3rd Day Of Cycle Research Articles

A Randomized Trial of Combined Letrozole with Metformin Versus Clomiphene Citrate with Metformin in Polycystic Ovary (PCOS) patients

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common causes of anovulatory infertility. Currently, clomiphene citrate (CC) is considered the first-line therapy for ovulation induction for women with PCOS and infertility. Aromatase inhibitors (AIs) have been introduced as a new treatment option that could challenge CC for ovulation induction. Aim of the Work: The present study was designed to compare the efficacy of combined aromatase inhibitor (Letrozole) with metformin versus CC with metformin in PCOS patients. Patients and Methods: This study was done on 100 documented PCOS cases. They were divided into two groups, The 1st group received CC 50 mg twice daily from the 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with CC and continued for 3 cycles. The 2nd group received aromatase inhibitor (Letrozole) 2.5 mg twice daily from 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with letrozole and continued for 3 cycles. These cases were followed up for three cycles by transvaginal ultrasound folliculometry to document ovulation (size and number of follicles). Results: The results of the present study revealed both lines of treatment were effective in treatment of PCOS patients, with slight favorability in letrozole group but without statistically significant difference founded between CC group and letrozole group as regard ovulation rate, number of follicles at the end of first, second or third cycles, or as regard the diameter of follicles, i.e., both regimens showed efficacy to the same extent. Conclusion: both CC and letrozole are equally effective in treatment of infertility in PCOS patients, when combined with metformin treatment.

A Randomized Trial of Combined Letrozole with Metformin Versus Clomiphene Citrate with Metformin in Polycystic Ovary (PCOS) patients

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common causes of anovulatory infertility. Currently, clomiphene citrate (CC) is considered the first-line therapy for ovulation induction for women with PCOS and infertility. Aromatase inhibitors (AIs) have been introduced as a new treatment option that could challenge CC for ovulation induction. Aim of the Work: The present study was designed to compare the efficacy of combined aromatase inhibitor (Letrozole) with metformin versus CC with metformin in PCOS patients. Patients and Methods: This study was done on 100 documented PCOS cases. They were divided into two groups, The 1st group received CC 50 mg twice daily from the 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with CC and continued for 3 cycles. The 2nd group received aromatase inhibitor (Letrozole) 2.5 mg twice daily from 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with letrozole and continued for 3 cycles. These cases were followed up for three cycles by transvaginal ultrasound folliculometry to document ovulation (size and number of follicles). Results: The results of the present study revealed both lines of treatment were effective in treatment of PCOS patients, with slight favorability in letrozole group but without statistically significant difference founded between CC group and letrozole group as regard ovulation rate, number of follicles at the end of first, second or third cycles, or as regard the diameter of follicles, i.e., both regimens showed efficacy to the same extent. Conclusion: both CC and letrozole are equally effective in treatment of infertility in PCOS patients, when combined with metformin treatment.

Usefulness of Finasteride to induce ovulation in a non responder hyperandrogenic woman: birth of a healthy male infant

We report a case for the first time describing a new use of Finasteride. A 33-year-old woman participated with other hyperandrogenic anovulatory volunteers in our study on the efficacy of Finasteride in inducing ovulation [1]. She consulted her gynaecologist, because she was hoping to become pregnant. She reported oligomenorrhea, since menarche. Body mass index and a hirsutism score were evaluated according to the modified Ferriman–Gallway scoring system of 21 and 22, respectively. Pelvic examination showed micropolycystic enlarged ovaries. Serum levels of FSH, LH, T, DHT, androstenedione (A) and estradiol (E2)were measured on the 1st day of menses, using a recombinant immunoassay; T, DHT, A and E2 were repeated on the HCG day and DHT even on the 12th day after Finasteride discontinuance. Initial hormone levels were: FSH 4.1 mIU, LH 16.2 mIU, T 77 ng/dL, DHT 43 ng/dL, E2 55.9 pg/mL, and A 3.68 ng/mL. Initially, the patient underwent three consecutive cycles of controlled gonadotropin ovarian stimulation with recombinant FSH (b FSH, Organon, The Netherlands) starting at a daily dose of 150 IU on the 3rd day of cycle. Ovulation did not occur and after 21 days of stimulation, the cycles discontinued. On the 4th cycle, Finasteride was added. The patient was treated with recombinant FSH as described above for precedent stimulation cycles, plus 5 mg of Finasteride (Finastid; Neopharmed, Rome, Italy) daily, from day 1. On the 16th day of treatment, ultrasound examination showed one follicle of 20 mm; E2 was 180 pg/ml, human chorionic gonadotropin (HCG 10.000 UI; Gonasi; Amsa, Rome, Italy) was administered and Finasteride discontinued. On the same day, a significant decrease in DHT was achieved. After 14 days from Finasteride discontinuance, DHT was above basal level. Ultrasound examination revealed an intrauterine pregnancy. On the 6th week of amenorrhea, b hCG was 12.250 m UI/ml. The pregnancy evolved physiologically and after 40 weeks, a normal male infant of 3,600 g was delivered. Although follicular development is a complex interplay between many autocrine and paracrine factors, an important role is claimed by the competition between the enzymes aromatase and 5aR and their respective products E2 and DHT [2]. In PCOS, there is a raised activity of 5aR, responsible of higher level of intrafollicular DHT. The majority of ovarian follicles, in this syndrome, undergo atresia. Raised intrafollicular DHT concentrations are able to lead to follicular atresia that occurs at all stages of follicle development. Intrafollicular production of estrogens is indispensable for the growth of follicles. Atresic follicles exhibit decreased estrogen production and a lower estrogen/androgen ratio in the follicular fluid. In this case, sufficient exposure of antral follicles to FSH, increasing aromatase activity joined with low intrafollicular DHT level, due to Finasteride effect could be the critical stimulus for the follicle to escape atresia and reach the preovulatory follicle stage [3, 4]. In our patient, Finasteride not only favoured follicular growth (failure to achieved ovulation in 3 previous cycles), but also did not affect male genitalia differentiation. Finasteride seems not M. Tartagni G. R. Damiani (&) M. V. Tartagni G. Loverro Department of Obstetric and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy e-mail: damiani14@alice.it

Avaliação da Reserva Ovariana: Comparação entre a Dosagem do FSH Basal e o Teste do Clomifeno

Objetivo: avaliar a reserva ovariana por meio da dosagem do FSH no 3º dia do ciclo menstrual, comparando-o com o teste do clomifeno, e correlacionar os resultados com a resposta ovariana à hiperestimulação controlada com gonadotrofinas para a fertilização in vitro. Métodos: foram selecionadas 49 pacientes com idade superior a 30 anos que apresentavam quadro clínico de infertilidade há pelo menos 1 ano. Foi realizada avaliação da reserva ovariana destas pacientes pelo teste do citrato de clomifeno. Posteriormente, 26 das 49 pacientes foram submetidas à hiperestimulação ovariana controlada com gonadotrofinas. Destas 26 pacientes, 18 tiveram boa resposta à hiperestimulação ovariana e 8, má resposta. Foram calculadas as médias e os desvios-padrão referentes aos valores do FSH do 3º dia, do 10º dia e do somatório de ambos, no grupo das pacientes que responderam favoravelmente à estimulação ovariana. Posteriormente foi realizada a correlação dos valores obtidos com a resposta ovariana após a estimulação dos ovários com gonadotrofinas. Resultados: empregando-se a dosagem do FSH no 10º dia (média somada a 2 desvios-padrão) com valor >16,1 UI/mL para predizer a má resposta ovariana ao teste do clomifeno, observaram-se sensibilidade, especificidade e valores preditivos positivo e negativo de 50, 100, 100 e 81,8%, respectivamente. Considerando-se o teste do clomifeno positivo quando o valor do somatório das dosagens do FSH do 3º e do 10º dia somado a dois desvios-padrão foi > 22,6 UI/mL, obtiveram-se sensibilidade de 62,5%, especificidade de 100%, valor preditivo positivo de 100% e valor preditivo negativo de 85,7% . O uso da dosagem única do FSH no 3º dia do ciclo acima de 10 UI/mL para predizer a má resposta ovariana mostrou sensibilidade de 87%, especificidade de 100%, valor preditivo positivo de 100% e valor preditivo negativo de 94,7%. Conclusão: no presente estudo, a dosagem única do FSH no 3º dia do ciclo apresentou maior sensibilidade quando comparada ao teste do clomifeno para a avaliação da reserva ovariana.