Polycystic ovary syndrome, infertility, familial thrombophilia, familial hypofibrinolysis, recurrent loss of in vitro fertilized embryos, and miscarriage
| Autor: | Ping Wang, Sherif G. Awadalla, Robert N. Fontaine, Dan Cameron, Harvey Phillips, Charles J. Glueck |
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| Rok vydání: | 2000 |
| Předmět: |
Infertility
Adult medicine.medical_specialty Abortion Habitual Fertilization in Vitro Biology Thrombophilia Miscarriage Pregnancy Internal medicine Plasminogen Activator Inhibitor 1 medicine Humans Hypoglycemic Agents Testosterone Protein S deficiency Amenorrhea Gynecology Polymorphism Genetic Polycystic ovary syndrome (PCOS) Fibrinolysis Androstenedione Obstetrics and Gynecology medicine.disease Embryo Transfer Polycystic ovary Embryo transfer Metformin Endocrinology Treatment Outcome Reproductive Medicine Female Infertility Female Polycystic Ovary Syndrome |
| Zdroj: | Fertility and sterility. 74(2) |
| ISSN: | 0015-0282 |
| Popis: | To study reversible determinants of infertility and recurrent loss of transferred embryos after failure of 7 of 10 embryo transfers, 1 live birth, and 2 miscarriages.Measures of thrombophilia, hypofibrinolysis, reproductive hormones, and androgenic steroids before and after metformin therapy.Outpatient clinical research center.A 32-year-old amenorrheic, infertile woman with polycystic ovary syndrome (PCOS) who had 7 of 10 embryo transfers fail, 1 premature live birth, and 2 miscarriages at 8 and 17 weeks.Metformin (2.55 g/d) was given to ameliorate the endocrinopathy of PCOS.Coagulation, insulin, reproductive hormones, and androgenic steroids.The propositus had thrombophilia (familial protein S deficiency [free protein S 32%; normal/=65%]). She also had familial hypofibrinolysis with 4G4G polymorphism of the plasminogen activator inhibitor (PAI-1) gene and high PAI-1 activity (PAI-Fx), 42.5 U/mL, normal21.1. Polycystic ovary syndrome was characterized by amenorrhea, polycystic ovaries, high fasting serum insulin (39 microU/mL, normal20), androstenedione (763 ng/dL, normal250), and testosterone (229 ng/dL, normal83). After she received metformin for 4 months, PAI-Fx normalized (12.4 U/mL), as did insulin (12 microU/mL), androstenedione (185 ng/dL), and testosterone (39 ng/dL); weight fell from 109 to 91.3 kg (16%).Metformin reversed the endocrinopathy of PCOS. Familial thrombophilia and hypofibrinolysis may lead to thrombosis-mediated uteroplacental vascular insufficiency, failure to achieve pregnancy after embryo transfer, and miscarriage. |
| Databáze: | OpenAIRE |
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