Results: The mean age, parity, and duration of infertility in both groups were similar, but statistically significantly more polycystic ovaries were found in the letrozole group (odds ratio = 2.44; 95% confidence interval = 1.19-5.02). The total numbers of follicles were significantly higher in the CC group (3.6 ± 0.7 vs. 3.4 ± 0.4). Endometrial thickness at the time of hCG administration was significantly greater in the letrozole group (9.1 ± 0.22 mm vs. 8.2 ± 0.54 mm). The duration of stimulation was similar in the two groups. Ovulation occurred in 32 (64%) of 50 patients in the letrozole group and in 33(64.6%) of 50 patients in the CC group without significant difference. The pregnancy rate per cycle was 11.5% with letrozole and 8.9% with cc. Conclusion: Letrozole was associated with significantly fewer mature and growing follicles, thicker endometrium, and slightly higher pregnancy rate. Letrozole may be helpful in situations in which multiple pregnancy is not desirable or the risk of ovarian hyperstimulation syndrome is high. Objective: The combined oral contraceptive pill (COCP) is often used prior to controlled ovarian stimulation and IVF treatment. The evidence for this is limited but it is thought to have a beneficial effect in women with poor ovarian reserve. This study was designed to quantify the effect of the COCP on the ultrasonographic and endocrine markers of ovarian reserve. Methods: 34 subjects aged < 35 years taking a COCP containing 30mcg of oestrogen for more than one year were prospectively recruited and compared to 36 normo-ovulatory, age-matched controls who had not taken any hormonal contraception for more than one year. 3D datasets of both ovaries were acquired and analysed off line to quantify the antral follicle count stratified according to follicle size, ovarian volume and stromal vascularity as measured by 3D power Doppler angiography and pulsed wave Doppler. Serum levels of anti-Müllerian hormone (AMH) and FSH were assessed. The data are expressed as mean (± SD) or median (± range) and the differences between groups examined using an independent student's t test or Mann Whitney U test dependent on its distribution. A P value of < 0.05 was considered statistically significant. Results: There were no significant differences between the two groups in the number of small antral follicles measuring ≤ 6mm, serum AMH and FSH levels, or any of the pulsed wave Doppler indices (P > 0.05). The control non-pill user group had significantly more antral follicles measuring > 6mm in diameter (P < 0.01) and total AFC therefore. The COCP users had significantly smaller ovaries (P < 0.001) which were also less vascular on 3D power Doppler (VI: P = 0.009; FI: P = 0.049; and VFI: P = 0.002).
Conclusion:The COCP reduces the total number of antral follicles due to a significant reduction in the number of antral follicles measuring > 6mm, resulting in a reduction in volume. The COCP does not affect the functional ovarian reserve as measured by the small antral follicles (≤ 6mm) and serum AMH and FSH. O...
This important medical unit is a tertiary referral center in obstetrics and gynecology, with approximately 5,400 babies delivered each year, including 1,500 caesarean sections. The medical records of this pregnant women admitted for regular monitoring of pregnancy and delivery were reviewed retrospectively. In this study period, the authors identified pregnant women with known ereditary thrombophilia or later diagnosed during hospitalization in this centre and cerebral venous thrombosis in the puerperium, some of them being sent from other medical centres and hospitalized in this clinic for specialized care of their ongoing high-risk pregnancy. Eligible women were
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