Successful Implementation of Menstrual Cycle Biomarkers in the Treatment of  Infertility in Polycystic Ovary Syndrome-Case Report

Aleksandra M Kicińska; Aneta Stachowska; Anna Kajdy; Tomasz H Wierzba; Radosław B Maksym

doi:10.3390/healthcare11040616

Reproductive Endocrinology Luteal Phase

Successful Implementation of Menstrual Cycle Biomarkers in the Treatment of Infertility in Polycystic Ovary Syndrome-Case Report

Kicińska AM, Stachowska A, Kajdy A, Wierzba TH, Maksym RB

Published February 18, 2023 Healthcare (Basel, Switzerland), 11(4), 616

DOI 10.3390/healthcare11040616 PMID 36833150 PMC PMC9956032

RRM Academy Synopsis

Progesterone timed to a charted cycle preceded pregnancy in PCOS

A woman with PCOS conceived after her progesterone was timed to her charted cycle. The case report describes a 29-year-old woman with polycystic ovary syndrome (PCOS), also named PMOS (Polyendocrine Metabolic Ovarian Syndrome), and two years of infertility. With an instructor she charted her cycle, and she later gave birth to a healthy baby.

Key Findings

The woman, aged 29, had PCOS with menstrual cycles lasting up to several months and no ovulation; tube patency testing and her husband's semen tests showed no pathology.
Earlier treatment that included progesterone from a fixed cycle day produced regular bleeding every 26–32 days, and ovulation-stimulating medication added later did not lead to pregnancy.
After regular visits with a charting instructor, progesterone began on Day 23, three days after the basal body temperature rise, and she became pregnant in that cycle, her first pregnancy.
She went into labor spontaneously and delivered a healthy baby at Week 40 of gestation, with an Apgar score of 10.
Alongside the timed progesterone, she received treatment for thyroid function, an abnormal oral glucose tolerance test, a cervical culture finding, and suspected thrombophilia.

Interpretation

This is a single case report of one 29-year-old woman with PCOS. Her tubes and her husband's semen tests showed no pathology, and her course ended in a term delivery. The report describes progesterone begun after the charted rise in basal body temperature, together with treatment of thyroid, glucose, cervical culture, and clotting findings. The authors note that a single case limits scientific inference and name randomized crossover studies as the best test of the concept. They call for more research on cyclic progesterone therapy and for teaching it to clinicians and women.

RRM Context

Restorative reproductive medicine (RRM) reads the cycle from the body's own signs. Basal body temperature and cervical mucus charts let a clinician time treatment to the cycle a woman actually has. This fits the RRM principles of working with the body's own cycle and finding the cause before treating.

Our editorial summary of this paper, not the article's abstract.

Abstract

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Absent, impaired, or rare ovulation induces progesterone deficiency in the luteal phase, which is a critical problem in PCOS. A usual pattern of progesterone administration from a fixed and arbitrary pre-determined day of a menstrual cycle may preserve infertility but can easily be avoided. We present the case of a 29-year-old infertile woman who had been ineffectively treated for over two years. We introduced a line of therapy that was suited to her individual menstrual cycle by implementing biomarker recording. Supplementation based on a standardized observation of the basal body temperature (BBT) and cervical mucus stopped the vicious circle of absent ovulation and hyperandrogenism, restoring regular bleeding, ovulation cycles, and fertility. The implementation of a reliable fertility awareness method (FAM), accompanied by a standardized teaching methodology and periodic review of the observations recorded by the patient, validated through an ultrasound examination and plasma gonadotropins, estrogens, and progesterone concentrations, is key to achieving therapeutic success. The presented case is an example of a clinical vignette for many patients who have successfully managed to improve their fertility and pregnancy outcomes by applying the principles of a personalized treatment approach together with gestagens by recording their fertility biomarkers.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Cycle Biomarkers › Hormonal Markers · Infertility › Luteal Phase Defect › Progesterone Replacement

Aleksandra M Kicińska, Aneta Stachowska, Anna Kajdy, Tomasz H Wierzba, Radosław B Maksym

A Kicińska, A Stachowska, A Kajdy, T Wierzba, R Maksym

PMID 36833150 36833150 DOI 10.3390/healthcare11040616 10.3390/healthcare11040616 Kicińska et al. 2023, Kicińska 2023