scholarly journals Aromatase Inhibitors for Ovulation Induction

2006 ◽  
Vol 91 (3) ◽  
pp. 760-771 ◽  
Author(s):  
Robert F. Casper ◽  
Mohamed F. M. Mitwally
Keyword(s):  
Side Effects ◽  
Aromatase Inhibitors ◽  
Ovulation Induction ◽  
Assisted Reproductive Technologies ◽  
Evidence Synthesis ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Significant Risk ◽  
Reproductive Technologies ◽  
Poor Responders

Abstract Context: For the last 40 yr, the first line of treatment for anovulation in infertile women has been clomiphene citrate (CC). CC is a safe, effective oral agent but is known to have relatively common antiestrogenic endometrial and cervical mucous side effects that could prevent pregnancy in the face of successful ovulation. In addition, there is a significant risk of multiple pregnancy with CC, compared with natural cycles. Because of these problems, we proposed the concept of aromatase inhibition as a new method of ovulation induction that could avoid many of the adverse effects of CC. The objective of this review was to describe the different physiological mechanisms of action for CC and aromatase inhibitors (AIs) and compare studies of efficacy for both agents for ovulation induction. Evidence Acquisition: We conducted a systematic review of all the published studies, both controlled and noncontrolled, comparing CC and AI treatment, either alone or in combination with gonadotropins, for ovulation induction or augmentation, identified through the Entrez-PubMed search engine. Evidence Synthesis: Because of the recent acceptance of the concept of using AIs for ovulation induction, few controlled studies were identified, and the rest of the studies were pilot or preliminary comparisons. Based on these studies, it appears that AIs are as effective as CC in inducing ovulation, are devoid of any antiestrogenic side effects, result in lower serum estrogen concentrations, and are associated with good pregnancy rates with a lower incidence of multiple pregnancy than CC. When combined with gonadotropins for assisted reproductive technologies, AIs reduce the dose of FSH required for optimal follicle recruitment and improve the response to FSH in poor responders. Conclusions: Preliminary evidence suggests that AIs may replace CC in the future because of similar efficacy with a reduced side effect profile. Although worldwide experience with AIs for ovulation induction is increasing, at present, definitive studies in the form of randomized controlled trials comparing CC with AIs are lacking.

Advances in Treatment Options for Polycystic Ovary Syndrome

2012 ◽  
Vol 08 (01) ◽  
pp. 57 ◽  
Author(s):  
Sanam Lathief ◽  
Lubna Pal ◽  
◽  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Assisted Reproductive Technologies ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Comparable Efficacy ◽  
Hormonal Contraceptives ◽  
Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy seen in women of reproductive age. Clinical concerns relating to PCOS range from ovulatory infertility and menstrual disorders to risk of diabetes and cardiovascular disease. Hormonal contraceptives have been the mainstay of the management of common PCOS symptoms, such as menstrual irregularity and clinical stigmata of androgen excess (i.e., hirsutism and acne). An appreciation of the relevance of metabolic pathways in the pathophysiology of PCOS is relatively recent, and has translated into an expansion of the therapeutic strategies available for the management of PCOS. Insulin sensitizers were one of the first metabolic modulators to be incorporated in the clinical management paradigm, albeit with mixed results. Recognizing that insulin resistance is central to the pathophysiology of PCOS, newer agents—e.g., thiazolidinediones— followed, with almost comparable efficacy to metformin. Statins and most recently incretins constitute novel therapies with distinct metabolic targets that seem to hold promise in the management of PCOS. In tandem with the expansion in pharmaceuticals, a host of complementary and alternative medical therapies have generated interest for purported promise in the management of PCOS, including vitamin D, acarbose, and myo-inositol. The therapeutic options for managing PCOS-related infertility have also expanded. Clomiphene citrate (CC) has long been the first-line strategy for ovulation induction in the setting of anovulatory infertility; however, aromatase inhibitors are fast gaining acceptance as an ovulation induction strategy, with results comparable or even better than those seen with CC. An increasing level of therapeutic sophistication is reflected in ovarian stimulation protocols judiciously using gonadotropins, gonadotropin-releasing hormone antagonists, the procedure of ovarian drilling, and assisted reproductive technologies within vitrooocyte maturation.

Clinical and statistical analysis of obstetrics and perinatal complications in singleton and multiple pregnancy after assisted reproductive technology

2018 ◽  
pp. 67-73
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  
S.O. Ovcharenko ◽  
◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Fetal Distress ◽  
Reproductive Technologies ◽  
Fetal Growth Retardation ◽  
Multiple Pregnancies ◽  
Perinatal Complications

The objective: conduct a comparative clinical and statistical analysis of obstetric and perinatal complications in singleton and multiple pregnancies after assisted reproductive technologies (ART) according to archival documents (pregnancy observation data and birth history) and identify features of multiple pregnancy. Materials and methods. During the period 2017–2019, 522 women gave birth in maternity hospital «Leleka» after assisted reproductive technologies, 331 women were observed in the maternity hospital «Leleka». 445 women gave birth with a singleton pregnancy and 77 with a multiple pregnancy. A clinical and statistical analysis of 150 pregnancy and childbirth histories was performed. All pregnant women were divided into two groups: Group I – 75 pregnant women with singleton pregnancies after ART; Group II – 75 pregnant women with multiple pregnancies after ART. The selection criteria for comparative clinical and statistical analysis were women whose pregnancies occurred as a result of ART, namely by in vitro fertilization (IVF) using five-day frozen embryos. Mathematical research methods were performed in accordance with the recommendations of O.P. Minzer (2013). The reliability of the cancellation of the mean pairs was calculated using the Student’s and Fisher’s criteria. Graphs were designed using the program «Microsoft Excel». Results. Complications of early pregnancy in multiple pregnancies were: anemia (47.8% vs. 22.9%; p<0.01), placental dysfunction (43.3% vs. 22.9%; p<0.01), the threat of abortion (41.8% vs. 28.6%; p<0.01). Complications of the second half of pregnancy: preeclampsia (52.7% vs. 20.6%; p<0.01), fetal growth retardation (20.0% vs. 7.4%; p<0.01), gestational anemia (76,4% vs. 32.4%; p<0.01), placental dysfunction (47.3% vs. 22.1%; p<0.05). Complications in childbirth in women with multiple pregnancies were as follows: premature rupture of membranes (30.9% vs. 10.3%; p<0.05), anomalies of labor activity (16.4% vs. 5.9%; p>0.05), fetal distress (29.1% vs. 14.7%; p<0.05), premature placental abruption (3.6% vs. the absence of this indicator in group I). In patients of group II with multiple pregnancies 3.7 times more often the pregnancy ended prematurely compared with singleton (21.8% vs. 5.9%; p<0.05). Early preterm births predominated, of which births occurred in 3.6% of cases at 22–28 weeks, 7.3% at 28–32 weeks, and 6.4% at 32–34 weeks. Significant increase in the frequency of 32.7% of abdominal births in multiple pregnancies against 11.8% of patients in pregnancy with a single fetus (p<0.01). The structure of indications in patients of group II was as follows: severe preeclampsia 27.8%, development of fetal growth retardation and fetal distress of 11.1%, respectively, premature placental abruption 16.7%, the following single indications (pelvic presentation of the fetus, transverse or oblique position of the fetus, clinically narrow pelvis, abnormalities of labor, scar on the uterus) – 33.3%. Significant increase in the total frequency of neonatal asphyxia of varying severity in multiple pregnancies (35.0% vs. 5.9%; p<0.05), fetal growth retardation (27.3% vs. 11.8%; p<0.01). Conclusions. Multiple pregnancies are a high risk factor for gestational anemia, preeclampsia, placental dysfunction, early fetal growth retardation, and fetal distress during pregnancy and childbirth. This causes a high level of abdominal delivery. Therefore, further research to predict and prevent obstetric and perinatal complications in multiple pregnancies after ART is relevant today. Keywords: obstetric and perinatal complications of pregnancy, multiple pregnancy, assisted reproductive technologies.

scholarly journals A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

2019 ◽  
Vol 7 (9) ◽  
pp. 95 ◽  
Author(s):  
Michael Costello ◽  
Rhonda Garad ◽  
Roger Hart ◽  
Hayden Homer ◽  
Louise Johnson ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Supporting Evidence ◽  
First Line ◽  
Ovary Syndrome ◽  
Ultrasound Monitoring

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.

scholarly journals The predictors of preterm labour in patients with multiple pregnancy

2020 ◽  
pp. 144-150
Author(s):  
S. V. Barinov ◽  
A. A. Belinina ◽  
O. V. Koliado ◽  
I. V. Molchanova ◽  
A. A. Shkret ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Assisted Reproductive Technologies ◽  
Preterm Labour ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Risk Groups ◽  
Reproductive Technologies ◽  
Cervical Insufficiency ◽  
Logistic Analysis ◽  
Prophylactic Measures

Introduction. The number of women with multiple pregnancy is increasing worldwide, especially in countries with a high level of health care, where assisted reproductive technologies are widely used. According to foreign studies, one third of twins are born as a result of Assisted Reproductive Technologies (ART), so only an increase in multiple pregnancy can be predicted in the future. The main obstetric problem with these pregnancies is the problem of carrying.Objective: To identify the predictors of preterm birth in patients with multiple pregnancy in order to improve monitoring and prophylactic measures among this cohort of women.Material and methods: A retrospective controlled observational study, including 154 patients with multiple pregnancies was carried out. Logistic analysis was used to identify the predictors of preterm labour.Results: The study showed that the predictors of preterm birth varied from one trimester to another. Based on the identified predictors, the predictive models for each trimester of pregnancy were compiled. Most of the identified predictors are related to obstetrical history. Risk groups formation, based on the identification of these predictors, is extremely important for qualified medical support. Prophylactic measures should be performed on the pre-conceptional stage. Pregnancy planning should be recommended only after treatment of chronic endometritis, followed by control of vaginal microflora and progesterone support. It is hardly possible to talk about the prevention of cervical insufficiency. However, cervical correction is an important factor for perinatal outcomes improving. The research suggests that the insertion of cervical pessary in women with multiple pregnancy and cervical insufficiency allows to prolong the gestational period for 7 weeks.Conclusion: a comprehensive approach of management of women with multiple pregnancy based on the prognostic scales of preterm labour, allows to reduce the preterm birth rate.

scholarly journals Efficacy and Side Effects of Letrozole Over Clomiphene citrate for Ovulation Induction of the Patients with PCOS: A Randomized Controlled Trial

2021 ◽  
Vol 15 (2) ◽  
pp. 69-73
Author(s):  
Poly Begum ◽  
Dipti Rani Shaha ◽  
Md Kamrul Hassan ◽  
Dilruba Zeba
Keyword(s):  
Side Effects ◽  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Ovulation Rate ◽  
Medical College ◽  
Drug Of Choice ◽  
Group B

Clomiphene citrate (CC) has been the drug of choice for the treatment of anovulatory subfertility in women with polycystic ovarian syndrome (PCOS) for a long time. Despite high ovulation rate of CC, its pregnancy rate is low. Letrozole, an aromatase inhibitor has been considered as an alternative of CC but its effectiveness is yet controversial. Our aim was to compare the efficacy and side effects of Letrozole over CC. This randomized control clinical trial was conducted in Diabetic Association Medical College and Hospital, Faridpur, Bangladesh from January 2018 to December 2019. A total of 160 women diagnosed as PCOS by Rotterdam criteria seeking treatment of subfertility were included in the study. Participants were randomly divided into two groups. Group A got Letrozole and Group B got CC as treatment. Transvaginal ultrasonogram (TVS) was performed on 12 to 13th day of the cycle to see the details of the follicles and the endometrium. The demographic information of the participants and the side effects of the drugs were recorded. Successful pregnancies were followed up for 12 weeks. Ovulation rate was almost similar among the participants of both of the groups. But monofo licular development and pregnancy rate were significantly higher among the Letrozole group (p = 0.004 and p = 0.008 respectively). Multifo licular development, multiple pregnancy, and abortion rate were significantly higher in the CC group. Patients who took Letrozole had significantly higher endometrial thickness than CC group. Both of the groups reported relatively similar incidence of side effects. Due to the higher pregnancy rate and lower incidence of abortion or multiple pregnancy, Letrozole can be an effective alternative to CC for the treatment of anovulatory subfertility of the PCOS patients. Faridpur Med. Coll. J. 2020;15(2): 69-73

Lesioni cutanee stellate e simmetriche in un gemello “rimasto solo”

2021 ◽  
Vol 40 (6) ◽  
pp. 383-385
Author(s):  
Claudia Sciarrotta ◽  
Gregorio Serra ◽  
Mandy Schierz ◽  
Giovanni Corsello
Keyword(s):  
Twin Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
Intrauterine Death ◽  
Second Trimester ◽  
Aplasia Cutis Congenita ◽  
Multiple Gestations ◽  
Vanishing Twin Syndrome ◽  
Twin Pregnancies

The incidence of multiple pregnancy has increased, particularly because of the advances in assisted reproductive technologies. Multiple gestations are high risk pregnancies, especially the monochorionic ones. Two/thirds of initially twin pregnancies result in singles at birth, a condition defined as vanishing twin syndrome. The intrauterine death of one of the twins can cause direct fetal damage to the surviving one on several levels. The paper describes the case of a child born from twin pregnancy that was interrupted for one of the co-twins at early second trimester of gestation who presented with aplasia cutis congenita.

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