Fertility and sterility · 2013
The basic fertility workup in women with polycystic ovary syndrome: a systematic review.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Nahuis Marleen J, Oosterhuis G Jurjen E, Hompes Peter G A, van Wely Madelon, Mol Ben Willem J, van der Veen Fulco
Аннотация
OBJECTIVE: To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems.
DESIGN: Systematic review.
SETTING: Not applicable.
PATIENT(S): The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant).
INTERVENTION(S): Performance of a semen analysis or tubal patency test before or during treatment.
MAIN OUTCOME MEASURE(S): Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests.
RESULT(S): Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available.
CONCLUSION(S): Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.
DESIGN: Systematic review.
SETTING: Not applicable.
PATIENT(S): The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant).
INTERVENTION(S): Performance of a semen analysis or tubal patency test before or during treatment.
MAIN OUTCOME MEASURE(S): Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests.
RESULT(S): Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available.
CONCLUSION(S): Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.