RESUMEN
BACKGROUND: Pregnancy rates among infertile women have been reported to increase after hysterosalpingography, but it is unclear whether the type of contrast medium used (oil-based or water-soluble contrast) influences this potential therapeutic effect. METHODS: We performed a multicenter, randomized trial in 27 hospitals in the Netherlands in which infertile women who were undergoing hysterosalpingography were randomly assigned to undergo this procedure with the use of oil-based or water-based contrast. Subsequently, couples received expectant management or the women underwent intrauterine insemination. The primary outcome was ongoing pregnancy within 6 months after randomization. Outcomes were analyzed according to the intention-to-treat principle. RESULTS: A total of 1119 women were randomly assigned to hysterosalpingography with oil contrast (557 women) or water contrast (562 women). A total of 220 of 554 women in the oil group (39.7%) and 161 of 554 women in the water group (29.1%) had an ongoing pregnancy (rate ratio, 1.37; 95% confidence interval [CI], 1.16 to 1.61; P<0.001), and 214 of 552 women in the oil group (38.8%) and 155 of 552 women in the water group (28.1%) had live births (rate ratio, 1.38; 95% CI, 1.17 to 1.64; P<0.001). Rates of adverse events were low and similar in the two groups. CONCLUSIONS: Rates of ongoing pregnancy and live births were higher among women who underwent hysterosalpingography with oil contrast than among women who underwent this procedure with water contrast. (Netherlands Trial Register number, NTR3270 .).
Asunto(s)
Medios de Contraste , Histerosalpingografía/métodos , Infertilidad Femenina/diagnóstico por imagen , Aceites , Índice de Embarazo , Agua , Adulto , Femenino , Humanos , Nacimiento Vivo , Embarazo , Adulto JovenRESUMEN
BACKGROUND: The aim of the study was to elucidate the relationship between growth hormone (GH) secretion and insulin resistance in polycystic ovary syndrome (PCOS) patients. In order to exclude the influence of obesity on these parameters, only non-obese PCOS patients were studied. METHODS: Eleven PCOS patients and 11 controls with a body mass index (BMI) = 25 kg/m2 were studied. PCOS patients were studied on cycle day 14-15, controls on cycle day 5-9. GH secretion was determined by frequent sampling, from 20.00 h to 08.00 h. Insulin sensitivity was determined by a euglycaemic hyperinsulinaemic clamp and was expressed as the M-value. Insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) levels were determined once. RESULTS: Pooled GH levels were significantly lower in PCOS patients than controls, as was GH pulse amplitude. The number of GH pulses was not different between PCOS patients and controls. The M-value was significantly lower in PCOS patients, although a wide overlap between patients and controls was present. IGF-1 and IGFBP-3 levels were not different between the groups. There was no correlation between the M-value and pooled GH or IGF-1 and IGFBP-3 levels. CONCLUSION: Non-obese patients with PCOS have impaired GH secretion and some but not all have impaired insulin sensitivity. These findings indicate that these patients may also be at risk for cardiovascular diseases and/or diabetes mellitus.