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Showing 14 results for Clomiphene

Mohammad Ghafourzadeh, Mojgan Karimi, Mohammad Ali Karimazadeh, Mahshid Bokai,
Volume 2, Issue 2 (7-2004)

Background: Infertility affects about 10-15% of reproductive-age couples. About half the causes of infertility are female related and approximately 40% of the cases are caused by anovulation, mostly in PCO women. Objective: This study was conducted to determine and compare the effects of two drug treatment regimens: higher dose of clomiphene and a combination of lower dose of clomiphene and tamoxifen in treating infertile women with PCO. Materials and Methods: The study was a randomized clinical trial conducted on 100 infertile patients who referred to Yazd-Iran Infertility Clinic between the years 2001-2003. The patients were selected who had received at least 3 periods of clomiphene, but no pregnancy had occurred. They were randomly divided into two groups. In the first group, clomiphene was increased to 100 mg and the second group 20 mg of tamoxifen was added to 50 mg of clomiphene from day 5-9 of menstruation cycle. Infertility duration, duration of medicine used, PCT score, endometrial thickness, ovulation, and pregnancy rate were studied in both groups. Results: Ovulation rate in clomiphene group was 54.9%; Tamoxifen + clomiphene group was 73.5% without significant differences in both groups. (PV = 0.053). Positive pregnancy rate in clomiphene group was 39.2%; clomiphene + tamoxifen group was 61.2% (P value < 0.05), which could be concluded that pregnancy rate was higher in clomiphene/tamoxifen group than in the clomiphene group. The presence of a dominant follicle in the two treatment groups in women between 18-24 was not significant, but in women between 25-39 years was significant (PV= 0.049) (Table III). Conclusion: The recommendation is to add Tamoxifen to Clomiphene in 35-39 women with 20? BMI ?26.99 before the use of gonadotropins treatment in PCOS with or without IUI, because these options have higher risk of multiple pregnancy and ovarian hyperstimulation syndrome. Article
Robab Davar, Abbas Aflatoonian,
Volume 2, Issue 2 (7-2004)

Background: In patients with anovulatory infertility the first choice of treatment for ovulation induction is an antiestrogen, most commonly clomiphene citrate (CC). However, 20-25% of the women are resistant to CC and do not ovulate perhaps due to antiestrogenic mechanism of the CC action, which involves long-lasting estrogen receptor (ER) depletion. Objective: The objective of the study was to mimic the action of CC without depletion of ERs by the administration of an aromatase inhibitor letrozole in a selected group of Poly Cystic Ovary (PCO) patients who demonstrated failure to ovulate after treatment with CC. Materials and Methods: 20 patients with anovulation due to polycystic ovary syndrome (PCOS), who had previously inadequately responded to CC were selected for study. The aromatase inhibitor letrozole was administered orally in a dose of 2.5 mg on days 3-7 of the menstrual cycle. Then, occurrence of ovulation, endometrial thickness, and pregnancy rates were determined. Result(s): Only one patient had one dominant follicle (1.8 cm diameter) on day 14 of the cycle (estradiol = 200 pg/ml). IUI was done; however, no pregnancy took place. In the remaining cases, several sonographies were done between days 9 to 15 of the cycle; however, all cycles were cancelled due to absence of a dominant follicle (>1.4 cm). Conclusion(s): Our study did not confirm the favorable effect of letrozole for induction of ovulation in patients with clomiphene resistant PCO. Article
Ferdous Mehrabian, Behnaz Khani Robati,
Volume 8, Issue 1 (7-2010)

Background: Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges.
Case: A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy (IUP). Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra- or post-procedural complications but the IUP was aborted spontaneously on the second postoperative day.
Conclusion: Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively if they are clinically stable and the abdominal pregnancy is recognized early in gestation.
Robab Davar, Mojgan Javedani, Mohammad Hossein Fallahzadeh,
Volume 9, Issue 1 (7-2011)

Background: Polycystic ovary syndrome (PCOS) is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20– 25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be “clomiphene– resistant”. Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion.
Objective: The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI.
Materials and Methods: In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index (BMI), and infertility period. They were randomly allocated to a metformin-letrozole group (n=50) and a metformin-clomiphene citrate group (n=50). Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups.
Results: Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage (2%) occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group.
Conclusion: There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter. Article
Sedigheh Ghandi, Raheleh Ahmadi, Mahmoud Fazel,
Volume 9, Issue 4 (7-2011)

Background: Although heterotopic gestation is common in assisted reproductive techniques, it is very rare in natural conception and clomiphene induced pregnancy. Diagnosis and appropriate intervention of heterotopic pregnancy requires a high index of suspicious.
Case: In this paper a case of heterotopic pregnancy in a 30-year old woman with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 9 weeks of gestation is reported.
Conclusion: This case suggests that a heterotopic pregnancy must always be considered particularly after the induction of ovulation by clomiphene citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.
Soheila Akbari, Maryam Ayazi Roozbahani, Fatemeh Ayazi Roozbahani,
Volume 10, Issue 1 (7-2012)

Background: Clomiphene citrate (CC) an agonist and antagonist of estrogen, is the first line treatment in ovarian stimulation. Anti-estrogenic effect of CC in endometrial thickness and cervical mucus has negative effect on pregnancy rate. Letrozole is an Aromatase Inhibitor has been seen that has acceptable pregnancy rate compared to CC.
Objective: The aim of this study was to compare the efficacy of letrozole and clomiphene citrate (CC) with gonadotropins for ovarian stimulation in women candidate for intrauterine insemination (IUI).
Materials and Methods: One hundred sixty patients eligible to IUI therapy enrolled in this study. Patients randomized to two groups: group A (received letrozole-gonadotropin) and group B (received CC-gonadotropin). In group A (n=80) letrozole was given on days 3-7 of the menstrual cycles. In group B clomiphen citrate was given like letrozole combined with human menopausal gonadotropin (hMG) administered every day starting on day 8. Ovulation was triggered with urinary HCG when the leading follicle (s) reached 18 mm in diameter. A single IUI was performed 36-40 hours later. The ovarian stimulation response (E2 levels and number of follicles, clinical pregnancy and endometrial thickness) was primary outcome.
Results: Both groups were similar in demographic characteristics. There was a significantly lower peak serum E2 level in the letrozole group compared with CC. (236±86 Vs. 283±106 pg/mL, respectively; p<0.002). The number of mature (>18 mm) preovulatory follicles was significantly higher in CC group than letrozole group (2.2±.68 Vs. 2.02±0.63 respectively; p=0.025). Endometrial thickness measured at the time of hCG administration was significantly higher in letrozole group. (9.08±1.2 mm Vs. 8.1±1.9 mm; p=0.0001). The clinical pregnancy rate was comparable between two groups.
Conclusion: Letrozole is a good and cost-effective alternative to CC in IUI cycles.
Fariba Seyedoshohadaei, Farnaz Zandvakily, Shole Shahgeibi,
Volume 10, Issue 6 (4-2012)

Background: Unovulation is the most common cause of infertility. The first line oral treatment has been clomiphene citrate. Another anti-estrogen used for ovulation induction is tamoxifen. Many unovulatory infertile women are resistance to anti-estrogens and need another treatment. Alternative treatments are aromatas inhibitors.
Objective: This study was designed to compare the effectiveness of clomiphene, tamoxifen and letrozole in ovulation induction outcomes in isolated non PCOS unovulatory patients.
Materials and Methods: 150 unovulatory infertile women who had isolated non- polycystic ovarian syndrome (PCOS), randomized to 3 groups. Group A received clomiphene 50 mg to maximum 150 mg for 5 days, Group B received tamoxifen 10mg to maximum 30 mg for 5 days, Group C received letrozole 2.5 mg for 5 days, to maximum 7.5 mg until ovulation was induced. If ovulation failed to occur with 5 days treatments, drug continued for 7 days. Treatment has been stopped if they became pregnant or if patient didn’t ovulate with maximum dose for 7 days (resistant to treatment) or failed to concept after six months despite ovulation (failure of treatment). Main outcome measures were: number of mature follicles, endometrial thickness, pregnancy rate, multiple pregnancy rate, live birth and miscarriage.
Results: Overall ovulation rate was 60 (73.4%), this rate in group A was 39 (78%), in group B it was 24 (68%) and in group C was 37 (74%). Pregnancy rate in groups A, B and C were, 32 (64%), 20 (40%), and 25 (50%) respectively, and live birth rate was 22 (44%) in A, 17 (34%) in B and 21 (42%) in C. Miscarriage rate with clomiphene was 10 (20%) while this was 3 (6%) in tamoxifen and 4 (8%) in letrozole group (p=0.05). One twin pregnancy was occurred with clomiphene and one with tamoxifen, while all pregnancies with letrozole were singleton.
Conclusion: Because of higher pregnancy rate with clomiphene citrate than tamoxifen and letrozole, Clomiphene citrate is still the first-line therapy for ovulation induction. Surprisingly, pregnancies after tamoxifen and letrozole have lower miscarriage rate than clomiphene.
Zahra Moazami Goudarzi, Hossein Fallahzadeh, Abbas Aflatoonian, Masoud Mirzaei,
Volume 12, Issue 8 (8-2014)

Background: Some trials have compared laparoscopic ovarian drilling (LOD) with gonadotropins but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies.
Objective: To evaluate the relative efficacy of LOD and gonadotropins for infertile women with clomiphene citrate- resistant poly cystic ovary syndrome (PCOS).
Materials and Methods: A complete electronic literature search in databases including EMBASE, MEDLINE, Cochrane Library and Google scholar for some specific keywords was accomplished. We contained randomized clinical trials comparing outcomes between LOD, without medical ovulation induction, and gonadotropins.
Results: Six trials, covering 499 women, reported on the primary outcome of pregnancy rate. There was no evidence of a difference in pregnancy rate when LOD compared with gonadotropins (OR: 0.534; 95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I2=73.201%). There was evidence of significantly fewer live births following LOD compared with gonadotropin (OR: 0.446; 95% CI: 0.269-0.74, p=0.02, 3 trials, 318 women, I2=3.353%). The rate of multiple pregnancies was significantly lower in the LOD arm compared to the gonadotropins arm (OR: 0.127; 95% CI: 0.028-0.579, p=0.008, 3 trials, 307 women, I2=0%).
Conclusion: Our result revealed that there was no evidence of a significant difference in rates of clinical pregnancy and miscarriage in women with clomiphene citrate-resistant PCOS undergoing LOD compared to the gonadotropin arm. The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive. The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women. However, more focus on the long-term effects of LOD on ovarian function is suggested.
Maryam Eftekhar, Farnaz Mohammadian, Robab Davar, Soheila Pourmasumi,
Volume 12, Issue 11 (12-2014)

Background: Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol.
Objective: To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders.
Materials and Methods: In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I (n= 80), women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II (n= 87), patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates.
Results: There was a significant difference in the mean endometrial thickness between two groups (9.16±1.2 mm vs. 8.3±0.3 mm). The implantation rate was significantly higher in letrozole group compare to clomiphene group (7.2 vs. 6.6%, p=0.024 respectively). No significant differences were found in chemical and clinical pregnancy rate between two groups.
Conclusion: In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated.
Ahmad Mahran, Ayman Abdelmeged, Hossam Shawki, Abdelrazek Moheyelden, Asmaa Mohamed Ahmed,
Volume 14, Issue 1 (1-2016)

Background: Clomiphene citrate (CC) is the first line agent used for ovulation induction in patients with polycystic ovarian syndrome (PCOS). However, there is marked discrepancy between the ovulation and pregnancy rates achieved, which may be attributed to the undesirable effect of CC on cervical mucus and endometrium.
Objective: The aim of this study was to evaluate the effect of Isosorbid monoitrate (ISMN) as nitric oxide (NO) donors on the ovulation and pregnancy rates in an ovulatory women with PCOS treated with CC.
Materials and Methods: Ninety patients with PCOS were randomly allocated into three groups. Patients in group A) were treated with 100 mg CC for five days starting from the fifth day of the cycle. Patients in group B) and C) received 10 mg and 20 mg of ISMN respectively in addition to CC, applied vaginally till the diagnosis of ovulation.
Results: There was a significant increase in the ovulation and pregnancy rates in the patients treated with CC+ISMN as compared with patients treated with CC alone (p< 0.001).
Conclusion: Concomitant use of NO with CC seems to improve the ovulation and pregnancy rates in the patients with PCOS with no significant increase in side effects as compared with CC alone.
Leila Pourali, Sedigheh Ayati, Shirin Tavakolizadeh, Hourieh Soleimani, Fatemeh Teimouri Sani,
Volume 15, Issue 1 (1-2017)

Background: Clomiphene citrate is one of the effective drugs for infertilitytreatment due to oligo-ovulation or anovulation. Intrauterine insemination (IUI) isone of more adherent methods for treatment of infertile cases which is followed bycontrolled ovarian hyperstimulation (COH).
Objective: the aim of this study was to evaluate Clomiphene citrate versus letrozolewith gonadotropins in IUI cycles.
Materials and Methods: In this prospective randomized trial, 180 infertile patientswho were referred to Milad Hospital were selected. The first group received 5mg/day letrozole on day 3-7 of menstrual cycle. The second group received 100mg/day Clomiphene in the same way as letrozole. In both groups, humanmenopausal gonadotropin was administered every day starting on day between 6-8of cycle. Ovulation was triggered with urinary Human Chorionic Gonadotropin(5000 IU) when have two follicles of ≥16 mm. IUI was performed 36 hr later.
Results: The number of matured follicles, cycle cancellation, and abortion were thesame in both groups. Endometrial thickness was higher at the time of humanmenopausal gonadotropin administration in letrozole group. Chemical and clinicalpregnancy rates were much higher in letrozole group. Ovarian hyperstimulation wassignificantly higher in clomiphene group.
Conclusion: Letrozole appears to be a good alternative to clomiphene citrate withfewer side effects.
Shekoufeh Atashpour, Hossein Kargar Jahromi, Zahra Kargar Jahromi, Mozhgan Maleknasab,
Volume 15, Issue 9 (9-2017)

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women which affect fertility. Clomiphene citrate is used as first-line treatment for this disorder, which is associated with some complications and therapeutic resistance.
Objective: In this research, we compare the effectiveness of ginger with clomiphene on sexual hormones such as Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), estrogen and progesterone in order to treat PCOS effectively with fewer side effects.
Materials and Methods: In this experimental study, 63 adult female rats (170-200 gr) were studied and divided randomly into 9 groups as control (not received any interventional substance for 60 and 89 days), sham (were given distilled water and ethyl alcohol intraperitoneally daily for 60 and 89 days), and 7 experimental groups receiving estradiol valerate (PCOS inducing agent, intramuscular) alone and with 100 mg/kg clomiphene or different doses of ginger extract (175 and 350 mg/kg) orally daily for 60 and 89 days. Sexual hormones were analyzed and compared in different groups.
Results: Our results showed that in the PCOS-induced group, LH and estrogen concentration increased while progesterone and FSH concentration decreased remarkably (p<0.05) as compared to control group. Furthermore, in groups receiving clomiphene and ginger extract, we demonstrated significant (p<0.05) improvement in hormonal secretion as compared to the PCOS-induced group. Clomiphene, compared with the lower dose of ginger extract, had a better improving effect on balancing sexual hormones in PCOS. Moreover, ginger extract at higher doses has better effects in improving PCOS.
Conclusion: As the long-term administration of clomiphene citrate has some side effects, the use of ginger as a herbal medicine without any side effects at high doses can be an effective and good alternative in improving PCOS.
zingiber officinal R. on primary dysmenorrhea. J Med Plants 2010; 9: 81-86.
Behpour Yousefi, Elnaz Rahbar,
Volume 17, Issue 6 (6-2019)

Background: Clomiphene citrate (CC) is one of the widely used drugs as an ovulation stimulant, but its adverse effects on the endometrium results in lowering down the pregnancy rate. Endometrium CD98 is also important in the process of implantation.
Objective: To evaluate the immunohistochemistry expression levels of endometrial CD98 following injection of CC with and without Human chorionic gonadotropin (HCG) in ovariectomized and non-ovariectomized rats.
Materials and Methods: Seventy two (12-14 wk old) female Wistar rats were randomly divided into two groups (n = 36): (a) ovariectomized and (b) non-ovariectomized. Each group was further divided into six subgroups (n = 6/each): (1) CC 10 mg/kg, (2) CC 20mg/kg, (3) HCG, (4) CC 10 mg/kg with HCG, (5) CC 20 mg/kg with HCG, and (6) control. The experimental subgroups received a single dose of CC (daily, five days) and HCG
(after the last injection of CC) alone or in combination. Immunohistochemistry staining was performed on paraffin-embedded endometrial tissues to evaluate the expression levels of CD98.
Results: Animals undergoing ovariectomy presented a significantly lower expression level of endometrial CD98 (p < 0.001) when compared with non-ovariectomized in the same condition that groups were subdivided. There was also a dose-dependent reduction (p < 0.001) in the expression of CD98 in non-ovariectomized subgroups when compared with control group. In addition, injection of HCG following treatment with CC improved its expression.
Conclusion: It was concluded that CC impairs CD98 expression in endometrium and this impairment is intensified with the removal of the ovary. Also, an injection of HCG following treatment with CC can slightly improve the expression of CD98.
Robabeh Taheripanah, Maryam Kabir-Salmani, Masoomeh Favayedi, Marzieh Zamaniyan, Narges Malih, Anahita Taheripanah,
Volume 18, Issue 3 (3-2020)

Background: Pinopods concentrations in endometrial surface is a marker of implantation. estradiol valerate (EV) was used for change the adverse effects of Clomiphene Citrate (CC) on the endometrium. Endometrial morphology was less examined in this fields.
Objective (s): To assess whether there is a significant difference in endometrial pinopods concentrations and other parameters after adding estradiol valerate (EV) and progesterone to higher doses of clomiphene citrate (CC).
Study design: In this prospective randomized clinical trial, a total of 30 women, who did not respond to 100 mg CC from February 2016 until June 2016 were evaluated. They received 150 mg CC alone or CC with EV or CC plus progesterone. On day 21 of the menstrual cycle, endometrial biopsy and a blood sampling and scanning by electron microscopy were performed.

Results: On day 21 of the menstrual cycle there was no significant difference regarding pinopods concentrations (P=0.641) and serum estrogen levels (P=0.276) between groups. Serum progesterone levels on day 21 of the menstrual cycle among patients treated with CC, was higher than the other two groups (P=0.007).
Conclusions: The addition of EV and progesterone to higher dosages of CC, did not changes the pinopods concentration and serum estrogen levels on day 21 of the menstrual cycle. It can be concluded that the anti- estrogenic effects of CC just appear on the endometrium. In this study, there were higher levels of serum progesterone on day 21 of the menstrual cycles in the CC alone compared to other two groups.

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