title: Simvastatin effects on androgens, inflammatory mediators, and endogenous pituitary gonadotropins among patients with PCOS undergoing IVF: results from a prospective, randomized, placebo-controlled clinical trial.
abstract: OBJECTIVE
  To evaluate effects of simvastatin on selected biochemical parameters and reproductive outcome among patients with polycystic ovary syndrome (PCOS) who undergo in vitro fertilization (IVF).
  
  
  METHODS
  Patients with PCOS were randomized to receive either oral simvastatin, 20 mg/d (n = 32), or placebo (n = 32) in a prospective, double-blind, randomized clinical trial (NCT 005-75601) in parallel with controlled ovarian hyperstimulation for IVF. All patients were determined to be at average risk for cardiovascular disease, based on high-sensitivity C-reactive protein (hsCRP) measurement at entry. After an 8-week treatment interval concluding at periovulatory human chorionic gonadotropin administration, selected clinical and laboratory parameters were measured.
  
  
  RESULTS
  Mean serum total testosterone level decreased by 25% in the simvastatin group, compared to a 10% reduction in the placebo group (P < 0.001). A trend of lower serum luteinizing hormone levels was noted in experimental and control groups (29% vs 22%, respectively), although this difference was not significant (P > 0.05). Neither fasting insulin nor quantitative insulin sensitivity check index were significantly impacted by simvastatin (P > 0.05). As expected, total cholesterol was not modified among placebo patients but was significantly reduced after simvastatin (P = 0.001). In addition, hsCRP and vascular cell adhesion protein-1 were both significantly lower after simvastatin therapy compared to controls (P ≤ 0.005 for both). At study completion, no important change in body mass index was observed in either group (P ≥ 0.60). Although oocyte maturation, fertilization, and clinical pregnancy rates were all higher after simvastatin, none of these improvements were statistically significant.
  
  
  CONCLUSIONS
  This report presents data from the first prospective, randomized, placebo-controlled clinical investigation of simvastatin in the setting of PCOS and IVF. Simvastatin seems to be compatible with gonadotropin therapy for IVF and can offer beneficial endocrine and cardiovascular effects for patients with PCOS who undergo embryo transfer. Although the observed improvements in reproductive function were mild, the reductions in hsCRP and vascular cell adhesion protein-1 after simvastatin treatment were significant, suggesting the need for further clinical trials to clarify simvastatin's impact on reproductive physiology.
authors.affiliation: Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Batool
authors.initials: B
authors.lastname: Rashidi
authors.forename: Jhila
authors.initials: J
authors.lastname: Abediasl
authors.forename: Ensiyeh
authors.initials: E
authors.lastname: Tehraninejad
authors.forename: Haleh
authors.initials: H
authors.lastname: Rahmanpour
authors.forename: Eric Scott
authors.initials: ES
authors.lastname: Sills
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000728:Androgens / Q000737:chemistry*; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006062:Gonadotropins / Q000378:metabolism; D006065:Gonadotropins, Pituitary / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D010062:Ovulation Induction; D010902:Pituitary Gland / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000378:metabolism / Q000628:therapy*; D011446:Prospective Studies; D019821:Simvastatin / Q000008:administration & dosage / Q000494:pharmacology*; D013739:Testosterone / Q000097:blood
chemical_list: D000728:Androgens; D000924:Anticholesteremic Agents; D006062:Gonadotropins; D006065:Gonadotropins, Pituitary; D013739:Testosterone; D019821:Simvastatin