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The basic fertility workup in women with polycystic ovary syndrome: a systematic review
Marleen J Nahuis1, G Jurjen E Oosterhuis, Peter G A Hompes
1Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands. m.nahuis@vumc.nl
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.
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