A study of comparison of effectiveness of letrozole (5mg) versus clomephene citrate (100 mg) for ovulation induction among infertile women

Clomiphene citrate has been traditionally used as the drug of the choice for treatment of women with anovulatory infertility. In the last decade, an aromatase inhibitor, letrozole has emerged as an alternative ovulation induction agent among anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to the clomiphene citrate therapy is confirmed by literatures. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause. Clomiphene citrate is considered as the drug of choice for the first line treatment of anovulatory dysfunction for a variety of reasons. Clomiphene citrate has some side effects like multi-follicular development and cyst formation and resistance of clomiphene are areas of concern and desire for an effective alternative persists.An aromatase inhibitor, letrozole, was introduced into infertility practice in the year 2000 and is regarded as a second line option, particularly in women with clomiphene resistance, and it has found acceptance in various clinical situations and the indications for use have expanded., To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women. The study included 100 women presented with anovulatory infertility. The infertile women were divided into 2 groups of 50: Group A received 100 mg Clomiphene Citrate from day 3 to day 5 of menstruation and Estradiol Valerate 4 mg on the 12 day of menstruation until 16 day of menstruation; Group B treated by 5 mg Letrozole from day 3 to day 5 of the menstruation and as Group A, Estradiol Valerate 4 mg on the 12 day of menstruation until 16 day of menstruation given to Group B, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. Participants were of 20 to 39 years age, had normal uterine cavity and had a male partner with a sperm concentration of at least 14 million per millilitre; and during the study the women and their partners agreed to have regular intercourse with the intent of conception. The live birth during the treatment period was the primary outcome. Women who received letrozole had more cumulative live births than those women who had received clomiphene citrate (36 out of 50 [72%] vs. 28 out of 50 [56%]), without significant differences in overall congenital anomalies, there were no congenital anomalies. With letrozole as compared to clomiphene the cumulative ovulation rate was higher. Higher incidence of hot flushes was associated with a clomiphene, and letrozole was associated with fatigue and dizziness. Rates of other adverse effects were almost similar among these 2 groups. A significant difference in the follicular and endometrial development was evident among these 2 groups. As compared to with clomiphene, an aromatase inhibitor, letrozole was associated with higher live-birth and ovulation rates among infertile women. The results of the study demonstrated letrozole to be superior to clomiphene citrate in the maintenance of endometrial thickness.

Effect of laparoscopic ovarian drilling on serum anti-Mullerian hormone in clomiphene citrate resistant polycystic ovarian syndrome patients

Background: PCOS (polycystic ovarian syndrome) is the most common cause of anovulatory infertility, the purpose of our study was to see the effect of laparoscopic ovarian drilling on the ovarian reserve (with AMH as an indicator of ovarian reserve) and its safety as 2nd line of treatment in patients resistant to clomiphene citrate.Methods: This was a prospective interventional study conducted on 40 clomiphene citrate resistant PCOS women attending the infertility OPD. This study was conducted over a period of 1 year May 2019 to May 2020. Laparoscopic ovarian drilling (LOD) was done and these subjects were studied preoperatively and postoperatively on day 7 and day 30 for change in AMH (anti-Mullerian hormone) levels.Results: There is a significant change in the AMH level post LOD day 7 and 30 but not so severe that it will lead to premature ovarian failure. The amount of drop in AMH (day 30) increases till 20 ng/ml beyond which it shows a decrease.Conclusions: If LOD is done in a proper manner in women with sufficient ovarian reserve (high AMH), it will not adversely affect the ovarian reserve (the fall is not enough to cause premature ovarian insufficiency).

Ovulation Induction and Intrauterine Insemination for Hypogonadotropic Hypogonadism

Hypogonadotropic Hypogonadism (HH) is a rare gynae- endocrinological cause of anovulatory infertility. Gonadotropins are given to induce ovulation. Various ART techniques have been used for assisting conception in these women. In this study, we aimed to calculate the chances of success of ovulation and pregnancy rates after ovulation induction and intrauterine seminal insemination in HH women. We reviewed and analyzed the chances of success of ovulation and conception with ovulation induction and intrauterine seminal insemination in thirty two couples who underwent 56 intrauterine insemination cycles. The average age of these women was 27.2+/- 3.2 years. Ovulation was documented in 55/56 cycles. An average of 12.89+/-5.05 days of stimulation was required to induce ovulation. The pregnancy rate was 50%. Thus, intrauterine insemination offers a cheaper yet good alternate option of reproductive techniques in addition to ovulation induction with gonadotropins, in hypogonadotropic hypogonadism, especially in the low resource settings.

Cervical elastograhy in patients with cervical insufficiency and a history of anovulatory infertility

Cervical insufficiency is one of the most frequent reasons for late miscarriage and preterm birth. Its rate is increased in women who conceived after the use of additional reproductive technologies. The objective: to assess the parameters of cervical elastography in women with cervical insufficiency and anovulatory infertility in a history. Materials and methods. 40 pregnant women with cervical insufficiency who conceived after treatment of infertility associated with anovulation were examined in the term of 16–20 weeks: in the I group (20 persons) pregnancy conceived after conservative treatment of infertility, in the II (20 patients) – after in vitro fertilization. 20 women with the physiological course of pregnancy without cervical insufficiency and with spontaneous gestation were controls. Cervical elastography index was used to assess the strain of cervical tissue. Results. According to the results of compression elastography all patients in the I and II groups had red or yellow color of the internal cervical os and cervical canal. In the persons without cervical insufficiency the cervical tissue was firm (purple and blue color). The number of women with purple color of the anterior labia of the cervix in the I and II groups was in 4.67 (р=0.001) and 2.33 (р=0.03) times less compared to the controls, of the posterior labia – in 3,2 times (р=0.001) in both groups. Conclusion. In women with cervical insufficiency and a history of anovulatory infertility there are considerable changes of strain in internal os and cervical canal of the cervix.

THE NATURE OF REPRODUCTIVE DISORDERS IN WOMEN WITH HYPERANDROGENISM SYNDROMEq

PCOS occupies a leading place in the population of women with clinical manifestations of excessive androgen secretion and is detected in 72.1-82% of cases, while among women with anovulatory infertility-in 55-91% of cases (Lizneva D. (2016). The criteria, prevalence and phenotypes of PCOS. Fertil.Steril., 106 (1), 6-15). The article discusses the results of a study conducted based on the City Perinatal Center of Tashkent to study the frequency and nature of reproductive disorders in women with symptoms of hyperandrogenism. The study involved women of reproductive age with various menstrual disorders and infertility. The analysis of anamnestic, subjective and objective, clinical and laboratory data of patients was carried out

Assessment of the hormonal levels in different management strategies for women with cervical insufficiency and a history of anovulatory infertility

Cervical insufficiency (CI) is one of the causes of preterm birth. The rate of CI is higher in women after in vitro fertilization treatment for infertility compared to the general population. The aim. To assess the hormonal level in women with CI and a history of anovulatory infertility in the second and third trimesters of pregnancy in different management strategies for CI. Materials and methods. 60 pregnant women with CI who conceived through in vitro fertilization treatment for anovulatory infertility were divided into two groups: in the I group (30 women), CI was corrected only with cervical cerclage / pessary in the II trimester of pregnancy, in the II group (30 persons), cervical cerclage / pessary was combined with vaginal progesterone 200 mg ones a day until 34 full weeks of gestation. 30 pregnant women without СІ or infertility with the physiological course of pregnancy were controls. The concentrations of estradiol, progesterone, placental lactogen, prolactin and cortisol were determined in the terms of 19–22 and 30–32 weeks of gestation in the maternal blood serum. Results. In the patients with CI at 19–22 gestational weeks, the estradiol and placental lactogen concentrations were slightly lower in the I and II groups than those in the control women, the level of progesterone was less in the I group by 13.44 %, in the II group – by 17.30 % (P < 0.05) compared to the controls; the levels of prolactin and cortisol in the I and II groups were increased significantly (P < 0.001). At 30–32 gestational weeks, the levels of estradiol (P < 0.05), progesterone (a decrease of 23.10 %, P < 0.001) and placental lactogen (a decrease of 10.74 %, P < 0.05) were significantly less as compared to the physiological ranges, while these parameters in the II group patients were on the lower limit of normal. In the I group, the concentrations of prolactin and cortisol were higher by 41.70 % (P < 0.001) and 27.36 % (P < 0.001), respectively, than the controls, in the II group – only by 24.10 % (P < 0.05) and 13.70 % (P < 0.05), respectively. Conclusions. In the women with cervical insufficiency after in vitro fertilization treatment for anovulatory infertility, the levels of estradiol, progesterone and placental lactogen are not significantly different from physiological indices, but the prolactin and cortisol concentrations are much higher. Adjunctive vaginal progesterone treatment to cervical cerclage/pessary in the third trimester of pregnancy promotes the normalization of progesterone, estradiol and placental lactogen levels, the decrease in prolactin and cortisol indices at 30–32 gestational weeks compared to the women with cervical cerclage/pessary alone.

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

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.

Homoeopathic Management in a Case of Infertility with PCOS

Infertility is the inability of a sexually active couple, not using any birth control, to get pregnant after 1 year of trying. About one-quarter of female infertility is caused by a problem with ovulation. Polycystic ovary syndrome (PCOS) accounts for more than 75% of cases of anovulatory infertility. PCOS is a disorder of chronically abnormal ovarian function and hyperandrogenism (abnormally elevated androgen levels) manifested by irregular menstrual cycles, polycystic ovaries, excess unwanted hair, obesity etc. A case of a female aged 21 years with irregular menses for the past 2 years diagnosed with PCOS and inability to conceive has been reported here. The case was worked out as per homoeopathic principles and individualised homoeopathic medicine, Pulsatilla nigricans (Puls. nig.) was prescribed and the patient responded positively and conceived

EVALUATION OF HORMONAL FUNCTION IN WOMEN WITH CERVICAL INSUFFICIENCY AND INFERTILITY IN THE HISTORY

The aim: To assess the levels of hormones in women with cervical insufficiency and infertility in the history in the II trimester of gestation. Materials and methods: 120 pregnant women with cervical insufficiency and anovulatory infertility in the history were examined in the II trimester of gestation: in the I group (60 persons) pregnancy occurred after hormonal treatment of infertility, in the II group (60 individuals) – after in vitro fertilization. 30 pregnant women without cervical insufficiency and a history of infertility were controls. The levels of estradiol, progesterone, placental lactogen, prolactin and cortisol were determined in the blood serum. Results: The concentration of maternal progesterone was lower in the persons in the I group on 12.36 %, in the II group – on the 15.37 % (p=0.03) compared to the healthy women. Cortisol and prolactin amounts were statistically higher in I and II groups (p<0.001) than in controls. While the levels of estradiol and placental lactogen were slightly less in the subjects with cervical insufficiency and a history of anovulatory infertility compared to the healthy women. Conclusions: In pregnant women with cervical insufficiency and a history of anovulatory infertility in the II trimester of gestation there are decrease progesterone level and high prolactin and cortisol concentrations in blood serum. The changes in estradiol and placental lactogen amounts are not significant compared to healthy women.