- Nayereh Khadem
 - - Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashad University of Medical Sciences, Mashad, Iran
- Parisa Ensafi
- - Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashad University of Medical Sciences, Mashad, Iran
Received: 4/1/2003 Accepted: 4/1/2003 - Publisher : Avicenna Research Institute |
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Abstract
Infertility with an incidence of about 10-15% is a social problem that sometimes threatens the continuity of the family life. Clomiphen Citrate (C.C.) is one of the most commonly used drugs in the treatment of infertility. The purpose of this study was to compare the pregnancy and abortion rates after IUI in two groups of patients who received clomiphen citrate alone or C.C. in combination with ethinyl E2 to stimulate ovulation in patients undergoing IUI. This was a randomized clinical trial study performed at the Infertility Center of Mashad Medical Science University. The subjects were 159 women, aged 20-30 years with infertilty back ground of 1-10 years who were randomly assigned to two groups. The first group received C.C. plus ethinyl E2 and the other group C.C. alone. The number and diameter of the follicles, endometrial thickness, and pregnancy and abortion rates were evaluated by transvaginal ultrasonography and analyzed by chi-square and T-test. There was a significant difference in endometrial thickness between the two treatment groups (7.88 mm in group I vs. 7.02 mm in group II, p=0.001). There were no significant differences between pregnancy and abortion rates in the two groups. Pregnancy rate was 18.6% in group I vs. 14.5% in group II and first trimester abortion rate was in group I, 21% vs in group II, 25%. Ethinyl E2 can modulate the deleterious effects of C.C. on endometrial thickness, which could not contribute to higher pregnancy rates and lower spontaneous abortion rates.
Keywords:
Clomiphene citrate, Ethinyl estradiol, Pregnancy rate, Abortion rate, Intra uterine insemination To cite this article:References
- Speroff L., Glass R.H., Kase N.G. Clinical gynecologic endocrinology and infertility. 6th Edition. Baltimore,Lippincott, Williams- Wilkins. 1999;1098-1105.
- Zabrek Edward M., Faco G. Can I get pregnant? The basic infertility work up. Clin Obs Gyn. 1996; 39:230-232.
- Duran H.E., Morshedi M., Kruger T., Oehinger S. Intrauterine insemination: a systemic review on determinant of success. Hum Reprod update. 2002;8:373.
- Miskry T., Chapman M. The use of intrauterine insemination in Australia and New Zealand. Hum Reprod. 2002;17:956-9.
- Dhaliwal L.K., Sialy R.K., Gopalan S., Majumdar S. Minimal stimulation protocol for use with intrauterine insemination in the treatment of infertility. J Obs Gyn Res. 2002; 28:295-9.
- Dickey R.P., Taylor S.N., Lu P.Y., Sartor B.M., Rye P.H., Pyrzak R. Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles. Fertil Steril. 2001;75(1):69-78.
- Biljan M.M., Mahutte N.G., Tulandi T., Tan S.L. Prospective randomized double-blined Trial of the correlation between time of administration and antiestrogenic effects of clomiphene citrate on reproductive end organs. Fertil Steril. 1999;71: 633-8.
- Gerli S., Gholami H., Manna C. Use of ethinyl estradiol to reverse the ant estrogenic effects of clomiphene citrate in patients undergoing intrauterine insemination: a comparative, randomized study. Fertil Steril. 2000;73(1):85-9.
- Gelety T.J., Buyalos R.P. The effect of clomiphene citrate and menopausal gonadotropins on cervical mucus in ovulatory cycles. Fertil Steril. 1993;60:471-6.
- Massai M.R., de Ziegler D., Lesobre V., Bergeron C., Frydman R., Bouchard P. Clomiphene citrate effects cervical mucus and endometrial morphology independently of the changes in plasma hormonal levels induced by multiple follicular reccuitment. Fertil Steril. 1993;59:1179-86.
- Scirarra J.J, Watkins T.S. Sciarra Gynecology and Obstetrics. USA, JBL Lippincott. 1995;68 (5):2-5.
- Dickey R.P., Olar T.T., Taylor S.N., Curole D.N., Rye P.H. Sequential clomiphene citrate and human menopausal gonadotrophin for ovulation induction: comparison to clomiphene citrate alone and human menopausal gonadotrophin alone. Hum Reprod. 1993;8:56-9.
- Hammond M.G., Halme J.K., Talbert L.M. Factors affecting the pregnancy rate in clomiphene citrate induction of ovulation. Obs Gyn. 1983;62:196-202.
- Unfer V., Costavil L., Gali S., Papleo E., Marelli G., Renro G. Low dose of ethinyl estradiol can reverse the antiestrogenic effects of clomiphene citrate on endometrium. Gyn Obs Invest. 2001;511:120-123.
- Taubert H.D., Dericks-Tan J.S. High doses of estrogens do not interfere with the ovulation- induction effect of clomiphene. Fertil Steril. 1976;27:375-82.
- Insler V., Zakut H., Serr D.M. Cycle pattern and pregnancy rate following combined clomiphene-estrogen therapy. Obs Gyn. 1973; 41:602-7.
- Yagel S., Benchetrit A., Anteby E., Zacut D., Hochner-Celnikier D., Ron M. The effect of ethinyl estradiol on endometrial thickness and uterine volume during ovulation induction by clomiphene citrate. Fertil Steril. 1992;57;33-6.
- Bateman B.G., Nunley W.C. Jr., Kolp. L.A. Exogenous estrogen therapy for treatment of clomiphene citrate induced cervical mucus abnormalities: is it effective? Fertil Steril. 1990; 54:577-9.
- Ohno Y., Fujimoto Y. Endometrial estrogen and progesterone receptors and their relationship to sonographic appearance of the endometrium. Hum Reprod Update. 1998;4:560-4.
- Ransom M.X., Doughman N.C., Gareia A.J. Menotropins alone are superior to a clomiphene citrate and menotropin combination for super ovulation induction among clomiphene citrate failures. Fertil Steril. 1996;66:863-5.
- Maegawa M., Kamada M., Takayanagi M., Naka O., Irahara M., Aono T. Difference of the hormonal profile of the periovulatory phase in pregnant and non pregnant cycles of infertile woman with unexplained etiology. Gyn Obs Invest.1993; 35:228-31.
- Goldstein D., Zuckerman H., Harpaz S., Barkai, Gera A., Gordon S. Correlation between estradiol and progesterone in cycles with luteal phase deficiency. Fertil Steril. 1982;37:48-54.
- Yeko T.R., Nicosia S.M., Maroulis G.B., Bardawil W.A., Dawood M.Y. Histology of midluteal corpus luteum and endometrium from clomiphene citrate-induced cycles. Fertil Steril. 1992;57:28-32.
- Randall J.M., Templeton A. Transvaginal sonographic assessment of follicular and endometrial growth in spontaneous and clomiphene citrate cycles. Fertil Steril. 1991;56: 208-12.
- Eden J.A., Place J., Carter G.D., Jones J., Alaghband-zadeh J., Pawson M.E. The effect of clomiphene citrate on the follicular phase increase in endometrial thickness and uterine volume. Obs Gyn. 1989;73:187-90.
- Shimoya K., Tomiyama T., Hashimoto K. Endometrial development was improved by transdermal estradiol in patients treated with clomiphene citrate. Gyn Obs invest. 1999;47: 251-254.
- Ben-Ami M., Geslevich Y., Matilsky M ., Battino S., Shalev E. Exogenous estrogen therapy concurrent with clomiphene citrate lack of effect on serum sex hormone levels and endometrial thickness. Gyn Obs Invest.1994;37:180-182.
- Check J.H., Dietherich C., Lurie D. The effect of consecutive cycles of clomiphene citrate therapy on endometrial thickness and echopattern. Obs. 1995;86:341-345.
- Chang M.Y., Chiang C.H., Chiu T.H., Hsieh T.T., Soong Y.K. The antral follicle count Predicts the outcome of pregnancy in a controlled ovarian hyper stimulation/ intrauterine insemination program. J Assist Reprod Genet.1998;15:12-7.
- Dickey R.P., Taylor S.N., Lu P.Y., Sartor B.M., Rye P.H., Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate- intrauterine insemination.Fertil Steril. 2002;78:1088-95.