RESUMEN
Background: Gonadotropin-releasing hormone [GnRH] antagonist protocol has been proposed as a potentially proper option for the patients with limited ovarian reserve. Nevertheless, there is no significant difference in terms of clinical pregnancy between the GnRH antagonist and agonist cycles. The use of aromatase inhibitors such as letrozole was suggested by some studies
Objective: The object of this study was to evaluate the efficacy of letrozole cotreatment with GnRH-antagonist protocol in ovarian stimulation of poor responder patients undergoing intracytoplasmic sperm injection
Materials and Methods: A double-blinded randomized control trial was conducted on 70 infertile women with poor ovarian response based on Bologna criteria in two groups: letrozole+GnRH-antagonist [LA] group and placebo+GnRH-antagonist [PA] group [n=35/each]. The LA group involved at letrozole 2.5 mg daily over 5 days and recombinant human follicle stimulating hormone 225 IU/daily. The PA group received placebo over 5 days and recombinant human follicle stimulating hormone at the same starting day and dose, similar to LA group. GnRH-antagonist was introduced once one or more follicle reached >/= 14 mm. The main outcome measures were the number of oocytes retrieved, fertilization rate, implantation rate, cycle cancellation rate, and clinical pregnancy rate
Results: There were no significant differences in demographic characteristics between groups. There were no significant differences between groups regarding the number of oocytes retrieved [p=0.81], number of embryos transferred [p=0.82], fertilization rate [p=0.225], implantation rate [p=0.72], total cycle cancelation rate [p=0.08], and clinical pregnancy rate [p=0.12]
Conclusion: The use of letrozole in GnRH-antagonist cycles does not improve clinical outcomes in poor responder patients undergoing intracytoplasmic sperm injection
RESUMEN
Premature ovarian failure [POF] is a heterogeneous syndrome with several causative factors. Autoimmune mechanisms are involved in pathogenesis of 4-30% of POF cases. The present review focuses on the role of autoimmunity in the pathophysiology of POF. The evidences for an autoimmune etiology are: demonstration of ovarian autoantibodies, the presence of lymphocytic oophoritis, and association with other autoimmune disorders. Several ovarian antigenic targets have been identified in POF patients. The oocyte seems to be the most often targeted cell. Lymphocytic oophoritis is widely present in POF associated adrenal insufficiency. Addisons disease is one of the most common autoimmune disorders associated with POF. Early detection of this potentially life threatening disease was recommended in several studies. The gold standard for detecting autoimmune POF is ovarian biopsy. This procedure is not recommended due to unknown clinical value, expense, and risks. Several immunoassays have been proposed as substitute diagnostic tools. Nevertheless, there is no clinically proven sensitive and specific serum test to confirm the diagnosis of autoimmune POF or to anticipate the patient's chance of developing POF or associated diseases. Some authors suggested the possible effects of immuno-modulating therapy on the resumption of ovarian function and fertility in a selected group of autoimmune POF patients. However, in most instances, this treatment fails to reverse the course of the disease. Numerous studies illustrated that standard treatment outcome for infertility is less effective in the presence of ovarian autoimmunity. The antibody-induced damage could be a pathogenic factor. Nevertheless, the precise cause remains obscure
RESUMEN
Intrauterine insemination [IUI] is known as a routine method for infertility treatment. The effectiveness of IUI is not identical in all cases. So in this study to evaluate different methods of IUI in order to increase pregnancy rate, IUI with cleaning cervical canal by swab is compared to IUI without cervical canal cleaning. This study was conducted from 2008/2/1 to 2008/9/30 in Mirza-Kochak-Khan Infertility center. Totally 224 cases were selected for IUI divided into two groups. Group one [n=112] had cervical cleaning with swab before IUI and group two [n=112] was control group. Pregnancy rate were compared in two groups. Two groups were matched regarding age, type of infertility and number of follicles. Pregnancy rate in cervical canal cleaning [group one] and control group [group two] was 15.1% and 9.8% respectively. The difference was not significant. In this study with cleaning cervical canal by swab before IUI there was a non-significant increase in pregnancy rate