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Sanjay Chauhan, Sayeed Unisa, Beena Joshi, Ragini Kulkarni, Amarjeet Singh, Thilakavathi Subramanian, Ramendra Narayan Chaudhuri, A C Baishya, Shalini Bharat, Anushree Patil, Achhelal Pasi, Dinesh Agarwal
Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods...
January 2018: Indian Journal of Community Medicine
Yanglu Li, Xiangyan Ruan, Husheng Wang, Xue Li, Guiju Cai, Juan Du, Lijuan Wang, Yue Zhao, Alfred O Mueck
OBJECTIVE: To evaluate the prevalence of adverse pregnancy outcomes in healthy Chinese women and to investigate whether these outcomes could be decreased in patients with polycystic ovary syndrome (PCOS) by ethinylestradiol/cyproterone acetate (EE/CPA) pretreatment. DESIGN: Retrospective study. SETTING: Medical university. PATIENT(S): Six thousand healthy women (group A) were selected from 24,566 pregnant women by randomized sampling...
March 7, 2018: Fertility and Sterility
Mi-Jung Kim, Ji-Yeong Byeon, Young-Hoon Kim, Se-Hyung Kim, Choong-Min Lee, Eui Hyun Jung, Won Ki Chae, Yun Jeong Lee, Choon-Gon Jang, Seok-Yong Lee, Chang-Ik Choi
Clomiphene citrate, a selective estrogen receptor modulator, is metabolized into its 4-hydroxylated active metabolites, primarily by CYP2D6. In this study, we investigated the effects of the most common CYP2D6 variant allele in Asians, CYP2D6*10, on the pharmacokinetics of clomiphene and its two active metabolites (4-OH-CLO and 4-OH-DE-CLO) in healthy Korean subjects. A single 50-mg oral dose of clomiphene citrate was given to 22 Korean subjects divided into three genotype groups according to CYP2D6 genotypes, CYP2D6*wt/*wt (n = 8; *wt = *1 or *2), CYP2D6*wt/*10 (n = 8) and CYP2D6*10/*10 (n = 6)...
March 7, 2018: Archives of Pharmacal Research
Shayesteh Mehdinejadiani, Fardin Amidi, Mehdi Mehdizadeh, Mahmood Barati, Leili Safdarian, Reza Aflatoonian, Ashraf Alyasin, Marzieh Aghahosseini, Azar Pazhohan, Parisa Hayat, Farzaneh Mohammadzadeh Kazorgah, Aligholi Sobhani
Polycystic ovarian syndrome (PCOS) is a common endocrinologic disorder in women of reproductive age characterized by polycystic ovaries, oligo/anovulation, and hyperandrogenism. Not only anovulation but also endometrial dysfunction can reduce fertility in PCOS patients. Wnt pathway is responsible for endometrial proliferation which be strongly regulated by estradiol. To determine the effects of clomiphene citrate (CC) and letrozole, we measured the expression of some main ligands of Wnt/β-catenin signaling including Wnt7a, Wnt3, and Wnt8b in the endometrial samples taken from PCOS women on day 12 of the menses who received 100 mg CC or 5 mg letrozole as well as from women without treatment...
March 6, 2018: Gynecological Endocrinology
Cai-Rong Chen, Qiu-Xia Yan, Xiu-Qin Zhou, Ying-Jie Xian, Xiao-Yan Guo, Song Quan
OBJECTIVE: To compare the expression of pinopodes, the marker of endometrial receptivity, during the implantation window in Kunming mice stimulated with two different doses of raloxifene (RAL). METHODS: Forty-eight 8-week-old female Kunming mice were randomly divided into 4 groups (n=12), namely saline group, clomiphene citrate (CC, 18 mg/kg) group, RAL (33 mg/kg) group and RAL (44 mg/kg group). In each group, the mice received intragastric administration of 1 mL of normal saline containing CC or RAL at the specified doses or saline only as indicated for ovulation induction, once daily for 2 days...
February 20, 2018: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Pedro-Antonio Regidor, Adolf Eduard Schindler, Bernd Lesoine, Rene Druckman
Introduction The use of 2 × 2000 mg myo-inositol +2 × 200 μg folic acid per day is a safe and promising tool in the effective improvement of symptoms and infertility for patients with polycystic ovary syndrome (PCOS). In addition, PCOS is one of the pathological factors involved in the failure of in vitro fertilization (IVF). Typically, PCOS patients suffer of poor quality oocytes. Patients and methods In an open, prospective, non-blinded, non-comparative observational study, 3602 infertile women used myo-inositol and folic acid between 2 and 3 months in a dosage of 2 × 2000 mg myo-inositol +2 × 200 μg folic acid per day...
March 2, 2018: Hormone Molecular Biology and Clinical Investigation
Mohamed Kandil, Mohamed Rezk, Alaa Al-Halaby, Mohamed Emarh, Ibrahim Saif El-Nasr
STUDY OBJECTIVE: To compare the impact of ultrasound-guided transvaginal ovarian needle drilling (TND) versus laparoscopic ovarian drilling (LOD) on ovarian reserve and pregnancy rate in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). DESIGN: A randomized clinical trial (Canadian Task Force classification I). SETTING: A university hospital. PATIENTS: Of 644 patients who presented at an infertility clinic, 246 with CC-resistant PCOS were randomized for treatment...
February 21, 2018: Journal of Minimally Invasive Gynecology
Jian Li, Q Wu, Xiao-Ke Wu, Zhong-Ming Zhou, Ping Fu, Xiu-Hua Chen, Ying Yan, Xin Wang, Zheng-Wang Yang, Wei-Li Li, Elisabet Stener-Victorin, Richard S Legro, Ernest Hung-Yu Ng, Heping Zhang, Ben Willem J Mol, Chi Chiu Wang
STUDY QUESTION: Does second-hand smoke (SHS) exposure from husbands have adverse effects on sex hormones, metabolic profiles, clinical phenotypes and fertility outcomes in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction? SUMMARY ANSWER: SHS exposure is associated with worsened biochemical hyperandrogenism, higher incidence of metabolic syndrome and reduced conception rates in women with PCOS. WHAT IS KNOWN ALREADY: Smoking in women impairs fecundity at some stages of the reproductive process including folliculogenesis, embryo transport, endometrial angiogenesis and uterine blood flow...
February 20, 2018: Human Reproduction
Mohamad Irani, Stephen Chow, Derek Keating, Simone Elder, Zev Rosenwaks, Gianpiero Palermo
The objective of this study was to identify sperm score thresholds to achieve satisfactory intrauterine insemination (IUI) success rates according to the response to stimulation with clomiphene citrate (CC). To minimize the confounding effect of female age, we included only CC/IUI cycles of women ≤35 years old. A total of 1,194 CC/IUI cycles were included. Semen volume, concentration, and motility influenced the clinical pregnancy rate (CPR). Normal morphology (≥4%) was associated with a comparable CPR with 3%, 2%, and 1% normal forms (15...
February 20, 2018: Gynecological Endocrinology
Davinia White, Kate Hardy, Suzannah Lovelock, Stephen Franks
Low-dose, step-up gonadotropin is the treatment of choice for women with PCOS who have not conceived after anti-estrogen treatment, and as an effective alternative to pulsatile GnRH in women with hypogonadotropic hypogonadism (HH). There has been, however, no large-scale, comparative study between the two groups using low-dose gonadotropins. Here we performed a retrospective, comparative analysis, in a single clinic database, of efficacy and safety of induction of ovulation using low-dose gonadotropins in 364 Women with PCOS and 80 women with HH...
February 19, 2018: Reproduction: the Official Journal of the Society for the Study of Fertility
K Agrawal, Shalini Gainder, Lakhbir K Dhaliwal, Vanita Suri
Objective: To determine the efficacy of the stair-step protocol (SSP) using clomiphene citrate (CC) in patients with polycystic ovary syndrome (PCOS) and compare it with traditional regimen. Design: This was randomized control trial. Setting: Infertility Clinic. Patients: Sixty infertile PCOS women. Interventions: Patients were randomized into the study (SSP - 30 patients) and control group (traditional protocol - 30 patients)...
October 2017: Journal of Human Reproductive Sciences
Emaduldin Seyam, Enas Hefzy
OBJECTIVE: Laparoscopic ovarian drilling (LOD) is still a controversial decision; due to the long term hazards; so short and long term predictors after the procedure should be taken in consideration. The aim of this work was to investigate the role of the serum level of tumor necrosis factor alpha (TNF-α) and other polycystic ovarian disease (PCOD) relevant clinical and biochemical factors as a predictor of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD)...
February 2, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Karen Peeraer, Jeroen Luyten, Carla Tomassetti, Sarah Verschueren, Carl Spiessens, Ann Tanghe, Christel Meuleman, Sophie Debrock, Eline Dancet, Thomas D'Hooghe
Ovarian stimulation with low-dose human menopausal gonadotrophin (HMG) is superior to clomiphene citrate in intrauterine insemination (IUI) cycles with respect to clinical pregnancy rate, but it is unclear whether HMG is also the more cost-effective option. The aim of this study was to compare the cost-effectiveness of ovarian stimulation with low-dose subcutaneously administred HMG (37.5-75 IU per day) to orally administred clomiphene citrate (50 mg/day from day 3-7) in an IUI programme for subfertile couples...
December 27, 2017: Reproductive Biomedicine Online
Shifu Hu, Qiong Yu, Yingying Wang, Mei Wang, Wei Xia, Changhong Zhu
PURPOSE: Polycystic ovary syndrome (PCOS) is a common endocrine disturbance affecting women in the reproductive age group. The present study aimed to compare the effects of letrozole (LE) and clomiphene citrate (CC) for ovulation induction in women with PCOS. METHODS: The PUBMED, Web of Science, and EMBASE databases were screened systematically for randomized controlled trials (RCTs) published from database inception to July 2017. RESULTS: Eleven RCTs involving 2255 patients were included, and data were independently extracted and analyzed using 95% risk ratios (RRs) and confidence intervals (CIs) based on a random- or fixed-effect model (as appropriate)...
February 1, 2018: Archives of Gynecology and Obstetrics
Manish Banker, Azadeh Patel, Ashwini Deshmukh, Sandeep Shah
Introduction: Intrauterine insemination (IUI) is one of the most commonly performed procedure of assisted reproductive technology, for the treatment of infertility. Controlled ovarian hyperstimulation is an important first step while performing IUI. This study aims at establishing a relationship between stimulation protocol and pregnancy outcome following IUI. Methods: This is a retrospective study of 1001 cycles of IUI in which the patients were divided into two groups: Group A Clomiphene citrate (CC only) and Group B Clomiphene citrate and Gonadotropin or Gonadotropin alone(CC+GN OR GN alone)...
February 2018: Journal of Obstetrics and Gynaecology of India
Hatem Abu Hashim, Osama Foda, Mohamed El Rakhawy
PURPOSE: This systematic review and meta-analysis aimed to compare the effectiveness of unilateral vs. bilateral laparoscopic ovarian drilling (ULOD vs. BLOD) for improving fertility outcomes in infertile women with clomiphene-resistant polycystic ovary syndrome (PCOS) as well as its effect on ovarian reserve. METHODS: Searches were conducted on PubMed, ScienceDirect,, and CENTRAL databases from January 1984 to January 2017. Only randomized trials comparing ULOD with BLOD were included...
January 27, 2018: Archives of Gynecology and Obstetrics
Shirley Shue, Milena Radeva, Tommaso Falcone
STUDY OBJECTIVE: To determine if the number of fibroids removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive aged women. DESIGN: Retrospective cohort survey study (Canadian Task Force classification II-2) SETTING: University hospital PATIENTS: One hundred forty-four patients who underwent myomectomy for symptomatic fibroids and attempted to conceive afterwards INTERVENTION: Questionnaire mailed to reproductive-aged women who received robotic, laparoscopic, or abdominal myomectomy MEASUREMENTS AND MAIN RESULTS: Patients with >6 fibroids removed were less likely to achieve pregnancy after myomectomy than patients with ≤6 fibroids removed (22...
January 22, 2018: Journal of Minimally Invasive Gynecology
Yanan Wang, Ying Zhao, Siyi Yu, Youping Hu
In order to avoid international experts and scholars questioning the clinical effect of acupuncture, based on the traditional acupuncture theory and research reports, some questions are proposed from the research design, acupuncture effect and outcome explanation on the study of Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome published in JAMA in June 2017. And some thoughts and suggestions for the future development of the clinical acupuncture study are showed.
December 12, 2017: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
Yin Fan Arthur, Sherman Gu, Guanhu Yang
WU Xiaoke, Stener-Victorin and Richard Legro's team published a randomized clinical trial entitled Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial in JAMA on June 27, 2017. Their conclusion is "this finding does not support acupuncture as an infertility treatment in such women". We found that the trial design had serious flaws and that the results could not lead to the conclusion. Based on the reanalysis for the study data and those published in other medical journals recently from the team, it was found that acupuncture plus clomiphene or control acupuncture plus clomiphene had more excellent live birth rate, ovulation rate and cumulative ovulation rate than clomiphene alone, with statistical and clinical significance...
December 12, 2017: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
Weijuan Gang, Xianghong Jing
In recent years, more and more patients of polycystic ovary syndrome (PCOS) have strong desire to be treated with acupuncture. In "Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial" published in Journal of the American Medical Association (JAMA) on June 27, 2017, the finding of this research does not support acupuncture for such infertility women. The questions and doubts are proposed in the paper from the regimen of acupuncture treatment, the determination of primary outcome and the explanation of the results...
November 12, 2017: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
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