Endometrial shedding effect on conception and live birth in women with polycystic ovary syndrome

Michael Peter Diamond, Michael Kruger, Nanette Santoro, Heping Zhang, Peter Casson, William Schlaff, Christos Coutifaris, Robert Brzyski, Gregory Christman, Bruce R. Carr, Peter G. McGovern, Nicholas A. Cataldo, Michael P. Steinkampf, Gabriella G. Gosman, John E. Nestler, Sandra Carson, Evan E. Myers, Esther Eisenberg, Richard S. Legro

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

OBJECTIVE:: To estimate whether progestin-induced endometrial shedding, before ovulation induction with clomiphene citrate, metformin, or a combination of both, affects ovulation, conception, and live birth rates in women with polycystic ovary syndrome (PCOS). METHODS:: A secondary analysis of the data from 626 women with PCOS from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network trial was performed. Women had been randomized to up to six cycles of clomiphene citrate alone, metformin alone, or clomiphene citrate plus metformin. Women were assessed for occurrence of ovulation, conception, and live birth in relation to prior bleeding episodes (after either ovulation or exogenous progestin-induced withdrawal bleed). RESULTS:: Although ovulation rates were higher in cycles preceded by spontaneous endometrial shedding than after anovulatory cycles (with or without prior progestin withdrawal), both conception and live birth rates were significantly higher after anovulatory cycles without progestin-induced withdrawal bleeding (live births per cycle: spontaneous menses 2.2%; anovulatory with progestin withdrawal 1.6%; anovulatory without progestin withdrawal 5.3%; P<.001). The difference was more marked when rate was calculated per ovulation (live births per ovulation: spontaneous menses 3.0%; anovulatory with progestin withdrawal 5.4%; anovulatory without progestin withdrawal 19.7%; P<.001). CONCLUSION:: Conception and live birth rates are lower in women with PCOS after a spontaneous menses or progestin-induced withdrawal bleeding as compared with anovulatory cycles without progestin withdrawal. The common clinical practice of inducing endometrial shedding with progestin before ovarian stimulation may have an adverse effect on rates of conception and live birth in anovulatory women with PCOS.

Original languageEnglish (US)
Pages (from-to)902-908
Number of pages7
JournalObstetrics and Gynecology
Volume119
Issue number5
DOIs
StatePublished - May 1 2012

Fingerprint

Polycystic Ovary Syndrome
Live Birth
Progestins
Ovulation
Clomiphene
Menstruation
Birth Rate
Metformin
Ovulation Induction
Hemorrhage
National Institute of Child Health and Human Development (U.S.)
Reproductive Medicine

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Endometrial shedding effect on conception and live birth in women with polycystic ovary syndrome. / Diamond, Michael Peter; Kruger, Michael; Santoro, Nanette; Zhang, Heping; Casson, Peter; Schlaff, William; Coutifaris, Christos; Brzyski, Robert; Christman, Gregory; Carr, Bruce R.; McGovern, Peter G.; Cataldo, Nicholas A.; Steinkampf, Michael P.; Gosman, Gabriella G.; Nestler, John E.; Carson, Sandra; Myers, Evan E.; Eisenberg, Esther; Legro, Richard S.

In: Obstetrics and Gynecology, Vol. 119, No. 5, 01.05.2012, p. 902-908.

Research output: Contribution to journalArticle

Diamond, MP, Kruger, M, Santoro, N, Zhang, H, Casson, P, Schlaff, W, Coutifaris, C, Brzyski, R, Christman, G, Carr, BR, McGovern, PG, Cataldo, NA, Steinkampf, MP, Gosman, GG, Nestler, JE, Carson, S, Myers, EE, Eisenberg, E & Legro, RS 2012, 'Endometrial shedding effect on conception and live birth in women with polycystic ovary syndrome', Obstetrics and Gynecology, vol. 119, no. 5, pp. 902-908. https://doi.org/10.1097/AOG.0b013e31824da35c
Diamond, Michael Peter ; Kruger, Michael ; Santoro, Nanette ; Zhang, Heping ; Casson, Peter ; Schlaff, William ; Coutifaris, Christos ; Brzyski, Robert ; Christman, Gregory ; Carr, Bruce R. ; McGovern, Peter G. ; Cataldo, Nicholas A. ; Steinkampf, Michael P. ; Gosman, Gabriella G. ; Nestler, John E. ; Carson, Sandra ; Myers, Evan E. ; Eisenberg, Esther ; Legro, Richard S. / Endometrial shedding effect on conception and live birth in women with polycystic ovary syndrome. In: Obstetrics and Gynecology. 2012 ; Vol. 119, No. 5. pp. 902-908.
@article{c11fac8af351460e8c772894c4281f57,
title = "Endometrial shedding effect on conception and live birth in women with polycystic ovary syndrome",
abstract = "OBJECTIVE:: To estimate whether progestin-induced endometrial shedding, before ovulation induction with clomiphene citrate, metformin, or a combination of both, affects ovulation, conception, and live birth rates in women with polycystic ovary syndrome (PCOS). METHODS:: A secondary analysis of the data from 626 women with PCOS from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network trial was performed. Women had been randomized to up to six cycles of clomiphene citrate alone, metformin alone, or clomiphene citrate plus metformin. Women were assessed for occurrence of ovulation, conception, and live birth in relation to prior bleeding episodes (after either ovulation or exogenous progestin-induced withdrawal bleed). RESULTS:: Although ovulation rates were higher in cycles preceded by spontaneous endometrial shedding than after anovulatory cycles (with or without prior progestin withdrawal), both conception and live birth rates were significantly higher after anovulatory cycles without progestin-induced withdrawal bleeding (live births per cycle: spontaneous menses 2.2{\%}; anovulatory with progestin withdrawal 1.6{\%}; anovulatory without progestin withdrawal 5.3{\%}; P<.001). The difference was more marked when rate was calculated per ovulation (live births per ovulation: spontaneous menses 3.0{\%}; anovulatory with progestin withdrawal 5.4{\%}; anovulatory without progestin withdrawal 19.7{\%}; P<.001). CONCLUSION:: Conception and live birth rates are lower in women with PCOS after a spontaneous menses or progestin-induced withdrawal bleeding as compared with anovulatory cycles without progestin withdrawal. The common clinical practice of inducing endometrial shedding with progestin before ovarian stimulation may have an adverse effect on rates of conception and live birth in anovulatory women with PCOS.",
author = "Diamond, {Michael Peter} and Michael Kruger and Nanette Santoro and Heping Zhang and Peter Casson and William Schlaff and Christos Coutifaris and Robert Brzyski and Gregory Christman and Carr, {Bruce R.} and McGovern, {Peter G.} and Cataldo, {Nicholas A.} and Steinkampf, {Michael P.} and Gosman, {Gabriella G.} and Nestler, {John E.} and Sandra Carson and Myers, {Evan E.} and Esther Eisenberg and Legro, {Richard S.}",
year = "2012",
month = "5",
day = "1",
doi = "10.1097/AOG.0b013e31824da35c",
language = "English (US)",
volume = "119",
pages = "902--908",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Endometrial shedding effect on conception and live birth in women with polycystic ovary syndrome

AU - Diamond, Michael Peter

AU - Kruger, Michael

AU - Santoro, Nanette

AU - Zhang, Heping

AU - Casson, Peter

AU - Schlaff, William

AU - Coutifaris, Christos

AU - Brzyski, Robert

AU - Christman, Gregory

AU - Carr, Bruce R.

AU - McGovern, Peter G.

AU - Cataldo, Nicholas A.

AU - Steinkampf, Michael P.

AU - Gosman, Gabriella G.

AU - Nestler, John E.

AU - Carson, Sandra

AU - Myers, Evan E.

AU - Eisenberg, Esther

AU - Legro, Richard S.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - OBJECTIVE:: To estimate whether progestin-induced endometrial shedding, before ovulation induction with clomiphene citrate, metformin, or a combination of both, affects ovulation, conception, and live birth rates in women with polycystic ovary syndrome (PCOS). METHODS:: A secondary analysis of the data from 626 women with PCOS from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network trial was performed. Women had been randomized to up to six cycles of clomiphene citrate alone, metformin alone, or clomiphene citrate plus metformin. Women were assessed for occurrence of ovulation, conception, and live birth in relation to prior bleeding episodes (after either ovulation or exogenous progestin-induced withdrawal bleed). RESULTS:: Although ovulation rates were higher in cycles preceded by spontaneous endometrial shedding than after anovulatory cycles (with or without prior progestin withdrawal), both conception and live birth rates were significantly higher after anovulatory cycles without progestin-induced withdrawal bleeding (live births per cycle: spontaneous menses 2.2%; anovulatory with progestin withdrawal 1.6%; anovulatory without progestin withdrawal 5.3%; P<.001). The difference was more marked when rate was calculated per ovulation (live births per ovulation: spontaneous menses 3.0%; anovulatory with progestin withdrawal 5.4%; anovulatory without progestin withdrawal 19.7%; P<.001). CONCLUSION:: Conception and live birth rates are lower in women with PCOS after a spontaneous menses or progestin-induced withdrawal bleeding as compared with anovulatory cycles without progestin withdrawal. The common clinical practice of inducing endometrial shedding with progestin before ovarian stimulation may have an adverse effect on rates of conception and live birth in anovulatory women with PCOS.

AB - OBJECTIVE:: To estimate whether progestin-induced endometrial shedding, before ovulation induction with clomiphene citrate, metformin, or a combination of both, affects ovulation, conception, and live birth rates in women with polycystic ovary syndrome (PCOS). METHODS:: A secondary analysis of the data from 626 women with PCOS from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network trial was performed. Women had been randomized to up to six cycles of clomiphene citrate alone, metformin alone, or clomiphene citrate plus metformin. Women were assessed for occurrence of ovulation, conception, and live birth in relation to prior bleeding episodes (after either ovulation or exogenous progestin-induced withdrawal bleed). RESULTS:: Although ovulation rates were higher in cycles preceded by spontaneous endometrial shedding than after anovulatory cycles (with or without prior progestin withdrawal), both conception and live birth rates were significantly higher after anovulatory cycles without progestin-induced withdrawal bleeding (live births per cycle: spontaneous menses 2.2%; anovulatory with progestin withdrawal 1.6%; anovulatory without progestin withdrawal 5.3%; P<.001). The difference was more marked when rate was calculated per ovulation (live births per ovulation: spontaneous menses 3.0%; anovulatory with progestin withdrawal 5.4%; anovulatory without progestin withdrawal 19.7%; P<.001). CONCLUSION:: Conception and live birth rates are lower in women with PCOS after a spontaneous menses or progestin-induced withdrawal bleeding as compared with anovulatory cycles without progestin withdrawal. The common clinical practice of inducing endometrial shedding with progestin before ovarian stimulation may have an adverse effect on rates of conception and live birth in anovulatory women with PCOS.

UR - http://www.scopus.com/inward/record.url?scp=84860179633&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860179633&partnerID=8YFLogxK

U2 - 10.1097/AOG.0b013e31824da35c

DO - 10.1097/AOG.0b013e31824da35c

M3 - Article

VL - 119

SP - 902

EP - 908

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 5

ER -