How to Cite
Abstract
The declining fertility rate has been observed in the past few decades in Maldives. One of the most prevalent diseases that cause this complication is polycystic ovarian syndrome (PCOS). PCOS is a hormonal condition that has affected 13% of women in the reproductive age group globally. This is a chronic condition where various treatment options have been used to counter the complication. In this study, we analyze the effectiveness of one of the most common treatment regimens available in Maldives, letrozole, and letrozole combined with gonadotropins, for women with PCOS-related infertility.This quantitative, retrospective study analyzes data from 2019 to 2024. The population consists of women who received treatment for infertility due to PCOS at Indira Gandhi Memorial Hospital and My Clinic Private Limited, between January 1, 2019, and December 31, 2023. Our total study sample was 173 patients.Using the logistic regression model, we observed that, when compared with those who were more than 35 years, patients who were less than 25 years old, had a 9.5 times more likelihood of getting pregnant. After excluding the other variables, the odds ratio for ages less than 25 years increased from 9.5 to 13.3. Furthermore, patients who are 26 to 30 years of age show a significantly higher successful outcome when other variables are adjusted. This study shows that there is a significant relationship between age and treatment outcome of PCOS-related infertility.
References
Akre, S., Sharma, K., Chakole, S., & Wanjari, M. B. (2022). Recent advances in the management of polycystic ovary syndrome: A review article. Cureus, 14(8). https://doi.org/10.7759/cureus.27689
Amer, S. (2007). Gonadotropin induction of ovulation. Obstetrics, Gynaecology and Reproductive Medicine, 17(7), 205–210. https://doi.org/10.1016/j.ogrm.2007.06.001.
Mitwally, M. F., & Casper, R. F. (2003). Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Human Reproduction, 18(7), 1588-1597. https://doi.org/10.1093/humrep/deg311.
Bahawi, Y. O., Radwan, E. M., Khouj, M. A., Alotaibi, R. K., Bajuwaiber, N. A., Baghlaf, L. F., AlFaraj, W. F., & Oraif, A. M. (2023). Pregnancy rates in women with polycystic ovary syndrome (PCOS) using letrozole versus clomiphene citrate: A retrospective record review. Cureus, 15(7). https://doi.org/10.7759/cureus.42257
Balen, A. H., Morley, L. C., Misso, M., Franks, S., Legro, R. S., Wijeyaratne, C. N.,
Stener-Victorin, E., Fauser, B. C. J. M., Norman, R. J., & Teede, H. (2016). The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Human Reproduction Update, 22(6), 687–708. https://doi.org/10.1093/humupd/dmw025
Banerjee Ray, P., Ray, A., & Chakraborti, P. S. (2012). Comparison of efficacy of letrozole and clomiphene citrate in ovulation induction in Indian women with polycystic ovarian syndrome. Archives of Gynecology and Obstetrics, 285(3), 873–877. https://doi.org/10.1007/s00404-011-2091-7
Chen, Z., Zhang, M., Qiao, Y., & Yang, J. (2016). Effects of letrozole in combination with low-dose intramuscularinjection of human menopausal gonadotropin on ovulation and pregnancy of 156 patients with polycystic ovary syndrome. Pakistan Journal of Medical Sciences, 32(6). https://doi.org/10.12669/pjms.326.11391
Christ, J. P., & Cedars, M. I. (2023). Current guidelines for diagnosing PCOS. Diagnostics (Basel, Switzerland), 13(6), 1113. https://doi.org/10.3390/diagnostics13061113
Collins, J. A., Rand, C. A., Wilson, E. H., Wrixon, W., & Casper, R. F. (1986). The better prognosis in secondary infertility is associated with a higher proportion of
ovulation disorders. Fertility and Sterility, 45(5), 611–616. https://doi.org/10.1016/s0015-0282(16)49330-1
Costello, M. F., Misso, M. L., Wong, J., Hart, R., Rombauts, L., Melder, A., Norman, R. J., & Teede, H. J. (2012). The treatment of infertility in polycystic ovary syndrome: a brief update. The Australian & New Zealand journal of obstetrics & gynecology, 52(4), 400-403. https://doi.org/10.1111/j.1479-828X.2012.01448.x
Dai, X., Li, J., Fu, T., Long, X., Li, X., Weng, R., Liu, Y., & Zhang, L. (2023). Ovulation induction using sequential letrozole/gonadotropin in infertile women with PCOS: a randomized controlled trial. Reproductive Biomedicine Online, 46(2), 352–361. https://doi.org/10.1016/j.rbmo.2022.08.002
Delbaere, I., Verbiest, S., & Tydén, T. (2020). Knowledge about the impact of age on fertility: a brief review. Upsala Journal of Medical Sciences, 125(2), 167–174. https://doi.org/10.1080/03009734.2019.1707913
Deshpande, P. S., & Gupta, A. S. (2019). Causes and prevalence of factors causing infertility in a public health facility. Journal of Human Reproductive Sciences, 12(4), 287. https://doi.org/10.4103/jhrs.jhrs_140_18
Eniola, O. W., Adetola, A. A., & Abayomi, B. T. (2017). A review of Female Infertility; important etiological factors and management. Journal of Microbiology and Biotechnology Research, 2(3), 379-385. https://jmbronline.com/index.php/JMBR/article/view/130
Fatema, K., Das, T. R., Kazal, R. K., Mahamood, S., Pervin, H. H., Noor, F., & Chakma, B. (2021). Prevalence and characteristics of polycystic ovarian syndrome in women attending in outpatient department of obstetrics and gynecology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(3), 830. https://doi.org/10.18203/2320-1770.ijrcog20210469
National Institute of Child Health and Human Development (NICHD). (2024). Treatments for infertility resulting from PCOS. Retrieved May 17, 2024, from https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/treatments/infertility
Flickr, F. us on. (2024). Treatments for infertility resulting from PCOS. Https://www.nichd.nih.gov/. Retrieved May 17, 2024, from https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/treatments/infertility
Gao, Y., Jiang, S., Chen, L., Xi, Q., Li, W., Zhang, S., & Kuang, Y. (2022). The pregnancy outcomes of infertile women with polycystic ovary syndrome undergoing
intrauterine insemination with different attempts of previous ovulation induction.Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.922605
Glueck, C. J., Dharashivkar, S., Wang, P., Zhu, B., Gartside, P. S., Tracy, T., & Sieve, L.
(2005). Obesity and extreme obesity, manifest by ages 20-28 years, dramatically increase lifetime risk of polycystic ovary syndrome in white and black women. Gynecological Endocrinology, 21(6), 3–5. https://doi.org/10.1080/09513590500371929
American College of Obstetricians and Gynecologists. (2023). Having a baby after age 35: How aging affects fertility and pregnancy.
https://www.acog.org/womens-health/faqs/having-a-baby-after-age-35-how-aging
-affects-fertility-and-pregnancy
Jabeen, F., Khadija, S., & Daud, S. (2022). Prevalence of Primary and Secondary Infertility.
Saudi Journal of Medicine, 7(1), 22–28. https://doi.org/10.36348/sjm.2022.v07i01.004
Kotlyar, A. M., & Seifer, D. B. (2023). Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes. Reproductive Biology and Endocrinology, 21(1). https://doi.org/10.1186/s12958-023-01120-7
Li, M., Ruan, X., & Mueck, A. O. (2022). Management strategy of infertility in polycystic ovary syndrome. Global Health Journal (Amsterdam, Netherlands), 6(2), 70–74. https://doi.org/10.1016/j.glohj.2022.03.002
Maldives National Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH). (2021). https://health.gov.mv/storage/uploads/7jqJZrq5/o4bszjk3.pdf
Mitwally, M. F., & Casper, R. F. (2003). Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Human Reproduction, 18(7), 1588–1597. https://doi.org/10.1093/humrep/deg311
World Bank Open Data. (2022). World Bank Open Data. https://data.worldbank.org/share/widget?indicators=SP.DYN.TFRT.IN&locations=MV
World Health Organization. (2023). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
Rotterdam ESHRE/ASRM‐sponsored PCOS consensus workshop group. (2004). Human
Reproduction, 19(1), 41-47. https://doi.org/10.1093/humrep/deh098Sachdeva
Sagle, M. A., Hamilton-Fairley, D., Kiddy, D. S., & Franks, S. (1991). A comparative, randomized study of low-dose human menopausal gonadotropin and follicle-stimulating hormone in women with polycystic ovarian syndrome. Fertility and Sterility, 55(1), 56–60.
https://doi.org/10.1016/s0015-0282(16)54059-x
Sakar, M. N., & Oğlak, S. C. (2020). Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome. Pakistan Journal of Medical Sciences, 36(7). https://doi.org/10.12669/pjms.36.7.3345
The President’s Office. (2023). The President decides to offer blanket coverage for “Endometriosis” and “PCOS” treatments under the Aasandha Scheme. https://presidency.gov.mv/Press/Article/29321
UNFPA Maldives. (2024). Uniting for reproductive health equity in the Maldives.https://maldives.unfpa.org/en/UnitingForRH-OpEd
Vargas-Tominaga, L., Alarcón, F., Vargas, A., Bernal, G., Medina, A., & Polo, Z. (2019). Associated factors to pregnancy in intrauterine insemination. JBRA Assisted Reproduction, 23(4), https://doi.org/10.5935/1518-0557.20190060
Waldman, I. N., & Legro, R. S. (2019). Polycystic ovary syndrome. In S. S. Channing & J. A. Simon (Eds.), The Ovary (pp. 415–435). Elsevier.
Wu, Q., Gao, J., Bai, D., Yang, Z., & Liao, Q. (2021). The prevalence of polycystic ovarian syndrome in Chinese women: A meta-analysis. Annals of Palliative Medicine, 10(1), 74–87. https://doi.org/10.21037/apm-20-1893
Yu, X., Cao, Z., Hou, W., Hu, W., & Yan, G. (2019). Effects of letrozole combined with human menopausal gonadotropin in ovarian stimulation for intrauterine insemination cycles. Annals of Translational Medicine, 7(23), 771–771. https://doi.org/10.21037/atm.2019.11.58