Prediction of ovarian response by comparing basal markers of ovarian reserve in invitro fertilization

Sixty women undergoing their first invitro fertilization cycle [IVF] were included in this prospective study which was performed at Al-Azhar University Hospital, Dammieta from April 2003 to May 2005 to identify and compare predictors of poor ovarian response in IVF. The number of antral follicles and total ovarian volume were measured by transvaginal ultrasound [TVS] on cycle day 3 followed by the measurement of basal levels of follicle stimulating hormone [FSH], estradiol [E2] and inhibin B. The antral follicle count was the best single predictor for poor ovarian response: Area under the receiver characteristic curve = 0.88. Addition of basal FSH and inhibin B levels to a logistic model with antral follicle count significantly improved the prediction of poor response. Addition of E2 and total ovarian volume didn't improve the prediction. On conclusion the antral follicle count provides better prognostic information on the occurrence of poor response during hormonal stimulation for IVF than does the currently used endocrine markers. However, addition of endocrine markers mainly FSH and inhibin provide more prediction

Comparative study between effect of aromatase inhibitor and clomiphene citrate in gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility

To compare the effects of aromatase inhibitor, letrozole and clomiphene citrate [CC] in gonadotrophin dose required for controlled ovarian stimulation [COS] in patients with unexplained infertility undergoing intra uterine insemination [IUI]. Non randomized prospective study. Al-Azhar University Hospital, Dammieta. Ninety patients with unexplained infertility undergoing COS and IUI. Thirty two women received letrozole in a dose of 2.5mg/day from day 3 to day 7 of the menstrual cycle + FSH, 18 women received CC in a dose of 100mg/day from day 3 to day 7 of the menstrual cycle + FSH and 40 women received FSH only as a control group. All patients were given highly purified FSH [75-150IU] starting of day 3 to day 7 until the day of hCG administration. Total FSH dose/cycle, number of mature ovarian follicles, estradiol [E2], lutenizing hormone [LH] levels, endometrial thickness, cervical mucus score at the day of hCG and pregnancy rate. The FSH dose was significantly lower in letrozole + FSH group and CC + FSH group when compared with FSH only group without a difference in number of follicles >/= l8mm. E2 levels were significantly lower in the letrozole + FSH group compared with the other two groups. Cervical mucus score, endometrial thickness and pregnancy rate were significantly lower in CC + FSH group when compared with the other two groups. Similar to CC, aromatase inhibition with letrozole reduces FSH dose required for COS without the undesirable anti-estrogenic effects sometimes seen with CC