TRANSVAGINAL SONOGRAPHIC ASSESSMENT OF FOLLICULAR DEVELOPMENT AND ENDOMETRIAL THICKNESS IN LETROZOLE STIMULATED CYCLES OF PCOS AND NON-PCOS INFERTILE WOMEN

2021 ◽  
pp. 7-9
Author(s):  
Anshu Anshu ◽  
Usha Kumari ◽  
Debarshi Jana
Keyword(s):  
Menstrual Cycle ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Follicular Development ◽  
Study Groups ◽  
Transvaginal Sonography ◽  
Infertile Women ◽  
Follicle Diameter ◽  
Anovulatory Infertility

Background: Infertility in polycystic ovary syndrome (PCOS) is one of the leading causes of anovulatory infertility. Ovulation induction is indicated for the management of anovulatory infertility in PCOS and for augmentation of ovulation in ovulatory infertility, in unexplained infertility. The aim of this retrospective study was to compare and determine the efcacy of letrozole administration in infertile women with PCOS to that of infertile women without PCOS by transvaginal sonography. This Methods: study was done at Obstetrics and Gynaecology Department of JLNMCH, Bhagalpur, Bihar from January to December 2020. Fifty six infertile women including 16 diagnosed as having PCOS and 40 infertile women with regular menstrual cycle (non-PCOS) were included in this study. Patients were treated with letrozole 7.5 mg/day from day 2-6 of the menstrual cycle. Subjects were monitored once during the days 11 to 14 of the cycle by transvaginal ultrasound. Main outcome measures were number of ovulatory follicles, dominant follicle diameter and endometrial thickness. Letrozole as an ovulation inducing drug was found equally effective in t Results: erms of follicular recruitment, follicular maturation and endometrial development both in PCOS and non-PCOS women, as there was no signicant difference regarding mature follicular development and endometrial response between the two study groups. Association of endometrial response particularly with follicular diameter 18 mm or more among the study groups revealed no statistically signicant difference. In conclusion, our results indicate that the Conclusion: effect of letrozole on endometrial thickness and follicular development in patients of anovulatory PCOS did not signicantly differ compared to non-PCOS infertile women.

scholarly journals Transvaginal sonographic assessment of follicular development and endometrial thickness in letrozole stimulated cycles of PCOS and non-PCOS infertile women

2019 ◽  
Vol 9 (3) ◽  
pp. 234-239
Author(s):  
Naushaba Tarannum Mahtab ◽  
Nusrat Mahmud ◽  
TA Chowdhury
Keyword(s):  
Retrospective Study ◽  
Menstrual Cycle ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Follicular Development ◽  
Study Groups ◽  
Infertile Women ◽  
Follicle Diameter ◽  
Significant Difference ◽  
Anovulatory Infertility

Background: Infertility in polycystic ovary syndrome (PCOS) is one of the leading causes of anovulatory infertility. Ovulation induction is indicated for the management of anovulatory infertility in PCOS and for augmentation of ovulation in ovulatory infertility, in unexplained infertility. The aim of this retrospective study was to compare and determine the efficacy of letrozole administration in infertile women with PCOS to that of infertile women without PCOS by transvaginal sonography. Methods: This retrospective study was done at Centre for Assisted Reproduction (CARE), BIRDEM General Hospital 2 from January to December 2011. Fifty six infertile women including 16 diagnosed as having PCOS and 40 infertile women with regular menstrual cycle (non-PCOS) were included in this study. Patients were treated with letrozole 7.5 mg/day from day 2-6 of the menstrual cycle. Subjects were monitored once during the days 11 to 14 of the cycle by transvaginal ultrasound. Main outcome measures were number of ovulatory follicles, dominant follicle diameter and endometrial thickness. Results: Letrozole as an ovulation inducing drug was found equally effective in terms of follicular recruitment, follicular maturation and endometrial development both in PCOS and non-PCOS women, as there was no significant difference regarding mature follicular development and endometrial response between the two study groups. Association of endometrial response particularly with follicular diameter 18 mm or more among the study groups revealed no statistically significant difference. Conclusion: In conclusion, our results indicate that the effect of letrozole on endometrial thickness and follicular development in patients of anovulatory PCOS did not significantly differ compared to non-PCOS infertile women. Birdem Med J 2019; 9(3): 234-239

scholarly journals Monitoring of Ovarian Follicular Development and Ovulation with Transvaginal Sonography (TVS) in Infertile Women in Eastern Region of Nepal

2016 ◽  
Vol 5 (1) ◽  
pp. 43-48
Author(s):  
Manoj Bhattarai
Keyword(s):  
Menstrual Cycle ◽  
Ovarian Follicle ◽  
Follicular Development ◽  
Transvaginal Sonography ◽  
Eastern Region ◽  
Follicular Growth ◽  
Dominant Follicle ◽  
Infertile Women ◽  
Mean Diameter ◽  
Ovarian Follicular Development

Background Ultrasonography is the first line imaging modality for evaluation of ovaries, monitoring ovarian follicular development and detecting ovulation in infertile women; thus plays a significant role in infertility management. This study was undertaken to evaluate the pattern of ovarian follicular growth and to predict and detect ovulation in infertile women by transvaginal sonography in eastern region of Nepal.Material and Methods Hospital based prospective cross-sectional study on 100 infertile patients referred for ultrasonographic monitoring of ovarian follicle was conducted over duration of 26 months. Serial transvaginal sonography of the patients was performed using standard procedure daily from day 10 of menstrual cycle till detection of ovulation. Identification of ovarian dominant follicle, monitoring of dominant follicle development and detection of ovulation was assessed in relation to the day of menstrual cycle.Results Increase in mean diameter of the dominant follicle was seen in serial ultrasound scan till ovulation, which occurred in all cases by day 16 of menstrual cycle. The average daily follicular growth rate ± SD from day 10 of menstrual cycle till detection of ovulation was 2.2 ± 0.2 mm per day and the mean diameter ± SD of dominant follicle on the day prior to ovulation was 21.4 ± 2.8 mm (range: 17.2 – 26.3 mm).Conclusion Transvaginal sonography is an excellent method for monitoring of ovarian follicular development and shows a linear increase in mean diameter of dominant follicle from day 10 of menstrual cycle till detection of ovulation.Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, 43-48

scholarly journals Clomiphene Citrate versus Letrozole for Induction of Ovulation in Infertile women having Polycystic Ovarian Syndrome (Randomized Controlled Trial)

2021 ◽  
Vol 4 (7) ◽  
pp. 01-09
Author(s):  
Abdel Rahman Mohammed Saleh ◽  
Mahmoud Youssef Ali Ahmed Abdalla ◽  
Nourhan Adel Abu Elfotouh Tantawy
Keyword(s):  
Menstrual Cycle ◽  
Polycystic Ovary Syndrome ◽  
Congenital Adrenal Hyperplasia ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
P Value ◽  
Adrenal Hyperplasia ◽  
Ovary Syndrome ◽  
Infertile Women

Background: Polycystic ovary syndrome is a disorder but with unclear etiology that its diagnosis depends on exclusion of other etiologies with ovulatory disorders and androgen excess as congenital adrenal hyperplasia, 21-hydroxylase deficient non classic congenital adrenal hyperplasia (NCAH), adrenal or ovarian androgen-secreting tumors, disorders of adrenocortical dysfunction as Cushing’s disease, and abuse of androgenic or anabolic drugs. Polycystic ovary syndrome affects approximately 6-15% of women in reproductive age and constitutes 50% of the causes of infertility in women. Aim of the Work: To compare the efficacy of letrozole on ovulation induction to that of clomiphene citrate in women suffering polycystic ovary syndrome and the effect on the follicular maturation, endometrial thickness and pregnancy rate. This study was carried in the outpatient infertility clinic of Ain-Shams Maternity Hospital during the period from November 2020 till April 2021. Patients and Methods: This study included 80 infertile women diagnosed as having polycystic ovary syndrome. Women were randomized into two groups. Letrozole group (1) included 40 women who were given the aromatase inhibitor (Letrozole) orally in a 5mg dose daily from day 3 to day 7 of the menstrual cycle. While Clomiphene citrate group (2) included 40 women who were given the clomiphene citrate orally in 100mg dose daily from day 3 to day 7 of the menstrual cycle. All women were counseled and informed consent was obtained before recruitment. Results: In this study, ovulation rate was significantly more frequent in the Letrozole group (82.5%, 33 women reached ovulation successfully) than in Clomiphene citrate group (60%, 24 women reached ovulation successfully) within P value=0.024. Clomiphene citrate at a dose of 100mg showed more efficacies in the number of follicle ≥18mm than Letrozole at a dose of 5mg. In Letrozole group, the number of follicles (≥18mm in diameter) ranged from 1 to 2 with a Mean±SD= 1.4±0.65 and in Clomiphene citrate group, the number of follicles (≥18mm in diameter) ranged from 1 to 3 with a Mean±SD= 1.9± 0.41 (P value=0.0001). Conclusion: Letrozole can be considered as a first line treatment of anovulation in polycystic ovary syndrome. But, moreover studies including larger number of cases will further confirm the efficacy of letrozole versus clomiphene citrate in induction of ovulation, reaching to the optimum doses for aromatases inhibitors, more observation on endometrial thickness, incidence of pregnancy outcomes, incidence of abortion and incidence of congenital fetal malformations.

scholarly journals Role of Transvaginal Ultrasound in Infertility: Experience at a Tertiary Care Hospital in Dhaka City

2018 ◽  
Vol 15 (2) ◽  
pp. 41-47
Author(s):  
Jannat Ara Ferdows ◽  
Ishrat Jahan ◽  
Fahmida Sharmin Joty ◽  
Raunak Jahan ◽  
Zobaida Sultana Susan ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Tertiary Care ◽  
Follicular Development ◽  
Cross Sectional Study ◽  
Transvaginal Sonography ◽  
Care Hospital ◽  
Cross Sectional ◽  
Medical College

Background: Infertility problem is a global problem and now infertile couples are more aware for the treatment of infertility. Transvaginal sonography since 1995 has expanded the scope of use of ultrasonography in assessment of endometrial thickness, ovarian volume, follicular development in response to hormone in different phase of menstrual cycle in relation to infertility management. In this study it may be assumed that present study may help to establish transvaginal sonography as a new and reliable diagnostic method by which we will be able to proceed accurately with more confidence in diagnosing infertility.Objectives: The purpose of the present study was to assess the role of TVS in diagnosing& evaluating causes of infertility and the comparison between clinical correlation and TVS findings in infertility.Methodology: It is a Hospital based cross sectional study conducted in outdoor department of Obstetrics and Gynecology in Sir Salimullah Medical College (SSMC) and Mitford Hospital, Dhaka, Bangladesh and in a infertility clinic in Dhaka, from March 2009 to August 2009. Sample size was 98 cases of infertile women.Result: Amongst 98 women, 64 cases were represented with primary infertility and 34 patients came with secondary infertility; common age group is 29-35 years; most frequent TVS finding is PCOD with its various presentation and ovarian volume.Conclusion: Transvaginal sonography is painless, quicker, costeffective and can be done as a out door patient in the department. It can be used as a first-line diagnostic procedure for infertility in Bangladesh.But it demands costly equipments, special TVS probe as well as expertise of the operator. At present there are few number of IVF centres in some districts of Bangladesh where transvaginal sonography is the most useful procedure and they play an important role in the diagnosis of causes of infertility.Journal of Science Foundation, July 2017;15(2):41-47

scholarly journals Aromatase Inhibitor for Ovulation Induction: A Comparative Study Between Letrozole and Clomiphen Citrate in Anovulatory Infertile Women

1970 ◽  
pp. 10-12
Author(s):  
Rokshana Ivy ◽  
Afroza Chowdhury ◽  
Kulsum Haque ◽  
Hasmot Ara
Keyword(s):  
Menstrual Cycle ◽  
Comparative Study ◽  
Aromatase Inhibitor ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Follicular Development ◽  
First Line ◽  
Effective Agent ◽  
Infertile Women ◽  
Significant Difference

The study was designed to compare the effectiveness of Letrozole and clomiphen citrate in the treatment of anovulatorv infertility. Thirty patients were selected randomly who had anovulatorv infertility. In letrozole group, fifteen patients got 5-7.5 mg of letrozole orally and in clomiphen citrate group, 100-150 mg of clomiphen citrate was given orally for maximum of six cycles and in both the groups the drugs were started from day 3 -7 of the menstrual cycle. There were no significant differences between the age, duration and type of fertility. But statistically significant increase of follicular development in letrozole group (ñ=0.020). Mean endometrial thickness was 8.33±1.54 and 5.36±1.84 respectively in letrozole and in clomiphen citrate group (ñ =0.048). There was no significant difference in ovulation in both the groups but pregnancy was more (33.3%) with the letrozole group. Letrozole is an effective agent for ovulation induction. It can be used as an alternative to CC as a first-line of treatment for ovulation induction. DOI: 10.3329/bjpp.v25i1.5739Bangladesh J Physiol Pharmacol 2009; 25(1&2) : 10-12

Clinical and Hormonal Profile of Polycystic Ovary Syndrome

2009 ◽  
Vol 1 (2) ◽  
pp. 22-25
Author(s):  
Ferdousi Begum
Keyword(s):  
Menstrual Cycle ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Serum Insulin ◽  
Pcos Patient ◽  
Serum Prolactin ◽  
Transvaginal Sonography ◽  
Ovary Syndrome ◽  
Cross Sectional ◽  
Hormonal Profile

ABSTRACT Objectives The objectives of the study were to find out the clinical features, biochemical and hormonal profile of patients with polycystic ovary syndrome (PCOS) in Bangladesh. Material and Methods A case control and cross-sectional study was undertaken among 78 PCOS patients attending infertility clinic and 33 controls at BIRDEM Hospital, Dhaka. Inclusion criteria for cases were oligo/amenorrhea, transvaginal sonography suggesting PCO and/ or features of hyperandrogenemia with exclusion of other causes. Controls were women with regular menstrual cycle. Results Age and height of cases and controls were similar. BMI >25 was 67% among cases and 19% among controls (P<0.001); waist hip ratio >0.8 was 64% among cases and 29% among controls (P<0.001). Mean BMI of cases was 28.2 + 4.5 and that of cases was 21.05 + 4.1; mean fasting glucose among cases was 5.93 + 1.08 and among controls was 4.4 + 1.11 mmol/L (P<0.01); mean fasting serum insulin level was 32.15+ 12.13 among cases was 11.32 +10.02 ìU/ml among controls(P<.001); insulin resistance (fasting HOMA-IR>6.8) was 42.32% in cases and 12% in control (P<.001). Patients with PCOS had following clinical and biochemical parameters: oligomenorrhea- 74%, amenorrhea- 26%, mean Ferriman-Galaway score -19.89 + 5.06. At day 3 of menstrual cycle meanserum LH was 12.79+7.1 mmol/L, serum FSH was 5.23 + 2.5 miu/ml and serum prolactin was 415.15+180.5 mmol/L; 30% had biochemical hyperandrogenemia. Conclusions PCOS patient in Bangladesh are usually overweight, hirsute (grade I and II), hyperandrogenemic, insulin resitant and have altered LH to FSH ratio.

scholarly journals Effects of Letrozole-HMG and Clomiphene-HMG on Incidence of Luteinized Unruptured Follicle Syndrome in Infertile Women Undergoing Induction Ovulation and Intrauterine Insemination: A Randomised Trial

2015 ◽  
Vol 8 (4) ◽  
pp. 244 ◽  
Author(s):  
Azra Azmoodeh ◽  
Mansoureh Pejman Manesh ◽  
Firouzeh Akbari Asbagh ◽  
Azizeh Ghaseminejad ◽  
Zeinab Hamzehgardeshi
Keyword(s):  
Menstrual Cycle ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Randomised Trial ◽  
Induction Of Ovulation ◽  
Infertile Women ◽  
Significant Difference ◽  
Preovulatory Follicles ◽  
Luteinized Unruptured Follicle

<p><strong>BACKGROUND: </strong>Luteinized unruptured follicle (LUF) syndrome is considered a cause of ovulation failure and a subtle cause of infertility. Preovulatory injection of human chorionic gonadotropin (HCG) prevents or treats LUF syndrome, but it has also occurred after the induction of ovulation with clomiphene/HMG and HCG. This study was designed for evaluation and comparison of LUF incidence in eligible infertile women undergoing two stimulation protocols (clomiphene + HMG<strong> </strong>and letrozole + HMG) in addition to intrauterine insemination (IUI). Some related factors were compared between LUF and non-LUF cycles as secondary outcomes.</p> <p><strong>METHODS:</strong> The study was designed as a prospective randomized controlled trial. Patients were randomized using a table of random numbers into two equal protocol groups.<strong> </strong>For group A, (n = 90) clomiphene citrate was administrated orally in doses of 100 mg/day, and group B (n = 90) orally received letrozole 5 mg/day from day 3 to 7 of the menstrual cycle. Then HMG 75IU/day was administered intramuscularly in both groups on day 8 of the menstrual cycle and the dose was adjusted on the basis of ovarian response. The optimum size of preovulatory follicles for the injection of HCG (10,000 IU) was considered 18–23 mm. The number and size of preovulatory follicles were assessed by vaginal ultrasound 12 h before HCG (D0). Endometrial thickness was measured as well. IUI was performed on all patients 38–40 h after HCG. The second ultrasound examination was performed to observe the evidence of oocyte releasing at the time of IUI (D1). If the follicles were unruptured,<strong> </strong>a<strong> </strong>third sonography was performed on day 7 after HCG (D7) to observe LUF syndrome.</p> <p><strong>RESULTS: </strong>There was a significant difference between clomiphene-HMG and letrozole-HMG in LUF (p = 0.021) and pregnancy (p = 0.041). The complete LUF in letrozole-HMG was lower than the alternative group and the pregnancy rate was higher. The patients in the non-LUF group had higher midluteal progesterone and a thicker endometrium compared to LUF cycles (p = 0.039) and (p &lt; 0.001). The results of our multivariate logistic regression indicate that size 18–19.9 mm leads to the complete LUF  less than ≥22 mm [AOR: 0.25, P = 0.005], and  in size 20– 21.9 mm  as well [AOR: 0.17, P = 0.002].</p> <p><strong>CONCLUSION: </strong>Letrozole, with lower incidences of LUF, is more effective than clomiphene citrate for the induction of ovulation in IUI cycles. In our study, we illustrated that larger follicles of ≥22 mm diameter were associated with higher incidences of LUF. We recommend that further studies investigate and focus on the relationship between follicular size and/or full hormonal profiles and LUF.<strong></strong></p>

scholarly journals Comparison of ovulation induction with letrozole plus dexamethasone and letrozole alone in infertile women with polycystic ovarian disease: An RCT

2020 ◽  
Author(s):  
Farahnaz Farzaneh ◽  
Fatemeh Afshar
Keyword(s):  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Ovarian Response ◽  
Male Factor ◽  
Polycystic Ovarian Disease ◽  
Ovarian Disease ◽  
Infertile Women ◽  
Follicle Diameter ◽  
Group I ◽  
The Mean

Background: Infertility is characterized by the inability to obtain a successful pregnancy after 6 months or more with unprotected and regular intercourse. In developing countries, the incidence of infertility is 2%. The causes of infertility could be male factor or female factor, or mixed factor. Objective: This study was conducted with the aim of comparison the ovarian response to letrozole alone and letrozole plus dexamethasone in infertile women with poly cystic ovarian disease (PCOS). Materials and Methods: This randomized clinical trial was conducted on 120 infertile women with PCOS referred to Ali-Ebne-Abitaleb hospital, Zahedan, Iran from February to August 2017 into two groups: group I received letrozole alone and group II recived letrozole plus dexamethasone. The endometrial thickness, follicle diameter, and ovulation were evaluated and compared by ultrasound on days 12 to 14. Results: The mean thickness of endometrium was not different between two groups. Pregnancy rate was 8% in letrozole group and 23% in Letrozole plus Dexamethasone (p = 0.024). Also, the mean diameter of follicles in two groups were not statistically significant. Conclusion: Overall, this study showed that dexamethasone may increase pregnancy rate. Key words: Letrozole, Dexamethasone, PCOS, Induction ovulation.

scholarly journals Use of letrozole versus clomiphene citrate combined with gonadotropins for ovulation induction in infertile women with polycystic ovary syndrome: a pilot study

2017 ◽  
Vol 6 (9) ◽  
pp. 4098 ◽  
Author(s):  
Amitoj Athwal ◽  
Ratnabali Chakravorty ◽  
Dipanshu Sur ◽  
Rupam Saha
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Prospective Trial ◽  
Serum Estradiol ◽  
Ovary Syndrome ◽  
Infertile Women ◽  
Ovulation Stimulation ◽  
Group Serum

Background: The aim of the study was to evaluate the efficacy of letrozole and clomiphene citrate (CC) in gonadotropin-combined for ovulation stimulation in women with polycystic ovary syndrome (PCOS). It was a prospective pilot study.Methods: This prospective trial included 124 patients of infertile women with PCOS. Letrozole dose of 5 mg/day (n = 65) or a CC dose of 100 mg/day (n = 59) was given on day 3 to day 7 of the menstrual cycle, combined with gonadotropin i.e. follicle stimulating hormone (FSH) at a dose 75 IU every day starting on day 7 and continued to day 9. Main outcome measures were occurrence of ovulation, number of mature follicles, serum estradiol (E2) and endometrial thicknesses on the day of human chorionic gonadotropin (hCG), and pregnancy rates.Results: The clinical profile including mean age, duration of infertility, BMI, baseline FSH, LH and E2 of patients belonging to both groups were comparable. The numbers of mature follicles (4.3±0.3 vs. 2.9±0.7) were significantly higher in letrozole+FSH group. Serum E2 levels on the day of hCG (301.78±85.7 vs. 464.7±72.9 pg/mL) were significantly lower in the letrozole+FSH group. Significant differences were found in endometrial thickness measured on the day of hCG in letrozole+FSH group (p=<0.0001). The rate of ovulation was higher in letrozole+FSH group and it was marginally statistically significant (p=0.040). The rate of pregnancy was slightly greater in the letrozole+FSH group (17.85% versus 13.33%), although not statistically significant.Conclusions: Letrozole in combination with FSH appears to be a suitable ovulation inducing agent versus CC with FSH in PCOS. This combination may be more appropriate in patients who are particularly sensitive to gonadotropin.

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