ovulation induction

Poor Ovarian Response (POR) to ovarian stimulation is a challenging factor in Assisted Reproduction Technology (ART). This study aimed to compare the efficacy of a conventional antagonist with high doses of gonadotropin protocol with double stimulation protocol in females with POR. This randomized clinical trial study was conducted on 60 women aged >35 with PORS at the Avicenna Infertility Center, Tehran, Iran. The participants were randomly divided into 2 groups (n=30 /each). In group 1, from the second day of the menstrual cycle, gonadotropin started at a dose of 450-600 units. In group 2, the second day of the menstrual period began with Letrozole 5 mg every night and an oral tablet of Clomiphene citrate 50 mg every day, and from the fourth day started 150 units of gonadotrophin (Triptorelin, 0.2 mg).  In this study, at the end of the follicular phase, there was a significant correlation between protocol type and the number of Germinal Vesicles (GV) (p=0.04). The mean number of oocytes retrieved was 2.76±1.9 in the conventional method and 3.23±2.1 in the double stimulation group (p=0.90). The number of fertilized oocytes was 31 in the conventional protocol and 25 in the double stimulation protocol. The mean number of pregnancies that led to the fetus was 1.38±1.3 in the conventional protocol and 0.96±0.9 in the double stimulation group (p=0.018). The results of this study show that the embryos in the double-stimulation group were more capable of completing the pregnancy, and the double-stimulation group had a higher live birth rate.

Various protocols have been approved to improve the response rate leading to successful fertilizationin poor ovarian responders (PORs). The application of double ovarian stimulation (DuoStim) in the follicular andluteal phases of the same ovarian cycle has been shown as an intriguing option to achieve more oocyte retrievals inthe shortest time. The aim of the current study, is to compare the outcomes of different protocols, minimal stimulation(MS) and Duostim. This randomized clinical trial was performed on 42 in vitro fertilization (IVF) candidateswith POR diagnosis. Patients were classified into two equal groups and treated with the DuoStim protocol and MSprotocol. The IVF outcomes, including retrieved follicles, oocytes, metaphase II (MII) oocytes and embryos, werecompared between these groups. The patients’ characteristics including age, anti-mullerian hormone (AMH), follicle-stimulating hormone(FSH), luteinizing hormone (LH), and antral follicle count (AFC) were collected and compared. It showed there wasno significant difference between the two groups' baseline characteristics (P>0.05). We observed that the DuoStimprotocol resulted in a significantly higher score in comparison with the MS protocols, including the number of follicles(6.23 ± 2.93 vs. 1.77 ± 1.66, P<0.001), retrieved oocytes (3.86 ± 2.57 vs. 1.68 ± 1.58, P=0.002), MII oocytes (3.36 ±2.42 vs. 1.27 ± 1.27, P=0.001) and obtained embryos (2.04 ± 1.64 vs. 0.77 ± 0.86, P=0.003). The DuoStim protocol is a favourable and time saving plan that is associated with more oocytes in a singlestimulation cycle. The DuoStim protocol significantly can result in more frequent MII oocytes and embryos. We figuredthat the higher number of oocytes and embryos might have led to a higher rate of pregnancy (registration number:IRCT20200804048303N1).

 Preserving fertility in women with cancer before therapeutic interventions is very important. This study was evaluating the 8 years’ experience of an onco-fertility center from 2013 to 2020 on fertility preservation and its outcomes in female cancer survivors.

 Participants were females with an approved cancer diagnosis of reproductive ages that were referred for fertility preservation. After proper counseling by an expert team, the final decision on the fertility preservation method was made based on the patient's condition and survival expectation. The primary goal was to collect data about the fertility, clinical and survival outcomes of these women and pregnancy rate as a secondary objective that were compared between cancer types.

 Totally 337 participants were recruited with a mean±SD age of 30.7±6.6 years. Gynecological cancers accounted for 166 (49.3%) of all cases followed by breast (107 (31.8%)) and other cancers (64 (19.0%)) respectively. Of those, 144 (42.7%) cases entered into the ovulation induction cycle and the others did not continue due to lack of correct information and late referral, and inability to postpone treatment as the major reasons. Comparing between 3 groups (gynecological, breast and other cancers), a higher rate of pregnancy otherwise not statistically different was detected in gynecological cancer survivors. In the breast cancer survivors, the chance of oocyte retrieval and fertility was not lower than in other cancers.

Many patients and even their therapists are unfamiliar with the methods of fertility preservation, and when they consider it, the golden time is usually passed. Therefore, having a good consultation with the survivors and patient education may be the most important issue that led to a timely referral for preserving fertility in cancer patients.

Induction of ovulation results in changes in ovary including the tissue immune cells. Administration of progesterone following induction of ovulation may ameliorate some of these changes. The present study was conducted to examine the effect of this administration of progesterone on mast cell count and tissue histamine level in mice ovary at pre-implantation time.

An experimental study on 15 NMRI mice was carried out. The groups of study were control group, induction of ovulation group and a group for administration of progesterone after induction of ovulation. Mast cells count was through toluidine blue staining and tissue histamine level measure was through spectrophotometry. Analysis of variance (ANOVA) was used for data analysis.

The mean of mast cell count was significantly different between the groups (P <.001). Pairwise comparisons showed that induction group had significantly higher mast cells in comparison with control group (P =.039), indicating the effect of ovulation induction on mast cell count. The count was higher in progesterone group in comparison with induction group (P =.020). Mean of histamine level was significantly different between the groups (P <.001). Induction group had significantly higher histamine level in comparison with control group (P <.001). However, histamine level was not significantly different between induction and histamine groups (P =.998).

Ovulation induction raises ovary mast cell population and histamine level. However, progesterone could notimprove this change. Further studies should be conducted to find further roles of mast cells and histamine in ovary

Phytoestrogens can be used as an alternative to clomiphene for ovulation induction in patients with polycystic ovarian (PCO). In this study, we evaluated the impact of phytoestrogens (Cimicifuga racimosa) in combination with clomiphene on the endometrium thickness and follicle number in women with PCO.

This study was a prospective clinical trial conducted in the infertility research center of Milad Hospital in Mashhad, Iran, during 2016 and 2017 on 100 women with PCO syndrome. The patients were randomly divided into two equal groups. The patients in both groups were treated by clomiphene citrate 50 mg, twice a day for 5 days, from the second day of the menstrual cycle and for three consecutive cycle periods. The intervention group received Cimicifuga racemosa tablets 10 mg twice a day for 10 days from the second day of the menstrual cycle, in addition to the mentioned standard treatment. The two groups were compared in terms of the number and size of follicles and endometrial thickness on the ultrasound.

There was no significant differences between the number of medium (p=0.288), large (p=0.086), and total (p=0.288) follicles between the two groups. Also, no significant difference was observed in endometrial thickness between the two groups (p=0.227).

As a result, adding Cimicifuga racemosa to clomiphene could not increase the endometrial thickness and the number of follicles in PCO patients.

The purpose of this study was to compare the efficacy of tamoxifen and clomiphene citrate in induction of ovulation in women with PCOS and anovulation.

In this prospective cohort study, 104 women with PCOS and primary infertility were enrolled after fulfilling the inclusion and exclusion criteria. The patients were allocated in two groups; group A (n=54) received tamoxifen 40 mg once daily (Days 3-7) and group B (n=50) received clomiphene citrate 100 mg once daily (Days 3-7). Serial ultrasounds were done till the administration of human chorionic gonadotropin (hCG). The ovulation and pregnancy rates in both groups were compared. The number of dominant follicles, estradiol levels, and endometrial thickness were also studied. Comparison was done using chi-square and student’s t-test and a p-value of less than 0.05 was considered statistically significant.

The number of dominant follicles and serum estradiol levels were significantly higher in group B (p<0.05), whereas the endometrial thickness was significantly more in group A (p<0.05). The ovulation rates were similar in both groups (66.6% vs. 70%, p=0.715). Pregnancy rate per treatment cycle and per ovulatory cycle was marginally higher in group A (14.81% and 22.22%, respectively), as compared to group B (14% and 20%, respectively), but the difference was not statistically significant (p>0.05).

Tamoxifen and clomiphene citrate are both equally effective in induction of ovulation and achieving a pregnancy in women with PCOS.

Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment.

To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP).

Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation.

Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP.

The most appropriate dose for ovulation in patients with PCOS is 100 mg CC.

 Hysterosalpingography (HSG) is a common diagnostic method that has therapeutic effects on fertility success.

 The purpose of this study was to investigate the effect of HSG on the biochemical pregnancy rate of women with primary and secondary infertility in patients referring to Ali-ibn Abitalib Hospital in Zahedan.

 A descriptive-analytical study was performed on 100 women with primary and secondary infertility referred to Ali-ibn Abitalib Hospital of Zahedan for performing HSG. Following performing the examinations, initial tests, and procedures, as well as ruling out acute pelvic infection by the expert gynecologist, the patients were referred to the radiologist for HSG. All patients in the study underwent HSG. Data were analyzed by SPSS version 21 software.

 The mean age of patients in the study was 30.36 ± 5.25 years, and the mean duration of infertility was 4.81 ± 2.31 years. There was no significant relationship between the type of pregnancy and the outcome of pregnancy. There was no statistical relationship between age, abdominal surgery history, and HSG in both groups of women with spontaneous pregnancy or ovulation induction. There was a significant relationship between the mean duration of infertility and spontaneous pregnancy.

 The use of HSG as a therapeutic approach is not effective, but it could have therapeutic effects as a diagnostic method in women with early infertility.

Mucin-1(Muc1) is one of the first molecules in the endometrium that confronts implanting embryos.There is insufficient knowledge about the impacts of diabetes and drugs developed for diabetes treatment on expressionof this molecule at the time of implantation. Therefore, this study aimed to investigate the impacts of diabetes andinsulin, metformin and pioglitazone on Muc1 expression at the time of implantation. This experimental study was conducted on a total of 63 female Wistar rats divided into 9groups. To induce type 1diabetes, streptozotocin (STZ) and for induction of type 2 diabetes, nicotinamide (NA) andSTZ were injected intraperitoneally. For superovulation, human menopausal gonadotropin (HMG) and human chorionicgonadotropin (HCG) were used. Insulin, metformin and pioglitazone were administered for two weeks. Finally,the endometrial expression of Muc1 was evaluated by quantitative real-time reverse transcription–polymerase chainreaction (RT-PCR). Muc1 expression was non-significantly increased in type 1 and type 2 diabetic groups compared to the controlgroup (P=0.61 and 0.13, respectively); also, it increased in insulin-treated type 1 diabetic group compared to thecontrol group (P=0.0001). Its expression was increased in insulin-treated type 1 diabetic group compared to untreateddiabetic group (P=0.001). The expression level of Muc1 was significantly reduced in superovulated and insulin-treatedtype 1 diabetic group compared to the insulin-treated type 1 diabetic group (P=0.001). One of the causes of fertility problems in diabetes, is changes in Muc1 expression during implantation.On the other hand, the use of insulin in these patients can even lead to overexpression of this gene and worsen thecondition. However, these changes can be partially mitigated by assisted reproductive technology (ART) such as superovulation.Also, treatment with metformin and pioglitazone can restore Muc1 expression to near normal levels andhas beneficial effects on implantation

Pinopods concentrations in endometrial surface is a marker of implantation. estradiol valerate (EV) was used for change the adverse effects of Clomiphene Citrate (CC) on the endometrium. Endometrial morphology was less examined in this fields.

Objective (s): 

To assess whether there is a significant difference in endometrial pinopods concentrations and other parameters after adding estradiol valerate (EV) and progesterone to higher doses of clomiphene citrate (CC).

Study design: In this prospective randomized clinical trial, a total of 30 women, who did not respond to 100 mg CC from February 2016 until June 2016 were evaluated. They received 150 mg CC alone or CC with EV or CC plus progesterone. On day 21 of the menstrual cycle, endometrial biopsy and a blood sampling and scanning by electron microscopy were performed.

On day 21 of the menstrual cycle there was no significant difference regarding pinopods concentrations (P=0.641) and serum estrogen levels (P=0.276) between groups. Serum progesterone levels on day 21 of the menstrual cycle among patients treated with CC, was higher than the other two groups (P=0.007).

The addition of EV and progesterone to higher dosages of CC, did not changes the pinopods concentration and serum estrogen levels on day 21 of the menstrual cycle. It can be concluded that the anti- estrogenic effects of CC just appear on the endometrium. In this study, there were higher levels of serum progesterone on day 21 of the menstrual cycles in the CC alone compared to other two groups.

Ovarian stimulation (OS) for poor ovarian response (POR) patients is still a major challenge in assisted reproductive techniques. Aromatase inhibitors as co-treatment in antagonist protocol are suggested to these patients, but there are controversial reports.

To evaluate the effectiveness Letrozole (LZ) as adjuvant treatment in gonadotropin-releasing hormone (GnRH)-antagonist protocol in POR patients undergoing in vitro fertilization/ intracytoplasmic sperm injection cycles.

This double-blind randomized clinical trial was conducted in Arash women's hospital. One hundred sixty infertile women with POR based on Bologna criteria were allocated into two groups randomly: LZ + GnRH-antagonist (LA) and placebo + GnRH-antagonist (PA) groups. In the experimental group, the patients received 5 mg LZ on the first five days of OS with 150 IU of recombinant human follicle-stimulating hormone (rFSH) and 150 IU of human menopausal gonadotropin (HMG). The cycle outcomes were compared between groups.

The total number of retrieved oocytes and the metaphase II oocytes in LA-treated group were significantly higher than those in the control group (p = 0.008, p = 0.002). The dosage of hMG used and the duration of OS and antagonist administration in LZ-treated group were significantly lower than those of the control group. The number of patients with no oocyte, in the control group, was higher than the LZ-treated group, and the clinical pregnancy rate in LA-treated group (25%) was higher than the control group (18%); however, the differences were not significant statistically.

Adding 5 mg of LZ to rFSH/hMG antagonist protocol may improve the in vitro fertilization/intracytoplasmic sperm injection cycle outcome in POR patients.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age (6.8%-18%) and is one of the leading causes of infertility due to ovulation factors in 55%-70% of infertile women. In this study, we compared the first-line and second-line treatments of infertility through ovulation induction with clomiphene citrate and letrozole, respectively, in the infertile patients with PCOS.
Patients and This randomized clinical trial included 80 infertile patients with PCOS intent on pregnancy. Having considered the inclusion criteria and obtaining the informed consent, the patients were divided into two groups of 40 and treated with either clomiphene citrate or letrozole. In the first group, two tablets of clomiphene (50 mg/d) were taken and in the second group, two tablets of letrozole (2.5 mg/d) were prescribed on the third to seventh days of the menstrual cycle for 5 days. Over the course of the treatment for 3 months, pregnancy rate was detected at every menstrual cycle by performing BHCG titers. Data were entered into SPSS software version 21.0. All data were analyzed using independent t-test, and chi-square test with a significance level less than 0.05. Mean age of patients, and mean body mass index (BMI), as well as duration of infertility were not significantly different between letrozole and clomiphene groups. Fifteen patients in the clomiphene group (37.5%) reported a history of infertility treatment, compared to the letrozole group in which 12 patients (30%) reported such treatment, though this difference was not statistically significant. In the clomiphene group, the menstrual cycle was compatible with PCOS in 30 patients (75%), while in the group receiving letrozole, it was compatible in 33 patients (82.5%). Hyperandrogenism consistent with PCOS was present in 25 patients (62.5%) in the clomiphene group and in the group receiving letrozole in 22 patients (55%). The evidence of PCOS-compatible ultrasonography was found in 31 patients (77.5%) in the clomiphene group and in 35 patients (87.5%) in the letrozole group. The frequency of pregnancy in the clomiphene group (45%) was lower than that in the letrozole group (50%). Chi-square test showed that this difference was not statistically significant. It seems that the efficacy and success rate of clomiphene and letrozole in the treatment of infertility due to ovulation failures are similar in patients with PCOS in that both could increase ovulation and pregnancy rate. In other words, these two drugs are not superior to each other and can be selected according to the patient"s tolerance, cost, and side effects.

Polycystic ovary syndrome (PCOS) is considered as one of the causes of infertility. Anti-Mullerian hormone (AMH) is 2-3 times higher in patients with the PCOS compared to others. The present study aimed to survey the association between basal AMH levels and ovarian response in infertile PCOS patients. In this cross-sectional study, 70 infertile PCOS women were enrolled referring to Milad Infertility Center (Mashhad, Iran) from May 2011 to April 2012. The basal blood level of AMH was evaluated. The patients received 5 mg of letrozole from the fifth cycle day (for 5 days) and then received 150 units of gonal F in the form of the recombinant follicle-stimulating hormone (FSH) on the ninth day of the cycle. Five thousand units of human chorionic gonadotropin (hCG) were prescribed for the patients who had one follicle of ≥ 18mm. Then, they should have had intercourse 36 hours later. After ovulation induction (OI) on the 10th cycle day, the second serum sample of AMH was taken. Changes of AMH did not have a significant relationship with the ovarian response, namely, it was lower in patients with positive ovarian response compared to those without any ovarian response. In addition, the basal level of AMH in patients with a positive response (3.91 ± 2.14) had no significant difference with the secondary AMH (3.27 ± 2.39) after the OI (P = 0.19). Generally, the AMH was not a predictor of ovarian response in PCOS patients and the amount of AMH reduced after the treatment. This effect was maybe related to letrozole and gonadotropin.

The purpose of this study was to compare the effects of letrozole plus recombinant follicle stimulating hormone (R-FSH) and human menopausal gonadotropin (HMG) on ovarian stimulation in intrauterine insemination (IUI) cycle. This randomized clinical trial was conducted on 130 women with polycystic ovary syndrome (PCOS) resistant to clomiphene and letrozole who were divided into A and B groups. Both groups received 5 mg of letrozole daily from the third to seventh day of the cycle and then group A (n = 59) received 75 units of HMG intramuscularly per day and group B received 75 units of R-FSH subcutaneously per day. Follicular maturation was triggered with 250 μg of recombinant human chorionic gonadotrophin (R-hCG) and IUI was performed 36 hours later. Main results under study were the number of matured follicles, endometrial thickness on the day of hCG injection, and the rate of chemical and clinical pregnancy. The 2 groups were not significantly different in demographic information. The rate of pregnancy was significantly higher in the letrozole + R-FSH group than in the letrozole+HMG group (20% and 5.8% respectively, P = 0.04). There was no significant difference between the 2 groups in the number of mature follicles (≤18 mm) and endometrial thickness at the time of hCG injection (P > 0.05). Letrozole plus R-FSH is a recommended regimen for ovarian stimulation in PCOS patients.

Recent studies have shown that vitamin D has an essential role in the reproductive system. In this study, we aimed to investigate the effect of vitamin D levels in patients undergoing ovulation induction (OI), and subsequent intrauterine insemination (IUI) procedure.
One hundred and four infertile and one hundred and three fertile women were recruited in this cross-sectional study which was conducted in a tertiary level maternity hospital. Infertile patients were divided into pregnant and non-pregnant subgroups after treatment. Individual characteristics and 25-hydroxyvitamin D3[25 (OH) D3] levels were compared between the groups.
The vast majority of our study population consisted of women who had vitamin D deficiency (96.6%). There was no statistically significant difference between infertile and fertile groups in terms of serum 25 (OH) D3lev- els (P=0.512). Similarly, no significant difference was observed between the pregnant and non-pregnant subgroups of infertile patients regarding 25 (OH) D3levels (P=0.267).
There is no association between female infertility and serum vitamin D levels. Vitamin D does not pre- dict pregnancy in infertile women undergoing OI with IUI. Further research which will provide a comparison between much more women who have deficient and sufficient 25 (OH) D3levels is warranted.

Different combination of gonadotropin preparation has been introduced with no definite superiority of one over others in in vitro fertilization (IVF), but individualized regimens for each patient are needed.

The aim of the present study was to investigate the effect of controlled ovarian stimulation with recombinant- follicle stimulating hormone (r-FSH) plus recombinant-luteinizing hormone (rLH) versus human menopausal gonadotropin (HMG) plus r-FSH on fertility outcomes in IVF patients.

This is a randomized clinical trial study that was performed from October 2014-April 2016 on 140 infertile patients with a set of inclusion criteria that referred to infertility clinics in Vali- asr and Gandhi Hospital in Tehran. The women were randomly divided into two treatment groups. The first group (n=70) received rFSH from the second day of cycle and was added HMG in 6th day and the 2nd group (n=70), received rFSH from the second day of cycle and was added recombinant-LH in 6th day. Then ovum Pick-Up and embryo transfer were performed. In this study, we assessed the outcomes such as; chemical and clinical pregnancy rate, live birth and abortion rate.

Number of follicles in ovaries, total number of oocytes or M2 oocytes and quality of fetuses has no significant differences between two groups (p>0.05). Total number of fetuses were significantly higher in patients who received rFSH HMG (p=0.02). Fertility outcomes consisted of: live birth rate, chemical pregnancy and clinical pregnancy rate were higher in rFSH HMG group in comparison to rFSH LH group (p

It seems that in IVF patients, HMG rFSH used for controlled ovarian hyperstimulation have better effects on fertility outcomes, but in order to verify the results, it is recommended to implement studies on more patients.

N-acetyl cysteine (NAC) was proposed as an adjuvant to clomiphenecitratefor ovulation induction in patients with polycystic ovary syndrome (PCOS)without clomiphene citrate resistance.

To evaluate the effect of NAC on pregnancy rate in PCOS patients whowere candidates for intrauterine insemination.

In this randomized clinical trial 97 PCOS women aged 18-38 years were enrolled in two groups, randomly. For the case group (n=49), NAC(1.2 gr) clomiphene citrate (100 mg) letrozole (5mg) were prescribed dailyfromthe third day of menstruation cycle for five days. The control group (n=48) had thesame drug regimen without NAC. In order to follicular development, GONAL-Fwas injected on days of 7-11 menstrual cycles in all participants. When the folliclesize was 18mm or more, HCG (10000 IU) was injected intramuscular and theintrauterine insemination was performed after 34-36 hr.

There was no significant difference between study groups regarding BMI(p=0.28), FSH level (p=0.66), LH level (p=0.67), mean endometrial thickness(p=0.14), mean number of mature follicles (p=0.20) and the pregnancy occurrence(p=0.09).

NAC is ineffective in inducing or augmenting ovulation in PCOSpatients who were candidates for intrauterine insemination and cannot berecommended as an adjuvant to CC in such patients.

The relationship between ovulation induction and ovarian cancer is an important issue in gynecology..
The studied patient was a 32-year-old G1P1 woman with abdominal pain who was diagnosed with a large ovarian cyst during ovulation induction, which could possibly raise the risk of ovarian torsion. She had a 2-year secondary infertility and had received three cycles of ovulation induction with letrozole 6 months earlier. An emergency laparoscopy showed large complex ovarian cysts without torsion. We then performed a cystectomy. Based on the pathology report revealing a primary ovarian cystadenocarcinoma, the patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and retroperitoneal lymphadenectomy..
The emergence of a suspected ovarian cyst during letrozole-induced ovulation is of great importance and needs to be investigated..

Polycystic ovary syndrome (PCOS) is highly associated with an ovulatory infertility, features of the metabolic syndrome, including obesity, insulin resistance and dyslipidemia. Serum concentrations of high sensitive C-reactive protein (hs-CRP) were significantly higher in obese than in non-obese PCOS patients at baseline, suggesting a relationship between elevated hs-CRP levels and obesity. The aim of this study was to evaluate whether cycle day 3 hs-CRP levels before clomiphene citrate (CC) treatment would predict cycle outcomes in women with PCOS.
This cross-sectional study was conducted among 84 infertile women with PCOS who were treated with CC at Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey, between January 2014 and January 2015. Based on the exclusion criteria, cycle outcomes of remaining 66 infertile women with PCOS treated with CC were analyzed. The hs-CRP levels and insulin resistance indexes were evaluated on day 3 of the CC treatment cycle. The primary outcome measures were number of preovulatory follicles measuring≥17 mm and pregnancy rates.
The mean ± SD age of the patients was 24.0 ± 3.8 years (range 18-36). The mean ± SD body mass index (BMI) of the patients was 25.7 ± 4.9 (range 17-43). Fifty patients developed dominant follicle (75%) and 5 patients established clinical pregnancy during the study (clinical pregnancy rate: 7%). The mean ± SD baseline hs-CRP, fasting insulin and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) values of the patients with and without dominant follicle generation during treatment cycle were 6.42 ± 7.05 and 4.41 ± 2.95 (P=0.27), 11.61 ± 6.94 and 10.95 ± 5.65 (P=0.73), 2.68 ± 1.79 and 2.41 ± 1.30 (P=0.58), respectively. The mean ± SD baseline hs-CRP, fasting insulin and HOMA-IR values of the patients with and without clinical pregnancy establishment following treatment cycle were 6.30 ± 2.56 and 5.90 ± 6.57 (P=0.89), 11.60 ± 7.54 and 11.44 ± 6.61 (P=0.95), 2.42 ± 1.51 and 2.63 ± 1.70 (P=0.79), respectively.
In this study, we did not observe a predictive value of cycle day 3 hs-CRP levels on preovulatory follicle development and pregnancy rates among infertile PCOS patients treated with CC. Also, no relationship between HOMA-IR values and dominant follicle generation or clinical pregnancy establishment was demonstrated in our study, confirming the previous studies emphasizing the neutral effect of metformin utilization before and/or during ovulation induction to pregnancy rates.