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This multicenter, randomized trial compared the effects of clomiphene citrate plus placebo, metformin plus placebo, and combination therapy in infertile women with the polycystic ovary syndrome. The rate of live birth was significantly higher with clomiphene than with metformin; there was no significant difference between the rates with combination therapy and with clomiphene alone. Multiple birth was a complication associated with clomiphene but was infrequent. These data support the use of clomiphene over metformin for the treatment of infertility in women with the polycystic ovary syndrome. In infertile women with the polycystic ovary syndrome, the rate of live birth was significantly higher with clomiphene than with metformin. The polycystic ovary syndrome affects 7 to 8% of women 1 and may be the most common cause of female infertility. 2 Anovulation, 2 early pregnancy loss, 3 and later pregnancy complications 4 have all been implicated in the low fecundity of women with this disorder. Obesity is also common in such women, 5 and this condition alone appears to have an adverse effect on reproduction. 6 , 7 The cause of the polycystic ovary syndrome is poorly understood, and both the diagnosis and treatment of the disorder are controversial. 5 , 8 , 9 Women with this syndrome have hyperandrogenism, 10 morphologic changes in the ovary (polycystic), 10 inappropriate gonadotropin secretion (elevated . . .

In two identical, double-blind, randomized, 6-month phase 3 trials, elagolix (an oral gonadotropin-releasing hormone antagonist), administered with hormonal add-back therapy (estradiol, 1 mg, and norethindrone acetate, 0.5 mg, once daily) was more effective in reducing heavy menstrual bleeding in women with uterine fibroids than placebo. Bone loss was attenuated with add-back therapy, as compared with elagolix alone.

This double-blind, multicenter, randomized trial showed that letrozole, as compared with clomiphene, was associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome. The polycystic ovary syndrome, which is diagnosed on the basis of hyperandrogenism, oligo-ovulation with associated oligomenorrhea, and polycystic ovaries on ultrasonography, affects 5 to 10% of reproductive-age women and is the most common cause of anovulatory infertility. 1 Although the syndrome is a complex reproductive–metabolic disorder, the hypothalamic–pituitary axis has been the target of first-line ovulation-induction therapy. Clomiphene citrate, a selective estrogen-receptor modulator that antagonizes the negative feedback of estrogen at the hypothalamus with a consequent increase in ovarian stimulation by endogenous gonadotropin, has been used for this indication for decades. Clomiphene has drawbacks, including its overall poor efficacy (only a . . .

Women with polycystic ovary syndrome (PCOS) have increased risk for pregnancy complications, possibly related to pre-existing obesity and excessive gestational weight gain (GWG). To assess the contributions of diagnosis and preconception weight on GWG and perinatal outcomes. Prospective cohort study of singleton pregnancies in PCOS (n = 164) and ovulatory controls (n = 176) from infertility treatment. GWG, birthweight, pregnancy complications. From preconception baseline, normal-weight women with PCOS gained 2.3 pounds more during the first trimester (95% CI, 0.3 to 4.3; P = 0.02), and by the end of the second trimester, 4.2 pounds more than controls (95% CI, 0.7 to 7.7; P = 0.02). Women who were overweight with PCOS gained significantly more weight than did controls by the end of the second trimester (5.2 pounds; 95% CI, 0.2 to 10.2; P = 0.04), whereas women with obesity and PCOS and control women had similar weight gain throughout pregnancy. Within normal-weight, overweight, and obese groups, prevalence of pre-eclampsia and gestational diabetes did not differ between the PCOS and control groups, nor was there a difference in birthweight. Preconception body mass index (BMI) was significantly associated with GWG; for every 1-kg/m2 increase in preconception BMI, GWG decreased by 0.62 pounds (95% CI, -0.85 to -0.40; P < 0.001). Women with PCOS who are of normal weight or are overweight before conception experience more GWG than do ovulatory controls. Within normal-weight, overweight, and obese groups, rates of perinatal complications do not significantly differ between women with PCOS and controls. Preconception BMI is the strongest predictor of GWG.

To the Editor: Schlaff et al. (Jan. 23 issue) 1 discuss options for the management of uterine fibroids, mentioning a variety of interventional therapies and stating that data from randomized, controlled trials show that the effectiveness of these therapies is limited. We consider this statement to be misleading. On the contrary, since the publication of the 2008 practice guidelines from the American College of Obstetricians and Gynecologists, uterine-artery embolization has been recognized as one of three surgical options with level A evidence supporting its safety and effectiveness. 2-4 All patients should be counseled about this surgical alternative during the process of informed . . .

Nature Communications 6: Article number: 7502 (2015); Published: 18 August 2015; Updated: 12 February 2016 In the original version of this Article the genetic locus 8p23.1 was incorrectly referred to as 8p32.1 throughout. For example, in the Abstract, the sentence beginning ‘Three loci reach genome-wide significance in the case-control meta-analysis…' originally read ‘Three loci reach genome-wide significance in the case-control meta-analysis, two novel loci mapping to chr 8p32.