Letrozole compared to clomiphene citrate in patients with unexplained infertility undergoing IUI

To compare the efficacy of Ietrozole as ovulation induction agent for patients with unexplained infertility as regards is mean number of follicles resulting, endumetrial thickness and pregnancy rate [PR] in comparison to CC alone and in combination with gonadotropines [HMG] and Ietrozole in combination with HMG for COH and IUI A prospective randomized comparative study. Infertility outpatient clinic, Faculty of Medicine. Consequtive patients who agreed to participate were randomized on an alternating basis to receive either 2.5 mg bid letrozole or 50 mg bid CC on days 3-7, or letrozole followed by HMG, or CC followed by HMG 75IU/day until the day of HCG [15 patients in each group].Folliculometry starting D7 was done till the Ieading follicle[s] reached 18mm ovulation was triggered by HCG 10000 IU and endometrial thickness was measured on the day of HCG administration. A single IUI was done 36 hours after HCG administration. The luteal phase was supported by vaginal micronized progesterone 600 mg/day. Pregnancy was established by blood beta-subunit detection 2 weeks after IUI. A total of 60 patients [15 patients in each group] meeting the inclusion criteria were included All patients had primary unexplained infertility of less than 3 years and there was no statistically significant difference in age nor BMI between the 4 groups. The outcome measures we examined were endometrial thickness, mean number of mature follicles > 18 mm on day of HCG administration and pregnancy rate. The mean endometrial thickness was: 8.8 mm in the letrozole group, 8.3 mm in the CC group, 8.5 mm in the letrozole + HMG group. 9.9 mm in the CC + HMG group i.e. the showed the least mean endometrial thickness but with no statistically significant difference between the 4 groups. mean number of mature follicles >18 mm on the day of HCG was: 3.2 in the letrozole group. 2 6 in the CC group, 2.4 in the letrozole + HMG group .3.4 in the CC + HMG group with no statistically significant difference between the 4 groups. Pregnancy rate per cycle for the 4 groups was: 20% in the letrozole group, 40% in the CC' group, 13.3% in the letrozole + HMG group, 26.7% in the CC + HMG group with no statistically significant difference between the 4 groups. In conclusion we tailed to prove that there is clinical preference of Ietrozole or combined protocols over CC alone in COH + IUI or women with unexplained infertility, this could be attributed to the small sample size, bigger study is needed before Ietrozole is prescribed as a first- line induction drug being more expensive than CC

effect of a non-steroidal aromatase inhibitor anastrazole on symptomatic uterine leiomyomata in premenopausal women

To evaluate the effect of a non-steroidal aromatase inhibitor anastrazoIe on symptomatic uterine leiomyomata in premenopausal women. This was a prospective intervention study carried out at Kasr El-Aini hospital. 48 premenopausal women with symptomatic uterine leiomyomata were enrolled and treated with anastruzole 1mg daily for three cycles of 28 day each. The effect of treatment was evaluated on leiomyoma and uterine volumes, endometrial thickness, gonadotrophins, estradiol and hematocrite levels, menstrual pattern, severity of leiomyoma-related symptoms and adverse effects. The effects of leiomyoma location, size and age of participants on tumor volume changes were evaluated. 40 women with 52 Ieiomyomata finished the study. Anastrazole resulted in a mean 52% reduction of leiomyoma volume [173.7 to 83.3ml, p<0.00.], a 29% reduction in total uterine volumes [290.2 to 205. 1ml, p<0.001] and an increase of the hematocrite levels [34.3% to 38.1%, p<0.001] at the end of treatment. Leiomyoma location had no significant effect on volume decrease. Leiomyoma volume decreased in women aged older than 40 years [p<0.001], whereas no significant difference was found in women younger than 40. The size of large Ieiomyomata [greater than 50mm] decreased significantly [p<0.001], Less difference was observed in small leiomyomata [50mm or less] [p=0.01]. No difference were detected in hormonal status. Aromatase inhibitor, Anastrazol was useful in the management of symptomatic Leiomyoma without causing serious hypoestrogenic adverse effects. Further clinical trials are warranted regarding long-term administration

role of endometrial-subendometrial blood flow distribution assessed by power doppler in the prediction of pregnancy in women with unexplained infertility undergoing intrauterine insemination

The aim of this study was to investigate the role of endometrial-subendometrial blood flow assessed by power Doppler in the prediction of pregnancy in patients with unexplained infertility undergoing intrauterine insemination in clomiphene citrate induced cycles. Prospective clinical study. University teaching hospital. One hundred thirty five patients with unexplained infertility undergoing intrauterine insemination in clomiphene citrate induced cycles were recruited. Transvaginal ultrasound was performed on the day of Human chorionic gonadotrophin [HCG] administration to determine the uterine artery resistance index [RI] and pulsatility index [PI] by pulsed Doppler and to detect the blood flow in endometrial-subendometrial area by power Doppler. Pregnancy occurred in twenty one patients [21/129] [16%]. The [RI] and [PI] were similar in pregnant group and non pregnant group. Pregnancy occurred in 31% of patients with endometrial and subendometrial flow [7/22], in 19% of patients with subendometrial flow only [13/68] and in 2.5% of patients with absent endometrial and subendometrial flow [1/39]. The detection of the blood flow in the endometrial-subendometrial area by power Doppler may be a useful marker in prediction of pregnancy in patients with unexplained infertility undergoing intrauterine insemination

Maternal and fetal concentration of serum placental growth factor and their correlation to glycemic control and doppler study in diabetic and normal pregnancy

To determine whether maternal diabetes is associated with altered human placental growth factor [PIGF] level in serum of both mother and fetus and study he relation between PIGF and Doppler parameters, Prospective analytic comparative study. 30 normal pregnant female, 60 patients with gestational diabetes, 30 diabetic controlled and 30 diabetic uncontrolled. PIGF was measured in stored maternal serum samples taken in the 3[rd] trimester and cord sample of their babies after delivery by enzyme-linked immunosorbent assays [ELISA]. Diabetes during pregnancy was diagnosed with the 75-g oral glucose tolerance test and by applying world health organization criteria. Doppler velocimetry of umbilical vessels was evaluated for vascular impedance, in terms of pulsatility index and S/D ratio. Insignificant difference in serum maternal PIGF in both diabetic and non diabetic groups in the third trimester [p 0.139]. Cord serum PIGF was lower in diabetic controlled than uncontrolled group [p 0.023]. But there was significant negative correlation between maternal PIGF and cord serum PIGF in control [r -.537] and uncontrolled diabetic group [r -.384], p<0.05. Significant positive correlation between cord serum PIGF and S/D ratio was found [r .383], p<0.037. Significant negative correlation was found between PIGF in maternal serum and Doppler parameters in diabetic controlled group [r - 0.362], p value < 0.049 and in diabetic uncontrolled group [r = 0.500], p value < .005. FBS was positively correlated to cord serum PIGF in both controlled [r .603 and p value <0.001] and uncontrolled diabetic groups [r .934 and p value <0.001]. Maternal serum PIGF is similar in 3[rd] trimester in diabetic pregnancy and in control group. Serum cord PIGF was higher in uncontrolled than controlled diabetics. Significant negative correlation between maternal PIGF and cord serum PIGF in control and uncontrolled diabetic group. Rise in cord serum PIGF is related to chronic fetal hypoxia as evident by abnormal Doppler. Further studies are needed to confirm results