Induction of ovulation should be preceded by period of progesterone withdrawal bleeding
MONDAY, Oct. 5, 2015 (HealthDay News) — Menstrual preconditioning could prevent major obstetrical syndromes in women with polycystic ovary syndrome (PCOS), according to a clinical opinion piece published in the October issue of the American Journal of Obstetrics & Gynecology.
Ivo Brosens, M.D., from Catholic University Leuven in Belgium, and Giuseppe Benagiano, M.D., from Sapienza University in Rome, focus on a new theory of the pathogenesis of major obstetric complications that are associated with PCOS.
The authors note that the ovarian and endometrial features of PCOS in adolescent and adult women are similar to the presence of multiple ovarian cysts, anovulation, and endometrial progesterone resistance seen in the neonate. Neonatal progesterone resistance is likely to persist and adversely affect young women with PCOS in the absence of cyclic menstruations of menarche. Consequently, primagravid women with PCOS may be at risk of defective deep placentation, as manifested by increased major obstetric syndromes risk. In a large epidemiologic study, the risk of preeclampsia and preterm delivery was found to be elevated among 13- to 15-year-olds but not 16- to 17-year-olds.
“It is proposed therefore that induction of ovulation in the infertile nulligravid woman with PCOS should be preceded by a period of progesterone withdrawal bleedings to achieve full endometrial progesterone response by the time of pregnancy,” the authors write.
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