RESUMEN
Objective: the aim of this study was to see the effect of adding aromatase inhibitor, letrozole to a high doses of rFSH/hMG-antagonist regimen on the number of the mature follicles, retrieved oocytes, egg's quality, clinical pregnancy rate, and rate of cycle cancellation in poor responder patients with a previous history of at least 2 cancelled IVF cycles
Study Design: this study included 83 infertile couples who had at least two cancelled IVF trials due to poor ovarian response. Those patients were divided into two groups, letrozole group, included 41 infertile couples, and control group included 43 infertile couples, and compared
Results: patients.in both groups were comparable in terms of age [37.3 +/- 1.2 versus 35.7 +/- 2.4 years], .day 3 FSH, LH, and E2 serum levels as shown in table 1. There was no significant differences among both groups regarding the number of stimulation days [10.3 +/- 0.6 versus 9.6 +/- 0.4], mean FSH/hMG dose administered [4,236 +/- 219 versus 4,463 +/- 238], and endometrial thickness [8.6 +/- 1.3 versus 9.8 +/- 0.9]. However, there were significant differences between both groups in terms of cancellation rate due to poor response [12.2% versus 34.9, p < 0.001], number of mature follicles [5.8 +/- 1.2 versus 3.4 +/- 0.6, p = 0.039], and in the number of retrieved oocytes [8.3 +/- 1.6 versus 4.2 +/- 0.6, p < 0.001]. In addition, there were significant differences in the terms of fertilization rate [86.4% versus 64.9%, p = 0.038], and in the clinical pregnancy rate [44.4% versus 25%, p = 0.36] between the two groups, however, there is no significant difference between them regarding the percentage of the multiple pregnancies [25% versus 28.6%, p = 0.43]
Conclusion: in conclusion, addition of aromatase inhibitors, letrozole in the first 10 days of the stimulation induction using a high doses of rFSH/hMG antagonist regimen, were associated with a higher number of mature follicles, less cancellation rate, more retrieved mature oocytes, and higher clinical· pregnancy rate in low responder patients with a previous history of at least 2 cancelled IVF cycles
RESUMEN
Aim of the study: To assess the effects of vaginally administered isosorbide mononitrate [a nitric oxide donor, effox tablets 40 mg] on maternal and fetal hemodynamics and the ripening of the cervix. Study design: We conducted a randomized controlled study: two matched groups were recruited as regards. Parity, bishop score, gestational age. Women that were recruited for induction of labor, were randomly selected to receive vaginally administered isosorbide mononitrate 40 mg [n=40] one tablet [study group]or to undergo vaginal examination only [n=40] [control group]Maternal pulse, blood pressure and fetal heart rate were recorded at 0 base line, every 30 minutes till 6 hours. Umbilical artery resistance index and pulsatility index measurements were performed at 0,3 and after 6 hours. Cervical Bishop scores were measured at 0 base line and at the end of the treatment program period [6 hours from the application of isosorbide mononitrate] Maternal pulse rates were increased after the administration of isosorbide mononitrate, 40 mg, compared to the pulse rates in the vaginal examination only group. [greater difference in means, 16 beets per minute, P<0.01]. Maternal systolic and diastolic blood pressures were decreased in the study group than in the control group [greatest difference in mean systolic and diastolic blood pressure, 15 and 16 mml Hg respectively, with a P<0.001]. Fetal heart rate was increased in the study group, than in the control group, with a difference in mean, 19 beats/minute with a P<0.05. No women required treatment for hypotension or for maternal and fetal tachycardia except for headache, which needs mild analgesics to be relieved. The forty mg dose of isosorbide mononitrate had no significant effect on umbilical artery resistance or pulsatility index. Changes in the Bishop score, was more marked in the 40mg isosorbide mononitrate group than in the control group and the difference was statistically significant P<0.05. Conclusions: Vaginal administration of 40 mg isosorbide mononitrate to pregnant women at term has a safe effect on both maternal and fetal hemodynamics. Thus nitric oxide donors are suitable agents for preinduction cervical ripening at term, and can be used as outpatient method with no need for fetal monitoring, being a uterine relaxing agent