PCO and associated LPD

In contrast VEGF  levels are increased  in PCOS ans also  temporally  and spatially different  in compared to normal   controls.  A recent animal study   suggests a novel auto / paracrine action of cytokines specifically tumor necrosis  factor alpha (TNF-α)    on the up regulation of VEGF  for angiogenesis stimulation in equine early CL.

Possibly this is  a result of increased sensitivity of lutein granulosa cells of  polycystic ovaries   to insulin which leads to increased VEGF  production in compared to normal ovaries . Although controversy   exists it is possible that impaired   angiogenesis may be a  cause of LPD in PCOS . The other angiogenic  factors such  as angiopoietins , epidermal growth factors,  insulin like  growth factors   fibroblast   growth  factor 1 and 2 also participate  in luteal angiogenesis  but it is not known  whether   these factors  are involved in the pathogenesis of LPD.

Treatment  of LPD should target  to normalize menstrual abnormalities  and improve pregnancy   rates. As  LPD is a multifactorial   disorder   individualized approach   of the patient is  necessary  . Administration of progesterone    or human chorionic   gonadotropin is the most  common treatment   of LPD. Ovulation can be  induced by clomiphene  citrate   and / or  gonadotropin.

Conclusion

Should we prescribe aspirin along with CC/ Letrozole in treatment cycles as ecosprin is angiogenic? What is the members practice pattern ??  Many factors associated with PCOS lead to luteal phase Insuffiency in ovulatory PCO. These adverse factors which eventually cause LPD & subfertility in PCO cases are  1)  hyperinsulinemia   2) elevated AMH levels   and 3) impaired  angiogenesis.  These three factors either singularly or separately  are    involved in the pathophysiology  of LPD. Given the important of CL function for the achievement and maintenance   of pregnancy researchers speculated that LPD  could be another  possible  factor involved in infertility   observed in women  with PCOS. The identification   of new angiogenic factors  in LPD  eventually could  open routes  to new  therapeutic approaches  for the treatment of patients  with PCOS . Further   investigations are needed to understand the exact pathophysiological   mechanisms.