The basic fertility workup in women with polycystic ovary syndrome a systematic review

Capsule:
In subfertile women with anovulation we evaluated the prevalence of additional fertility-reducing factors and the diagnostic and prognostic capacity of fertility tests.

Authors:
Marleen J. Nahuis, M.D., G. Jurjen E. Oosterhuis, M.D., Peter G.A. Hompes, M.D., Madelon van Wely, M.D., Ben Willem J. Mol, Ph.D., Fulco van der Veen, Ph.D.

Volume 100, Issue 1, Pages 219-225, July 2013

Abstract:

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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