Impaction of laparoscopic ovarian electrocautery on doppler indices of stromal blood flow in women with polycystic ovary syndrome

Polycystic ovary syndrom [PCOS] is characterized by infertility, oligomenorrhea, and hyperandrogenism. Clomiphene citrate [CC], an antiestrogen, is first-line treatment for PCOS, if CC fails to induce ovulation, laparascopic electrocautery of the ovaries is offered. In this prospective controlled study, 52 women with clomiphen-resistant PCOS [group 1] and 46 women with regular menstrual cycles as a control group [group 2] were included. Hormonal profile and doppler blood flow changes within the ovarian stroma befor and after laparascopic ovarian electrocautery [LOE] in women with clomiphen- resistant polycystic ovary syndrome assessed and compared between groups. The doppler indices [pulsatility index and resistance index] of ovarian stromal blood flow were significantly lower in group 1 befor LOE than in group 2. The serum levels of testosteron [T] and LH were significantly reduced in group 1 after LOE compared with in group 1 befor LOE [P < 0.05]. Doppler indices [pulsatility index and resistance index] of ovarian stromal blood flow were significantly increased after LOE. Laparascopic electrocautery reduced serum T and LH and reduced ovarian blood flow velocities, which may explain the reduction of ovarian hyperstimulation syndrome in women with PCOS after LOE. Laparascopic electrocautery of the ovaries is now accepted as the preferred first-line treatment of women with PCOS who are resistant to clomiphen citrate. All affected women could be considered for this treatment

Progesterone/estradiol ratio in the late follicular phase of long gonadotropin-releasing hormone agonist cycles did not differ between conceived and not-conceived women

There is a challenging debate on the effect of premature luteinization on the clinical outcome of 'controlled ovarian hyperstimulation' [COH] using long 'gonadotropin-releasing hormone agonist' [GnRHa] cycles. Premature luteinization is defined as late follicular progesterone/estradiol ratio more than 1 on the day of human chorionic gonadotropin [HCG] administration. We carried out a retrospective case-control study on 75 conceived cases versus 75 not-conceived control women, receiving long GnRHa cycles in their first cycle of treatment. Premature luteinization developed in 15% of the case group vs. 22% of the control group. Neither the late follicular progesterone/estradiol [P/E2] ratio was significantly different between the two groups, nor the day 3 follicle stimulating hormone [FSH], serum estradiol level on the HCG day, total amount of human menopausal gonadotropins ampoules, number of follicles, retrieved oocytes and transferred embryos. Endometrial thickness was significantly more in the pregnant women than in the non-pregnant group. Premature luteinization seems not to adversely affect the clinical outcome of COH

Half-dose depot triptorelin comparable to reduced daily buserelin: a randomized clinical trial

Pituitary suppression by depot GnRH agonist may be excessive for ovarian stimulation. This study compares the efficacy of a single half-dose depot triptorelin and reduced-dose daily buserelin in a long protocol ICSI/ET. A total of 182 patients were randomized into two groups using sealed envelopes. Pituitary desensitization was obtained in group 1 [91 patients] with half-dose [1.87 mg] depot triptorelin in the mid-luteal phase of their menstrual cycle, and in group 2 [91 patients] with standard daily dose [0.5 mg] buserelin, which was then reduced to 0.25 mg at the start of human menopausal gonadotropin [HMG] stimulation. No significant differences were found among those who received HCG in terms of clinical pregnancy rate [34.4% in both groups], implantation rate [14.8% in group 1 versus 11.1% in group 2], fertilization rate [93.3 versus 95.6%], poor response rate [11.1 versus 6.7%], and miscarriage rate [11.1 versus 7.8%]. No significant differences were seen in number of HMG ampoules used, follicles at HCG administration, and oocytes retrieved. The number of days of stimulation was significantly reduced in group 2 [11.2 +/- 1.8 in group 1 versus 10.6 +/- 1.9, P = 0.030]. A half-dose of depot triptorelin can be successfully used in ovarian stimulation instead of reduced-dose daily buserelin, with more patient comfort and reduced stress and cost of injections

Activity of follicular fluid phosphatases and their correlation with levels of serum esteroidal hormones and gonadotropins

The aim of this study was to evaluate the correlation between serum levels of ovarian and gonadotropin hormones, age and number of follicles with follicular alkaline and acid phosphatase activity in infertile women under controlled ovarian hyperstimulation. After collection of follicular fluid and calculation of the number of follicles, the specific activity of alkaline [ALP] and acid phosphatase [ACP] was determined according to the total protein in 19 women at the time of puncture. Also at that time, the levels of progesterone, estradiol, and follicle stimulating hormone [FSH] and leuteinizing hormone [LH] of their sera were measured. The correlation of follicular ALP and ACP with each serum hormone levels, women age and number of follicles was calculated using non-parametric analysis. The ALP has a correlation with progesterone [P=0.01] levels but doesn't have any correlation with the other factors. However, the ACP activity has a correlation not only with follicular number but also with estradiol and progesterone levels [P=0.05]. Thus ACP activity is more affected by ovarian hormone than ALP and it can affect the ovarian microenvironment and oocyte development

Determinig the relation between non-fasting serum leptin- BMI ratio and follicular fluid leptin to ART outcomes

Considering the economical and psychological burden of assisted reproductive technologies [ART], finding factors predicting ART results is of great value. So this study was undertaken to evaluate whether serum and follicular and serum leptin to body mass index [BMI] are predictive of ART outcomes. 99 non-polycystic ovary patients from the body of patients referring to infertility ward of Shariati Hospital, from April to September 2005, were selected and underwent the long protocol of GnRH agonist ovarian hyperstimulation. Serum leptin was measured on the 3rd day of menstrual cycle. Follicular fluid [FF] was collected on the day of oocyte retrieval. The serum and follicular fluid leptin levels were determined by ELISA. Mean the levels of serum and follicular fluid leptin and leptin to BMI ratios were compared in pregnant and nonpregnant women, using SPSS software, student t-test. P-values <0.05 were considered significant. Geometrical mean serum leptin [16.42 +/- 1.48ng/ml for the nonpregnant and 14.09 +/- 2.20 ng/ml for the pregnant cases], follicular fluid leptin [8.73 +/- 2.56ng/ml for the nonpregnant and 11.072.76ng/ml for the pregnant cases] and serum leptin to BMI ratios [0.64 +/- 1.61 for the nonpregnant and 0.55 +/- 2.04 for the pregnant cases] were not significantly different. According to the results, serum and follicular leptin levels and serum leptin to BMI ratios are not predictive of ART outcomes and in the meantime they should not be considered as a prognostic factor but further studies are recommended with more selective criteria to address infertility causes