Current management of polycystic ovary syndrome in women with genetic desire

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is an endocrine and reproductive disorder, whose prevalence ranges from 4 to 21 % and is considered in obstetrics and gynecology as the first cause of anovulatory infertility, whose etiological basis is related to epigenetics, hypothalamic and ovarian dysfunction, influenced by other factors, such as excessive exposure to androgens,  insulin resistance and obesity (1-3) Objective: To  determine the current management of polycystic ovary syndrome in women with reproductive desire. Methods: A literature review was carried out selecting 35 medical articles, obtained from databases such as: PubMed, Cochrane, ScienceDirect, Mendeley, Wiley Online Library and journals; Obstetrics and Gynecology. Results: In six randomized controlled trials with a total number of 723 patients, ovulation and clinical pregnancy rates were significantly higher among the letrozole/gonadotropin group versus the letrozole monotherapy group (p <0.001). Liraglutide improved insulin sensitivity as measured by HOMA after 2 weeks, prior to weight loss, thereby improving glucose metabolism, reducing systolic blood pressure, and reducing body weight in PCOS patients. Inositol is a new molecule that has been shown to improve the metabolic profile of PCOS patients. After a thorough analysis, metformin and myo-inositol were found to be comparable in their effects on clinical, hormonal, and biochemical profiles. However, myoinsositol had a better safety and tolerability profile due to minimal side effects compared to metformin, however, mioinositol is still being studied. Ovarian perforation is a surgical technique that is used as a second line of therapy, when treatment with clomiphene citrate, metformin or letrozole has failed in patients with PCOS and can be performed laparoscopically or through transvaginal access. Laparoscopic ovarian perforation significantly reduces anti-Müllerian hormone and antral follicle count, significantly increasing the ovulation rate in PCOS patients compared to transvaginal ovarian perforation. Conclusion: The use of letrozole in combination with chorionic gonadotropins has given good results. Currently, new drugs such as liraglutide stand out with optimal results in terms of weight reduction and insulin resistance and therefore could benefit patients with PCOS and obesity. The use of myo-inositol, as well as vitamin D, whose deficiency contributes to the development of PCOS, are still being studied, but they are not yet part of the definitive management protocol. Finally, when medical treatment has failed, surgical treatment can be resorted to by laparoscopic abdominal or transvaginal route with good results