[ comparative study comparing low-dose step-up versus step-down in polycystic ovary syndrome resistant to clomiphene]

Polycystic ovary syndrome [PCOS] is one of the most common cause of infertility in women. Clomiphene is the first line of treatment, however 20% of patients are resistant to clomiphene. Because of follicular hypersensitivity to gonadotropins in pcod, multiple follicular growth and development occurs which is cause of OHSS and multiple pregnancy. Our aim of this random and clinical study was comparation between step-down and low dose step-up methods for induction ovulation in clomiphene resistant. 60 cases were included 30 women in low-dose step-up group and 30 women in step-down group. In low-dose step-up HMG 75u/d and in step-down HMG 225 u/d was started on 3[rd] days of cycle, monitoring with vaginal sonography was done on 8[th] days of cycle. When follicle with>14mm in diameter was seen HMG dose was continued in low-dose step-up and was decreased in step-down group. When follicle reached to 18mm in diameter, amp HCG 10000 unit was injected and IUI was performed 36 hours later. Number of HMG ampules, number of follicles>14mm on the day of HCG injection and level of serum estradiol was greater in low dose step up protocol than step down protocol [p<0/0001]. Ovulation rate and pregnancy rate was greater in low dose step up group than step down group with significant difference [p<0/0001]. Our study showed that low-dose step-up regimen with HMG is effective for stimulating ovulation and clinical pregnancy but in view of monofollicular growth, the step down method was more effective and safe. In our study multifolliular growth in step-up method was higher than step-down method. We can predict possibility of Ovarian Hyperstimulation Syndrome in highly sensitive PCOS patients

Assessment the diagnostic validity and the relationship between urinary fsh and serum fsh in menopausic and non-menopausic women

Background and purpose: FSH [Follicle stimulating Hormone] is a glycopeptid hormone released from anterior pituitary and is associated with ovarian function. Due to its daily and monthly cyclicity, successive sampling is used for certainty. Because of the kydney intervention in gradual releasing FSH, random and morning urinary sample was considered in menopausic and non-menopausic women

Methods and Materials: 50 woman with ages 35-60 years old participated in the study. The participants had not ured oral contraceptives, had normal renal function and were admitted for hysterectomy, due to benign illnesses, at Imam Khomeini Hospital in Sari, Iran. Frequcut sampling and random blood sample were taken a day before surgery by research aids blind to the participants menopausal status. FSH was measured through radio immunoassay and its correlation [gold standard] was obtained with each urinary sample in both groups. Sensitivity and specificity was studied

Results: Out of 47 cases admitted, 37 cases were monmenopausic with FSH less than 20 mlu/ml and 10 cases were menopausic with FSH more than 40 mlu/ml; 3 cases were ruled out because their FSH levels were not ascertained. FSh correlation with random and morning urinary samples were 31% and 84% respectiviely in nou-monopausic cases. In the second group, 68% and 77% were observed respectively. The sensitivity and specifity in random urine sample were 100% and 97% respectively; while in morning samples, they were both 100%

Conclusion: According to the findings, high correlations were observed between serum FSH and morning sample in menopausic cases, as well as with random sample. Also because of the satisfactory specificity and sensitivity of FSH measurement with urine samples, it is possible to replace floquent sampling with one morning sample in pathological and physiological instances. This method is non- invasive, simple and cheap