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Progestin Treatment for PCOS May Actually Hinder Pregnancy
by Leigh Ann Woodruff, May 28, 2012
Polycystic ovarian syndrome (PCOS) is often treated with progestin, a synthetic progesterone in birth control pills. Progestin is often used as the first step in fertility treatment for women with PCOS in order to regulate the menstrual cycle, and it can improve other symptoms of PCOS such as acne, male-type hair growth and male pattern hair loss.
Now a new study by the National Institutes of Health (NIH) research network finds that the hormone appears to decrase the odds of conception and giving birth in women with PCOS. The researchers found that women who skipped progestin treatment before receiving fertility drugs were four times more likely to conceive than were women given progestin.
"These are interesting findings, which are counter to the general thinking that inducing a period with Progestins BEFORE starting ovulation–inducing medications is necessary," says Laurence Jacobs, M.D., a fertility doctor with Fertility Centers of Illinois. "Since progestins are not natural hormones, it is not clear if this negative effect will also apply to the use of ‘natural progesterone’ to induce a period. More studies are needed."
PCOS is a hormonal disorder in which the ovaries, and sometimes the adrenal glands, produce excess amounts of androgens such as testosterone. Women typically have irregular menstrual periods and may have trouble getting pregnant. Often, they are treated with ovulation induction with the fertility drug clomiphene (Clomid), and before they receive ovulation induction, they may be given a single course of progestin in order to stimulate the bleeding that occurs during the monthly menstrual cycle.
The study, which was published online in Obstetrics and Gynecology, analyzed data from a 2007 RMN study comparing two fertility treatments for women with PCOS: the standard drug therapy clomiphene (Clomid), which stimulates ovulation, and the diabetes treatment drug metformin. the current analysis of the data found that ultimately, 20 percent of the women who did not receive progestin gave birth, compared with about 5 percent of the women who received progestin.
The researchers found that women who received a dose of progestin, followed by ovulation induction, ovulated in 30 percent of cases. Nearly 7 percent of these women conceived. Women who did not receive progestin ovulated 27 percent of the time, but nearly 28 percent of these women were able to get pregnant.