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

Leptin and postmenopausal osteoporosis

To investigate plasma leptin concentrations in postmenopausal women to improve the understanding of the role of leptin in determining bone mass. A prospective observational cross-sectional study. Departments of Obstetrics and Gynecology, Rheumatology and Chemical Pathology at Kasr El-Aini Hospital, Cairo University. Thirty postmenopausal women with osteoporosis [ages range 45-73 years and body mass index [BM1] range 23.31-39.37Kg/m[2]], and 30 age- and BMI-matched healthy postmenopausal women. Bone mineral densities were measured by dual energy X-ray absorptiometry [DEXA]. Plasma leptin concentrations were measured using enzyme-linked immunosorbent assay [ELIZA]. The correlation of plasma leptin concentrations and bone mineral density [BMD]. Plasma leptin concentrations were significantly higher in the osteoporotic group than the control group [67.44 +/- 48.60 Vs. 38.10 +/- 19.58, p=0.004]. No correlation was observed between plasma leptin and BMD values in the osteoporotic group [r=0.2462, p=0.198; r=0.3452, p=0.067 and r=0.1898, p=0.324 for T score spine, Rt. hip and Lt. hip, respectively] and the control group [r=0.0050, p=0.980; r=0.2564, p=0.188 and r=-0.0967, p=0.624 for T score spine, Rt. hip and Lt. hip, respectively], but there was a significant positive correlation between plasma leptin and BMI in the osteoporotic group [r=0.4911, p=0.007] and the control group [r=0.8205, p<0.001]. Circulating plasma leptin does not have a significant direct influence on bone mass in postmenopausal women