Clinical Opinion
Induction of ovulation in infertile women with hyperandrogenism and insulin resistance,☆☆

https://doi.org/10.1067/mob.2000.107627Get rights and content

Abstract

The polycystic ovary syndrome is a common cause of anovulatory infertility. Women with severe insulin resistance are a unique subset of polycystic ovary syndrome. The syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN syndrome) is one presentation of the insulin-resistant subset of polycystic ovary syndrome. Insulin resistance and hyperandrogenism are caused by genetic and environmental factors. In women with anovulatory infertility caused by hyperandrogenism and insulin resistance, clomiphene citrate treatment often fails to result in pregnancy. For these women, weight loss and insulin sensitizers can be effective methods of inducing ovulation and pregnancy and may reduce the number of clomiphene-resistant women with polycystic ovary syndrome who are treated with gonadotropins, ovarian surgery, or in vitro fertilization–embryo transfer. (Am J Obstet Gynecol 2000;183:1412-8.)

Section snippets

Identification of unique phenotypes and genotypes in PCOS

It is likely that many unique reproductive disease processes cause both hyperandrogenism and anovulation (PCOS). A major goal of gynecologic endocrinology is to discover the many genes that influence the development of hyperandrogenism and anovulation in women and to understand the influence of environment in the development of PCOS. It is unlikely that substantial progress can be made in our understanding of the pathogenesis of PCOS if it is viewed as a single homogeneous disease with a single

How can clinicians detect insulin resistance and hyperinsulinemia

There is no clear consensus on how to detect insulin resistance and hyperinsulinemia. Laboratory tests that have been proposed to be useful in detecting insulin resistance include fasting insulin concentration, fasting glucose-to-insulin ratio, glucose or insulin response to an oral or intravenous glucose challenge, glucose response to an intravenous injection of insulin, and glucose-insulin clamp studies (eg, euglycemic hyperinsulinemic clamp). A major problem is that the least

Treatment of anovulation in infertile hyperandrogenic and insulin-resistant women

For the clinician a therapeutic imperative is to prescribe focused treatments that are based on the unique disease processes of each patient. It is probable, as the therapeutic armamentarium evolves, that each unique cause of hyperandrogenism and anovulation will be treated with focused and specific interventions. Although the concept has not been directly tested in clinical trials, women with PCOS who are lean, have a markedly elevated LH concentration, and have normal insulin and glucose

Use of metformin for ovulation induction

A hypothesis that is central to this Clinical Opinion article is that infertile anovulatory women with PCOS and no evidence of insulin resistance are not likely to ovulate when given an insulin sensitizer. It is likely that women with insulin resistance are more likely to respond to treatment with an insulin sensitizer. This hypothesis has not been directly tested in a clinical trial. Metformin may best be utilized as part of a stepwise approach to ovulation induction in infertile women with

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  • Cited by (0)

    Supported in part by grant HD-29164 from the National Institutes of Health.

    ☆☆

    Reprint requests: Robert L. Barbieri, MD, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, ASB1-3, 75 Francis St, Boston, MA 02115. E-mail: Rbarbieri@ partners.org.

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