1. Tamoxifen and clomiphene citrate for ovulation induction – a metaanalysis
   
2. Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermia
   

Gynaecology

3. Estrogen increases collagen I and III mRNA expression in the pelvic support tissues of the rhesus macaque.
   

Gynaecologic Oncology

4. Duration of human chorionic gonadotropin surveillance for partial hydatidiform moles
   

1. Tamoxifen and clomiphene citrate for ovulation induction

Both selective estrogen receptor modulators, tamoxifen and clomiphene have been used for ovulation induction for patients with anovulatory infertility. This meta-analysis sought to compare the effectiveness of tamoxifen to clomiphene for the induction of ovulation and achievement of pregnancy. MEDLINE, BIOSIS, PreMEDLINE, CINAHL, International Pharmaceutical Abstracts, DDSR, ACP Journal Club, DARE and CCTR, along with reference lists and national experts were searched. Inclusion criteria were prospective clinical trials, which compared tamoxifen and clomiphene for ovulation induction in infertile couples with isolated anovulatory infertility. Main outcome measures were ovulation rate and clinical pregnancy rate. Pooled odds ratios were obtained using random effects meta-analysis. Four trials were included. After pooling all the trials, the use of tamoxifen or clomiphene citrate resulted in similar ovulation rates [odds ratio (OR) 0.755, 95% confidence interval (CI) 0.513-1.111]. There was no benefit of tamoxifen over clomiphene citrate in achievement of pregnancy per cycle (OR 1.056, 95% CI 0.583-1.912) or per ovulatory cycle (OR 1.162, 95% CI 0.632-2.134). It is concluded that Clomiphene citrate and tamoxifen are equally effective in inducing ovulation. Although data regarding pregnancy rates and outcome are limited, there does not appear to be a significant benefit of one medication over the other.

Reference

Steiner AZ, Terplan M, Paulson RJ. Comparison of tamoxifen and clomiphene citrate for ovulation induction: a meta-analysis. Hum Reprod. 2005 Jun;20(6):1511-5.

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2. Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermia

A retrospective study was performed to assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa from different types of azoospermia. Two hundred twelve patients underwent 257 ICSI cycles. Cycles of ICSI were divided into four groups according to the etiology of azoospermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular sperm aspiration and percutaneous epididymal sperm aspiration were the sperm retrieval methods used for ICSI. Fertilization, pregnancy, and miscarriage rates. Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). CONCLUSION(S): Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal sperm was used compared with testicular sperm.

Reference

Pasqualotto FF, Rossi LM, Guilherme P, Ortiz V, Iaconelli A Jr, Borges E Jr. Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermic patients. Fertil Steril. 2005 Mar;83(3):606-11.

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3. Estrogen increases collagen I and III mRNA expression in the pelvic support tissues of the rhesus macaque.

Aimed was to study the effect of estradiol and raloxifene on collagen synthesis, by measuring the expression collagen I and III mRNA. Nineteen nulliparous young adult rhesus macaques underwent oophorectomy and were treated for 5 months with estradiol alone, raloxifene, or no hormone. Tissue samples were acquired from the lateral vaginal wall, and included the paravaginal attachment and levator ani muscle. Expression of mRNA for collagen I and III was measured by in situ hybridization. Estradiol increased mRNA for collagen I and III compared with no hormone and raloxifene treatment (ANOVA, P < .05). Collagen mRNA was localized to fibroblasts in the vaginal connective tissue and the connective tissue investments of striated muscle. Collagen mRNA was not expressed in epithelial, smooth, and striated muscle cells. The data show that estrogen, but not raloxifene, increases collagen gene transcription and indicates stimulation of collagen synthesis in pelvic floor connective tissues.

Reference

Clark AL, Slayden OD, Hettrich K, Brenner RM. Estrogen increases collagen I and III mRNA expression in the pelvic support tissues of the rhesus macaque. Am J Obstet Gynecol. 2005 May;192(5):1523-9.

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4. Duration of human chorionic gonadotropin surveillance for partial hydatidiform moles.

Partial hydatidiform moles infrequently progress to gestational trophoblastic neoplasia. The purpose of this study was to determine the optimal duration of human chorionic gonadotropin surveillance. Therefore, the clinical follow-up of all women who were diagnosed with partial hydatidiform mole at our institution from 1983 to 2003 were retrospectively reviewed. One hundred sixty-three patients were identified with a median age of 23 years (range, 14-42 years). Seventy-four patients (45%) attained undetectable levels of human chorionic gonadotropin; none of the patients had gestational trophoblastic neoplasia. Forty patients completed the 6 months of recommended follow-up; 6 patients conceived during surveillance, and 28 patients did not return for any further office visits 1 to 5 months after achieving remission. Eighty-three patients (51%) were lost to follow-up before normalization of human chorionic gonadotropin. Six women (4%) had stage I gestational trophoblastic neoplasia during surveillance. Our results support the suggestion that a single undetectable human chorionic gonadotropin level after evacuation is sufficient follow-up to ensure remission in patients with partial hydatidiform moles.

Reference

Lavie I, Rao GG, Castrillon DH, Miller DS, Schorge JO. Duration of human chorionic gonadotropin surveillance for partial hydatidiform moles. Am J Obstet Gynecol. 2005 May;192(5):1362-4.

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