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Number of follicles > 15 mm in diameter on the day of hCG administration, number of motile spermatozoa inseminated, clinical pregnancy rate.
This randomized controlled trial of independent cases and controls was conducted at the Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia from February 01 to December 31, 2008. The 42 subjects diagnosed as PCOS were divided into group A and B (21 subjects in each) for management with CC + metformin and CC alone, respectively. Group A received 500 mg three times a day of metformin continuously from the first cycle for 6 months or till pregnancy was confirmed. In both groups CC was started at a dose of 50 mg from day-2 till day-6 of the menstrual cycle. The dose of CC was increased to 100 mg in second and 150 mg in third cycle, and then remained 150 mg for the remaining three cycles. With ovulation the dose of CC was unaltered in both groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 16.
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In vitro fertilization center, Hacettepe University Faculty of Medicine and Etlik Zubeyde Hanim Women's Health and Research Hospital, Ankara, Turkey.
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The blood basal testosterone-, LH-, FSH levels, 17-CS and 17-HOCS excretion with the urine, circadian rhythms of testosterone-, LH- and FSH secretion were studied in 21 boys, aged 11 to 13 years, with abnormal puberty, manifesting in pronounced sexual hirsutism in the presence of infantile testicles. Functional tests, using chorionic gonadotropin, clomiphene citrate and spironolactone, were performed, as well. The blood level of testosterone and the change in its circadian secretion were markedly reduced in all the subjects under examination. 17-CS excretion with the urine was within normal, whereas that of 17-HOCS was increased, indicating the intensified adrenal functional activity. The study of the blood gonadotropic hormone basal level and circadian rhythms, as well as of the hypophyseal functional reserves revealed diverse changes in LH and FSH production, i.e. a high activity of the hypophyseal LH function and low FSH secretion were noted. The pathogenetic mechanisms of disturbed maturation in abnormal puberty are discussed.
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Myometrial strips and pieces of uterine arteries were obtained from nonpregnant premenopausal women undergoing hysterectomy. Spontaneous activity of myometrium and responses of myometrium and artery to K(+)-depolarization and vasopressin were recorded under isometric conditions. Quantification of the responses was done by planimetry.
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To explore the best therapy for infertility caused by polycystic ovary syndrome (PCOS).
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LOD is an established and safe method as a second line treatment for PCOS related infertility.
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Metabolism of the triarylethylene antiestrogen enclomiphene (EC) has been studied in rabbit liver. Incubation of EC with microsomes in the presence of NADPH gave two metabolites, EC-1 and EC-2, as determined by thin-layer chromatography (TLC). EC-1 had mass-spectral features that were identical to those of synthetic desethylenclomiphene, and was indistinguishable from this compound by TLC and gas-liquid chromatography (GLC). EC-2 was similarly identical to synthetic 4-hydroxyclomiphene, but was separable from 3-hydroxyclomiphene by TLC ang GLC. EC-2 methyl ether was homogeneous with 4-methoxyclomiphene, but not with 4'-methoxyclomiphene, in GLC. These results suggest that enclomiphene is metabolized in a manner qualitatively similar to that reported for other structurally related antiestrogens.
We evaluated 31 infertile women having laparoscopy for evaluation of tubal patency and evidence of ovulation in two groups during (a) the luteal phase (17 women) and (b) the follicular phase (14 women). A third group was composed of 14 women with polycystic ovarian syndrome, but they were resistant to clomiphene citrate for induction of ovulation and had laparoscopic ovarian cautery. Peritoneal fluid was collected during laparoscopy. Estimation of T-helper cytokine interleukin (IL)-2, tumor necrosis factor (TNF)-alpha, IL-4 and IL-6 in serum, peritoneal fluid and culture of the peritoneal mononuclear cells was performed by ELISA. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, estradiol and progesterone were evaluated by the Vidas Parametric System.
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Administration of clomiphene and clomiphene plus L-thyroxine was evaluated in the second and third months of treatment and was followed by a total of 11 ovulatory cycles, six in group A and five in group B. No significant difference was found between groups. Mean progesterone concentrations measured 16 days after the last clomiphene tablet were 5.5+/-1.2 ng/ml in group A and 5.1+/-1.3 ngl/ml in group B.
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Although Met can significantly improve a patient's insulin resistance, we found that in patients diagnosed with CIRCPOS, LOD can be much more effective in improving rates of normal menstruation, ovulation, and pregnancy.
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We studied previously poor responders to superovulation regimens for in-vitro fertilization and embryo transfer, six women in an open study, four of whom had ultrasound diagnosed polycystic ovaries, and 17 women in a double blind study, 12 of whom had polycystic ovaries.
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A Cochrane systematic review and metaanalysis examined the evidence for metformin in treating polycystic ovary syndrome. Since this was published there have been a number of new trials, some of which have been reasonably large involving participants from many different countries.
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The concurrent use of low-dose r-FSH and clomiphene citrate would seem not only to be cost-effective but also highly satisfactory in that it prevents high-order multiple pregnancies.
Donor insemination was performed in two fertility clinics using cryopreserved semen from the same sperm bank. Donors were selected in agreement with American Fertility Society recommendations. In the first clinic, cup insemination was combined with intra-uterine insemination in 321 cycles. Follicular development was closely monitored with vaginal echography and serum hormonal measurements. In the second clinic, 1287 insemination cycles were performed using intra-cervical insemination, timed only on basal body temperature. In the first clinic, a total of 53 pregnancies were obtained, of which seven were in 55 unstimulated cycles (12.5%), 21 in 159 cycles with clomiphene citrate stimulation (13.1%, P > 0.1), and 25 in 107 cycles stimulated with clomiphene plus human menopausal gonadotrophin (HMG) (23.9%, P < 0.03). No multiple pregnancies were observed in the latter group. In the second clinic, 159 pregnancies occurred during 1287 insemination cycles (12.4%). It is concluded that neither intra-uterine insemination, nor hormonal and echographic cycle monitoring, nor clomiphene citrate enhances the success rate of artificial insemination with donor semen, but HMG treatment probably exerts a favourable effect.
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Eighty patients with clinically confirmed PCOS were syndrome differentiated as four types, i.e., Shen-yin deficiency syndrome (21 cases), Shen-yang deficiency syndrome (18 cases), phlegm-dampness accumulation syndrome (19 cases), and Gan-stagnancy transformed heat syndrome (22 cases). They all took 100 mg clomiphene as the ovulation induction for 5 successive days. Results of ovulation in all patients were analyzed and compared.
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Patients with unexplained infertility following standard infertility screening tests usually undergo timing therapy that coordinates the time of ovulation and coitus, controlled ovarian hyperstimulation, or intrauterine insemination. If the treatment is unsuccessful, diagnostic laparoscopy is performed. However, with recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparoscopy and proceeds directly to ART. Therefore, the value of diagnostic laparoscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography (HSG) findings. Between January 1997 and December 2006, 57 infertile patients with normal HSG findings underwent diagnostic laparoscopy at Kinki University Hospital. In 46 (80.7%) of these patients, diagnostic laparoscopy revealed pathologic abnormalities. Specifically, endometriosis and peritubal and/or perifimbrial adhesions were found in 36 (63.2%) and 5 (8.8%) of the patients, respectively. In 8 patients (14.0%), the management plan was switched to ART because of severe tubal diseases. Among the 57 patients, 29 pregnancies (50.9%) were achieved, including 6 ART-mediated pregnancies. We conclude that diagnostic laparoscopy is beneficial for patients with unexplained infertility and normal HSG findings. Indeed, by diagnostic laparoscopy, we are able to detect the cause(s) of infertility in the pelvic cavity and to design a suitable management plan, which could lead to postoperative pregnancy. Therefore, because of the potential diagnostic and therapeutic benefits, patients with unexplained infertility and normal HSG findings should undergo diagnostic laparoscopy prior to ART.
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The ultra-short GnRH-a/hMG regimen is a fairly good ovarian hyperstimulation regimen, especially for poor responders in CC alone or CC/hMG regimens.
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Twenty-nine couples with an average of 5 years of infertility were selected for treatment by intrauterine insemination of washed semen (AIH). The criteria for selection were (i) the female partner showed no detectable fertility disorders by routine screening; (ii) the male partner showed subnormal semen quality on conventional semen analysis. Ovulation was stimulated uniformly with clomiphene citrate and precipitated with human chorionic gonadotrophin (HCG). Inseminations were performed 31-32 h post-HCG, with the day of HCG determined by ultrasound monitoring of follicular development. The fertilizing capacity of the male partners' spermatozoa was tested in vitro using donated human oocytes and/or the zona-free hamster oocyte penetration assay. Up to eight cycles of AIH were alternated with cycles of natural intercourse. While no pregnancies occurred in the group during normal coital cycles, the AIH pregnancy rate was 17% per couple, but only 3% per insemination cycle. Four further pregnancies were achieved spontaneously in couples from the study group within 3 years of completion of the AIH therapy and four patients became pregnant following subsequent GIFT or IVF treatments. Neither of the in-vitro tests was helpful in predicting the outcome of AIH, spontaneous pregnancy nor of subsequent assisted conception procedures.
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Assisted reproduction clinic.
Setting clomiphene (CC)/human chronic gonadotropin (hCG) (50 cycles, 31 patients) and CC/hmg/hCG regimens (16 cycles, 16 patients who had failed in CC/hCG) as control groups, the ultra-short GnRH-a/hMG/hCG regimen (15 cycles, 15 patients who had failed in CC alone or CC/hMG regimens) as study group, the number of leading follicles, endometrial thickness, cervical mucus scores and hormone levels on the day of hCG administration, and the pregnancy rates were compared among of these three groups.
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Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.