scholarly journals N-Acetylcysteine for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Divyesh Thakker ◽  
Amit Raval ◽  
Isha Patel ◽  
Rama Walia
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
Bibliographic Databases ◽  
Ovary Syndrome ◽  
Randomized Controlled ◽  
Significant Difference

Objective. To review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS).Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC.Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo.Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods. Systematic review registration number isCRD42012001902.

scholarly journals The Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
Liangzhen Xie ◽  
Duojia Zhang ◽  
Hongli Ma ◽  
Hui He ◽  
Qing Xia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Polycystic Ovary Syndrome ◽  
Randomized Controlled Trials ◽  
Live Birth ◽  
Polycystic Ovary ◽  
Controlled Trials ◽  
Ovary Syndrome ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Randomized Controlled

Purpose. To assess the efficacy and safety of berberine on reproductive endocrine and metabolic outcomes in women with polycystic ovary syndrome (PCOS). Methods. PubMed (from 1950), the Cochrane Library, the CNKI (from 1979), the VIP (from 1989), and the Wanfang Data (from 1990) and the reference lists of the retrieved articles were searched for randomized controlled trials in human beings with the search terms including “polycystic ovary syndrome/PCOS” and “berberine/BBR/Huangliansu (in Chinese)/Xiao bojian (in Chinese)” till 30 May 2019. Relevant indicators were collected and the data were analyzed by using RevMan 5.3 software. Results. Eventually, a total of 12 randomized controlled trials were included in this systematic review. Our study suggested that berberine had similar live birth rates compared with placebo or metformin and lower live birth rates (RR: 0.61, 95% CI: 0.44 to 0.82) compared with letrozole. There was a significant difference between berberine and placebo and between berberine and no treatment in terms of decreasing total testosterone and luteinizing hormone to follicle-stimulating hormone (LH/FSH) ratio (8 RCTs, 577 participants, MD: −0.34, 95% CI: −0.47 to −0.20; 3 RCTs, 179 participants, MD: −0.44, 95% CI: −0.68 to −0.21, respectively). Berberine was associated with decreasing total cholesterol (3 RCTs, 201 participants; MD: −0.44, 95% CI: −0.60 to −0.29), waist circumference (3 RCTs, 197 participants, MD: −2.74, 95% CI: −4.55 to −0.93), and waist-to-hip ratio (4 RCTs, 258 participants, MD: −0.04, 95% CI: −0.05 to −0.03) compared with metformin, but not with improved BMI (4 RCTs, 262 participants, MD: −0.03, 95% CI: −0.46 to 0.39). Berberine did not increase the incidence of gastrointestinal adverse events (3 RCTs, 567 participants, RR: 1.01, 95% CI: 0.76 to 1.35) or serious events during pregnancy (RR: 0.98, 95% CI: 0.70 to 1.37) compared with placebo. Conclusion. This review found no solid evidence that berberine could improve live birth or other clinical outcomes in women with PCOS. However, berberine appeared to be more efficacious for improving insulin resistance and dyslipidemia and decreasing androgen levels and LH/FSH ratio in women with PCOS when compared with metformin.

scholarly journals Acupuncture and Clomiphene Citrate for Live Birth in Polycystic Ovary Syndrome: Study Design of a Randomized Controlled Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Hongying Kuang ◽  
Yan Li ◽  
Xiaoke Wu ◽  
Lihui Hou ◽  
Taixiang Wu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Polycystic Ovary ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Fertility Treatment ◽  
Ovary Syndrome ◽  
Randomized Controlled ◽  
Multicenter Randomized Controlled Trial

Acupuncture is an alternative therapy to induce ovulation in women with polycystic ovary syndrome (PCOS), but there is no study reporting the live birth rate following ovulation induction by acupuncture or its potential as an adjuvant treatment to clomiphene citrate (CC). We assess the efficacy of acupuncture with or without CC in achieving live births among 1000 PCOS women in Mainland China. This paper reports the methodology of an ongoing multicenter randomized controlled trial. The randomization scheme is coordinated through the central mechanism and stratified by the participating sites. Participants will be randomized into one of the four treatment arms: (A) true acupuncture and CC, (B) control acupuncture and CC, (C) true acupuncture and placebo CC, and (D) control acupuncture and placebo CC. To ensure the quality and integrity of the trial we have developed a unique multinational team of investigators and Data and Safety Monitoring Board. Up to the end of April 2013, 326 subjects were recruited. In conclusion, the success of this trial will allow us to evaluate the additional benefit of acupuncture beyond the first line medicine for fertility treatment in PCOS women in an unbiased manner.

scholarly journals GnRH Antagonist Versus Modified Prolonged GnRH Agonist Protocol in Polycystic Ovary Syndrome (PCOS): Analysis Using Propensity Score Matching

2020 ◽  
Author(s):  
Leizhen Xia ◽  
Lifeng Tian ◽  
Jun Tan ◽  
Shanshan Zhang ◽  
Qiong-Fang Wu
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Live Birth ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Polycystic Ovary ◽  
Economic Cost ◽  
Live Birth Rate ◽  
Ovary Syndrome ◽  
The Cost ◽  
Severe Ohss

Abstract Background: Women with polycystic ovary syndrome (PCOS) have been reported with low pregnancy rate and high OHSS risk in in vitro fertilization (IVF) programs due to the decreased endometrial receptivity and high ovarian reserve. The aim of the study was to compare the effectiveness, safety and economic cost of GnRH antagonist (GnRH-ant) and modified prolonged GnRH agonist (mGnRH-a) protocol in PCOS patients.Methods: This study was a retrospective cohort study that included 2164 women with (PCOS) undergoing assisted reproductive technology (ART) treatment from January 2014 to April 2019. Among them, 2018 women received mGnRH-a treatment and 146 women received GnRH antagonist (GnRH-ant) treatment. The two groups were matched by propensity scores with a ratio of 1:4 (GnRH-ant versus mGnRH-a) accounting for potential confounding factors. The primary outcomes were the live birth rate (LBR), incidence of moderate-to-severe OHSS and the cost of controlled ovarian hyperstimulation (COH). LBR was defined as live birth per started treatment cycle after first fresh or frozen embryo transfer.Results: Women with the mGnRH-a protocol had an increased endometrial thickness on HCG injection day, compared with GnRH-ant protocol (10.84 vs. 9.62, P<0.001), furthermore, the number of transferable embryos on day 3 (7 vs. 5, P=0.022), clinical pregnancy rate (67.81% vs. 52.74%, P=0.0007), implantation rate (56.05%, vs. 43.44%, P<0.001) and live birth rate (58.22% vs. 41.78%, P=0.0004) were also significantly higher in the mGnRH-a protocol group. However, there were no significant differences in the incidence of moderate-to-severe OHSS (4.28% vs. 2.05%, P=0.333), the incidence of severe OHSS (0.17% vs. 0%, P=1) and the cost of COH (RMB: 7736.9 vs. 8046.54, P=0.113). Conclusion: The mGnRH-a protocol has a higher live birth rate than GnRH-ant protocol with the similar safety and economic cost among infertile women with PCOS.

scholarly journals Effects of Dietary Glycemic Index and Glycemic Load on Cardiometabolic and Reproductive Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Maryam Kazemi ◽  
Amir Hadi ◽  
Roger A Pierson ◽  
Marla E Lujan ◽  
Gordon A Zello ◽  
...  
Keyword(s):  
Systematic Review ◽  
Polycystic Ovary Syndrome ◽  
Glycemic Index ◽  
Polycystic Ovary ◽  
Meta Analysis ◽  
Glycemic Load ◽  
Controlled Trials ◽  
Ovary Syndrome ◽  
Randomized Controlled ◽  
Dietary Glycemic Index

ABSTRACT Women with polycystic ovary syndrome (PCOS) exhibit cardiometabolic (e.g., insulin resistance) and associated reproductive disruptions. Lifestyle modification (e.g., diet) is recommended as the first-line therapy to manage PCOS; however, a favorable dietary regimen remains unclear beyond energy restriction. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to summarize evidence on impacts of dietary glycemic index (GI) or glycemic load (GL) on cardiometabolic and reproductive profiles to update the International Evidence-based Guideline for the Assessment and Management of PCOS. Databases of MEDLINE, Cochrane, Web of Science, and Scopus were searched through 30 October 2019, and confirmed on 25 March 2020, to identify RCTs (≥8 wk) comparing the effects of diets with lower (LGI/LGL) and higher (HGI/HGL) GI/GL on glucoregulatory outcomes, lipid profile, anthropometrics, and androgen status in PCOS. The primary outcome was HOMA-IR. Data were pooled by random-effects models and expressed as weighted mean differences and 95% CIs. The risk of bias was assessed by the Cochrane tool. Ten RCTs (n = 403) were eligible. Eight evaluated LGI and 2 LGL diets. LGI diets decreased HOMA-IR (−0.78; −1.20, −0.37; I2 = 86.6%), fasting insulin (−2.39; −4.78, 0.00 μIU/mL; I2 = 76.8%), total cholesterol (−11.13; −18.23, −4.04 mg/dL; I2 = 0.0%), LDL cholesterol (−6.27; −12.01, −0.53 mg/dL; I2 = 0.0%), triglycerides (−14.85; −28.75, −0.95 mg/dL; I2 = 31.0%), waist circumference (−2.81; −4.40, −1.23 cm; I2 = 53.9%), and total testosterone (−0.21; −0.32, −0.09 nmol/L; I2 = 8.6%) compared with HGI diets (all: P ≤ 0.05) without affecting fasting glucose, HDL cholesterol, weight, or free androgen index (all: P ≥ 0.07). Some results were contradictory and only described narratively for 2 RCTs that evaluated LGL diets, since inclusion in meta-analyses was not possible. LGI diets improved glucoregulatory outcomes (HOMA-IR, insulin), lipid profiles, abdominal adiposity, and androgen status, conceivably supporting their inclusion for dietary management of PCOS. Further RCTs should confirm these observations and address whether LGI diets improve more patient-pressing complications, including ovulatory cyclicity, infertility, and cardiovascular disease risk in this high-risk population. This review was registered at www.crd.york.ac.uk/PROSPERO as CRD42020175300.

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