Comparison of pregnant and non-pregnant women with clomiphene resistant polycystic ovary syndrome in treatment with metformin and letrozole

Polycystic ovary syndrome [PCOS] is one of the most common causes of anovulatory infertility. Clomiphen citrate [CC] is the first line therapy for women with infertility and PCOS. These patients usually respond to clomiphene citrate in doses between 50-100 mg/day. However, failure of the patient to respond to a dosage of 150 mg/day of clomiphene citrate is considered as clomiphene resistant. The aim of this study was to compare between pregnant and non-pregnant women in cases of PCOS patients with CC resistant. Meanwhile, we evaluated ovulatory rate, pregnancy rate and live birth rates. We studied 106 CC-resistant PCOS patients who attended to Amir-Al-Momenin Hospital [Semnan, Iran] during the years 2005-2008. After an initial 6-8 weeks of metformin [1500mg daily: 500mg q8h], they received 2.5mg letrozole for 5 days starting on cycle day 3. If they failed to show ovluation with 2.5mg letrozole, doses were increased to 5 and 7.5 mg daily in the subsequent cycles. One patient developed generalized rash with metformin and excluded from the study. 14 of 105 patients [13.33%] conceived with metformin alone. Overall, ovulation rate was 83.91 [91.2%]. Overall, pregnancy rate was 60/105 [57.14%] with 45 [74.9%] full term pregnancies, 10 [16.7%] abortions and 5 [8.3%] preterm births. The only significant difference between the responder and non-responder was found in the age of patients [P=0.008]. No significant differences were found in BMI, period of infertility, menstrual pattern, hirsutism, pictures of PCO in one or two ovaries in sonography, LH, and FSH or LH/FSH ratio. Combination of metformin with incremental doses of letrozole associated with a good pregnancy rate in CC-resistant PCOS patients. The treatment seems especially more effective in young weman

[Comparaing the causes of abortion in patients with two or more than two consecutive miscarriages]

Recurrent miscarriage is defined as the loss of three or more pregnancies. Recurrent Pregnancy Loss [RPL] is traditionally investigated after three or more consecutive losses. Although some believe that the investigation must be launched after two miscarriages, there is not enough compelling evidence to draw conclusion. In this cross-sectional study, we studied 58 women with two or more consecutive abortions [37 women with two and 21 women with three or more miscarriages] from 2005 to 2009. The following risk factors were analyzed and compared between the two groups: endocrine dysfunctions, genetic abnormalities, uterine anomalies, infections, thrombophilia, polycystic ovary syndrome, autoimmune disorders, sperm characteristics, and advanced maternal age. We did not find any known factor for pregnancy losses in 18 [31.03%] patients but in the rest, the most common cause of Recurrent pregnancy loss was endocrine disorders [41.4%]. The other causes were uterine abnormalities [12.1%], infections [12.1%], maternal age more than 35 years [12.1%], thrombophilia [8.6%], abnormal semen analysis [8.6%], genetic defects [6.9%] and autoimmune disorders [1.7%]. There were no significant differences between the two groups in regards with the causes of abortion except uterine abnormality [P=0.039] which was more frequent in women with three or more three miscarriages [23.8%] relative to women with two abortions [5.4%]. There were no significant differences between women with two or women with three or more three abortions in regards with the causes of abortion except uterine anomalies. Therefore, it seems quite reasonable and perhaps beneficial to start the investigation in patients with two abortions