Metformin versus laparoscopic ovarian drilling in the treatment of clomiphene-citrate resistant patients with polycystic ovary syndrome

To evaluate the efficacy of metformin as compared with laparoscopic ovarian drilling in the treatment of clomiphene citrate resistant women with polycystic ovary syndrome. A prospective comparative study. A total of 100 infertile, clomiphene citrate resistant women with polycystic ovary syndrome, aged 20 - 34 years, euthyroid, with normal prolactin level were evaluated prospectively during the period between March 2000 and June 2002. Patients were divided into two groups. Group 1 includes 50 patients who received metformin tablet 500 mg three times daily throughout the cycle. Group 2 includes 50 patients who underwent laparoscopic ovarian drilling. Clinical and menstrual characteristics in addition to the hormonal profile were evaluated before and after the treatment for 6 months. There were no significant differences between the two groups as regards age, body weight, duration of infertility and serum hormone levels [androgens, gonadotrophins, insulin] before admission to the study. A significant improvement was achieved in both groups as regards the regularity of menstrual cycles, reduction in the serum levels of testosterone, androstenedione, LH/FSH ratio, ovulation and pregnancy rates were observed after the treatment. But there were no significant differences between the metformin group as compared with the drilling group as regards the ovulation rate [80% vs. 84%] and pregnancy rate [32% vs. 30%] respectively. Clomiphene citrate resistant patients with polycystic ovary syndrome can be treated effectively either by metformin or by laparoscopic ovarian drilling. A Significant improvement was achieved as regards regulation of menstrual cycles and the rates of ovulation and pregnancy most probably due to the significant decrease in the levels of androgens and leutinizing hormone post-laparoscopic ovarian drilling in addition to the decrease in the fasting insulin level post-metformin therapy

Vaginal pH and parabasal cells in postmenopausal women

This is a prospective study to determine a specific range of vaginal pH level that correlates with elevated parabasal cells in vaginal smears. To be used clinically as an indicater of hypoestrogenism. Seventy four postmenopausal women presenting to the gynecology clinics of Al Galaa Teaching Maternity Hospital complaining of urinary incontinence, hot Flushes or other post menopausal symptoms were studied. Women were excluded if they had vaginal infections or pelvic organ prolapses past the hymen. pH was measured and cytology smears made from the mid-vagina. A pathologist who was not aware of pH results evaluated the smears. Spearman rho was used to correlate pH and percentage of parabasal cells. Logistic regression was used to analyze the relationship between pH and increased parabasal cells in vaginal smears. Predictive values were used to select a pH level as a cutoff point to predict increased cells. Seventy-four women were included in this study but 70 women completed it. The correlation coefficient between pH and percentage of parabasal cells was 0.6 [P < .001]. Logistic regression showed association of pH with 20% or more parabasal cells [P < 0.001]. Positive and negative predictive values for pH level above 6.0 as a predictor of 20% or more parabasal cells were 96.3% and 87.5%, respectively. The prevalence of elevated parabasal cells was 22.9%. Vaginal pH above 6.0 correlates with high levels of parabasal cells [20% or more] from the midvagina and can be used clinically and in research work as an indicator of hypoestrogenism