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Li Zhang - One of the best experts on this subject based on the ideXlab platform.
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transvaginal ultrasound guided ovarian interstitial laser treatment in anovulatory women with Clomifene Citrate resistant polycystic ovary syndrome
Fertility and Sterility, 2007Co-Authors: Xuemei Li, Xiumin Chen, Li ZhangAbstract:WJ Zhu,a XM Li,a XM Chen,a Z Lin,b L Zhangc a Department of Reproductive Health bDepartment of Gynecology cDepartment of Central Laboratory, ShenZhen Maternity and Child Healthcare Hospital, ShenZhen, China Correspondence: Dr WJ Zhu, Department of Reproductive Health, ShenZhen Maternity and Child Healthcare Hospital, No. 3012# Fuqiang Road, Shenzhen 518048, Guangdong Province, China. Email zhuwenjie542004@yahoo.com.cn
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transvaginal ultrasound guided ovarian interstitial laser treatment in anovulatory women with Clomifene Citrate resistant polycystic ovary syndrome
British Journal of Obstetrics and Gynaecology, 2006Co-Authors: Xuemei Li, Xiumin Chen, Li ZhangAbstract:Objective To assess the effectiveness of transvaginal, ultrasound-guided, ovarian, interstitial laser coagulation treatment in anovulatory women with polycystic ovary syndrome (PCOS). Design A pilot study. Setting Assisted reproductive technology unit. Sample Twenty-three anovulatory women with Clomifene-Citrate-resistant PCOS. Methods Ultrasound-guided, transvaginal, ovarian, interstitial yttrium-aluminium-garnet laser treatment. Main outcome measures Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin and estradiol levels, spontaneous ovulation rate and pregnancy rate were measured over 6 months of follow up. Results Regular ovulation occurred in 19 out of 22 (86.4%) women in the 6 months following ovarian treatment (one woman was lost to follow up). On the postoperative second, fourth and sixth month, the mean serum LH levels were 4.54 SD 1.21 iu/l, 4.90 SD 2.18 iu/l and 4.42 SD 1.03 iu/l, significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative level of 13.89 ± 3.62 iu/l; the mean serum testosterone levels were 2.69 SD 1.83 nmol/l, 2.42 SD 1.11 nmol/l and 2.28 SD 1.96 nmol/l and significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative baseline value of 5.37 SD 3.09 nmol/l; the mean LH/FSH ratios of 0.93 SD 0.26, 0.88 SD 0.17 and 0.81 SD 0.14 were also significantly lower than the preoperative value of 2.78 SD 1.21 (P < 0.001). Pregnancy occurred in eight women and there was a cumulative pregnancy rate at 6 months of 36% (8/22) among the subjects. There were no significant operative complications. Conclusion Ultrasound-guided, transvaginal, ovarian, interstitial laser treatment appears effective in improving hormonal profiles and inducing ovulation and successful pregnancy in women with Clomifene-resistant PCOS.
J Burrage - One of the best experts on this subject based on the ideXlab platform.
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Clomifene Citrate and intrauterine insemination as first line treatments for unexplained infertility are they cost effective
Human Reproduction, 2011Co-Authors: Sarah Wordsworth, Kirsten Harrild, Jill Mollison, A Harrold, D Mcqueen, H Lyall, L Johnston, J Buchanan, L M Robertson, J BurrageAbstract:background: First-line treatments for unexplained infertility traditionally include Clomifene Citrate (CC) or unstimulated intrauterine insemination (IUI). A recently published randomized controlled trial considered the effectiveness of CC and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management (EM). This paper reports the economic evaluation conducted alongside this trial in order to assess whether health care providers are gaining value for money in this clinical area. methods: Five hundred and eighty women across five Scottish hospitals were randomized to either EM, CC or IUI for 6 months. The primary outcome measure was live births. Resource-use data were collected during the trial and costs were calculated from a UK National Health Service (NHS) perspective. Incremental cost–effectiveness ratios were calculated, expressed as cost per live birth, in order to compare the cost–effectiveness of CC and IUI with that of EM to treat unexplained infertility. results: Live birth rates in the three randomized groups were: EM ¼ 32/193 (17%), CC ¼ 26/194 (13%) and IUI ¼ 43/193 (22%). The mean (standard deviation) costs per treatment cycle were £0 for EM, £83 (£17) for CC and £98 (£31) for IUI. The mean treatment costs per patient for EM, CC and IUI were £12 (£117), £350 (£220) and £331 (£222), respectively. The cost per live birth for EM, CC and IUI was £72 (95% confidence interval £0–£206), £2611 (£1870–£4166) and £1487 (£1116 –£2155), respectively. The incremental cost–effectiveness ratio for IUI versus EM was £5604 (2£12204 to £2227), with CC dominated by IUI. conclusions: Despite being more expensive, existing treatments such as empirical CC and unstimulated IUI do not offer superior live birth rates compared with EM of unexplained infertility. They are unlikely to be a cost-effective use of limited NHS resources. The study’s main limitation is that it did not consider the psychological effects on couples. ISRCT Number: 71762042.
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Clomifene Citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial
BMJ, 2008Co-Authors: Sohinee Bhattacharya, Kirsten Harrild, Jill Mollison, Sarah Wordsworth, A Harrold, D Mcqueen, H Lyall, L Johnston, J BurrageAbstract:Objective To compare the effectiveness of Clomifene Citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. Design Three arm parallel group, pragmatic randomised controlled trial. Setting Four teaching hospitals and a district general hospital in Scotland. Participants Couples with infertility for over two years, confirmed ovulation, patent fallopian tubes, and motile sperm. Intervention Expectant management, oral Clomifene Citrate, and unstimulated intrauterine insemination. Main outcome measures The primary outcome was live birth. Secondary outcome measures included clinical pregnancy, multiple pregnancy, miscarriage, and acceptability. Results 580 women were randomised to expectant management (n=193), oral Clomifene Citrate (n=194), or unstimulated intrauterine insemination (n=193) for six months. The three randomised groups were comparable in terms of age, body mass index, duration of infertility, sperm concentration, and motility. Live birth rates were 32/193 (17%), 26/192 (14%), and 43/191 (23%), respectively. Compared with expectant management, the odds ratio for a live birth was 0.79 (95% confidence interval 0.45 to 1.38) after Clomifene Citrate and 1.46 (0.88 to 2.43) after unstimulated intrauterine insemination. More women randomised to Clomifene Citrate (159/170, 94%) and unstimulated intrauterine insemination (155/162, 96%) found the process of treatment acceptable than those randomised to expectant management (123/153, 80%) (P=0.001 and P
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Clomifene Citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility pragmatic randomised controlled trial
BMJ, 2008Co-Authors: Sohinee Bhattacharya, Kirsten Harrild, Jill Mollison, Sarah Wordsworth, A Harrold, D Mcqueen, H Lyall, L Johnston, J Burrage, S GrossettAbstract:Objective To compare the effectiveness of Clomifene Citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. Design Three arm parallel group, pragmatic randomised controlled trial. Setting Four teaching hospitals and a district general hospital in Scotland. Participants Couples with infertility for over two years, confirmed ovulation, patent fallopian tubes, and motile sperm. Intervention Expectant management, oral Clomifene Citrate, and unstimulated intrauterine insemination. Main outcome measures The primary outcome was live birth. Secondary outcome measures included clinical pregnancy, multiple pregnancy, miscarriage, and acceptability. Results 580 women were randomised to expectant management (n=193), oral Clomifene Citrate (n=194), or unstimulated intrauterine insemination (n=193) for six months. The three randomised groups were comparable in terms of age, body mass index, duration of infertility, sperm concentration, and motility. Live birth rates were 32/193 (17%), 26/192 (14%), and 43/191 (23%), respectively. Compared with expectant management, the odds ratio for a live birth was 0.79 (95% confidence interval 0.45 to 1.38) after Clomifene Citrate and 1.46 (0.88 to 2.43) after unstimulated intrauterine insemination. More women randomised to Clomifene Citrate (159/170, 94%) and unstimulated intrauterine insemination (155/162, 96%) found the process of treatment acceptable than those randomised to expectant management (123/153, 80%) (P=0.001 and P<0.001, respectively). Conclusion In couples with unexplained infertility existing treatments such as empirical Clomifene and unstimulated intrauterine insemination are unlikely to offer superior live birth rates compared with expectant management. Trial registration ISRCT No: 71762042
Xuemei Li - One of the best experts on this subject based on the ideXlab platform.
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transvaginal ultrasound guided ovarian interstitial laser treatment in anovulatory women with Clomifene Citrate resistant polycystic ovary syndrome
Fertility and Sterility, 2007Co-Authors: Xuemei Li, Xiumin Chen, Li ZhangAbstract:WJ Zhu,a XM Li,a XM Chen,a Z Lin,b L Zhangc a Department of Reproductive Health bDepartment of Gynecology cDepartment of Central Laboratory, ShenZhen Maternity and Child Healthcare Hospital, ShenZhen, China Correspondence: Dr WJ Zhu, Department of Reproductive Health, ShenZhen Maternity and Child Healthcare Hospital, No. 3012# Fuqiang Road, Shenzhen 518048, Guangdong Province, China. Email zhuwenjie542004@yahoo.com.cn
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transvaginal ultrasound guided ovarian interstitial laser treatment in anovulatory women with Clomifene Citrate resistant polycystic ovary syndrome
British Journal of Obstetrics and Gynaecology, 2006Co-Authors: Xuemei Li, Xiumin Chen, Li ZhangAbstract:Objective To assess the effectiveness of transvaginal, ultrasound-guided, ovarian, interstitial laser coagulation treatment in anovulatory women with polycystic ovary syndrome (PCOS). Design A pilot study. Setting Assisted reproductive technology unit. Sample Twenty-three anovulatory women with Clomifene-Citrate-resistant PCOS. Methods Ultrasound-guided, transvaginal, ovarian, interstitial yttrium-aluminium-garnet laser treatment. Main outcome measures Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin and estradiol levels, spontaneous ovulation rate and pregnancy rate were measured over 6 months of follow up. Results Regular ovulation occurred in 19 out of 22 (86.4%) women in the 6 months following ovarian treatment (one woman was lost to follow up). On the postoperative second, fourth and sixth month, the mean serum LH levels were 4.54 SD 1.21 iu/l, 4.90 SD 2.18 iu/l and 4.42 SD 1.03 iu/l, significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative level of 13.89 ± 3.62 iu/l; the mean serum testosterone levels were 2.69 SD 1.83 nmol/l, 2.42 SD 1.11 nmol/l and 2.28 SD 1.96 nmol/l and significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative baseline value of 5.37 SD 3.09 nmol/l; the mean LH/FSH ratios of 0.93 SD 0.26, 0.88 SD 0.17 and 0.81 SD 0.14 were also significantly lower than the preoperative value of 2.78 SD 1.21 (P < 0.001). Pregnancy occurred in eight women and there was a cumulative pregnancy rate at 6 months of 36% (8/22) among the subjects. There were no significant operative complications. Conclusion Ultrasound-guided, transvaginal, ovarian, interstitial laser treatment appears effective in improving hormonal profiles and inducing ovulation and successful pregnancy in women with Clomifene-resistant PCOS.
Sarah Wordsworth - One of the best experts on this subject based on the ideXlab platform.
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Clomifene Citrate and intrauterine insemination as first line treatments for unexplained infertility are they cost effective
Human Reproduction, 2011Co-Authors: Sarah Wordsworth, Kirsten Harrild, Jill Mollison, A Harrold, D Mcqueen, H Lyall, L Johnston, J Buchanan, L M Robertson, J BurrageAbstract:background: First-line treatments for unexplained infertility traditionally include Clomifene Citrate (CC) or unstimulated intrauterine insemination (IUI). A recently published randomized controlled trial considered the effectiveness of CC and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management (EM). This paper reports the economic evaluation conducted alongside this trial in order to assess whether health care providers are gaining value for money in this clinical area. methods: Five hundred and eighty women across five Scottish hospitals were randomized to either EM, CC or IUI for 6 months. The primary outcome measure was live births. Resource-use data were collected during the trial and costs were calculated from a UK National Health Service (NHS) perspective. Incremental cost–effectiveness ratios were calculated, expressed as cost per live birth, in order to compare the cost–effectiveness of CC and IUI with that of EM to treat unexplained infertility. results: Live birth rates in the three randomized groups were: EM ¼ 32/193 (17%), CC ¼ 26/194 (13%) and IUI ¼ 43/193 (22%). The mean (standard deviation) costs per treatment cycle were £0 for EM, £83 (£17) for CC and £98 (£31) for IUI. The mean treatment costs per patient for EM, CC and IUI were £12 (£117), £350 (£220) and £331 (£222), respectively. The cost per live birth for EM, CC and IUI was £72 (95% confidence interval £0–£206), £2611 (£1870–£4166) and £1487 (£1116 –£2155), respectively. The incremental cost–effectiveness ratio for IUI versus EM was £5604 (2£12204 to £2227), with CC dominated by IUI. conclusions: Despite being more expensive, existing treatments such as empirical CC and unstimulated IUI do not offer superior live birth rates compared with EM of unexplained infertility. They are unlikely to be a cost-effective use of limited NHS resources. The study’s main limitation is that it did not consider the psychological effects on couples. ISRCT Number: 71762042.
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Clomifene Citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective?
Human Reproduction, 2010Co-Authors: Sarah Wordsworth, Kirsten Harrild, Jill Mollison, A Harrold, D Mcqueen, H Lyall, J Buchanan, L M Robertson, L JohnstonAbstract:BACKGROUNDFirst-line treatments for unexplained infertility traditionally include Clomifene Citrate (CC) or unstimulated intrauterine insemination (IUI). A recently published randomized controlled trial considered the effectiveness of CC and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management (EM). This paper reports the economic evaluation conducted alongside this trial in order to assess whether health care providers are gaining value for money in this clinical area.METHODSFive hundred and eighty women across five Scottish hospitals were randomized to either EM, CC or IUI for 6 months. The primary outcome measure was live births. Resource-use data were collected during the trial and costs were calculated from a UK National Health Service (NHS) perspective. Incremental costeffectiveness ratios were calculated, expressed as cost per live birth, in order to compare the costeffectiveness of CC and IUI with that of EM to treat unexplained infertility.RESULTSLive birth rates in the three randomized groups were: EM 32/193 (17), CC 26/194 (13) and IUI 43/193 (22). The mean (standard deviation) costs per treatment cycle were £0 for EM, £83 (£17) for CC and £98 (£31) for IUI. The mean treatment costs per patient for EM, CC and IUI were £12 (£117), £350 (£220) and £331 (£222), respectively. The cost per live birth for EM, CC and IUI was £72 (95 confidence interval £0£206), £2611 (£1870£4166) and £1487 (£1116£2155), respectively. The incremental costeffectiveness ratio for IUI versus EM was £5604 (-£12204 to £2227), with CC dominated by IUI.CONCLUSIONSDespite being more expensive, existing treatments such as empirical CC and unstimulated IUI do not offer superior live birth rates compared with EM of unexplained infertility. They are unlikely to be a cost-effective use of limited NHS resources. The studys main limitation is that it did not consider the psychological effects on couples. © 2010 The Author.
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Clomifene Citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial
BMJ, 2008Co-Authors: Sohinee Bhattacharya, Kirsten Harrild, Jill Mollison, Sarah Wordsworth, A Harrold, D Mcqueen, H Lyall, L Johnston, J BurrageAbstract:Objective To compare the effectiveness of Clomifene Citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. Design Three arm parallel group, pragmatic randomised controlled trial. Setting Four teaching hospitals and a district general hospital in Scotland. Participants Couples with infertility for over two years, confirmed ovulation, patent fallopian tubes, and motile sperm. Intervention Expectant management, oral Clomifene Citrate, and unstimulated intrauterine insemination. Main outcome measures The primary outcome was live birth. Secondary outcome measures included clinical pregnancy, multiple pregnancy, miscarriage, and acceptability. Results 580 women were randomised to expectant management (n=193), oral Clomifene Citrate (n=194), or unstimulated intrauterine insemination (n=193) for six months. The three randomised groups were comparable in terms of age, body mass index, duration of infertility, sperm concentration, and motility. Live birth rates were 32/193 (17%), 26/192 (14%), and 43/191 (23%), respectively. Compared with expectant management, the odds ratio for a live birth was 0.79 (95% confidence interval 0.45 to 1.38) after Clomifene Citrate and 1.46 (0.88 to 2.43) after unstimulated intrauterine insemination. More women randomised to Clomifene Citrate (159/170, 94%) and unstimulated intrauterine insemination (155/162, 96%) found the process of treatment acceptable than those randomised to expectant management (123/153, 80%) (P=0.001 and P
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Clomifene Citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility pragmatic randomised controlled trial
BMJ, 2008Co-Authors: Sohinee Bhattacharya, Kirsten Harrild, Jill Mollison, Sarah Wordsworth, A Harrold, D Mcqueen, H Lyall, L Johnston, J Burrage, S GrossettAbstract:Objective To compare the effectiveness of Clomifene Citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. Design Three arm parallel group, pragmatic randomised controlled trial. Setting Four teaching hospitals and a district general hospital in Scotland. Participants Couples with infertility for over two years, confirmed ovulation, patent fallopian tubes, and motile sperm. Intervention Expectant management, oral Clomifene Citrate, and unstimulated intrauterine insemination. Main outcome measures The primary outcome was live birth. Secondary outcome measures included clinical pregnancy, multiple pregnancy, miscarriage, and acceptability. Results 580 women were randomised to expectant management (n=193), oral Clomifene Citrate (n=194), or unstimulated intrauterine insemination (n=193) for six months. The three randomised groups were comparable in terms of age, body mass index, duration of infertility, sperm concentration, and motility. Live birth rates were 32/193 (17%), 26/192 (14%), and 43/191 (23%), respectively. Compared with expectant management, the odds ratio for a live birth was 0.79 (95% confidence interval 0.45 to 1.38) after Clomifene Citrate and 1.46 (0.88 to 2.43) after unstimulated intrauterine insemination. More women randomised to Clomifene Citrate (159/170, 94%) and unstimulated intrauterine insemination (155/162, 96%) found the process of treatment acceptable than those randomised to expectant management (123/153, 80%) (P=0.001 and P<0.001, respectively). Conclusion In couples with unexplained infertility existing treatments such as empirical Clomifene and unstimulated intrauterine insemination are unlikely to offer superior live birth rates compared with expectant management. Trial registration ISRCT No: 71762042
Xiumin Chen - One of the best experts on this subject based on the ideXlab platform.
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transvaginal ultrasound guided ovarian interstitial laser treatment in anovulatory women with Clomifene Citrate resistant polycystic ovary syndrome
Fertility and Sterility, 2007Co-Authors: Xuemei Li, Xiumin Chen, Li ZhangAbstract:WJ Zhu,a XM Li,a XM Chen,a Z Lin,b L Zhangc a Department of Reproductive Health bDepartment of Gynecology cDepartment of Central Laboratory, ShenZhen Maternity and Child Healthcare Hospital, ShenZhen, China Correspondence: Dr WJ Zhu, Department of Reproductive Health, ShenZhen Maternity and Child Healthcare Hospital, No. 3012# Fuqiang Road, Shenzhen 518048, Guangdong Province, China. Email zhuwenjie542004@yahoo.com.cn
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transvaginal ultrasound guided ovarian interstitial laser treatment in anovulatory women with Clomifene Citrate resistant polycystic ovary syndrome
British Journal of Obstetrics and Gynaecology, 2006Co-Authors: Xuemei Li, Xiumin Chen, Li ZhangAbstract:Objective To assess the effectiveness of transvaginal, ultrasound-guided, ovarian, interstitial laser coagulation treatment in anovulatory women with polycystic ovary syndrome (PCOS). Design A pilot study. Setting Assisted reproductive technology unit. Sample Twenty-three anovulatory women with Clomifene-Citrate-resistant PCOS. Methods Ultrasound-guided, transvaginal, ovarian, interstitial yttrium-aluminium-garnet laser treatment. Main outcome measures Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin and estradiol levels, spontaneous ovulation rate and pregnancy rate were measured over 6 months of follow up. Results Regular ovulation occurred in 19 out of 22 (86.4%) women in the 6 months following ovarian treatment (one woman was lost to follow up). On the postoperative second, fourth and sixth month, the mean serum LH levels were 4.54 SD 1.21 iu/l, 4.90 SD 2.18 iu/l and 4.42 SD 1.03 iu/l, significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative level of 13.89 ± 3.62 iu/l; the mean serum testosterone levels were 2.69 SD 1.83 nmol/l, 2.42 SD 1.11 nmol/l and 2.28 SD 1.96 nmol/l and significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative baseline value of 5.37 SD 3.09 nmol/l; the mean LH/FSH ratios of 0.93 SD 0.26, 0.88 SD 0.17 and 0.81 SD 0.14 were also significantly lower than the preoperative value of 2.78 SD 1.21 (P < 0.001). Pregnancy occurred in eight women and there was a cumulative pregnancy rate at 6 months of 36% (8/22) among the subjects. There were no significant operative complications. Conclusion Ultrasound-guided, transvaginal, ovarian, interstitial laser treatment appears effective in improving hormonal profiles and inducing ovulation and successful pregnancy in women with Clomifene-resistant PCOS.