Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice

doi:10.1007/s42000-023-00494-y

Review

. 2024 Mar;23(1):49-58.

doi: 10.1007/s42000-023-00494-y. Epub 2023 Oct 4.

Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice

Radmila Sparić¹, Mladen Andjić², Aleksandar Rakić³, Jelica Bjekić-Macut⁴, Sarantis Livadas⁵, Olivera Kontić-Vučinić¹, George Mastorakos⁶, Djuro Macut⁷

Affiliations

¹ University of Belgrade Faculty of Medicine, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia.
² Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia.
³ Clinic for Gynecology and Obstetrics Narodni front, Belgrade, Serbia.
⁴ Department of Endocrinology, UMC Bežanijska Kosa, University of Belgrade Faculty of Medicine, Belgrade, Serbia.
⁵ Endocrine Unit, Athens Medical Centre, Athens, Greece.
⁶ Unit of Endocrine Diseases, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁷ University of Belgrade Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotića 13, Belgrade, 11000, Serbia. djmacut@gmail.com.

PMID: 37792213
DOI: 10.1007/s42000-023-00494-y

Review

Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice

Radmila Sparić et al. Hormones (Athens). 2024 Mar.

. 2024 Mar;23(1):49-58.

doi: 10.1007/s42000-023-00494-y. Epub 2023 Oct 4.

Authors

Radmila Sparić¹, Mladen Andjić², Aleksandar Rakić³, Jelica Bjekić-Macut⁴, Sarantis Livadas⁵, Olivera Kontić-Vučinić¹, George Mastorakos⁶, Djuro Macut⁷

Affiliations

¹ University of Belgrade Faculty of Medicine, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia.
² Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia.
³ Clinic for Gynecology and Obstetrics Narodni front, Belgrade, Serbia.
⁴ Department of Endocrinology, UMC Bežanijska Kosa, University of Belgrade Faculty of Medicine, Belgrade, Serbia.
⁵ Endocrine Unit, Athens Medical Centre, Athens, Greece.
⁶ Unit of Endocrine Diseases, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁷ University of Belgrade Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotića 13, Belgrade, 11000, Serbia. djmacut@gmail.com.

PMID: 37792213
DOI: 10.1007/s42000-023-00494-y

Abstract

Purpose: Polycystic ovary syndrome (PCOS) is an endocrine, metabolic, and reproductive disorder which, according to the Rotterdam criteria, affects up to 24% of women of childbearing age. Although the prevalence of infertility in this subpopulation of women is high, the optimal treatment has not been fully established yet. Insulin resistance is considered to be an important mechanism involved in the development of PCOS; hence, the aim of this narrative review is to present an overview of the current pharmacological insulin-sensitizing treatment modalities for infertile women with PCOS.

Methods: A MEDLINE and PubMed search for the years 1990-2023 was performed using a combination of keywords. Clinical trials with insulin sensitizers used for infertility treatment as well as analyses of systematic reviews and meta-analyses were evaluated. When deemed necessary, additional articles referenced in the retrieved papers were included in this narrative review.

Results: Several insulin-sensitizing compounds and various therapeutical protocols are available for infertility treatment of women with PCOS. Metformin is the most common adjuvant medication to induce ovulation in infertile women with PCOS and is more frequently administered in combination with clomiphene citrate than on its own. Recently, inositol and glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as possible options for infertility treatment in PCOS.

Conclusion: The future of medical treatment of PCOS women with infertility lies in a personalized pharmacological approach, which involves various compounds with different mechanisms of action that could modify ovarian function and endometrial receptivity, ultimately leading to better overall reproductive outcomes in these women.

Keywords: GLP-1 receptor agonists; Infertility; Inositol; Insulin sensitizers; Metformin; PCOS.

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Genetics of primary hyperparathyroidism, our first Batrinos' scholar review, metabolic syndrome, and quite a bit of reproductive endocrinology: a great issue.
Stratakis CA. Stratakis CA. Hormones (Athens). 2024 Mar;23(1):1-2. doi: 10.1007/s42000-023-00523-w. Hormones (Athens). 2024. PMID: 38195949 No abstract available.

References

1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004 - DOI
1. Conway G, Dewailly D, Diamanti-Kandarakis E et al (2014) The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 171:P1–P29. https://doi.org/10.1530/EJE-14-0253 - DOI - PubMed
1. Stevanovic D, Bozic-Antic I, Stanojlovic O et al (2019) Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): a psychometric study with the Serbian version. Women Health 59:1015–1025. https://doi.org/10.1080/03630242.2019.1587664 - DOI - PubMed
1. Patel S (2018) Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol 182:27–36. https://doi.org/10.1016/j.jsbmb.2018.04.008 - DOI - PubMed
1. Panidis D, Tziomalos K, Misichronis G et al (2012) Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod 27:541–549. https://doi.org/10.1093/humrep/der418 - DOI - PubMed

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[1] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004 - DOI

[2] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004 - DOI

[3] Conway G, Dewailly D, Diamanti-Kandarakis E et al (2014) The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 171:P1–P29. https://doi.org/10.1530/EJE-14-0253 - DOI - PubMed

[4] Conway G, Dewailly D, Diamanti-Kandarakis E et al (2014) The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 171:P1–P29. https://doi.org/10.1530/EJE-14-0253 - DOI - PubMed

[5] Stevanovic D, Bozic-Antic I, Stanojlovic O et al (2019) Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): a psychometric study with the Serbian version. Women Health 59:1015–1025. https://doi.org/10.1080/03630242.2019.1587664 - DOI - PubMed

[6] Stevanovic D, Bozic-Antic I, Stanojlovic O et al (2019) Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): a psychometric study with the Serbian version. Women Health 59:1015–1025. https://doi.org/10.1080/03630242.2019.1587664 - DOI - PubMed

[7] Patel S (2018) Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol 182:27–36. https://doi.org/10.1016/j.jsbmb.2018.04.008 - DOI - PubMed

[8] Patel S (2018) Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol 182:27–36. https://doi.org/10.1016/j.jsbmb.2018.04.008 - DOI - PubMed

[9] Panidis D, Tziomalos K, Misichronis G et al (2012) Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod 27:541–549. https://doi.org/10.1093/humrep/der418 - DOI - PubMed

[10] Panidis D, Tziomalos K, Misichronis G et al (2012) Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod 27:541–549. https://doi.org/10.1093/humrep/der418 - DOI - PubMed

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Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice

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Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice

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