSS]), especially in patients with polycystic ovary syndrome (PCOS). Several procedures to induce ovulation in PCOS patients have been proposed. Some of them are validated options, while some are experimental. Lifestyle modifications, including diet and regular physical activity, are the first-line approach in the treatment of obese PCOS women. Clomiphene citrate (CC) has been considered for many years the first-line approach for simple ovulation induction in PCOS women, even if to date, the combination of CC and metformin seems to be more effective than CC alone. Furthermore, more data need to be acquired before long-term metformin administration could be introduced as the gold standard therapy from an endocrine viewpoint. Gonadotropins may be considered for second-line treatment for inducing ovulation in anovulatory patients after failure of CC and metformin treatments alone or in combination, or in women who, having ovulated, do not conceive after six ovulatory cycles. Gonadotropins administration in a chronic low-dose step-up regimen has a high success rate but requires extensive monitoring, has high costs, and is associated with several complications, such as high cancelled cycles, OHSS and multiple pregnancies. Among the other experimented medical therapies, only aromatase inhibitors (AIs) are promising for the treatment of anovulation in infertile PCOS patients. Finally, in CC-resistant women having suspected or known organic gynecological disease (i.e., endometriosis or leiomyoma), laparoscopic ovarian drilling (LOD) could be considered a valid option; otherwise, it should be avoided because there is no evidence that its efficacy is superior in comparison with other therapeutic options. The beneficial effect of each of these proposals vary according to the clinical characteristics of the patient. This concern is especially important and complex given the different PCOS phenotypes. The recognition of predictors of treatment response is a pivotal factor for the success of a therapy because their identification could lead clinicians to the best individualized treatment to improve the efficacy of the therapy, while optimizing its safety profile. In the current chapter, we will describe the predictive factors for infertility treatments commonly used in the PCOS population. In particular, we will examine data available in the literature regarding the efficacy predictors for treatment with metformin, CC, LOD, AIs and gonadotropins.

10.2217/ebo.12.174

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