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Whether electroacupuncture is effective for patients with polycystic ovary syndrome is still inconclusive. Therefore, this study aims to evaluate the add-on effects of electroacupuncture to conventional drugs for the treatment of polycystic ovary syndrome.
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One hundred six consecutive triplet pregnancies treated from 1984 through 1992.
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To determine whether differences existed in mood and coping styles among fertile men, oligoasthenospermic men, or euspermic men whose wives were undergoing ovulation stimulation with clomiphene and IUI.
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To evaluate the relationship between the E2 response during the clomiphene citrate (CC) challenge test and ovarian responsiveness to exogenous gonadotropins.
This was a proof-of-principle, randomized, open-label, fixed dose, active-control, two-center phase IIB study in 12 men with secondary hypogonadism treated previously with topical testosterone.
Metformin, an oral antihyperglycemic drug, acts as an insulin sensitizer in the treatment of type 2 diabetes mellitus. It has also been widely used in the treatment of polycystic ovary syndrome (PCOS) and gestational diabetes mellitus. Although randomized clinical trials have failed to establish its superiority over other forms of treatment, metformin continues to be a treatment option in specific subgroups of women either alone or as an adjunct with other therapies in management of PCOS.
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Large military tertiary care center.
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The use of micro-dose hCG after CC in the late follicular phase results in continued follicle growth, increased E 2 levels, ovulation, and pregnancies. This treatment offers an efficient and cost-effective alternative before gonadotropin therapy for this type of patient.
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To evaluate the incidence of congenital malformations among offspring of mothers who conceived with clomiphene citrate (CC) or with letrozole treatment for infertility.
In women with unexplained infertility undergoing COH with CC/hMG, the occurrence of a spontaneous LH surge is a favorable event associated with a significantly increased pregnancy rate. The data showed a lower miscarriage rate, but there was insufficient power to confirm or refute this result.
1. Cyclofenil diphenol (F6060), a weak non-steroidal oestrogen, was shown previously to inhibit [35S]proteoglycan synthesis [Mason, Lineham, Phillipson & Black (1984) Biochem. J. 223, 401-412] and to induce fragmentation of the Golgi apparatus into small vesicles [Lancaster, Fryer, Griffiths & Mason (1989) J. Cell Sci. 92, 271-280] in cultures of Swarm chondrosarcoma chondrocytes. Two structurally related compounds, F6204 and F6091, show a similar concentration-related effect, with complete inhibition of [35S]proteoglycan synthesis at 90 micrograms/ml. The apparent [3H]protein synthesis is only approx. 40% inhibited with [3H]lysine as precursor. Stilboestrol, clomiphene and tamoxiphen are also potent inhibitors of [35S]proteoglycan synthesis. 2. Syntheses of chondroitin 4-[35S]sulphate and chondroitin 6-[35S]sulphate, which are Golgi-mediated events, are inhibited 40-68% and 3-48% respectively by concentrations of cyclofenil between 50 and 70 micrograms/ml. [3H]Hyaluronan synthesis, which occurs by a different mechanism at the plasma membrane, is inhibited by 47-66%. These results suggest that cyclofenil may act via more than one inhibitory mechanism. Cyclofenil diphenol inhibits polymerization of chondroitin sulphate on to p-nitrophenyl beta-xyloside even when the chondrocytes are loaded with the initiator prior to treatment. 3. Cyclofenil diphenol interferes with the cellular uptake of amino acids via the system A carrier, as shown by inhibition of uptake of methylaminoisobutyric acid, a specific substrate for this system. The drug had no effect on the uptake of 2-deoxyglucose by the cells. 4. Cyclofenil diphenol (90 micrograms/ml) caused a decrease in the pool size of UDP-N-acetylglucosamine, UDP-N-acetylgalactosamine and UDP-hexoses, but this was insufficient to account for the accompanying profound inhibition of [35S]proteoglycan synthesis. Entry of [3H]glucosamine into the cell and into the UDP-N-acetylhexosamine pool did not appear to be affected. 5. Cyclofenil diphenol inhibited the substitution of 3H-labelled proteoglycan core protein with chondroitin sulphate chains. Core protein was identified in treated cultures on the basis of immunoprecipitation with an antiserum against the hyaluronate-binding region and distinguished from precipitated proteoglycan on SDS/PAGE.
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The reproductive system consists of a series of feedback loops involving the higher centers, the hypothalamus, the pituitary, and the gonads. The factors involved in physiologic restraint of the hypothalamic pituitary gonadal axis until the time of puberty are complex. The pattern (frequency and amplitude) of GnRH signal is important in regulating pituitary LH and FSH secretion. This signal can be amplified and modulated at the pituitary level at least in part by the sex steroids. Hypothalamic hypogonadism can be considered a disorder of the hypothalamic GnRH pulse generator that results in deficient or dysrhythmic GnRH release. The mechanisms underlying the abnormal GnRH release in acquired, functional disorders such as anorexia nervosa and amenorrhea of joggers remain controversial. Evaluation of patients with hypothalamic hypogonadism involves exclusion of hyperprolactinemia, space-occupying lesions, and other systemic disorders. The pulsatile administration of GnRH for induction of fertility represents a major advance in the treatment of these patients.
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Seven randomised controlled studies assessing six comparisons and including 1120 women in total were included in this review.1) O + P FET versus natural cycle FET: this comparison demonstrated no significant differences in outcomes but confidence intervals remain wide, and therefore moderate differences in either direction remain possible (OR 1.06, 95% CI 0.40 to 2.80, P 0.91).2) GnRHa + O + P FET versus O + P FET: this comparison showed that the live birth rate per woman was significantly higher in the former group (OR 0.38, 95% CI 0.17 to 0.84, P 0.02). The clinical pregnancy rate was also higher but not significantly so (OR 0.76, 95% CI 0.52 to 1.10, P 0.14).3) O + P FET versus follicle stimulating hormone (FSH) FET, 4) O + P FET versus clomiphene FET and 5) GnRHa + O + P FET versus clomiphene FET: there were no differences in the outcomes in the comparison of these cycle regimens.6) Clomiphene + human menopausal gonadotrophin (HMG) FET versus HMG FET: in a comparison of two ovulation induction regimes the pregnancy rate was found to be significantly higher in the HMG group (OR 0.46, 95% CI 0.23 to 0.92). There were also fewer cycle cancellations and a lower multiple pregnancy rate when HMG was used without clomiphene but these did not reach statistical significance.
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The Authors have treated 40 women affected by primary or secondary infertility due to various etiologies (with the exclusion of the tubal factor as cause of infertility) for 123 cycles with clomiphene citrate (CC) 50 mg/daily/6 days from day cycle IV to/days from day cycle IX+pure follicle-stimulating hormone (FSH) 75 IU/daly from day cycle VII day cycle IX and 150 IU/d of pure follicle-stimulating hormone (FSH) from day cycle 10th to day cycle XII/XIII. In all patients human chorionic gonadotropin (HCG 5000IU) was administered when the level of 17 B-estradiol was > or = 900 pg/ml and the follicular diameter > or = 19 mm. After 24 hours from the administration of human chorionic gonadotropins (HCG), the patients underwent intrauterine insemination with washed semen and the insemination was repeated in all patients 24 hours after the first-one. This protocol has allowed to obtain 12 pregnancies (30%); the cancelled cycles were 9 (of whom 5, equal to 4.06%, for mild hyperstimulation and 4, equal to 3.25%, for non compliance). Our results confirm the value of the protocol and the low risk of ovarian hyperstimulation following the use of pure follicle-stimulating hormone (FSH) in association with clomiphene citrate (CC).
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Fifteen ovulatory patients undergoing ovarian stimulation with clomiphene citrate-human menopausal gonadotropin-human chorionic gonadotropin (hCG) for in vitro fertilization were studied. All 15 attained peak estradiol (E2) levels of greater than 600 pg/ml. Eight patients had an endogenous luteinizing hormone (LH) surge before the administration of hCG. The characteristics of these "surge" patients were compared with those of the remaining seven "nonsurge" patients. There was no significant difference in the peak morning E2 achieved before hCG or the endogenous LH surge, nor in the peak absolute increase in E2 over a 24-hour period in these two groups. The surge group had significantly higher E2 levels per follicle greater than or equal to 15 mm, measured by ultrasound on the morning of the day of administration of hCG or the LH surge (P less than or equal to 0.005). In addition, nonsurge patients had a greater number of follicles greater than or equal to 15 mm, compared with surge patients (P less than or equal to 0.05). It is hypothesized that greater quantities of nonsteroidal hormones, such as inhibin, produced by a greater number of preovulatory follicles in nonsurge patients, may block the pituitary response to hypothalamic gonadotropin-releasing hormone in the face of high and rising E2 levels.
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The study objective was to investigate whether ultrasound (US) monitoring is essential during treatment with clomiphene citrate (CC) for ovulation induction, as recommended by the Royal College of Obstetricians and Gynaecologists (RCOG) and the National Institute for Clinical Excellence (NICE). We performed a systematic review of all studies investigating the effects of US in the treatment of ovulatory dysfunction with CC. The main objective of this review was to investigate whether US monitoring during CC treatment reduced multiple pregnancy rates. There was insufficient evidence to suggest that US monitoring reduces multiple pregnancy rates or improves pregnancy rates. On the other hand, no indication that treatment with CC is safe without US monitoring was identified. The small number of relevant studies and the heterogeneity observed in the methodologies of each study prohibit reliable conclusions to be drawn. There is currently no basis for amending the evidence base (good-practice points) used in the RCOG and NICE guidelines, which recommend the use of US to monitor the ovaries during stimulation with CC.
Spontaneous abortions occurred in 11 of 20 women given clomiphene compared with two of 20 who had pituitary suppression. Eleven preferences were found for buserelin and two for clomiphene. In seven pairs both women had successful pregnancies. One pair was discarded because one of the women did not become pregnant. The ratio of luteinising hormone concentration to follicular diameter was found to be a possible diagnostic indicator of spontaneous abortion.
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It is still controversial whether the day of clomiphene citrate initiation has any impact on the pregnancy rate. This study aimed to compare the perifollicular vascularity and endometrial receptivity of ovulatory women who started clomiphene citrate on day 2 and day 5.
Open label, single-arm, prospective trial.
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The stimulation regimens and the results of ovulation induction in anovulatory patients and in patients suffering from a Luteinized Unruptured Follicle (LUF) syndrome are discussed as well as the findings concerning superovulation in IVF cycles. The percentage of multiple pregnancies (less than or equal to 20 p. cent) is acceptable, due to the accurate daily performance of hormonal determinations. The pregnancy rate is lower in a LUF population, than in anovulatory patients. This is likely due to the unknown pathophysiology of the LUF syndrome. Compared to natural cycles, the maximum serum LH concentration is reduced in stimulated cycles although multiple oocytes have to mature in superovulated patients. A possible explanation for these reduced LH surges could be an increase in inhibin -like substances. There is still a need for more research to find out the real interaction between the follicle and the hypothalamic-hypophysial axis.