DOCSLIB.ORG

Effects of Laparoscopic Ovarian Drilling in Treating Infertile Anovulatory

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Effects of Laparoscopic Ovarian Drilling in Treating Infertile Anovulatory Effects of laparoscopic ovarian drilling in treating ORIGINAL ARTICLE infertile anovulatory polycystic ovarian syndrome patients with and without metabolic syndrome Grace WS Kong 江穎珊 Objective To compare the effects of laparoscopic ovarian drilling in LP Cheung 張麗冰 treating infertile polycystic ovarian syndrome in patients with 駱 紅 Ingrid H Lok and without metabolic syndrome. Design Retrospective review. Setting A university-affiliated hospital in Hong Kong. Patients A total of 89 infertile anovulatory polycystic ovarian syndrome patients, who underwent laparoscopic ovarian drilling with completed metabolic screening and seen over a 5-year period from 2002 to 2007. Main outcome measures The clinical, hormonal, and metabolic characteristics as well as spontaneous ovulation rates, reproductive outcomes, and diabetes risks during pregnancy observed after laparoscopic ovarian drilling. Results Approximately one fifth (21%) of polycystic ovarian syndrome patients had the metabolic syndrome. There were no differences in spontaneous ovulation rates (68% vs 61%, P=0.76), cumulative pregnancy rates (68% vs 61%, P=0.77), and diabetes risks during pregnancy (64% vs 42%, P=0.13) between patients with and without metabolic syndrome. Conclusion Laparoscopic ovarian drilling was equally effective in inducing ovulation in polycystic ovarian syndrome patients with metabolic syndrome. Thus, patients with metabolic syndrome should not be precluded from laparoscopic ovarian drilling, which has the additional advantage of enabling full tubo-peritoneal assessment at the same time. Introduction Polycystic ovarian syndrome (PCOS) is the most common reproductive endocrinopathy affecting 6 to 12% of women during their reproductive age.1,2 It is also the major cause of anovulatory infertility.3 The first-line treatment of anovulatory infertility in PCOS patients is clomiphene citrate.3-5 Laparoscopic ovarian drilling (LOD) has been shown to be an effective means of inducing ovulation in these patients when clomiphene citrate fails.5,6 Polycystic ovarian syndrome has diverse phenotypes whose aetiology remains unclear. Hyperandrogenism mediated through elevated luteinising hormone (LH) Key words Diabetes mellitus, type 2; [endocrine pathway] and/or insulin resistance (metabolic pathway), which are both Hyperandrogenism; Infertility, female; important pathophysiological features but the relative contribution of these pathways Metabolic syndrome X; Polycystic ovary to the disease mechanism varies in different subjects, which possibly accounts for syndrome; its clinical heterogeneity.7,8 Emerging evidence suggests that a significant proportion of 9 10,11 12,13 Hong Kong Med J 2011;17:5-10 PCOS patients have central obesity, glucose intolerance, atherogenic dyslipidaemia and hypertension,14 which contribute to the development of metabolic syndrome (MetS). According to our earlier study,15 patients with PCOS had a 5-fold increased risk of Department of Obstetrics and developing MetS. Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, While LOD seems to be more effective in inducing ovulation in LH-predominant Shatin, Hong Kong 6 16 GWS Kong, MRCOG patients, after the procedure, both LH and androgen levels decrease but there is no 17-19 LP Cheung, FRCOG impact on metabolic parameters (including plasma glucose, insulin, and lipid levels). IH Lok, MD In addition, LOD was noted to be less effective in inducing ovulation in obese PCOS 20 Correspondence to: Dr GWS Kong women. It was therefore unclear as to whether LOD would work effectively in PCOS Email: [email protected] patients with MetS. Hong Kong Med J Vol 17 No 1 # February 2011 # www.hkmj.org 5 # Kong et al # in the lower abdomen. A pair of grasping forceps was 腹腔鏡卵巢打孔術治療有或無新陳代謝症 used to hold the ovarian ligament for manipulation 候群的多囊卵巢綜合徵無排卵性不孕患者 of the ovary; a laparoscopic ovarian diathermy was introduced via the 5-mm port for drilling. A 的成效 laparoscopic ovarian diathermy needle with a distal 目的 比 較 有或無新陳代謝症候群的多囊卵巢綜合徵 operating needle measuring 8 mm in length and 2 mm （PCOS）不孕患者，其腹腔鏡卵巢打孔術的治療成 in diameter was used with a standardised monopolar 效。 coagulation current set at 30 watts. The output waveform of the current had a nominal frequency of 設計 回顧研究。 500 kHz and a maximum output of 99 watts at 300 Ω 安排 香港一所大學附屬醫院。 resistances. A total of 3 to 10 punctures 7 to 8 mm 患者 2002至2007年的5年期間，共89位PCOS無排卵性不 in depth were made in each ovary depending on its 孕患者接受腹腔鏡卵巢打孔術治療及代謝篩查。 size. Each penetration lasted 4 to 5 seconds.6,16 主要結果測量 臨床、激素和代謝特徵，以及接受治療後的自然排卵 率、妊娠情況和糖尿病風險。 Clinical, anthropometrical, and biochemical 結果 約有五分之一（21%）PCOS患者出現新陳代謝症 parameters 候群。將有新陳代謝症候群與無新陳代謝症候群 A standard data sheet was used to record the 兩組的結果比較，發現無論在自然排卵率（ 68% personal, medical and drug histories; regularity and 比 ， . ）、累積妊娠率（ 比 ， 61% P=0 76 68% 61% length of the menstrual cycle; symptoms of hirsutism ），以及妊娠期間的糖尿病風險（ 比 ， P=0.77 64% 42% and acne; duration and cause of infertility and ）都沒有顯著分別。 P=0.13 previous ovulation induction method and response. 結論 以腹腔鏡卵巢打孔術治療有新陳代謝症候群的PCOS Sitting blood pressure was measured after 5-minute 患者，同樣能有效地刺激排卵。所以這些患者不應被 rest using a standard sphygmomanometer. Body 抹剎接受上述治療的機會；患者也可於治療期間同時 weight, body height, and waist circumferences were 作全面的腹膜管檢查。 measured. Waist circumference was taken as the narrowest measurement midway between the top of iliac crest and the lower rib margin. Serum hormone assays were performed for This retrospective study aimed to compare the LH, follicle stimulating hormone (FSH), and total clinical, hormonal, and metabolic characteristics, testosterone using blood samples taken in the early as well as the reproductive outcomes after LOD in follicular phase (defined as day 2 to 3 of the menstrual PCOS patients with and without MetS. The primary cycle) or after progestogen-induced menstruation. outcome measure was the spontaneous ovulation The concentrations were measured using validated rate after LOD, and secondary outcome measures assays on an Immulite 1000 semi-automated were pregnancy outcomes and the diabetes risk immunoassay analyser (Diagnostic Products during pregnancy. Corporation, Los Angeles [CA], US) in our laboratory at the Department of Clinical Chemistry, Prince Methods of Wales Hospital. We defined LH predominance as elevated LH-to-FSH ratio of ≥2.5 or increased Patient selection basal concentration of LH to ≥10 IU/L. Biochemical All infertile Chinese PCOS patients who underwent hyperandrogenaemia was defined as elevated total LOD at the Prince of Wales Hospital, a university- testosterone of ≥3 nmol/L, which was the 97.5th affiliated hospital in Hong Kong, over a 5-year period percentile of the values of total testosterone of from 2002 to 2007 were reviewed. In our unit, LOD healthy women. Overnight fasting blood samples was offered to patients with PCOS according to the were taken on the same day as the hormonal assay Rotterdam consensus,21 so they had to have evidence for measurement of total cholesterol, triglycerides of chronic anovulation and sonographic appearance (TG), high-density lipoprotein cholesterol (HDL-C), of polycystic ovaries when undergoing laparoscopic low-density lipoprotein cholesterol, fasting plasma assessment for infertility. glucose (FPG), and fasting insulin. A 2-hour plasma glucose concentration was also determined as part of a 75 g oral glucose tolerance test (OGTT). Laparoscopic ovarian drilling All operations were performed by a designated team, which comprised two surgeons. The procedure in Metabolic syndrome our centre involved a three-puncture laparoscopy: Metabolic syndrome was defined according to the a 10-mm laparoscope was inserted via the primary AHA/NHLBI (American Heart Association and the sub-umbilical port, with two additional 5-mm ports National Heart, Lung and Blood Institute)–modified 6 Hong Kong Med J Vol 17 No 1 # February 2011 # www.hkmj.org # Ovarian drilling and metabolic syndrome # Adult Treatment Panel III criteria in 2005 (ATPIII Statistical Package for the Social Sciences (Windows 2005).22 This entailed co-occurrence of three or more version 16; SPSS Inc, Chicago [IL], US). Continuous of the following risk factors: variables were presented as mean (standard deviation [SD]) or median (interquartile range [IQR]), (1) Impaired fasting glucose (FPG ≥5.6 mmol/L) or impaired glucose tolerance after 75 g OGTT and analysed using independent sample t test for normally distributed data or Mann-Whitney U test for (2-hour plasma glucose ≥7.8 and <11.1 mmol/L) non-parametric variables. Categorical variables were or type II diabetes (FPG ≥7 mmol/L or 2-hour expressed as proportions (percentages) and analysed plasma glucose ≥11.1 mmol/L).23 by Chi squared or Fisher’s exact tests as appropriate. (2) Elevated systolic and/or diastolic blood pressure of ≥130/85 mm Hg. (3) Reduced fasting HDL-C of <1.3 mmol/L. Results (4) Elevated fasting TG of ≥1.7 mmol/L. (5) Central obesity with waist circumference of A total of 109 consecutive anovulatory infertile PCOS ≥80 cm in Asian women.24 In cases where waist Chinese patients underwent LOD over the 5-year circumference was not measured, a body mass study period with a median follow-up duration of 16 index (BMI) of 25 kg/m2 was used as a surrogate, (range, 8-26) months were examined. Twenty women which corresponded to a waist circumference of who had incomplete metabolic screening were 80 cm (r=0.92, P<0.001) in data derived from our excluded. There were no differences in the clinical previous studies.15,25 and biochemical characteristics between those
Load more

Recommended publications
  • Microrna-125B Controls Growth of Ovarian Granulosa Cells in Polycystic Ovarian Syndrome by Modulating Cyclin B1 Expression
    Basic research MicroRNA-125b controls growth of ovarian granulosa cells in polycystic ovarian syndrome by modulating cyclin B1 expression Jie Deng, Chanyu Li, Jianbo Luo, Jiaqiong Xie, Cong Peng, Xiaoyang Deng Department of Gynecology, the First Affiliated Hospital of Chengdu Medical College, Corresponding author: Chengdu, Sichuan, China Xiaoyang Deng Department Submitted: 7 January 2019 of Gynecology Accepted: 27 April 2019 The First Affiliated Hospital of Chengdu Arch Med Sci Medical College DOI: https://doi.org/10.5114/aoms.2019.85809 Chengdu, Sichuan Copyright © 2019 Termedia & Banach China 610500 Phone/fax: +86 028-83016137 Abstract E-mail: pingli2865@yahoo. com Introduction: There is a lot of evidence that suggests that microRNAs (miRs) play an imperative role in the pathogenesis of polycystic ovary syndrome (PCOS). This study was designed to decipher the role of miR-125b in PCOS pathogenesis. Material and methods: Expression analysis of miR-125b was determined by real-time quantitative polymerase chain reaction and the KGN ovarian granulosa cell viability was examined by CCK-8 assay. DAPI assay and flow cytometry were carried out for the detection of apoptosis and cell cycle dis- tribution respectively. Protein levels were checked by immunoblotting. Results: The miR-125b transcript levels were considerably high in polycystic ovaries and ovarian granulosa KGN cells. The inhibition of miR-125b expres- sion decreased the viability of the KGN cells by arresting the cells at the G2/M check point. Target Scan analysis revealed cyclin B1 as the target of miR-125b and suppression of miR-125b caused considerable up-regulation of cyclin B1 expression. Like miR-125b inhibition, cyclin B1 silencing also inhibited the KGN cell viability via G2/M arrest.
    [Show full text]
  • Ghasemi Gh. Comparison of Laparoscopic Ovarian Drilling
    Archive of SID Original Article Comparison of Laparoscopic Ovarian Drilling Success between Two Standard and Dose-Adjusted Methods in Polycystic Ovary Syndrome: A Randomized Clinical Trial Leili Hafizi, M.D.1, Maliheh Amirian, M.D.2, Yasmin Davoudi, M.D.3, Mona Jaafari, M.D.1, Ghazal Ghasemi, M.D.1* 1. Department of Obstetrics and Gynaecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2. Department of IVF and Infertility, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 3. Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Abstract Background: One of the treatment methods for increasing the ovarian response to ovulation induction in polycystic ovary syndrome (PCOS) is laparoscopic ovarian drilling (LOD). The optimal amount of the electrosurgical energy discharged in the ovaries to achieve maximum treatment response with minimal follicle injury is unknown. This study was performed to compare the success level of LOD by means of standard and dose-adjusted treatment methods among infertile clomiphene-resistant PCOS women. Materials and Methods: This randomized clinical trial was conducted on infertile clomiphene citrate-resistant PCOS women in the Gynaecology Department of Imam Reza Hospital between 2016 and 2017. The patients were randomly di- vided into two groups based on the ovarian cautery method. The two groups were examined and compared regarding the antral follicles, the serum levels of anti-Müllerian hormone (AMH), androgens, and mid-luteal progesterone one month after surgery. The regularity of cycles, ovulation, and pregnancy were examined monthly up to six months after surgery. Results: In total, 60 women received bilateral LOD (n=30 per group).
    [Show full text]
  • The Outcome of Laparoscopic Ovarian Drilling in Patients With
    ORIGINAL ARTICLE The Outcome of Laparoscopic Ovarian Drilling in Patients with Clomiphene-resistant Polycystic Ovarian Syndrome in Ogbmoso, Nigeria: A Prospective Evaluation Akintunde O Fehintola1, Olufemi T Awotunde2, Olumuyiwa A Ogunlaja3, Samuel E Akinola4, Sunday A Oladeji5, Olurotimi I Aaron6, Funmito O Fehintola7 ABSTRACT Background: Polycystic ovary syndrome (PCOS) is commonly encountered in women with anovulatory infertility. The surgical ovarian drilling procedure aims to restore spontaneous ovulatory cycles. This function is similar to the goal of clomiphene citrate and/or metformin. Objective: We conducted this study to determine the outcome of laparoscopic ovarian drilling (LOD) among patients who presented with clomiphene-resistant PCOS. Materials and methods: The study was prospective in design. We studied 43 patients with clomiphene-resistant PCOS who had laparoscopic ovarian drilling (LOD) using monopolar diathermy at the Bowen University Teaching Hospital, Ogbomoso. The study took place between January 2014 and June 2016. Clinical data recorded at different intervals of follow-up included the menstrual pattern and reproductive history. Results: We successfully performed laparoscopic ovarian drilling without any complication. Four (9.3%) of the patients were lost to follow-up. Thirty (76.9%) of the remaining 39 patients resumed regular menstrual cycles with spontaneous ovulation, while 23 (59.1%) patients achieved spontaneous pregnancy within 6 and 18 months following LOD. No record of multiple pregnancies. Factors associated with failed LOD treatment included obesity and a long duration of infertility. Conclusion: LOD is a feasible and effective first-line treatment option in patients with clomiphene-resistant PCOS in sub-Saharan Africa. Emphasis should be on weight reduction with early application of LOD to treat patients with clomiphene-resistant PCOS.
    [Show full text]
  • Hirsutism and Polycystic Ovary Syndrome (PCOS)
    Hirsutism and Polycystic Ovary Syndrome (PCOS) A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient Education Committee and the Publications Committee. No portion herein may be reproduced in any form without written permission. This booklet is in no way intended to replace, dictate or fully define evaluation and treatment by a qualified physician. It is intended solely as an aid for patients seeking general information on issues in reproductive medicine. Copyright © 2016 by the American Society for Reproductive Medicine AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Hirsutism and Polycystic Ovary Syndrome (PCOS) A Guide for Patients Revised 2016 A glossary of italicized words is located at the end of this booklet. INTRODUCTION Hirsutism is the excessive growth of facial or body hair on women. Hirsutism can be seen as coarse, dark hair that may appear on the face, chest, abdomen, back, upper arms, or upper legs. Hirsutism is a symptom of medical disorders associated with the hormones called androgens. Polycystic ovary syndrome (PCOS), in which the ovaries produce excessive amounts of androgens, is the most common cause of hirsutism and may affect up to 10% of women. Hirsutism is very common and often improves with medical management. Prompt medical attention is important because delaying treatment makes the treatment more difficult and may have long-term health consequences. OVERVIEW OF NORMAL HAIR GROWTH Understanding the process of normal hair growth will help you understand hirsutism. Each hair grows from a follicle deep in your skin. As long as these follicles are not completely destroyed, hair will continue to grow even if the shaft, which is the part of the hair that appears above the skin, is plucked or removed.
    [Show full text]
  • Ovarian Drilling for Fertility
    AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE 1209 Montgomery Highway • Birmingham, Alabama 35216-2809 • TEL (205) 978-5000 • FAX (205) 978-5005 • E-MAIL [email protected] • URL www.asrm.org PATIENT FACT SHEET Ovarian Drilling for Infertility This fact sheet was developed in collaboration with The Society of Reprodutive Surgeons If you have polycystic ovary syndrome (PCOS), you may Will I get pregnant after ovarian drilling? have very irregular cycles. This usually means that you Your chances of pregnancy are good as long as your may have difficulty getting pregnant because you don't menstrual cycles become more regular and no other problems ovulate or release an egg on a regular basis. This medical make it hard for you to conceive. In the year after ovarian condition changes the amount of important substances, drilling, about half of the patients get pregnant. You are called hormones, that your body produces. You end up with less likely to get pregnant with twins or triplets after ovarian too much testosterone (yes, women, not just men, produce drilling than if you are taking fertility drugs. However, testosterone!) and insulin. your cycles may become irregular again as time goes by. Certain medications may be helpful in making the cycles or Sometimes menstrual cycles do not become more regular some hormone levels more normal in these patients. Birth after this surgery, but it may be easier to induce ovulation control pills can make you have a monthly cycle, but will with fertility drugs after the surgery. prevent you from becoming pregnant. Clomiphene, a fertility drug that is taken by mouth, may help you ovulate on a What are the risks of ovarian drilling? more regular basis.
    [Show full text]
  • PCOS: It's Not Just a Problem for the Ovaries
    Diagnosis and Management of PCOS Anita L. Nelson, MD Professor Emeritus, Obstetrics & Gynecology, David Geffen School of Medicine at UCLA Clinical Professor Obstetrics & Gynecology, University Southern California Professor and Chair of Obstetrics & Gynecology, Western University of Health Sciences Women’s Healthcare Symposium University of Missouri School of Nursing July 17, 2018– Kansas City, MO Conflict of Interest Disclosure Anita L. Nelson, MD Agile Pharmaceutical, ContraMed, Grants/ Estetra SPRL, Evofem Inc, FHI Research (MonaLisa), Merck Honoraria/ Allergan, Bayer, Merck Speakers Bureau Consultant/ Agile, AMAG Pharma, Bayer, Advisory Board ContraMed, Merck, PharmaNest Anita L. Nelson, MD - 7/15/2018 1:13 PM PCOS 2018-07-17 UMKC Kansas City 2 Learning Objectives At the end of this presentation, the participant will be able to: Describe the epidemiology and pathogenesis of polycystic ovarian syndrome. Discuss the diagnostic criteria and differential diagnoses for PCOS. Tailor therapies to meet the individual needs of women with PCOS. Anita L. Nelson, MD - 7/15/2018 1:13 PM PCOS 2018-07-17 UMKC Kansas City 3 Prevalence of PCOS Most common endocrinopathy of reproductive-aged women Complete syndrome thought to affect 5-10% of premenopausal women Estimates rose to 15% using new definitions Functional androgen excess may affect up to 20% of reproductive-aged women Prevalence depends on definition used Yildiz BO, et al. JCEM. 2008;93:162-68. Anita L. Nelson, MD - 7/15/2018 1:13 PM PCOS 2018-07-17 UMKC Kansas City 4 Rotterdam Criteria for PCOS (2 out of 3 Criteria) 1. Oligo-ovulation or anovulation 2. Clinical and/or biochemical signs of hyperandrogenism 3.
    [Show full text]
  • Vaginal Ultrasound-Guided Ovarian Needle Puncture Compared To
    Archives of Gynecology and Obstetrics (2019) 299:1475–1480 https://doi.org/10.1007/s00404-019-05067-2 GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE Vaginal ultrasound‑guided ovarian needle puncture compared to laparoscopic ovarian drilling in women with polycystic ovary syndrome Şafak Hatırnaz1 · Seang Lin Tan2 · Ebru Hatırnaz1 · Önder Çelik3 · Mine Kanat‑Pektaş4 · Michael H. Dahan2 Received: 14 June 2018 / Accepted: 25 January 2019 / Published online: 6 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Study objective To compare pregnancy outcomes in PCOS women undergoing transvaginal ovarian injury (TVOI) and laparoscopic ovarian drilling (LOD) Design 126 infertile patients with PCOS were included in this prospective cohort study Canadian task force classifcation of level of evidence IIA. Setting University-afliated fertility center. Patients Sixty-seven infertile patients with the history of failed in vitro maturation underwent follow-up as the TVOI group. Fifty-nine infertile women who underwent LOD acted as controls. All subjects had PCOS with menstrual irregularity and were anovulatory by repetitive serum progesterone levels. Interventions The LOD group underwent six cauterizations of a single ovary with 30W for 4–6 s. Failed IVM subjects with 20–30 needle punctures per ovary acted as the TVOI group. Subjects were followed for six months. Measurements and main results There was not a signifcant diference between the groups when the cases were evaluated in terms of spontaneous pregnancy or miscarriage rates. BMI levels decreased in both the TVOI and the LOD groups in a similar fashion. However, serum AMH and AFC decreased greater after LOD than they did with TVOI over the six-month duration of the study (p < 0.001 in both cases).
    [Show full text]
  • Laparoscopic Evaluation of Adnexal Masses in Reproductive Age Group Dr
    Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online) Abbreviated Key Title: Sch. J. App. Med. Sci. ISSN 2347-954X (Print) ©Scholars Academic and Scientific Publisher A Unit of Scholars Academic and Scientific Society, India Surgical Oncology www.saspublisher.com Laparoscopic Evaluation of Adnexal Masses in Reproductive Age Group Dr. Suguna Maroju1, Dr. Rajeshwar Avancha2* 1Professor, Department of Obstetrics and Gynecology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar Telangana, India 2Assistant Professor, Department of Surgical Oncology, MNJ Cancer Hospital, Hyderabad, India Abstract: Adnexal masses are one of the most common pathologies among women of Original Research Article all age groups. The aim of the present study was to study laparoscopic diagnosis of adnexal masses in the reproductive age group and to study the spectrum of diverse *Corresponding author pathology of adnexal masses in the reproductive age group. Methods: This was a cross- Dr. Rajeshwar Avancha sectional study conducted at Prathima Institute of medical sciences, Karimnagar. 50 subjects between the ages of 18 to 40 years i.e. Reproductive age group were selected Article History for the study, with clinically suspected adnexal masses and ultrasonographically Received: 15.07.2018 diagnosed adnexal masses. In all cases detailed history was taken and Bimanual pelvic Accepted: 25.07.2018 examination was done for assessment of uterine size in weeks, mobility of uterus, size Published: 30.07.2018 of adnexal mass in cms, characteristics of mass such as surface, mobility and consistency, tenderness, and fullness in fornices and pouch of Douglas, nodules in pod DOI: was also noted. Ultrasound preferably trans-vaginal ultrasound was performed in the 10.21276/sjams.2018.6.7.48 Department of Radiology in PIMS.
    [Show full text]
  • MEDICAL COVERAGE POLICY SERVICE: Infertility/Assisted Reproductive Technology POLICY: Please Review the Plan's EOC (Evidenc
    MEDICAL COVERAGE POLICY SERVICE: Infertility/Assisted Reproductive Technology Policy Number: 141 Effective Date: 11/01/2020 Last Review: 09/24/2020 Next Review Date: 09/24/2021 Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your particular benefit plan. Each benefit plan contains its own specific provisions for coverage and exclusions. Not all benefits that are determined to be medically necessary will be covered benefits under the terms of your benefit plan. You need to consult the Evidence of Coverage to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between this policy and your plan of benefits, the provisions of your benefits plan will govern. However, applicable state mandates will take precedence with respect to fully insured plans and self- funded non-ERISA (e.g., government, school boards, church) plans. Unless otherwise specifically excluded, Federal mandates will apply to all plans. With respect to Senior Care members, this policy will apply unless Medicare policies extend coverage beyond this Medical Policy & Criteria Statement. Senior Care policies will only apply to benefits paid for under Medicare rules, and not to any other health benefit plan benefits. CMS's Coverage Issues Manual can be found on the following website: http://cms.hhs.gov/manuals/pub06pdf/pub06pdf.asp SERVICE: Infertility/Assisted Reproductive Technology PRIOR AUTHORIZATION: Not required. Genetic/genomic testing requires prior authorization. POLICY: Please review the plan’s EOC (Evidence of Coverage) or Summary Plan Description (SPD) for coverage details.
    [Show full text]
  • The Frequency of Insulin Resistance and Hyperlipidaemia in Women
    The frequency of insulin resistance and hyperlipidaemia in women with Polycystic Ovarian Syndrome (PCOS) attending Inkosi Albert Luthuli Central Hospital DR. NITASHA MAGAN Durban, 2010 - 1 - This dissertation is submitted to the University of KwaZulu Natal in fulfilment of the requirement for the degree of MMed. - 2 - Declaration I, Nitasha Magan , hereby declare that the work on which this dissertation is based is original and is my own unaided work carried out by me, under the supervison of Professor J.S. Bagratee. Signed: _______________________ Date : ________________________ - 3 - ACKNOWLEDGEMENTS I would like to thank my parents and brother for their tolerance, support and encouragement. I would like to express my gratitude to Professor J. Bagratee for his inspirational mentorship. - 4 - TABLE OF CONTENTS GLOSSARY i ABSTRACT ii 1. INTRODUCTION 1 2. BACKGROUND 5 2.1 HISTORY OF PCOS 7 2.2 AETIOLOGY 9 2.3 PATHOGENESIS 12 2.4 DIAGNOSIS 16 2.5 PCOS AND THE METABOLIC SYNDROME 18 2.6 MANAGEMENT 20 3. METHODS 24 4. RESULTS 27 5. DISCUSSION 35 6. RECOMMENDATIONS 39 APPENDIX 40 REFERENCES 42 - 5 - GLOSSARY BMI Body Mass Index DHEAS Dihydroepiandrosterone sulphate FSH Follicular Stimulating Hormone GNRH Gonadotropin Releasing Hormone HDL High density lipoprotein IGF Insulin Like Growth Factor IALCH Inkosi Albert Luthuli Central Hospital LH Lutenising Hormone LDL Low density lipoprotein 17ά OHP 17ά Hydroxyprogesterone PCOS Polycystic Ovarian Syndrome PRL Prolactin SD Standard Deviation SHBG Sex Hormone Binding Globulin TSH Thyroid Stimulating Hormone T4 Thyroxin i ABSTRACT BACKGROUND Polycystic ovarian syndrome is one of the commonest endocrinopathies in women of reproductive age. The prevalence of the disease is estimated to be around 5 % in general population (Azziz, 2004).
    [Show full text]
  • FOR WOMEN WHO HAVE PCOS in Laparoscopic Ovarian Drilling, an Insulated Needle Unipolar Electrode Is Ma
    36 return toFSHcyclicityin80%of cases. infollicle-stimulating hormone(FSH),and level,increase in testosterone forthe reduction isresponsible stroma destruction ofandrogen-producing butitisthoughtthatthe each point.Themechanismofaction isunclear, for2secondsat using40wattsofcoagulatingcurrent spaced punctures 6to12evenly inserted intheovaryperpendicular tothesurfacecreate is ovariandrilling,aninsulated needleunipolarelectrode In laparoscopic PCOS FOR WOMENWHOHAVE OBG Management | February 2011 | Vol. 23 No. 2 obgmanagement.com cHristy kraMeS for obg MaNaGeMent UPdAtE FERtILItY Two experts discuss the detrimental reproductive effects of obesity; the challenge of preventing ovarian hyperstimulation; and why 4 million or so “outcomes” validate Prof. robert edwards’s Nobel Prize in Physiology or Medicine ›› G. david Adamson, Md ›› Mary E. Abusief, Md Dr. Adamson is Director of Fertility Physicians Dr. Abusief is a Board-Certified Specialist in of Northern California in Palo Alto and San Jose; Reproductive Endocrinology and Infertility at Adjunct Clinical Professor at Stanford University Fertility Physicians of Northern California in Palo School of Medicine; Associate Clinical Professor at Alto and San Jose, Calif. the University of California, San Francisco, School of Medicine; and Past President of the American Society for Reproductive Medicine. The authors report no financial relationships relevant to this article. mpaired fertility is no small problem. • We know more about the effects of obe- I According to the Centers for Disease Con- sity on fecundity, and more about how to trol and Prevention (CDC), it affects 7.3 mil- increase the likelihood of pregnancy and lion women 15 to 44 years old in the United live birth in obese women • The development of in vitro fertilization In thIs States alone, or approximately 10% of the Article female population of reproductive age.1 (IVF) more than 30 years ago represents a Not long ago, there was little to be done significant achievement and vast benefit the grand about the problem.
    [Show full text]
  • Polycystic Ovary Syndrome (PCOS) Symptoms, Causes & Treatments - a Review
    International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583 Polycystic Ovary Syndrome (PCOS) Symptoms, Causes & Treatments - A Review Nobendu Mukerjee Department of Microbiology, Ramakrishna Mission Vivekananda Centenary College Rahara, Kolkata, India Abstract: Polycystic ovary syndrome [PCOS] is one of the most common endocrinopathy of women at reproductive age. Association between PCOS and type-1 endometrial cancer has often been reported. The prolonged an ovulation with consequent continued secretion of oestrogen unstopped by progesterone may enhance the development and growth of this into malignancy, particularly in young women. Hypersecretion of luteinizing hormone [LH], chronic hyperinsulinemia and increased insulin-like growth factor [IGF] levels may represent risk factors for endometrial cancer. Although, data analysis is carried out to calculate an estimate the risk of endometrial cancer in women with PCOS. Anecdotal cases of low-grade endometrial stromal sarcoma and carcinosarcoma have been reported in association with prolonged unopposed oestrogen stimulation, and in particular with PCOS. A few studies have addressed the possibility of an association between PCOS and epithelial ovarian cancer risk. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes them to skip menstrual periods and makes it harder for them to get pregnant. Nowadays almost maximum of woman are suffering from this fatal syndrome which shows various risk factors in their later pregnancy period. Till now research is going on for this syndrome. Keywords: androgenetic alopecia; cyproterone acetate; drospirenone; polycystic ovary syndrome; spironolactone, MAPK/ERK/p38 signaling pathway; metformin; clomiphene citrate. 1. Introduction luteinization and increase cycle fecundity.
    [Show full text]