Goserelin and oral contraceptive combination versus laparoscopic ovarian cauterization and their effects on the endocrine changes in women with clomiphene citrate resistant polycystic ovary disease

The aim of this study was to compare the effects of combination of long acting GnRH agonist [Goserelin] and oral contraceptive [OC] therapy and laparoscopic ovarian cauterization on the endocrine changes in women with clomiphene citrate [CC] - resistant polycystic ovary disease [PCOD]. Twenty one women with CC- resistant PCOD were included randomly in the study to either laparoscopic ovarian cautery [n = 10] or GnRH-a and OC therapy for 3 months [n = 11]. Serum concentrations of LH, F.S.H, androstenedione [A], testosterone [T] and sex hormone binding globulin [SHBG] were determined in each group and during the follicular phase of first menstrual cycle after cessation of each treatment. Our results showed that the mean serum concentrations and clinical profiles were similar in both groups. Both groups showed significant decrease in LH, A and T and significant increase in FSH compared with pretreatment levels. The SHBG concentration increased in both groups after therapy, however, the increase was significant only in the goserelin and OC group. There were no significant difference in the final concentrations of LH, FSH and A between the two study groups after each treatment, whereas, T was significantly decreased and SHBG significantly increased in the goserelin and OC group. The ovulation rate after the cessation of either therapy was similar [8/10 versus 9/11, p > 0.05]. On the basis of our results, we conclude that despite similar endocrine effects, medical treatment with GnRH-a and OC may be more appropriate and effective in reversing the abnormal cascade in PCOD. Although both regimens have temporary and similar improvement on PCOD, the adhesion forming potential, invasiveness, cost and surgical complications of laparoscopic ovarian cauterization may enable GnRH-a and OC combination to be cost effective option in women with CC-resistant PCOD

role of cervical score and ovarian ultrasonic scanning in assessment of low dose urinary follicle stimulating hormone and human menopausal gonadotropin therapy in polycystic ovarian disease

Cervical mucus and ultrasonic ovearian follicle monitoring for individualization of urinary follicle-stimualting hormone [ufsh] and human menopausal gonadotropin [hmg] therapy were used in clomiphene citrate resistant patients of polycystic ovarin disease [PCOD]. This study was carried out on 17 patients with PCOD, they were divided into group I : consisted of 7 patients receiving ufsh and group II: consisted of 10 patients receiving hmg. Cervical score and pelvic scanning for each patient were done daily. In this trial, the number of cycles in group I and II were 8 and 18 respectively. Ovulation and cycle fecundity were higher with hMG therapy than ufsh. This study revealed that low dose ufsh and hmg are effective in preventing the occurrence of hyperstimulation syndrome. Also, pelvic ultrasound is essential for follicular scanning and detection of ovulation while the cervical mucus score had a limited role in that aspect. Also, we conclude that hmg is more effective than ufsh in treating comiphene resistant PCOD

role of clinical parameters and laboratory tests for early identification and severity assessment of pregnancy induced hypertension

The purpose of this study is to evaluate the role of the clinical parameters and laboratory tests for early recognition and severity assessment of pregnancy-induced hypertension [PIH]]. Blood pressures, proteinuria, isometric handgrip exercise test, serum uric acid and plasma fibronectin were measured in 100 healthy normotensive primigravid women during the first, second and third trimesters of pregnancy and 7 days postpartum. Of the 100 gravid women, 85 did not develop clinical PIH [no PIH], 11 developed mild PIH and 4 demonstated severe PIH. The systolic, diastolic and mean blood pressures were significantly elevated [p< 0.001] in gravid women who developed PIH when compared to values of the normotensive gravid women from the 12 weeks' gestation onwards. Specificity, for predicting PIH early in pregnancy [13-20 weeks] with blood pressures [130 to 135 / 80 to 85 and MAP 90 to 95 mmhg], ranged from 79.2% to 86.6% and the negative predictive values [NPV] from 84.1% to 88.2%. The diastolic blood pressure had a high relative risk [4.9] among other blood pressure values. The isometric handgrip exercise tarts had a specificity of 90.3% and NPV of 92% with a relative risk [7.4] for PIH. The most significant difference [t=10.12; P< 0.001] of elevated uric acid values between women who developed PIH and the normotensive gravid women was observed form 35 to 35 weeks' gestation after the appearance of hypertension and proteinuria [29-34 weeks]. The specificity and NPV of uric acid were 45.1%, 42.2% respectively with a relative risk [1.5] Fibronectin increased from 83 +/- 15% in the first trimester to 190 +/- 37% of normal at term in women who developed PIH versus 75 +/- 20% to 88 +/- 15% in normotensive women. Fibronectin levels increased [13-20 weeks] earlier than the onset of hypertension and/or proteinuria [29-34 weeks] with specificity of 90.9%, NPV of 89.2% and a relative risk of 8.3. After delivery, fibronectin decreased only in PIH patients [t=9.57; P< 0.001]. A significant positive correlations [P< 0.001] between uric acid and fibronectin with MAP in patients with established PIH were observed