The Effect of Clomiphene Citrate versus Tamoxifen versus Letrozol on Endometrial Thickness and Blood Flow in Ovulation Induction in Women with Polycystic Ovaries.

Aim of Work: To compare between the effects of clomiphene citrate, tamoxifen and letrozol as ovulation induction agents on endometrial thickness and blood flow as non-invasive parameters of endometrial receptivity in women with polycystic ovaries. Patients and Methods: One hundred and fifty cases meeting the selection criteria were prospectively randomized into three groups 1st Group took 100 mg clomiphene citrate, 2nd Group took 5 mg letrozol and 3rd group took 40 mg tamoxifen. Transvaginal ultrasound and Doppler were done to measure endometrial thickness and endometrial blood flow both pulsatility index (PI) and resistance index (RI) at the day of the maximum follicular growth or at day 20 in the absence of the dominant follicle in the three groups. Results: Significantly thinner endometrium in the clomiphene citrate group as compared to the other two groups and lower impedance in the spiral arteries in both letrozol and tamoxifen groups (P value less than 0.001). Conclusion: Endometrium was thicker with lower impedance in the spiral arteries in both letrozol and tamoxifen groups as compared to clomiphene citrate group. Ovulation and pregnancy rates were not significantly different. Other studies are needed to measure the cumulative results of six cycles, increasing the dose in nonresponders and the incidence of miscarriage.

Síndrome de ovario poliquístico e infertilidad / Infertility and polycystic ovary syndrome

El Síndrome de Ovario Poliquístico (SOP) es una disfunción endocrino metabólica altamente prevalente en mujeres en edad reproductiva. De etiología incierta, se manifiesta de formas muy variadas, entre las que destacan irregularidad menstrual, oligo o anovulación, hiperandrogenismo clínico, imagen ecográfica de ovario poliquístico, obesidad, insulinorresistencia e infertilidad. Por su variedad de presentación es que su definición ha requerido varios consensos y es aún hoy motivo de controversia. La infertilidad asociada al SOP obedece a diferentes mecanismos, entre los que destacan la disfunción ovulatoria, la alteración del desarrollo endometrial, la insulinorresistencia, su impacto en la esteroidogénesis ovárica y suprerrenal y, la alta frecuencia de aborto espontáneo de primer trimestre. El enfoque diagnóstico y terapéutico del SOP debe contemplar todos estos aspectos en forma integral para restablecer adecuadamente el ambiente endocrino-metábolico previo a un embarazo y tener en cuenta las potenciales repercusiones en el mediano y largo plazo para estas pacientes como dislipidemia, diabetes mellitus tipo 2, enfermedad cardiovascular y, cáncer de endometrio y mama.

Polycystic ovary syndrome (PCOS) is a metablic endocrine disorder highly common in women of reproductive age. Of unknown etilogy, its symptoms are varied; including menstrual disorders, oligo or anovulation, clinical hyperandrogenism, visualization of polycystic ovaries on ultrasound, obesity, insulin resistance and infertility. Due to the wide range of clinical symptoms, attempts have been made to reach consensus, however controversy remains. Infertility associated to PCOS responds to different mecanisms such as ovulatory disorders, alterations in endometrial development, insulin resistance, impact on ovarian and suprarenal steroidogenesis and a high frequency of first trimester spontaneous abortions. The diagnostic and therapetic approach to PCOS must consider all these factors as a whole in order to provide an adecuate endocrine-metabolic environment prior to pregnancy and to anticipate any possible medium or long-term impact in these patients, including dyslipidemia, Type II Diabetes mellitus, cardiovascular disease and endometrial and breast cancer.

Clinical study on the treatment for refractory polycystic ovarian syndrome by laparoscopic ovarian electrocautery / 中国微创外科杂志

Objective To evaluate the efficacy of laparoscopic ovarian electrocautery in refractory polycystic ovarian syndrome (PCOS). Methods A total of 16 PCOS patients who had no response to ovulation-inductive therapy were treated by ovarian electrocautery via laparoscope. After surgery, the ovulation as well as response to ovulation-inductive drugs was observed. The serum concentrations of FSH, LH, T, E 2 before and after operations were respectively compared. Results All 16 cases were pathologically diagnosed as polycystic ovary. There were significant decreases in luteinizing hormone (LH) and testosterone (T) after operations (P