Comparison of Metformin and Simvastatin Administration in Women With Polycystic Ovary Syndrome Before Intra-Cytoplasmic Sperm Injection Cycle: A Prospective, Randomized, Clinical Trial Study.

BACKGROUND: Drugs administration as a pretreatment regiment before ICSI cycle in PCOs patients could enhance the success rate. OBJECTIVES: The aim of this study was to compare the effectiveness of metformin with Simvastatin in patients with polycystic ovary syndrome (PCOs) candidates for intra-cytoplasmic sperm injection (ICSI) before starting the cycle. PATIENTS AND METHODS: In this prospective, double blind, randomized clinical trial the efficacy of these drugs was evaluated in 40 women with PCO syndrome (20 patients in each group; A: simvastatin and B: metformin) candidates for ICSI. In the both groups, metformin and simvastatin administrated for eight weeks before starting the ICSI cycle. Endocrine, metabolic and clinical parameters were measured before and after drug therapy; also, the results of ICSI cycle evaluated in the both groups. RESULTS: Both drugs improved hirsutism score significantly, but simvastatin better than metformin (Group A, 24.5 ± 3.6 P: 0.0001 VS Group B, 22.9 ± 5.9 P: 0.003). The reduction in body mass index (BMI) was not significant in the groups. Simvastatin reduced some biochemical parameters such as FSH, LH, testosterone, total cholesterol, LDL and increased HDL level significantly, whereas metformin decreased FSH, TG, testosterone and total cholesterol significantly. Overall, respectively 35% and 30% of patients treated with metformin and Simvastatin became pregnant. There was no significant difference between the effects of these two drugs on ICSI cycle results like oocyte in meiosis2 (M2) phase (1.35 ± 1.6 vs. 2 ± 3.87, P value: 0.4) and the number of Grade A, embryo (1.2 ± 1.3 vs. 1.1 ± 1.4, P value: 0.7). CONCLUSIONS: Simvastatin effectively improved hyperandrogenism signs and symptoms in patients with PCO, but this effect as a pretreatment regiment was not more expressive than metformin in ICSI cycle outcome.

A new look at tamoxifen: co-administration with letrozole in intrauterine insemination cycles.

OBJECTIVE: To assess the effectiveness of tamoxifen administration with letrozole in the context of intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: This prospective double-blinded study included 130 patients. After randomization, 65 patients in group A received letrozole + tamoxifen and human menopausal gonadotropin (HMG), whereas 65 patients in group B received placebo instead of tamoxifen. In both groups, the parameters recorded were total number of follicles with ≥16 and 18 mm diameter, endometrial thickness and appearance, and total HMG administered. The results were compared between groups after single-stage IUI was performed. RESULTS: Total dominant follicles in both groups were similar (mean number of follicles with diameter ≥16 and 18 mm was 1.5 ± 1.4 and 1.6 ± 1.1, respectively, in group A and 1.5 ± 1.1 and 1.6 ± 1, respectively, in group B; at the same time with less HMG usage in group A (255 ± 167 vs. 313 ± 174 IU), and higher pregnancy rate in group A (18.7 vs. 11.7 %); but none of them was statistically significant). Surprisingly, endometrial thickness was significantly higher in group A (7.7 ± 1.5 vs. 7 ± 1.3 mm; P value 0.008). CONCLUSION: In addition to the efficacy of tamoxifen in co-administration with clomiphene citrate, it has promising effects with letrozole in induction of ovulation cycles with or without IUI.

Comparison of Intracytoplasmic Sperm Injection Outcomes between Oligozoospermic, Obstructive Azoospermic and Non-Obstructive Azoospermic Patients.

BACKGROUND: To determine the differences in sperm quality and results of intracytoplasmic sperm injection (ICSI) cycles between three groups of male factor infertile couples: oligozoospermic, obstructive azoospermic and non-obstructive azoospermic. MATERIALS AND METHODS: In this prospective cohort study, 628 male factor infertile couples who underwent ICSI cycles from April 2004 to March 2006 were enrolled. Three hundred fourteen oligozoospermic patients (group I), 180 obstructive azoospermic patients (group II) and 134 non-obstructive azoospermic patients (group III) were included. Fertilization, cleavage, implantation and clinical pregnancy, early abortion rates were assessed. Chisquare and analysis of variances with Post Hoc (Tukey test) were used for data analysis. RESULTS: Fertilization rates were significantly different in the three groups (group I: 66.6%; group II: 51.8%; group III: 47.7%; p=0.004). There were differences in the implantation rates (I: 19.5%; II: 17.6%; III: 6.4%; p=0.001). The cleavage rates were found to be 55.1% (group I), 47.5% (group II), 45.5%(group III), respectively. The clinical pregnancy rate was the lowest in the third group (I: 37.6%; II: 28.9%; III: 13.4%; p=0.001). There was no significant difference in early abortion rates between the three groups: (I: 10.7%; II: 9.8%; III: 8%; p=0.776). CONCLUSION: It can be concluded that patients with oligozoospermia may benefit the most from ICSI treatment. ICSI cycles which use spermatozoa from non-obstructive azoospermic patients have a lower chance for successful outcome. The results of this study suggest, in cases of failure to achieve pregnancy after 1 or 2 cycles in non-obstructive azoospermic patients, embryo donation would be a better alternative.

Intravenous ascorbic acid (vitamin C) administration in myomectomy: a prospective, randomized, clinical trial.

BACKGROUND: To assess the usefulness of using ascorbic acid (vitamin C) administration in abdominal myomectomy. MATERIALS AND METHODS: A total of 102 patients were divided two groups in this prospective, clinical trial. Group A had received 2 g of ascorbic acid during a myomectomy, and group B had a myomectomy without any interventions. The operative time, blood loss, days of hospitalization, post-operative complications and rate of blood transfusions were compared between the two groups. RESULTS: The blood loss (521.44 ± 199.24 vs. 932.9 ± 264.38 ml; p value <0.001), duration of the operation time (42 ± 13.9 vs. 68 ± 21.7 min; p value <0.001), days of hospitalization (2.7 ± 0.69 vs. 3.1 ± 0.59 days; p value 0.002) in group A were significantly less than in group B (p value 0.001). The chance risk ratio of a blood transfusion in group A was 0.4 (7.7 vs. 18% 95% CI of 0.1-1; p value 0.07). There was a significant correlation between the volume of bleeding and post-operative complications in both groups (p value in group A = 0.03; in group B = 0.004). CONCLUSION: The administration of ascorbic acid (vitamin C) in abdominal myomectomy could reduce the blood loss during the procedure, operation time and days of hospitalization.

Follicular dynamic and immunoreactions of the vitrified ovarian graft after host treatment with variable regimens of melatonin.

PROBLEM: This study investigates dose-dependent effects of melatonin on ovarian graft. METHOD OF STUDY: Vitrified-thawed whole ovaries of newborn mice were grafted into ovariectomized mature ones. Melatonin (20, 50, 100, and 200 mg/kg/day) was administrated to separate groups of host mice for 32 days. IgM and IgG antibodies, Th1 and Th2 cytokines, and melatonin in recipient's blood were measured. Subsequent survival of the grafted ovaries was scored. An assessment of follicular morphology was performed using TUNEL assay and hematoxylin-eosin staining. RESULTS: The administration of melatonin did not disturb the circadian rhythm of melatonin concentration. The ovarian graft lifespan was prolonged at 200 mg/kg/day melatonin (P < 0.001). However, in doses of higher than 20 mg/kg/day melatonin, the proportion of healthy follicles and ovary size decreased. Th1 cytokines levels were reduced dose dependently. However, the effect of melatonin on Th2 cytokines was not pronounced. IgM and IgG2a decreased in recipients receiving 200 mg/kg/day melatonin in comparison with non-treated group (P < 0.001), while this variables were significantly increased at the dose of 50 mg/kg/day (P < 0.001). CONCLUSION: Melatonin at 200 mg/kg/day has an immunosuppresent effect and produce prolongation of graft survival. However, the associated reduction in healthy follicles suggests that melatonin in doses of higher than 20 mg/kg/day has no preventative ischemic action.