Correction of hyperinsulinemia in oligoovulatory women with clomiphene-resistant polycystic ovary syndrome: a review of therapeutic rationale and reproductive outcomes

Polycystic ovary syndrome (PCOS) describes a convergence of chronic multisystem endocrine derangements, including irregular menses, hirsutism, obesity, hyperlipidemia, androgenization, large and cystic-appearing ovaries, insulin resistance and subfertility. Few PCOS patients exhibit all of these fea...

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Bibliographic Details
Published in:European Journal of Obstetrics and Gynecology 2000-08, Vol.91 (2), p.135-141
Main Authors: Sills, E.Scott, Perloe, Mark, Palermo, Gianpiero D
Format: Article
Language:English
Subjects:
Biological and medical sciences
Clomiphene - therapeutic use
Drug Resistance
Female
Genital system. Reproduction
Humans
Hyperinsulinism - complications
Hyperinsulinism - therapy
Hypoglycemic Agents - administration & dosage
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Infertility
Insulin resistance
Medical sciences
Metformin
Metformin - administration & dosage
Metformin - adverse effects
Metformin - therapeutic use
Ovulation
Pharmacology. Drug treatments
Polycystic ovary
Polycystic Ovary Syndrome - complications
Polycystic Ovary Syndrome - drug therapy
Polycystic Ovary Syndrome - physiopathology
Pregnancy
Reproduction
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Summary:Polycystic ovary syndrome (PCOS) describes a convergence of chronic multisystem endocrine derangements, including irregular menses, hirsutism, obesity, hyperlipidemia, androgenization, large and cystic-appearing ovaries, insulin resistance and subfertility. Few PCOS patients exhibit all of these features, and often only one sign or symptom is evident. The sequelae of PCOS reach beyond reproductive health, as women affected with PCOS have increased relative risks for myocardial infarction, hypertension, ischemic heart disease, thromboembolic disease and diabetes. Although the adverse health consequences associated with PCOS are substantial, unfortunately most women are not aware of these risks. Indeed, in infertility practice such concerns are secondary as most patients are referred for treatment specifically to achieve a pregnancy. Impairments in insulin metabolism appear central to the physiologic cascade of PCOS, yet clomiphene therapy fails to remedy this defect. Several investigators have described satisfactory reproductive outcomes for PCOS patients treated with oral insulin-lowering agents. In this report, we outline a diagnostic and therapeutic approach for women with PCOS refractory to clomiphene with attention to the underlying insulin imbalance associated with impaired fertility.
ISSN:0301-2115
1872-7654
DOI:10.1016/S0301-2115(99)00287-0