Volume 03 Issue 04-2023
1
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
04
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The frequency of PCOS is approximately 11% among women of childbearing age, and in the structure of endocrine
infertility it reaches 70%. The article presents data on a differentiated approach to the treatment of patients with PCOS
for the natural restoration of fertility. The study examined 150 patients who applied to the gynecological department
of clinic No. 1 of the Samarkand State Medical University for infertility in 2017-2021. Using the methods of differentiated
conservative and surgical treatment of infertility in women with different PCOS phenotypes, based on the study of
clinical, laboratory and ultrasound parameters, pregnancy occurred in 75.3% of patients.
KEYWORDS
Polycystic ovary syndrome (PCOS), normalization of div weight, correction of metabolic disorders, stimulation of
ovulation, gonadotropin releasing factor antagonists, combined oral contraceptives (COCs).
INTRODUCTION
Among women with hirsutism, polycystic ovaries are
detected in 65-70% of cases [4,12]. At the same time,
being an endocrine-dependent pathology, PCOS with
various menstrual irregularities and hirsutism is
diagnosed in more than 60% of cases [3,7, 15].
There is no consensus in the literature on the
treatment of PCOS. The primary therapy in the
Research Article
A DIFFERENTIATED APPROACH TO THE TREATMENT OF INFERTILITY IN
PCOS
Submission Date:
April 20, 2023,
Accepted Date:
April 25, 2023,
Published Date:
April 30, 2023
Crossref doi:
https://doi.org/10.37547/ajbspi/Volume03Issue04-01
Khasanova Dilafruz Abdukhamidovna
Assistant Department Of Obstetrics And Gynecology №1 Samarkand State Medical University Samarkand,
Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ajbspi
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
2
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
04
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
treatment of anovulatory infertility in patients with
PCOS is weight loss, of course, in cases of overweight.
It has been proven that menstrual function returns to
normal with a loss of 5 to 10% of div weight. With the
development of obesity, a decrease in div weight of
less than 5% from the initial one does not lead to the
expected effect, 5-10% gives a satisfactory effect, and
more than 10% leads to a good treatment effect [17, 19].
The use of insulin sensitizers is not only indicated in the
presence of insulin resistance, but also helps to reduce
the risk of developing hyperstimulation syndrome
during in vitro fertilization in patients with PCOS
[17,18]. The duration of therapy is 3-6 months, including
against the background of ovulation stimulation.
There are a large number of scientific papers in The
Cochrane Library database proving the beneficial
effect of COCs on the clinical manifestations of
hyperandrogenism
[16,23].
The
main
world
recommendations for the management of patients
with PCOS provide for the use of clomiphene citrate as
the first line treatment for anovulatory infertility [2, 8,
16]. Exogenous gonadotropins in in vitro fertilization
and laparoscopic drilling are considered as 2nd line
therapy [13, 17] when clomiphene citrate with or
without metformin is ineffective.
MATERIALS AND METHODS
The study examined 150 patients who applied to the
gynecological department of clinic No. 1 of the
Samarkand State Medical University for infertility in
2017-2021. The age of the examined patients was from
22 to 35 years, on average 29.8 ± 3.4 years.
50 patients were attempted to restore fertility without
surgery. In order to normalize ovulatory function and
treat infertility, 100 patients underwent endosurgical
interventions: 64 women had drilling or unilateral
ovarian resection, 36 women had bilateral ovarian
resection.
In the absence of ovulation within three months after
the operation, ovulation inducers (clomiphene citrate
and rFSH) were additionally and sequentially used,
each no more than three cycles according to generally
accepted methods. While maintaining anovulation, IVF
was recommended to patients. The IVF procedure was
also prescribed to patients with restored ovulatory
function against the background of folliculogenesis
inducers, but with persistent infertility.
We analyzed the effect of surgical treatment of PCOS,
taking into account the volume of the operation, on
the levels of homocysteine, AMH, total testosterone,
FSH, LH, the ratio of FSH/LH and total estradiol, which
were determined before and three months after the
intervention.
RESULTS AND DISCUSSIONS
All patients presented with unsuccessful infertility
treatment. A history of 138 (92%) had already been
treated to correct menstrual irregularities with the
help of hormonal and non-hormonal agents. But no
effect. In order to stimulate ovulation, 87 (58%)
patients were prescribed clomiphene citrate in the
Volume 03 Issue 04-2023
3
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
04
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
past (for 3-6 cycles). 81 patients (54%) were prescribed
hysteroscopy to exclude the uterine form of infertility
and in the presence of abnormal uterine bleeding to
exclude the pathology of the uterine cavity. In all cases,
a histological examination of the endometrial scraping
was additionally performed. At the same time, the
following pathological conditions were diagnosed in
39.3%: endometrial hyperplasia - in 20 (13.3%) patients;
endometrial polyps - in 5 (3.3%) patients; hypotrophy or
atrophy of the endometrium - in 34 (22.7%) patients
(similar changes were recorded among patients with
secondary
amenorrhea
and
with
severe
oligomenorrhea with delayed menstruation from 3 to
6 months); submucous myoma - in 1 (0.7%) patients.
During laparoscopy performed in 100 (66.7%) patients
for the purpose of surgical stimulation of ovulation, the
following concomitant factors of infertility were
found: adhesive process of the 1st degree according to
the classification of Hulka J.F - in 9 patients (6%);
external genital endometriosis I-II degree according to
AFSCE classification in 3 patients (2%); subserous
uterine myoma - in 4 patients (2.7%); ovarian cysts - in 3
patients (2%)
In total, during laparoscopy, these pathological
manifestations were detected in 19 (12.7%) patients, 5
(26.3%) of them had a combination of several types of
pathology.
Using the tactics of reducing div weight to a BMI
level below 29.9 and prescribing metformin in the first
cycle after the abolition of COCs, we managed to
induce ovulatory cycles in 43 (28.7%) patients.
However, we observed spontaneous pregnancy only in
three women of phenotype C (before treatment, they
had an ovulatory cycle, but were overweight).
In 40% of patients with PCOS, ovulation does not occur
after multiple cycles of CC treatment, they are
considered resistant (resistant) to CC. In our study, out
of 47 patients who underwent ovulation stimulation
with clomiphene citrate for 6 cycles, 16 women were
clomiphene-resistant (34% in relation to the group with
this method of treatment, and 10.7% in relation to all
examined ).
Conducted only 1 course of stimulation of ovulation
with gonadotropins, which resulted in ovulatory cycles
in 15 out of 21 women (71.4%). However, clinical
pregnancy occurred only in 11 patients of this group,
which was 7.3% in relation to all examined and 52.4% in
this group. All patients with the D phenotype (4
women) and 7 patients with the A phenotype became
pregnant. The protocol was canceled in 6 women who
had more than 3 follicles larger than 16 mm in the
middle of the protocol. 10 patients in this group (47.6%)
were referred for IVF.
In total, we observed 100 patients with various PCOS
phenotypes who underwent surgical treatment for
anovulation. In the postoperative period, the patients
were
observed
for
three
menstrual
cycles.
Spontaneous clinical pregnancy occurred in 67% of
women. 33% of patients from this group after the
diagnosis of anovulation 3 months after surgical
Volume 03 Issue 04-2023
4
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
03
ISSUE
04
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
705
)
(2022:
5.
705
)
(2023:
6.534
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
treatment were again prescribed clomiphene citrate
for 3 months. As a result, it was possible to achieve
natural conception in 8 patients with phenotype B, two
patients with phenotype A. In total, 10% of women with
PCOS became pregnant after repeated use of
clomiphene citrate after surgery.
Thus, we achieved a natural restoration of fertility in
only 133 women with PCOS.
CONCLUSION
Using the methods of differentiated conservative and
surgical treatment of infertility in women with PCOS
based on the study of clinical, laboratory and
ultrasound parameters, pregnancy occurs in 75.3% of
patients.
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American Journal Of Biomedical Science & Pharmaceutical Innovation
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–
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03
ISSUE
04
Pages:
01-06
SJIF
I
MPACT
FACTOR
(2021:
5.
705
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5.
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Publisher:
Oscar Publishing Services
Servi
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