What are the agents that we have at
our disposal for anovulatory subfertility?? Anovulation is a common cause of
female subfertility. Drugs
commonly used to treat anovulation include 1) selective oestrogen
receptor modulators, CC 2) aromatase inhibitors- Letrozole 3) Tamoxifen 4) gonadotrophins alone 5) combination of
CC/Letrozole in same cycle 7) combinations
of CC or Letrozole backed up gonadotrophins from day 7/8.
Additionally, there is a long list f
drugs/ measures which are considered as
supportive / adjunct for inducing ovulation. Such are about 12 in number
but last 5 have be used or prescribed judiciously after proper counseling.
Such
are a) Insulin sensitizers (metformin/ myoinositol/ Vitamin D ) b) Life
style modification mainly on Yoga- daily physical exercise, to avoid
smoking , alcohol, drug abuse, safe
agents to control if there be any concomitant medical diseases(like DM, HTN,
Epilepsy), c) reducing subfertility associated
stress and reproductive depression , d) Ovum nutrients which will improve mitochondria of
Granulosa cells and Oocyte quality too (
fertilizable oocyte) . These are mostly antioxidants e) empirical or rational
if Lab documented Bromocriptin/cabergolin f) Dexamethasone if adrenal androgens
like DHEASO4 is high-- g) LOD i)
thyroxine j) DHEA.( weak androgen ). and k) Dienogest for 3 months to control
endometrioses associated anovulation after te dienogest courses finished.,
Rationality of empirical Metformin/
Cabergolin / Decadron tab? Many are of
opinion that PCO related anovulation is due to high insulin( comp
hyperinsulinaemia). If serum insulin can be decreased than spont ovulation can
be restored. As serum insulin estimation is difficulty (as is testosterone ) so
they suggest either metformin or Myoinositol on empirical basis. Similarly
other empirical tr is with Bromocriptin at the dies of 1. 25 mg( Sicriptin is
the trade name 0Serum Institute of India) as transient hyperprolactinaemia has
been demonstrated in some cases of anovulation without any other demonstrable
cause, But some doctors empirically prescribes Decdac at the rate of 0.25 mg at
late night to suppress total adrenal androgens, Hirer argument is in cases PCO
both total androgens (there are five types of androgens are in circulation )
nada los high insulin, They claim that
if some amount of androgen from nay suttees reduced Ovulation rat is improved
and that is in the back of their mind for prescribing Decdac,
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