Comparing clomiphen citrate plus HMG with clomiphen citrate plus rFSH in IUI cycles in couples with unexplained or male factor infertility: a prospective randomized study

Different protocols are used for controlled ovarian hyper stimulation [COH], but the optimal method has not yet been determined. The aim of this study was to compare the outcome of controlled ovarian stimulation [COS] using clomiphen citrate [CC] plus HMG versus CC plus rFSH in intra uterine insemination cycles [IUI]. 144 women with unexplained or male factor infertility undergoing IUI cycles were randomized [72 patients in CC plus rFSH group and 72 patients in CC plus HMG group] and included in this single blind study from October 2006 to June 2010. The primary outcomes were clinical and ongoing pregnancy rates. The number of dominant follicles, mean of follicular size, endometrial thickness on the day of HCG administration, total dose of gonadotropins and duration of stimulation with gonadotropins were secondary outcomes. Clinical and ongoing pregnancy rates were not significantly different in the two groups .There was a significant higher multiple pregnancy rate in CC plus rFSH group [33.3%] versus CC plus HMG group [12.5%; p<0.005]. There were no statistically significant differences in the secondary outcomes between the two groups. According to our results it seems that CC plus HMG is a more suitable and cost-effective regimen than CC plus rFSH in IUI cycles in patients with unexplained or male factor infertility

Pregnancies following the use of sequential treatment of metformin and incremental doses of letrozole in clomiphen-resistant women with polycystic ovary syndrome

Clomiphen citrate [CC] is the first line therapy for women with infertility and poly cystic ovary syndrome [PCOS]. However, 20-25% of women are resistant to CC and do not ovulate. The objective of this study was to evaluate the efficacy of sequential treatment of metformin and incremental doses of letrozole in induction of ovulation in cases of CC-resistant PCOS patients. In this prospective before-after study, we enrolled 106 anovulatory PCOS women who failed to ovulate with CC alone from Amir-Almomenin University Hospital in Semnan, Iran. After an initial 6-8 weeks of metformin treatment, they received 2.5 mg letrozole daily on days 3-7 after menes. If they did not ovulate with 2.5 mg letrozole, the doses were increased to 5 to 7.5 mg daily in subsequent cycles. The main outcomes were ovulatory rate, pregnancy rate and cumulative pregnancy rate. 13.33% of patients conceived with metformin alone. Ovulation occurred in 83 out of remaining 91 patients [91.2%]. 78.02% of patients responded to lower doses of letrozole. Cumulative pregnancy rate was 60/105 [57.14%]. We suggest that treatment in CC-resistant PCOS patients should begin at first with lower doses of letrozole and could increase to the higher dose depending on the patient response before considering more aggressive therapeutic alternatives such as gonadotropins

[Comparison of the influence of oral and rectal acetaminophen on level of pain relief after circumcision]

Postoperative pain is a major problem in day-care pediatric surgery and acetaminophen is a common drug, which is used for pain control in infants. The aim of this study was to compare the effect of oral and rectal acetaminophen and also to evaluate the effect of loading single dose of rectal acetaminophen before surgery in pain relief after circumcision. In a randomized clinical trial, 45 children [3 to 6 years old] were divided into 3 groups before circumcision. The first group was received rectal acetaminophen [40 mg/kg] before and oral acetaminophen [15 mg/kg/qid] after circumcision. The second group was given rectal and the third group received oral acetaminophen [both 15 mg/kg/qid] after circumcision. Pain scores was measured every three hours and the amount of sleep hours in the first 24-hours after circumcision. In the study, pain scores and amount of sleep hours in the first group were significantly lower and higher than other groups. There was no significant difference in pain scores between other groups [second and third] but the amount of sleep hours was higher in second group. Efficacy of oral and rectal acetaminophen [15 mg/kg/qid] was similar in pain relief after circumcision but rectal acetaminophen had more sedative effect .In addition, the high dose of rectal acetaminophen [40 mg/kg] before circumcision significantly led to pain reduction in the first 24-hours after circumcision