Luteal support with intravaginal progesterone increases clinical pregnancy rates in women with polycystic ovary syndrome using letrozole for ovulation induction.

OBJECTIVE: To determine the effect of intravaginal micronized P on pregnancy rates in clomiphene citrate and letrozole ovulation induction cycles in women with polycystic ovary syndrome (PCOS). DESIGN: Retrospective chart review. SETTING: University-based assisted reproductive technology program. PATIENTS: Women with PCOS who underwent ovulation induction with either clomiphene citrate (n = 90) or letrozole (n = 31) from January 2002 to December 2008. INTERVENTION(S): Clomiphene citrate (50-250 mg x 5 days) or letrozole (5 mg x 5 days) were used for ovulation induction. After either intercourse or IUI, patients received intravaginal micronized P (200 mg twice daily) according to prescribing physician preference. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): In clomiphene cycles, clinical pregnancies were documented in 15.3% of cycles (19 of 124) in the P group, compared with 12.1% (11 of 91) of the non-P group. In letrozole cycles, clinical pregnancies were documented in 21.1% of cycles (8 of 38) in the P group, compared with none (0 of 13) in the non-P group. CONCLUSION(S): Women with PCOS who used letrozole for ovulation induction had higher clinical pregnancy rates when using intravaginal P support. Luteal supplementation with P should be strongly considered in women with PCOS, especially in those using letrozole for ovulation induction.

Long-term maternal and subsequent pregnancy outcomes 5 years after hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.

OBJECTIVE: To evaluate subsequent pregnancy outcome and impact of gestational age at onset of HELLP on long-term prognosis after HELLP over an average follow-up of 5 years STUDY DESIGN: One hundred twenty-eight patients with a history of HELLP filled out questionnaires and sent their medical records. Hemolysis, elevated liver enzymes, and low platelets data were stratified according to gestational age at onset of HELLP < or =28 weeks and >28 weeks. RESULTS: Fifty-three patients had subsequent pregnancies with 24% complicated by HELLP and 28% by preeclampsia. During follow-up, 33% of the patients had new onset hypertension develop, 32% had depression develop, 26% had anxiety develop, and 2.4% required dialysis. There was no significant difference in long-term outcome between comparison groups. CONCLUSION: Patients with a history of HELLP are at increased risk for preeclampsia and HELLP as well as long-term morbidities as depression and chronic hypertension. Gestational age at the onset of HELLP could be a predictor for long-term outcome.