Comparison of four different treatment regimes in hirsutism related to polycystic ovary syndrome

Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome. Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 patients were included in the study. Patients were divided into four groups in regard to the drug chosen for treatment. Group 1 (n = 48) received low-dose combined oral contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate, Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily). All patients were followed frequently with respect to side-effects, hirsutism scoring, and lipid and hormonal levels. All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole. The decrement level in hirsutism scoring was the largest in the ketoconazole group, followed by the cyproterone, oral contraceptive and spironolactone groups (34.6 ± 2.2%, 20.1 ± 2.7%, 18.1 ± 2.7% and 12.8 ± 3.7%, respectively, p < 0.05). Although high-density lipoprotein-cholesterol levels increased in all groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 ± 2.8%, 34.1 ± 5.5% and 29.1 ± 4.9%, respectively, p < 0.05), but not statistically different from that in Group 3 (22.3 ± 5.9%). The free testosterone levels decreased after treatment in all groups, but the decrement ratios did not differ significantly among groups, although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 ± 2.5%, 22.7 ± 10.2%, 26.7 ± 6.5% and 9.5 ± 19.9%, respectively). In conclusion, ketoconazole seems to be an excellent alternative to more-recognized therapies, but its effect on lipoprotein profile requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also be treated

Do the suppression criteria in gnRH-a cycles predict in vitro fertilization outcome?

The addition of gonadotropin releasing hormone analog (GnRH-a) to controlled ovarian hyperstimulation regimes has been reported to have several advantages, such as reduced cancellation rate, fewer premature luteinizations and increased clinical pregnancy rate. The aim of this study was to determine the effect of pituitary/ovarian suppression, in terms of the levels of luteinizing hormone (LH), estradiol and follicle stimulating hormone (FSH), and the duration of GnRH-a administration, on in vitro fertilization (IVF) outcome. Retrospectively, 153 IVF cycles with GnRH-a and human menopausal gonadotropin (hMG) were examined. After a minimum of 10 days of GnRH-a administration, the patients were started on hMG. The correlations were investigated between the fertilization rates, the numbers of retrieved oocytes and transferred embryos, the cancellation rates, the suppressed LH, FSH and estradiol levels, the total ampules of hMG used and the duration of GnRH-a usage. The duration of GnRH-a usage and the total ampules of hMG used were not correlated. The number of oocytes retrieved and total number of hMG ampules used showed weak correlations with suppressed levels of FSH (-0.297 and 0.285, respectively). However, the fertilization cleavage and pregnancy rates did not correlate with the LH, FSH and estradiol levels on hMG start days. In conclusion, for selected cases, 10 days of GnRH-a administration is sufficient to suppress endogenous gonadotropin levels. Since FSH and LH are protein hormones and their bioactivity may change in a manner that is unrelated to their immunological levels, it is not necessary to measure FSH, LH and estradiol levels to detect whether suppression is adequate. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted

Local Perceptions of Forest Certification in State-Based Forest Enterprises

Forest management certification plays a supportive role in the realization of wood production by evaluating social, economic and ecological objectives. This study analyzed the changes in the perceptions, views and expectations with respect to forest management certification held by those who live on forest land in Turkey, known as forest peasants, according to their education level, age and their engagement in forestry activities. The study was conducted at the Kastamonu Regional Directorate of Forestry located in northwestern Turkey. Data were collected using face-to-face survey with 407 forest peasants who randomly selected. In addition to the descriptive statistics, Kruskal–Wallis and Mann–Whitney U tests were used to analyze whether there were any significant differences among the views depending on the locals’ education level, age and their engagement in forestry activities. The results showed that forest peasants generally knew what certification was. The forest peasants stated that certification has benefits for occupational health and safety. However, they also stated that there had not been any significant increase in forestry worker wages or the price of forest products, that there had not been any noticeable difference in the forest administration’s forestry activities, and that the principles of participatory forest management had not been applied efficiently and effectively following certification. © 2018, Steve Harrison, John Herbohn