The Effectiveness of Clomiphene Citrate and Letrozole for Ovulation Induction Related to Endometrial Thickness and Number of Dominant Follicle

The aim of the study is to know the effectiveness of clomiphene citrate and letrozole for ovulationrelated to endometrial thickness and number of dominant follicle. Study design was cross sectional basedon medical records of women who underwent ovulation induction from January 2011-May 2015. A numberof 143 anovulation women were divided into clomiphene citrate 50mg, clomiphene citrate 100 mg, letrozole2.5mg and letrozole 5mg. Each group received the agent daily on 3rd-7th day of menstrual cycle. On 12thday of menstrual cycle, the transvaginal ultrasound was performed to measure endometrial thickness anddominant follicle number. From all subjects, 45 subjects (31.5%) were in 50mg clomiphene citrate groups, 29subjects (20.3%) in 100mg clomiphene citrate group, 23 subjects (16.1%) in 2,5mg letrozole group, and 46subjects (32.2%) in 5mg letrozole group. Subjects who received letrozole had thicker endometrium comparedto clomiphene citrate (p<0.05). Different doses were not associated with endometrial thickness betweensubjects who received either letrozole or clomiphene citrate. In addition, subjects receiving letrozole hadhigher proportion of having trilaminar endometrium morphology. We did not observe the difference in totalnumber of dominant follicle between groups. It is concluded that letrozole is more effective than clomiphenecitrate in terms of endometrial thickness but not for number of dominant follicles

Case Management of Pure Gonadal Dysgenesis 46, XY (Sindrom Swyer)

Disorders of sex development (DSD) are medical conditions in which the development of chromosomal, gonadal or anatomic sex varies from normal and may be incongruent with each other. Swyer syndrome is a condition caused by pure gonadal dysgenesis 46,XY, which followed by inadequate anti-mullerian (AMH) production results in maintenance and further development of mullerian duct into uterus. Therefore, many patients who suffer from this condition initially come with chief complaint of primary amenorrhea with insufficient development of secondary sexual characteristics. Patient’s gender orientation commonly is a female, since her brain was not sufficiently exposed with androgen hormone. Management of DSD patients should be based on patient-centered approach. Therefore, overall management of DSD patients should follow according to patient’s perception regarding to her gender orientation. Herein, we reported a case of Swyer syndrome in female aged 29 years with chief complain primary amenorrhea. Chromosomal analysis was 46,XY (20 mataphase), FSH level was 31.5miu/ml, LH 10.8miu/ml, estradiol (E2) <5pg/ml, testosteron total (T) <0.0025ng/ml. Medical management for this patient has the purpose to drive her feminization process in order to improve her physical appearance. However, since there is a great tisk for having gonadal tumor development from intra-abdominal dysgenetic gonad with Y chromosome, this patient has been strongly suggested to have bilateral gonadectomy.&nbsp

The Effectiveness of Phalleria Macrocarpa Bioactive Fraction in Alleviating Endometriosis And/or Adenomyosis Related Pain

The overexpression of estrogen receptor-beta (ER-ß) and the cyclooxygenase-2 (COX-2) enzyme coupled with the absence of expression of progesterone receptors (PR) is critical to thepathogenesis of endometriosis and adenomyosis associated pain.  DLBS1442, a novel bioactiveextract of Phaleria macrocarpa, exerts its action by downregulating the overexpressed ER-ß andCOX-2 products and up-regulating PR gene expression. This pilot study was conducted to evaluatethe effectiveness of DLBS1442 treatment in alleviating endometriosis- and/or adenomyosis-relatedpain. Ten endometriosis and/or adenomyosis patients were recruited consecutively at YasminClinic Dr. Cipto Mangunkusumo General Hospital in January - March 2013. Pain associated withmenses, including pre-menstrual pain, dysmenorrhea, dyschezia and dysuria, was measuredusing the visual analog scale (VAS) at each of the next three menstrual cycles. Patients reportingone or more pain symptoms with a VAS score = 4 were given 100 mg of DLBS1442 three timesdaily for 12 weeks. VAS score reduction was noted in the first post-treatment menstrual cycle(approximately 5.3 weeks after treatment initiation) and VAS scores continued to decline overthe final two cycles. DLBS1442 was effective in alleviating endometriosis- and/ or adenomyosisrelatedpain, as demonstrated by early pain reduction as evaluated using the VAS