Mosammat Rashida Begum

Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome

OBJECTIVE To compare the effectiveness of letrozole and clomiphene citrate (CC) in induction of ovulation in polycystic ovary syndrome (PCOS). DESIGN Prospective, randomized, not blinded, controlled trial. SETTING A tertiary level infertility care center. PATIENT(S) Sixty-four anovulatory patients with PCOS, who failed to ovulate when taking 100 mg/day CC in previous cycles. INTERVENTION(S) Patients were randomly divided into two groups by lottery and treated with either 7.5 mg/day letrozole (an aromatase inhibitor) or 150 mg/day CC for 5 days starting from day 3 of the menstrual cycle. MAIN OUTCOME MEASURE(S) Occurrence of ovulation, endometrial thickness, and pregnancy rate (PR). RESULT(S) Twenty (62.5%) patients from the letrozole group and 12 (37.50%) patients from the CC group ovulated during the observation period. Mean serum E2 level was 817.75 pg/mL and 448.03 pg/mL in the CC and letrozole groups, respectively, on the day of hCG administration. The mean endometrial thickness on the day of hCG administration was 9.03 mm and 10.37 mm in the CC and letrozole groups, respectively. The mean D21 serum P was 13.09 ng/mL and 19.09 ng/mL in the CC and letrozole groups, respectively. Thirteen patients from the letrozole group (40.63%) and six patients from the CC group (18.75%) became pregnant. CONCLUSION(S) Letrozole has better ovulation and PR in comparison to CC in patients with PCOS.

Prevention of gestational diabetes mellitus by continuing metformin therapy throughout pregnancy in women with polycystic ovary syndrome.

Aim:  The aim of the present study was to assess whether continuation of metformin therapy throughout pregnancy can reduce the development of gestational diabetes in women with polycystic ovarian syndrome (PCOS).

Loading dose versus standard regime of magnesium sulfate in the management of eclampsia: A randomized trial

To determine whether only loading dose of magnesium sulfate is effective in controlling convulsion in eclampsia.

Role of aromatase inhibitor in ovulation induction in patients with poor response to clomiphene citrate

Aim:  To examine the efficacy of aromatase inhibitor in the induction of ovulation.

Pretreatment and co‐administration of oral anti‐diabetic agent with clomiphene citrate or rFSH for ovulation induction in clomiphene‐citrate‐resistant polycystic ovary syndrome

The objective of this study was to explore the result of pretreatment and concomitant use of metformin with clomiphene citrate (CC) and rFSH for ovulation induction in clomiphene‐citrate‐resistant polycystic ovary syndrome (PCOS).

Role of Low Molecular Weight Heparin (LMWH) in the Treatment of Recurrent Missed Abortion

Objective (s): The aim of this study was to explore the outcome of treatment of low molecular weight heparin (LMWH) in recurrent missed abortion cases. Method: This prospective observational study was done between January 2005 and July 2014 in Infertility Care and Research Center, Dhaka, Bangladesh. Two hundred and ten (210) patients who were able to give clear history of missed abortion, who had no endocrine and hypertensive disorders and who conceived spontaneously or after fertility treatment were the target population for this study. After positive pregnancy test all patients started taking oral progesterone (Dydrogesterone 10 mg bd), folic acid and aspirin 75 mg daily. Patients were advised to come for ultrasonography at 6 weeks of pregnancy. After confirming intrauterine viable pregnancy by ultrasonography we started injection enoxaparin (LMWH) 40 mg sc daily to all patients and continued till 34 completed weeks. The primary end point was the live birth rate and secondary end points were the side effects, late pregnancy complications and neonatal outcome in the study population. Results: One hundred and nine (52.39%) patients had antiphospholipid syndrome. Among them antiphospholipid subgroup antibody found in 40.37% cases, ACLA found in 27.52% cases, LA found in 18.34% cases and both ACLA and LA found in 13.77% cases. Antinuclear antibody was positive in 10% cases. No abnormality was identified in 38.09% cases. Pregnancy continued successfully in 96.66% cases. There were no maternal and foetal complications. Except failed cases there was no need to discontinue the treatment. Conclusion: This observational study dealt only with recurrent missed abortion and found satisfactory outcome with low dose heparin therapy. Large, well-designed randomized trials are needed to establish the heparin therapy in recurrent missed abortion. Bangladesh J Obstet Gynaecol, 2014; Vol. 29(2) : 94-101

Insulin Resistance in PCOS

Insulin resistance, recently recognized as a strong predictor of disease in adults, has become the leading element of the metabolic syndrome and renewed as a focus of research. The condition exists when insulin levels are higher than expected relative to the level of glucose. Thus, insulin resistance is by definition tethered to hyperinsulinemia. There is a well established association between PCOS, insulin resistance and hyperinsulinemia. Insulin resistance is a pivotal defect in PCOS probably counts as one of the most important advances in the battle to control the disorder. This metabolic abnormality leads to a compensatory increase in circulating insulin and this elevated insulin level directly stimulates the ovary and adrenal gland to produce excess androgens1,2. It also decreases hepatic sex hormone binding globulin (SHBG)3, so increasing biologically available free testosterone concentration in the circulation4,5 causing hyperandrogenemia. This excess androgen is responsible for anovulation, oligomenorrhea, hirsutism and infertility.

Aromatase Inhibitor for Prevention of Ovarian Hyperstimulation Syndrome(OHSS)

Aromatase Inhibitor for Prevention of Ovarian Hyperstimulation Syndrome(OHSS) Ovarian hyperstimulation syndrome (OHSS) was first described by Muller in 1962. Since then this iatrogenically originated malady has been reported to afflict high numbers of women who are in infertility treatment. The most serious and potentially lethal complication of controlled ovarian hyperstimulation (COH) is a severe form of OHSS. The incidence of OHSS is 5%-10% of all ovarian hyperstimulation for assisted reproduction treatment. It is characterized by ovarian enlargement with multiple follicular development, intravascular volume depletion and haemoconcentration.