Background and Objectives: Polycystic ovarian syndrome (PCOS) is a widespread endocrine disorder affecting 5–18% of females in their childbearing age. The aim of this study is to assess the efficacy of combining a low dosage of human chorionic gonadotropin (HCG) along with clomiphene citrate (CC) for stimulating ovulation in infertile women diagnosed with CC-resistant PCOS. Materials and Methods: A randomized controlled trial was carried out on 300 infertile CC-resistant PCOS women. All participants were assigned to two groups: the CC-HCG group and the CC-Placebo group. Subjects in the CC-HCG group were given CC (150 mg/day for 5 days starting on the 2nd day of the cycle) and HCG (200 IU/day SC starting on the 7th day of the cycle). Subjects in the CC-Placebo group were given CC and a placebo. The number of ovarian follicles > 18 mm, cycle cancellation rate, endometrial thickness, ovulation rate, clinical pregnancy rate, and occurrence of early ovarian hyper-stimulation syndrome were all outcome variables in the primary research. Results: Data from 138 individuals in the CC-HCG group and 131 participants in the CC-Placebo group were subjected to final analysis. In comparison to the CC-Placebo group, the cycle cancellation rate in the CC-HCG group was considerably lower. The CC-HCG group exhibited a substantial increase in ovarian follicles reaching > 18 mm, endometrial thickness, and ovulation rate. The clinical pregnancy rate was higher in the CC-HCG group (7.2% vs. 2.3%; CC-HCG vs. CC-Placebo). Upon adjusting for BMI and age, the findings of our study revealed that individuals in the CC-HCG group who had serum prolactin levels below 20 (ng/mL), secondary infertility, infertility duration less than 4 years, baseline LH/FSH ratios below 1.5, and serum AMH levels more than 4 (ng/mL) had a higher likelihood of achieving pregnancy. In the CC-Placebo group, there was a greater prediction of clinical pregnancy for those with serum AMH (<4), primary infertility, serum prolactin ≤ 20 (ng/mL), baseline LH/FSH < 1.5, and infertility duration < 4 years. Conclusions: The use of a small dose of HCG along with CC appeared to be an effective treatment in reducing cycle cancelation, improving the clinical pregnancy rate and ovulation rate in CC-resistant PCOS patients. The trial was registered with Clinical Trials.gov, identifier NCT02436226

Objective: Vitamin D (Vit D) deficiency correlates women reproductive pathophysiology. We analyzed Vit D deficiency biomarkers in infertile women. Patients & method: This case-control study enrolled 80 infertile women polycystic ovary syndrome (PCOS), and other etiologies; anovulation and unexplained and 25 controls. Serum calcidiol and calcitriol were determined by ELISA and their direct ratio was calculated. Results: 72% of controls and 92.5% of patients had Vit D deficiency/insufficiency (calcidiol mean ± SDM of 33.50±22.10 vs 20.26±5.226 ng/mL and an AUC of 0.808±0.048). Calcitriol had an AUC of 0.909±0.031 that more effectively distinguished patients and etiologies (53.49±23.30 pg/mL) from controls (114.0±43.20 pg/mL; P<0.001). 4 other etiology cases and 17 controls had calcitriol levels ≥100 pg/mL. 64% of controls (4.090±0.020) and 16.25% of patients [2.634±0.855, P<0.04; 5 PCOS (3 primary/2 secondary), 3 secondary unexplained, and 5 others (one primary tubal, one primary/one secondary peritoneal, one primary/one cervical and one primary tubal had a normal ratio ≥3.333 at an AUC of 0.740±0.065. All biomarkers revealed patient levels ~50% lower than controls; lowest in PCOS and unexplained etiologies. Conclusion: Vit D levels are significantly reduced in infertile women; lowest in PCOS and unexplained etiology, for all biomarkers, where calcitriol was the optimal predictor of both infertility and etiology. Keywords: Female infertility, Polycystic ovary syndrome; unexplained infertility; Vitamin D; 25-Hydroxy-cholecalceferol, 1; 25-Dihydroxyl-cholecalceferol.

Background and Objectives: One of the most widely used reversible contraceptive techniques among women of reproductive age worldwide is oral contraceptives (OCPs). Despite their widespread use, OCPs are associated with increased risks of stroke, yet the extent of awareness of these risks among women remains insufficiently explored. This study aims to evaluate the level of awareness among women resident in Saudi Arabia regarding the potential risk of stroke linked to the use of OCPs. Materials and Methods: A cross-sectional descriptive study was conducted targeting women of reproductive age (18–49 years). Data was collected through an online self-administrated questionnaire distributed via social media platforms, encompassing sociodemographic characteristics, OCP usage patterns, and awareness of stroke risks, perceived side effects of OCPs, symptoms of stroke, and methods to reduce stroke incidence. Statistical analysis was performed using SPSS version 23, with descriptive statistics for categorical data and chi-square tests to assess associations. Results: A total of 516 women participated in the study. Of these, 148, or over a quarter (28.7%), of the participants reported using oral contraceptive pills; 86, or more than half (58%), who use OCPs are not sure what type of OCPs they use; 60, or over half of the participants (40.5%), have been using for less than a year. Over two thirds of the participants (350, 67.8%) are not aware that using OCP increases the risk of stroke. The most recognized side effect of OCPs use was weight gain (38.2%), while awareness of stroke as a side effect was significantly lower (24.6%). Additionally, 62.8% of respondents identified selecting the appropriate type of contraceptive as the best way to prevent stroke while taking OCPs. Conclusions: this study highlights the need for increased awareness and education about the potential risk of cerebral thrombosis associated with OCP use among Saudi women. Addressing this knowledge gap through targeted educational initiatives could help mitigate the risks and improve overall public health outcomes.