Early Initiation of Anti-Androgen Treatment in Women with PC
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Early initiation of anti-androgen treatment is associated with an increased probability of childbirth after spontaneous conception among women with PCOS, researchers from Uppsala University, Sweden found via population-based study.

They utilized five linked Swedish national registries.
Participants were 15, 106 women with PCOS and 73, 786 control women. They were followed from when they turned 18 years of age until the end of 2015, leading to a maximum follow-up of 10 years.

Information on anti-androgenic treatment was retrieved from the Swedish Prescribed Drug Registry with the use of Anatomic Therapeutic Chemical (ATC) codes.

Women with PCOS who were not treated with any anti-androgenic medication were regarded as normo-androgenic, while those treated were regarded as hyper-androgenic.

Women were further classified as being mildly hyper-androgenic if they received anti-androgenic combined oral contraceptive (aaCOC) monotherapy, or severely hyper-androgenic if they received other anti-androgens with or without aaCOCs. Early and late users comprised women with PCOS who started anti-androgenic treatment initiated either during adolescence (less than 18 years of age) or after adolescence (greater than 18years), respectively.

The probability of childbirth after spontaneous conception in the PCOS group compared to non-PCOS controls was 11% lower among normo-androgenic, and 40% lower among hyper-androgenic women with PCOS. Fecundity rate (FR) was lowest among severely hyper-androgenic women with PCOS compared to normo-androgenic women with PCOS, followed by mildly hyper-androgenic women with PCOS. Compared to early anti-androgenic treatment users, late users exhibited a lower probability of childbirth after spontaneous conception.

Overall, the researchers concluded that early initiation of anti-androgen treatment is associated with better spontaneous fertility rate.

They commented, “We lacked direct information on the intention to conceive and the androgenic biochemical status of the PCOS participants, applying instead the use of anti-androgenic medications as a proxy of hyper-androgenism.” “The duration of anti-androgenic treatment utilized was not known, only the age at which the prescription was prescribed was known.”

“There is a need for future interventional randomized prospective studies investigating critical windows of anti-androgen treatment,” researchers said.

Source:
https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/deaa357/6102682
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