Objective: To compare between gestagen versus oral contraceptive pills to induce withdrawal bleeding before induction of ovulation by clomiphene citrate in polycystic ovary syndrome.Design: Randomized controlled trial. Setting: Integrated Fertility Center and Agial Fertility Center. Sample: Fifty PCO female patients. Methods: The patients were subdivided in 2 groups according to computer generated randomized program:Group I: Twenty five PCO female patients treated by cidolut nor 5 mg tablets (two tablets every day for 5 days).Group II: Twenty five PCO female patients treated by cilest tablets (one tablet every day for 21 days).All patients were observed until withdrawal bleeding followed by ovulation induction by clomiphene citrate from the second day of menses (100 mg per day for 5 days). The patients were then followed up by:

OVARIAN CANCER HAS the second highest incidence in gynecological cancers and is the fifth leading cause of cancer death among women in the world. Characterizing the pathways that regulate the growth of ovarian cells is necessary for understanding the events that lead to development of ovarian cancer. The aim of the present study was to evaluate the potential clinical implication of circulating Activin A, follistatin, bikunin, ovarian tissue urokinase Plasminogen Activator (uPA) and Smad-2 (fusion between Drosophila mothers against dpp (Mad) and C. elegans Sma)expression for diagnosis and progression of ovarian cancer. Subjects: The study was carried out on 75 women divided as follows: 15 women with serous ovarian carcinoma, 15 women with mucinous ovarian carcinoma, 15 women with serous ovarian cystadenoma, 15 fertile healthy women, 15 postmenopausal healthy women. Methods: Serum levels of Activin A and Follistatin, and Plasma levels of Bikunin were estimated using ELISA. Urokinase plasminogen activator (uPA) was extracted from ovarian cancerous tissue and its levels estimated by ELISA. Detection of Smad2 mRNA in ovarian tissue was performed by Reverse Transcription-Polymerase Chain Reaction analysis (RT-PCR). Results: The levels of serum Activin A and Follistatin were found to be significantly higher in serous and mucinous ovarian carcinoma than in ovarian cystadenoma and controls (pre-and postmenopausal). Plasma levels of Bikunin were estimated to be significantly lower in patients with serous ovarian carcinoma and mucinous ovarian carcinoma than in controls and than patients with ovarian cystadenoma. In the present study, levels of uPA in ovarian tissue were significantly higher in serous ovarian carcinoma than in ovarian cystadenoma and controls. Levels of uPA were significantly higher in mucinous ovarian carcinoma than all other groups. Levels of uPA were found to be increased with progression of the stage of ovarian tumor. Correlation studies showed direct positive significant correlations between Activin A and Follistatin, Activin A and uPA, Follistatin and uPA. Also, Bikunin was found to be inversely correlated to Activin A, Follistatin and uPA. Smad-2 expression was detected in 75% of cases of serous ovarian cystadenocarcinoma, in 90% of mucinous ovarian carcinoma. Conclusions: In summary, activin A induces the proliferation of both serous and mucinous ovarian carcinoma. Therefore, activin A may be regarded as both a

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to 41.3 x 10 6 ). At the time of submission 2 out of 9 patients had established pregnancies. Median age of the 9 patients on androgen therapy (41.6 years) was markedly higher than the remaining 128 (30.6).CONCLUSIONS: Androgen therapy for andropause symptoms is an underappreciated cause of subfertility, particularly in older men. Clinicians need to be aware of this risk factor when evaluating patients with subfertility.

Objectives: To describe causes, sociodemographic characteristics, and prevalence of some factors that could participate in the occurrence of jaundice during pregnancy in Alexandria-Egypt. Methods: A descriptive study started January 2005 for one year duration, included 20 cases (all cases admitted to Alexandria Fever Hospital and Shatby University Hospital for Obstetrics and Gynecology with the clinical and laboratory diagnosis of jaundice). Questionnaire sheet administered through an interview with each patient includes demographic data, known risk factors, and medical history. Full clinical and obstetric examination was done, with an ultra-sound review, estimation of serum ALT, AST, alkaline phosphatase, bilirubin (total and direct), and serological screening against virus hepatitis A, B, C and E. Results: Most cases (n=17) were admitted to the Fever Hospital. Of them; 11 cases (55%) were due to HAV infection, 5 cases resulted from other virus hepatitis. Remaining 4 cases were due to conditions related to pregnancy. Age between 20 and 30 represented 80% of cases. Low social score accounts for 70% of cases. Only 7 cases presented during the 1 st trimester. Most cases got no previous history of jaundice (95%); only 4 cases got family history of jaundice. The majority of cases (65%) reported one or more virus known hepatitis risk factors; suffers anaemia (55%), hepatomegaly (90%), and got abnormal levels in blood chemistry. Conclusions: The study is an update in current causes, demographic pattern, and risk factors associated with clinical jaundice during pregnancy. It documents that many factors are implicated in the causation of this relatively uncommon clinical condition.