Objective: Since not all women wish to conceive a child through aggressive treatment, we investigated the usefulness of modified repeated intracyclic clomiphene citrate (CC) therapy (repeated CC therapy) as a newly de...Objective: Since not all women wish to conceive a child through aggressive treatment, we investigated the usefulness of modified repeated intracyclic clomiphene citrate (CC) therapy (repeated CC therapy) as a newly devised administration method. Methods: We evaluated the effects of CC administration on menstrual cycle length and retrospectively compared ovulation and pregnancy in 220 women who received CC at our hospital. Patients in the conventional method group received 50 mg per day for five days, starting on the fifth day of menstruation (withdrawal bleeding). Groups with and without menstrual cycle shortening after conventional CC administration were compared. The repeated CC therapy group was also compared with the non-shortened group. Repeated CC therapy was administered for the first five days as in the conventional method, and a second five-day repeat treatment was administered after an interval of five to seven days. Pregnancy rates, including indirect pregnancies, were evaluated by three different methods. Results: Ovulation and pregnancy rates were significantly better in the shortened group than in the non-shortened group (P < 0.001 and P = 0.010, respectively). Even in the non-shortened group, ovulation and pregnancy rates including indirect pregnancies were significantly improved when ovulation was observed with repeated CC therapy (P < 0.001 and P = 0.022, respectively). Conclusions: For patients whose menstrual cycle was not improved or shortened, repeated CC therapy as the newly devised CC administration method is useful as the next step after the conventional CC administration method.展开更多
The clomiphene citrate (CC), a nonsteroidal triphenylethylene compound, is a first line of medicine used for the induction of ovulation in anovulatory women worldwide. In spite of high ovulation induction with the use...The clomiphene citrate (CC), a nonsteroidal triphenylethylene compound, is a first line of medicine used for the induction of ovulation in anovulatory women worldwide. In spite of high ovulation induction with the use of CC, the pregnancy rate is much lower. Such a discrepancy could be due to the peripheral anti-estrogenic effect of CC, particularly at the level of ovary, endometrium and cervical mucus. CC induces ovulation by binding to the estrogen receptors and generates hypoestrogrnic state in hypothalamus leading to release of pituitary gonadotropins. CC may have a direct effect at the level of ovary but the molecular mechanism remains unclear. Animal studies suggest that the CC induces apoptosis in granulosa cells and results hypoestrogenic state in the ovary. Reduced estradiol 17β level in the ovary affects development and maturation of oocyte leading to oocyte apoptosis. Further, CC increases hydrogen peroxide (H2O2) level and thereby bax protein expression and DNA fragmentation in cumulus-granulosa cells as well as in oocytes. The exogenous supplementation of either estradiol 17β or melatonin reduces H2O2 level in ovary, delays meiotic cell cycle progression in oocyte and protects oocyte apoptosis. Hence, supplementation of estradiol 17β or melatonin along with CC could be beneficial to protect granulosa cell as well as oocyte apoptosis and inhibit deterioration of oocyte quality. Thus, maintenance of oocyte quality may overcome the adverse effect caused due to CC treatment during infertility management.展开更多
Background: The purpose of this study was to compare the effectiveness of Letrozole versus Clomiphene citrate for ovulation induction in polycystic ovarian syndrome (PCOS) with infertility. Methods: This was a prospec...Background: The purpose of this study was to compare the effectiveness of Letrozole versus Clomiphene citrate for ovulation induction in polycystic ovarian syndrome (PCOS) with infertility. Methods: This was a prospective randomized trial involving 150 women with PCOS attending the Infertility Clinic at three hospitals in Malaysia. During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (75 patients) or 100 mg Clomiphene citrate daily (75 patients) from the fifth until the ninth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The subjects were homogenously distributed. The difference between Letrozole and Clomiphene citrate for ovulation rate was 59 (78.7%) versus 40 (53.3%). Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of9.2 mm(SD ± 2.3) versus8.4 mm(SD ± 2.2) for patients taking Clomiphene citrate, and these differences were statistically significant展开更多
Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. The therapeutic strategies for clomiphene citrate (CC)- resistant patients include the addition of corticosteroids, extended d...Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. The therapeutic strategies for clomiphene citrate (CC)- resistant patients include the addition of corticosteroids, extended duration of clomiphene, gonadotrophin therapy, laparoscopic ovarian drilling, in vitro fertilization or the use of aromatase inhibitors recently. Letrozole decreases estrogen levels in the body, so it releases the hypothalamus and/or pituitary gland from the negative feedback of estrogen. This increases levels of gonadotrophins, which stimulates follicular growth. Objectives: To evaluate the role of letrozole alone and simultaneous use of letrozole and clomiphene citrate (CC) for ovulation induction in patients with clomiphene citrate-resistant PCOS (CCR-PCOS). Patients and Methods: This open-label randomised controlled study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt during the period from February 2018 to June 2019. The study included 60 CCR-PCOS patients who were randomly allocated by independent personnel into two arms: group A (letrozole alone) or B (letrozole + CC). In either group, monitoring the mean follicular diameter and endometrial thickness in the days 10, 12, and 14 of the cycle by transvaginal ultrasound and Measurement of serum Progesterone (ng/ml) 7 days after the expected time of ovulation. Results: We investigated various clinical and sonographic factors that may predict the outcome of the method of induction of ovulation in CCR-PCOS with no significant affection for the results. There was a non-significant difference between the studied groups regarding ovulation and pregnancy per cycle or per patient. Conclusion: Letrozole alone or simultaneous use of letrozole and CC offers a good second-line option for induction of ovulation in CCR-PCOS patients. However, the combination of CC and letrozole did not add any benefit over the use of letrozole alone regards ovulation rate, follicular volume, endometrial thickness, pregnancy rate and live birth rate.展开更多
Purpose: The purpose of this study is to assess the relationship between Clomifene citrate and retinal detachment in particular. Methods: a 42-year-old woman has developed bilateral retinal detachment after three cour...Purpose: The purpose of this study is to assess the relationship between Clomifene citrate and retinal detachment in particular. Methods: a 42-year-old woman has developed bilateral retinal detachment after three courses of clomiphene citrate. A literature research for bilateral retinal detachment does not include this severe ophthalmologic complication. Conclusion: This is the first reported case of bilateral retinal detachment after treatment with clomiphene citrate. The caution is warranted in treating infertility patients with CC, and patient should be well informed of this side effect before prescribing this therapy by gynecologist.展开更多
Background:?Unexplained infertility represents about 15% - 20% of infertile couples. Usually, these cases need assistance. Clomiphene citrate is the most used drug for this problem but sometimes pregnancy failed to ac...Background:?Unexplained infertility represents about 15% - 20% of infertile couples. Usually, these cases need assistance. Clomiphene citrate is the most used drug for this problem but sometimes pregnancy failed to achieve it, so other options for assistance are gonadotrophin or letrezole. The objective of our study was to compare the pregnancy rate for letrezole and gonadotropin inunexplained infertile women’s who failed to conceive with clomiphene citrate. Methods: This prospective quasi-randomized trial was carried out in cytogenetic unite at obstetrics and gynecology department, Zagazig University Hospital. 140 infertile females were included, induction of ovulation by letrozole for half of them and by gonadotrophin for the other half. Results: There was statistically highly significant decrease in duration of stimulation, E2 levels and endometrial thickness at day of HCG in letrezole group, no significant difference between two groups as regard number of follicles and pregnancy rate per cycle, while the cumulative pregnancy rate and the cost of stimulation are significantly higher in gonadotrophin group. Conclusion: In patient with unexplained infertility who failed to conceive with clomiphene citrate, gonadotrophins have a higher pregnancy rate than letrezole. However, pregnancy rate was high enough with lower cost with letrezole to be acceptable and justified its use in this group of patients.展开更多
Background:To investigate the potential advantage of using low-dose clomiphene citrate to promote ovulation in women with overweight or obesity.Methods:The patients with overweight were divided randomly into regular c...Background:To investigate the potential advantage of using low-dose clomiphene citrate to promote ovulation in women with overweight or obesity.Methods:The patients with overweight were divided randomly into regular clomiphene citrate group(clomiphene citrate 50 mg/d,n=83)and low-dose clomiphene citrate group(clomiphene citrate 25 mg/d,n=105).All patients received treatment from the 5th day of their menstrual cycles.Results:Luteinizing hormone levels and estradiol levels were more increased in the low-dose group compared with the regular group(P<0.05).Low-dose group showed significantly thicker endometrium,fewer dosage and shorter days of human menopausal gonadotropin,less numbers of mature follicles and lower rates of cancellation(P<0.05)on human chorionic gonadotropin day.After human chorionic gonadotropin injection,the ovulation rate in the low-dose group was significantly higher than the regular group(P<0.05).No difference was detected in the biochemical pregnancy rates both groups(P>0.05).Conclusion:The low-dose clomiphene citrate treatment significantly reduced the number of mature follicles and increased the thickness of endometrium on the human chorionic gonadotropin day with less side effects.The low-dose clomiphene citrate also achieved the better ovulation rate.展开更多
文摘Objective: Since not all women wish to conceive a child through aggressive treatment, we investigated the usefulness of modified repeated intracyclic clomiphene citrate (CC) therapy (repeated CC therapy) as a newly devised administration method. Methods: We evaluated the effects of CC administration on menstrual cycle length and retrospectively compared ovulation and pregnancy in 220 women who received CC at our hospital. Patients in the conventional method group received 50 mg per day for five days, starting on the fifth day of menstruation (withdrawal bleeding). Groups with and without menstrual cycle shortening after conventional CC administration were compared. The repeated CC therapy group was also compared with the non-shortened group. Repeated CC therapy was administered for the first five days as in the conventional method, and a second five-day repeat treatment was administered after an interval of five to seven days. Pregnancy rates, including indirect pregnancies, were evaluated by three different methods. Results: Ovulation and pregnancy rates were significantly better in the shortened group than in the non-shortened group (P < 0.001 and P = 0.010, respectively). Even in the non-shortened group, ovulation and pregnancy rates including indirect pregnancies were significantly improved when ovulation was observed with repeated CC therapy (P < 0.001 and P = 0.022, respectively). Conclusions: For patients whose menstrual cycle was not improved or shortened, repeated CC therapy as the newly devised CC administration method is useful as the next step after the conventional CC administration method.
文摘The clomiphene citrate (CC), a nonsteroidal triphenylethylene compound, is a first line of medicine used for the induction of ovulation in anovulatory women worldwide. In spite of high ovulation induction with the use of CC, the pregnancy rate is much lower. Such a discrepancy could be due to the peripheral anti-estrogenic effect of CC, particularly at the level of ovary, endometrium and cervical mucus. CC induces ovulation by binding to the estrogen receptors and generates hypoestrogrnic state in hypothalamus leading to release of pituitary gonadotropins. CC may have a direct effect at the level of ovary but the molecular mechanism remains unclear. Animal studies suggest that the CC induces apoptosis in granulosa cells and results hypoestrogenic state in the ovary. Reduced estradiol 17β level in the ovary affects development and maturation of oocyte leading to oocyte apoptosis. Further, CC increases hydrogen peroxide (H2O2) level and thereby bax protein expression and DNA fragmentation in cumulus-granulosa cells as well as in oocytes. The exogenous supplementation of either estradiol 17β or melatonin reduces H2O2 level in ovary, delays meiotic cell cycle progression in oocyte and protects oocyte apoptosis. Hence, supplementation of estradiol 17β or melatonin along with CC could be beneficial to protect granulosa cell as well as oocyte apoptosis and inhibit deterioration of oocyte quality. Thus, maintenance of oocyte quality may overcome the adverse effect caused due to CC treatment during infertility management.
文摘Background: The purpose of this study was to compare the effectiveness of Letrozole versus Clomiphene citrate for ovulation induction in polycystic ovarian syndrome (PCOS) with infertility. Methods: This was a prospective randomized trial involving 150 women with PCOS attending the Infertility Clinic at three hospitals in Malaysia. During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (75 patients) or 100 mg Clomiphene citrate daily (75 patients) from the fifth until the ninth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The subjects were homogenously distributed. The difference between Letrozole and Clomiphene citrate for ovulation rate was 59 (78.7%) versus 40 (53.3%). Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of9.2 mm(SD ± 2.3) versus8.4 mm(SD ± 2.2) for patients taking Clomiphene citrate, and these differences were statistically significant
文摘Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. The therapeutic strategies for clomiphene citrate (CC)- resistant patients include the addition of corticosteroids, extended duration of clomiphene, gonadotrophin therapy, laparoscopic ovarian drilling, in vitro fertilization or the use of aromatase inhibitors recently. Letrozole decreases estrogen levels in the body, so it releases the hypothalamus and/or pituitary gland from the negative feedback of estrogen. This increases levels of gonadotrophins, which stimulates follicular growth. Objectives: To evaluate the role of letrozole alone and simultaneous use of letrozole and clomiphene citrate (CC) for ovulation induction in patients with clomiphene citrate-resistant PCOS (CCR-PCOS). Patients and Methods: This open-label randomised controlled study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt during the period from February 2018 to June 2019. The study included 60 CCR-PCOS patients who were randomly allocated by independent personnel into two arms: group A (letrozole alone) or B (letrozole + CC). In either group, monitoring the mean follicular diameter and endometrial thickness in the days 10, 12, and 14 of the cycle by transvaginal ultrasound and Measurement of serum Progesterone (ng/ml) 7 days after the expected time of ovulation. Results: We investigated various clinical and sonographic factors that may predict the outcome of the method of induction of ovulation in CCR-PCOS with no significant affection for the results. There was a non-significant difference between the studied groups regarding ovulation and pregnancy per cycle or per patient. Conclusion: Letrozole alone or simultaneous use of letrozole and CC offers a good second-line option for induction of ovulation in CCR-PCOS patients. However, the combination of CC and letrozole did not add any benefit over the use of letrozole alone regards ovulation rate, follicular volume, endometrial thickness, pregnancy rate and live birth rate.
文摘Purpose: The purpose of this study is to assess the relationship between Clomifene citrate and retinal detachment in particular. Methods: a 42-year-old woman has developed bilateral retinal detachment after three courses of clomiphene citrate. A literature research for bilateral retinal detachment does not include this severe ophthalmologic complication. Conclusion: This is the first reported case of bilateral retinal detachment after treatment with clomiphene citrate. The caution is warranted in treating infertility patients with CC, and patient should be well informed of this side effect before prescribing this therapy by gynecologist.
文摘Background:?Unexplained infertility represents about 15% - 20% of infertile couples. Usually, these cases need assistance. Clomiphene citrate is the most used drug for this problem but sometimes pregnancy failed to achieve it, so other options for assistance are gonadotrophin or letrezole. The objective of our study was to compare the pregnancy rate for letrezole and gonadotropin inunexplained infertile women’s who failed to conceive with clomiphene citrate. Methods: This prospective quasi-randomized trial was carried out in cytogenetic unite at obstetrics and gynecology department, Zagazig University Hospital. 140 infertile females were included, induction of ovulation by letrozole for half of them and by gonadotrophin for the other half. Results: There was statistically highly significant decrease in duration of stimulation, E2 levels and endometrial thickness at day of HCG in letrezole group, no significant difference between two groups as regard number of follicles and pregnancy rate per cycle, while the cumulative pregnancy rate and the cost of stimulation are significantly higher in gonadotrophin group. Conclusion: In patient with unexplained infertility who failed to conceive with clomiphene citrate, gonadotrophins have a higher pregnancy rate than letrezole. However, pregnancy rate was high enough with lower cost with letrezole to be acceptable and justified its use in this group of patients.
文摘Background:To investigate the potential advantage of using low-dose clomiphene citrate to promote ovulation in women with overweight or obesity.Methods:The patients with overweight were divided randomly into regular clomiphene citrate group(clomiphene citrate 50 mg/d,n=83)and low-dose clomiphene citrate group(clomiphene citrate 25 mg/d,n=105).All patients received treatment from the 5th day of their menstrual cycles.Results:Luteinizing hormone levels and estradiol levels were more increased in the low-dose group compared with the regular group(P<0.05).Low-dose group showed significantly thicker endometrium,fewer dosage and shorter days of human menopausal gonadotropin,less numbers of mature follicles and lower rates of cancellation(P<0.05)on human chorionic gonadotropin day.After human chorionic gonadotropin injection,the ovulation rate in the low-dose group was significantly higher than the regular group(P<0.05).No difference was detected in the biochemical pregnancy rates both groups(P>0.05).Conclusion:The low-dose clomiphene citrate treatment significantly reduced the number of mature follicles and increased the thickness of endometrium on the human chorionic gonadotropin day with less side effects.The low-dose clomiphene citrate also achieved the better ovulation rate.
