Effect of Cyproterone Acetate and Ethinyl Estradiol in Infertile Polycystic Ovarian Syndrome in Females with Increased Ovarian Volume

Abstract

Background: The infertility observed in women can be attributed to endocrine, metabolic and gynecological disorders in PCOS, which have an impact on the function and quality of the ovary. Infertile women with PCOS have raised ovarian volume, stroma and follicles on ultrasonography.
Objectives: To estimate the effect of standard available combination of ethinyl estradiol and cyproterone acetate (CPA+EE) on increased ovarian volume in patients with infertility having polycystic ovarian syndrome (PCOS) of reproductive age.
Methods: A prospective observational cohort study was done in patients with infertility having PCOS as diagnosed by Rotterdam’s criteria and having increased ovarian volume. The women included in the study were divided into 3 groups according to their ovarian volume: Group I (10 to 15 cc), Group II (16 to 20 cc) and Group III (>21cc). These participants were subjected to CPA + EE treatment for a period of 3 months, and the change in the ovarian volumes was statistically analyzed thereafter. Then these patients were subjected to ovulation induction and monitored for pregnancy outcome.
Results: In Group 1, 68% patients showed reduction in ovarian volume on trans vaginal sonography after 3 months of the therapy & were put on ovulation induction giving 44% positive pregnancy tests. In Group 2, 46% patients showed a reduction in the ovarian volume and 33.33% patients had a positive pregnancy test. In Group 3, 40% patients showed a significant reduction in ovarian volume & were put on an ovulation induction protocol giving positive pregnancy test in 40%. Also, normalization of the FSH: LH ratio in 14 out of 21 participants with abnormal baseline ratio. Thus, overall a statistically significant decrease (p <0.05) in ovarian volume was observed in 84% patients after treatment with CPA+EE. And a positive pregnancy test was obtained in 40% patients with ovulation induction.
Conclusion: Thus, it can be concluded that CPA + EE can be used as a pre-induction protocol for treating infertile PCOS patients with polycystic ovarian morphology (PCOM).