Diagnostic Value of Progesterone Level and Progesterone/Estradiol Ration on the Day of hCG Administration

To the Editor:

Since the progesterone levels are related to serum estradiol levels, the use of the P/E ratio was proposed for the diagnosis of early luteinization, because it provided the best indicators in the ROC curve and logistics regression models. The poor response of the isolated determination of progeste-rone in these models is due to the fact that only excessive levels are associated to a detriment in the pregnancy rate, while in the rest of the spectrum both pregnancy rate and progesterone levels are associated positively. By contrast, the P/E ratio maintains a nearly constant negative relationship between its values and the pregnancy rate.

Five-day anastrozole in infertility needs supplemental hCG

To the Editor:

I read with great interest the article by Tredway D et al. (1), in which they concluded that “in terms of ovulation rates, 5-day anastrozole at 1,5, and 10 mg/d was less effective than CC at 50mg/d for cycle 1”. They have done a good work.

However, surprisingly, the ovulation rates for anastrozole groups were obviously low. In their Results Section, they mentioned that “most patients receiving anastrozole 1 mg/d (72.7%) and 5 mg/d (73.5%) achieved monofollicular development (one follicle ≥ 17 mm in diameter), compared with 70.4% of patients receiving CC”. We argue that monofollicular development (one follicle ≥ 17 mm in diameter) rates were similar between anastrozole and CC, why was ovulation rates difference so significant (the ovulation rates for anastrozole at 1, 5, and 10 mg/d were 30.4%, 36.8% and 35.9%, respectively, compared with 64.9% for CC at 50 mg/d)?

We believe that it is due to lack of supplemental hCG.

Ovarian reserve and oocyte maturity in cancer patients

To the Editor:

With great interest we read the article on ovarian reserve and oocyte maturity in cancer patients undergoing in vitro maturation treatment (IVM) by Moria et al. (1). Detailed information concerning this topic is of great value to doctors counselling cancer patients with regard to their wish to conceive in the (near) future.

The authors studied ovarian reserve and oocyte maturity in cancer patients in comparison to infertile patients (1). We wonder whether it is correct to compare cancer patients to infertile patients. Ideally, one would like to compare to healthy subjects to investigate the effect of cancer on fertility. We are aware that it would be ethically impossible to acquire these parameters on a group of fertile individuals as they would have to undergo unnecessary IVM. However, a viable solution to this problem would be to compare cancer patients with couples who are infertile due to an andrological factor.

To add GnRH antagonists to controlled ovarian stimulation in management of subfertile couples with IUI may not have additional effect in terms of clinical pregnancy rates

I read with interest the article published in your journal by Bakas et.al. (1).
The authors said that in the GnRH antagonist group, when the leading follicle had reached a mean diameter of ≥ 16 mm, 0.25 mg ganirelix was started. Why did authors choose a mean diameter of 18 mm to start of antagonist? It can be argued that when GnRH antagonists were first administered, premature elevation in LH had already occurred. In actuality we could not measure serum progesterone and LH serially. Therefore, the intervention may have been too late. In Lamback’s study, when GnRH anatgonist started at a dominant follicle, premature luteinization was detected in 3.4% of the cycles (2). Furthermore, it has been reported that almost 50% of the cycles that showed a premature LH elevation had dominant follicles that were 16.5 mm or smaller (3).

Rat serum albumin is not equal to human serum albumin

To the Editor:

We read with great interest the recently published article by Kutlu et al. (1). In the article, the authors showed that rats that had been operated to produce testicular torsion had a higher level of ischemia-modified albumin 4 hours after the onset of the disorder. The authors highlighted that although the blood and tissue MDA and MPO levels showed no difference between groups, the ischemia-modified albumin levels showed significant a difference in 4-hour torsion group compared with other groups. The results derived from the animal study showed a high level of ischemia-modified albumin in testicular torsion (TT), indicating a potential value for TT diagnosis, and the value of ischemia-modified albumin level in TT should be investigated with respect to prognosis.

Discussion on letrozole-Gn-antagonist group needing an early start of antagonist

To the Editor:

I read with great interest the article by Elassar et al. (1) in which they addressed the risk of a premature luteinizing hormone (LH) surge (LH ≥ 10 mIU/mL occurring before the detection of the leading follicle ≥ 18 mm in diameter) in letrozole-gonadotropin (Gn)-antagonist group and suggested that “an early start and possibly a higher dose of the antagonist should be considered when using letrozole.” This is a good concept. But they did not explore the cause. They mentioned “ovaries with diminished ovarian reserve are more prone to a premature LH surge.” However, it is not the cause leading to the high rate of premature LH surge associated with letrozole supplementation.