Does progestin for polycystic ovary syndrome reduce the chance of pregnancy?

This is an automatically translated article.

Progestin is one of the methods to treat polycystic ovary syndrome by using a hormone called progestin to stimulate menstruation. The question is, does taking this hormone affect fertility?

1. Overview of polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome is a condition that causes irregular periods due to a lack of monthly ovulation and high levels of androgens (male hormones) in women. Elevated androgen levels can sometimes cause the development of acne or hair loss. Most, but not all, women with PCOS are overweight or obese, and they are at increased risk for diabetes and sleep apnea. For women with PCOS who want to get pregnant, fertility drugs or injections are often needed to help a woman ovulate.

2. Causes of PCOS

The causes of polycystic ovaries are still not completely understood, related to the reproductive system, it is believed that abnormal levels of pituitary luteinizing hormone (LH) and high levels of male hormones ( androgens) interfere with the normal function of the ovaries.
For a normal menstrual cycle, the brain (including the pituitary gland), ovaries, and uterus normally follow a sequence of events once a month that helps prepare the body for pregnancy . The two hormones, follicle-stimulating hormone (FSH) and LH, are produced by the pituitary gland. Two other hormones, progesterone and estrogen, are made by the ovaries. During the first half of the cycle, a small increase in FSH stimulates the ovaries to develop a follicle (ovum). The follicle produces increased levels of estrogen, which causes the lining of the uterus to thicken and the pituitary gland to secrete large amounts of LH. This "spike" of LH in the middle ring causes an egg to be released from the ovary (called ovulation).
If the egg is fertilized by sperm, it will develop into an embryo and will travel through the fallopian tube to the uterus. After ovulation, the ovaries produce both estrogen and progesterone, which help prepare the uterus for implantation and pregnancy.
In women with PCOS, many small cysts (small cysts 4 to 9 mm in diameter) accumulate in the ovaries, hence the term polycystic ovary. None of these small follicles is capable of growing to a size that can trigger ovulation. As a result, estrogen, progesterone, LH, and FSH levels become unbalanced. Androgen is normally produced by the ovaries and adrenal glands. Androgen hormones may be elevated in women with PCOS due to high LH levels but may also be due to the high insulin levels commonly seen with PCOS.

The metabolic system controls the processing of carbohydrates, fats and proteins. Important hormones in the metabolic system include insulin, glucagon, glucagon-like peptides, and many more. PCOS is associated with elevated blood insulin levels. Insulin is a hormone produced by specialized cells in the pancreas. Insulin regulates blood sugar levels, when blood sugar levels rise, these cells produce insulin to help the body use glucose for energy.
If sugar does not respond to normal insulin levels, the pancreas will produce more insulin. Overproduction of insulin is called hyperinsulinemia; When the increased amount of insulin is needed to maintain normal sugar levels, a person is said to be insulin resistant; When blood glucose levels are not fully controlled, even if insulin levels rise, the person is said to have a sugar intolerance; If blood glucose levels continue to rise despite increased insulin, the person is said to have type 2 diabetes. Insulin resistance and hyperinsulinemia can occur in both normal weight and overweight women with PCOS. Among women with PCOS, up to 35% of obese women have impaired glucose tolerance by age 40, while up to 10% of obese women develop type 2 diabetes. This is much higher in women with PCOS than in women without PCOS. A family history of diabetes, overweight and obesity, as well as race and ethnicity can increase the likelihood of developing diabetes in women with PCOS.

3. PCOS Symptoms

The changes in hormone levels described above cause the classic symptoms of PCOS, including irregular and irregular periods, hair loss, acne, and trouble getting pregnant. Signs and symptoms of PCOS usually begin around the time of puberty, although some women don't develop symptoms until late adolescence or even early adulthood.
Irregular Menstrual Cycle: Without ovulation, the lining of the uterus does not ovulate and regrows as in a normal menstrual cycle. Instead, the endometrium becomes thicker and may shed irregularly, leading to heavy or prolonged bleeding. Irregular or absent periods can increase a woman's risk of endometrial overgrowth or even endometrial cancer. Women with PCOS typically have six to eight fewer menstrual periods per year. Some women have normal cycles during puberty, which can become irregular if a woman becomes overweight. Weight gain and obesity: PCOS is associated with gradual weight gain and obesity in about half of women. For some women with PCOS, obesity develops during puberty. Hair Growth and Acne: Hair growth can be seen on the upper lip, chin, neck, sideburns, chest, upper or lower abdomen, upper arms, and inner thighs. Acne is a skin condition that causes oiliness and blockage of hair follicles. Infertility: Many women with PCOS do not ovulate regularly, and these women may take longer to get pregnant. Heart disease: Women who are obese and also have insulin resistance or diabetes may have an increased risk of coronary heart disease, which increases the risk of having a heart attack. It is not known for sure whether women with PCOS have an increased risk of the condition. Losing weight and treating insulin abnormalities can both reduce this risk. Sleep Apnea: Sleep apnea is a condition that causes brief episodes in which breathing stops (apneas) during sleep. Patients with this problem often feel tired and sleepy during the day. In addition, there is evidence that people with untreated sleep apnea have an increased risk of insulin resistance, obesity, diabetes, and cardiovascular problems, such as high blood pressure, heart attack, and rhythm. abnormal heart or stroke. Sleep apnea can occur in up to 50% of women with PCOS. This condition can be diagnosed with a sleep study and a number of treatments are available. Other problems: Women with PCOS are more at risk for other problems that can affect quality of life. Includes depression and anxiety, sexual dysfunction, eating disorders.

4. Progestin and chances of getting pregnant

According to a National Institutes of Health study, the hormone progestin is often used as a first step in infertility treatment for polycystic ovary syndrome (PCOS) that reduces the ability to conceive and bear children.
PCOS is a disorder in which the ovaries and sometimes the adrenal glands produce excess amounts of hormones called androgens. Women with PCOS often have irregular periods and it can be difficult to get pregnant. Infertility treatment for people with this condition usually includes inducing ovulation with medication. Before inducing ovulation, your doctor may give you a course of progestin. Progestin thickens the lining of the uterus. If continuous progestin is not taken to maintain this thickening, the lining of the uterus will shed and begin to bleed. The core meaning behind the treatment is to promote bleeding that occurs at the beginning of the monthly menstrual cycle.
However, researchers found that women who skipped progestin treatment before taking fertility drugs were four times more likely to conceive than women who were given progestins. In the end, 20% of women who did not receive a progestin gave birth compared with about 5% of women who received a progestin.
The results indicate that progestin treatment before stimulation, says medical doctor Esther Eisenberg, of the National Institute of Child Health and Human Development's National Institute of Child Health and Human Development (NICHD) Reproductive Sciences Branch Ovulation will be counterproductive in helping women with PCOS get pregnant.
The study was conducted by Michael P. Diamond, MD, Wayne State University in Detroit, Richard S. Legro, MD, Penn State University School of Medicine in Hershey, and researchers at 16 institutions in the Biomedical Network The NICHD Fertility Collaboration (RMN) analyzed data from a 2007 RMN study that compared two fertility treatments for women with PCOS, the standard drug treatment clomiphene to stimulate ovulation, and the fertility drug clomiphene. Metformin diabetes treatment.
Women with PCOS frequently experience insulin resistance, a condition in which the body does not use insulin properly. Studies have shown that drugs like metformin make the body more sensitive to insulin and can increase ovulation rates in women with PCOS. However, a 2007 study found that women taking metformin alone were less likely to become pregnant and give birth than those taking clomiphene or a combination of clomiphene and metformin. Current analysis of data from a 2007 study that compared the effect of ovulation induction combined with prior progestin treatment with the effect of ovulation induction alone found that when women had their cycles When menstruating naturally, 72% will ovulate the next month, and about 5% of these women have been able to conceive.
However, of the women who received a single dose of progestin, 30% stimulated ovulation and almost 7% of these women conceived.

To ensure safety and get high efficiency when treating polycystic ovary, patients need to go to a reputable hospital to be examined by a specialist doctor and have a specific treatment regimen. Currently, Vinmec International General Hospital has a basic gynecological examination and screening package, which helps customers detect early diseases of inflammatory diseases for easy and inexpensive treatment. Screening detects gynecological cancer (cervical cancer) early even when there are no symptoms.
Basic gynecological examination and screening package for female customers, has no age limit and may have the following symptoms:
Abnormal vaginal bleeding Having menstrual problems: irregular menstrual cycle, irregular menstrual cycle Irregular vaginal discharge (smell, different color) Vaginal pain and itching Female clients have several risk factors such as poor personal hygiene, Unsafe sex, abortion,... Female customers have other symptoms such as: Abnormal vaginal discharge, itching, pain in the private area, abnormal vaginal bleeding. When registering for the Basic Gynecological Examination and Screening Package, customers will receive:
Gynecological Specialist Examination Transvaginal Uterine Ovarian Ultrasound Vaginal Bilateral Breast Ultrasound Tests such as: Treponema pallidum test rapid, Chlamydia rapid test, taking samples for cervical-vaginal cytology, bacterioscopic staining (female vaginal fluid), HPV genotype PCR automated system, Urinalysis by automatic machine.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

References: nih.gov, uptodate.com