ContextClomiphene citrate (CC) is the first line drug for ovulation induction but because of its peripheral antiestrogenic effect, letrozole was introduced as the 2nd line drug. It lacks the peripheral antiestrogenic effect and is associated with similar or even higher pregnancy rates. Since letrozole is a drug for breast cancer, its use for the purpose of ovulation induction became controversial in the light of studies indicating an increased incidence of congenital malformations.AimsTo evaluate and compare the incidence of congenital malformations among offsprings of infertile couples who conceived naturally or with clomiphene citrate or letrozole treatment.Settings and DesignA retrospective cohort study done at a tertiary infertility centre.Methods and MaterialA total of 623 children born to infertile women who conceived naturally or following clomiphene citrate or letrozole treatment were included in this study. Subjects were sorted out from medical files of both mother and newborn and follow up study was done based on the information provided by parents through telephonic conversations. Babies with suspected anomaly were called and examined by specialists for the presence of major and minor congenital malformations. Other outcomes like multiple pregnancy rate and birth weight were also studied.ResultsOverall, congenital malformations, chromosomal abnormalities were found in 5 out of 171 (2.9%) babies in natural conception group and 5 out of 201 babies in the letrozole group (2.5%) and in 10 of 251 babies in the CC group (3.9%).ConclusionsThere was no significant difference in the overall rate of congenital malformations among children born to mothers who conceived naturally or after letrozole or CC treatment.Key MessagesCongenital malformations have been found to be comparable following natural conception, letrozole and clomiphene citrate. Thus, the undue fear against letrozole may be uncalled for.

In this article, a large leiomyoma with degenerative changes arising from the rudimentary uterine knob in a patient with Mayer- Rokitansky-Kuster-Hauser (MRKH) syndrome and mimicking an ovarian neoplasm is reported. The patient was a 39-year-old woman, known case of MRKH with vaginal aplasia who presented with pain abdomen, loss of appetite and weight. On physical examination, a large pelvic mass was detected. A provisional diagnosis of left ovarian neoplasm was made on USG and CT scan for which an exploratory laparotomy was performed. Finally, it was diagnosed as a case of multiple leiomyomas with hyaline degeneration on histopathological examination. Myoma arising from a rudimentary uterine knob/anlage is a rare finding but should be considered in the differential diagnosis of pelvic mass in patients with MRKH syndrome. How to cite this article Singh S, Chakravarty B, Chakravarty M, Chakravarty A. Large Fibroid arising from Mullerian Remnant Mimicking as Ovarian Neoplasm in a Woman with MRKH Syndrome. Int J Infertility Fetal Med 2012;3(1):30-32.

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sperm collected from cauda epididymis (C57BL6 inbred and B6D2F1 outbred) for 4-6h. Zygotes were cultured either in suboptimal Whitten's medium and 20% O2 (IVFWM) or in optimal KSOM medium with amino acids and 5% O2 (IVFKAA) for 96h in 37 C. Control blastocysts were flushed from the uterus of mated mice (FB mice). Blastocysts were transferred to pseudo-pregnant recipients. Pups were reared to adulthood and peripheral tissues were collected and serum corticosterone levels measured. Total RNA and protein were isolated from fat, muscle and liver. mRNA expression of GR and a selected group of GR-downstream target genes were analyzed by qPCR; GR protein level by Western Blot. One-way AN-OVA with post hoc correction was used as appropriate; p<0.05 was considered significant.RESULTS: Serum corticosterone levels were not different. Increased GR expression was observed in blastocysts conceived by IVF, being higher in the group using suboptimal conditions (IVFWM) in both strains. Interestingly, fat tissue of both inbred and outbred males exhibited a 2-fold increase in the expression of GR mRNA and protein. Instead, females did not exhibit any changes in GR levels in all the tissues tested. Finally, known downstream targets of GR were upregulated in the fat tissue of male mice.CONCLUSIONS: Male mice conceived by IVF have higher GR levels and GR-target genes expression in fat tissues. Importantly, these findings indicate that memory of the preimplantation environment is maintained in adulthood in a tissue and sex specific manner. The metabolic implications of these findings are discussed. Concurrent studies are further evaluating epigenetic changes at the GR promoter.