Endometrial and follicular development following letrozole intervention in unexplained infertile patients failed to get pregnant with clomiphene citrate.

PURPOSE: This study is designed to evaluate and compare follicular phase parameters during ovarian stimulation with the clomiphene citrate (CC) and letrozole (LET) in unexplained infertile patients who failed to get pregnant following frequent CC-treated cycles. METHODS: A total of 64 unexplained infertile women who failed to get pregnant following frequent CC-treated cycles were studied for one CC-treated cycle (100 mg/day), 2 washout cycles, and then 1 LET-treated cycle (5 mg/day). Number of follicles over 14 mm in diameter, diameter of the largest follicles, endometrial thickness, serum estradiol (E2) and LH levels were measured when one mature follicle over 18 mm in diameter detected during transvaginal ultrasonography. RESULTS: The mean value of the largest follicle diameter, number of developed follicles >14 mm, endometrial thickness and LH in LET-treated cycle was significantly higher than CC-treated cycle (P values were 0.007, <0.001, <0.001, and 0.004, respectively), whereas mean level of E2 showed a significantly lower level during LET-treated cycle (P < 0.001). CONCLUSIONS: About 5 mg/day of LET is associated with better follicular phase parameters, endometrial development, serum E2 and LH levels in women with unexplained infertility who failed to get pregnant following frequent CC-treated cycles.

Serendipitous diagnosis of aortic coarctation by bilateral parvus et tardus renal Doppler flow pattern.

BACKGROUND: Aorta Coarctation (AC) is uncommon condition that in most adult patients is asymptomatic. Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg. AIM: To describe a novel renal artery Doppler flow pattern pathognomonic of aortic coarctation. METHODS: We enrolled 4 consecutive patients referred to renal artery Doppler Ultrasonography (DU) for diagnostic work-up of secondary arterial hypertension. All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension. RESULTS: We found in all 4 patients (age range 10 to 27 years) a bilateral "parvus-tardus" renal Doppler flow pattern. In all, echocardiographic and angiographic work-ups showed aortic coarctation. CONCLUSION: Careful physical examination should be performed in all hypertensive patients. Furthermore, the suspicion of AC can be raised by a bilateral renal arteries "parvus-tardus" Doppler flow pattern in young hypertensive patients screened for secondary hypertension.