Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Ghanem, Mohamad E.; Elboghdady, Laila A.; Hassan, Mohamad Hasyizan; Helal, Ahmed H.; Gibreel, Ahmed; Houssen, Maha E.; Shaker, Mohamed E.; Bahlol, Ibrahiem; Mesbah, Yaser

doi:10.1007/s10815-013-0090-2

Cited by 16 publications

(11 citation statements)

References 26 publications

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“…Ghanem et al in 2013 made a comparison of CC cotreatment with low-dose urinary FSH (uFSH) and uFSH alone in the process of OI for CC resistant PCOS, and reached a conclusion that CC reduced both uFSH duration and uFSH dose. [ 17 ] Similar results have been reported in 2015 by a prospective study conducted between CC + HMG group and HMG-only group. [ 18 ] Even as early as a decade ago, it had been shown, by a nonrandomized study, that the average ampoules of HMG required was decreased by 65% when concomitant use of CC with HMG was employed.…”

Section: Discussionsupporting

confidence: 86%

“…Ghanem et al in 2013 found that in PCOS patients undergoing OI, while there was no difference in large follicles (≥16 mm), the number of medium-sized follicles (12–15 mm) was 1.8 ± 2.03 in uFSH-only group compared with 1.1 ± 0.98 when using CC coadministered with uFSH. [ 17 ] This part of follicles may not be the targeted ones in OI treatment, but are potential to be retrieved after COH in IVF treatment. Hence, the fact that gonadotropins yield more medium-sized follicles gives a possible explanation for the contradiction between AFC and oocytes retrieved.…”

Section: Discussionmentioning

confidence: 99%

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Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization

Jiang

Kuang²

2017

Medicine

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The aim of this study was to explore the effect of clomiphene citrate (CC) on the cycle characteristics and outcomes of obese women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization (IVF).This is a retrospective cohort study, and it was conducted at the tertiary-care academic medical center.This study included 174 obese PCOS patients undergoing IVF.In the study group (n = 90), CC and human menopausal gonadotropin (HMG) were administered simultaneously beginning on cycle day 3, while in control group (n = 84) HMG was used only. Both of the 2 groups used medroxyprogesterone acetate (MPA) for preventing premature luteinizing hormone (LH) surges. Ovulation was cotriggered by a GnRH agonist and hCG when dominant follicles matured.The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the number of top-quality embryos, maturation rate, fertilization rate, cleavage rate, incidence of premature LH surge, and OHSS.The study group received obviously lower total HMG dose [1650 (975–4800) vs 2025 (1350–3300) IU, P = 2.038E–4] but similar HMG duration. While the antral follicle count (AFC) is higher in study group, the number of oocytes retrieved and top-quality embryos are remarkably less [5 (0–30) vs 13 (0–42), P = 6.333E–5; 2 (0–14) vs 3.5 (0–15), P = .003; respectively]. The mature oocyte rate is higher in study group (P = .036). No significant differences were detected in fertilization rate and cleavage rate between 2 groups.CC has a positive influence on cycle characteristics, but might be correlated with the impaired IVF outcomes (less oocytes retrieved and top quality embryos, lower oocyte retrieval rate) in obese PCOS patients undergoing IVF, when HMG and MPA are used simultaneously.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization

Jiang

Kuang²

2017

Medicine

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“…Gonadotropin may lead to the following drawback effect include cost, the risk of multiple pregnancies, hyperstimulation, and cycle cancellation [10]. rFSH used in combination with CC for CC-resistant PCOS was proven to be more effective in improving the ovulation rate than rFSH alone [11].…”

Section: Introductionmentioning

confidence: 99%

Letrozole With or Without Gonadotropin as a First-Line Ovulation Induction in Anovulatory Infertile Women Due to Polycystic Ovary Syndrome

Alizzi

2018

Asian J Pharm Clin Res

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Objectives: The objective is to evaluate the clinical outcome of using letrozole alone or with gonadotropin as first-line ovulation induction in anovulatory infertile polycystic ovary women. Methods: A prospective single-arm study. 80 infertile polycystic ovarian syndrome (PCOS) women had been recruited between January and October 2017. Letrozole on day 2–3 of the cycle was given. The women are sorted into two groups according to the size of the dominant follicle on day 7 or 8, Group A (letrozole only group) and Group B (letrozole plus gonadotropin).Results: In our study, the overall pregnancy rate was (67.5%) and ovulation rate was 91.3%. The ovulation rate was significantly higher in Subgroup A than B (97.9% vs. 81.3%). Pregnancy rate was higher in Subgroup A (72.9% vs. 59.4%), but it was statistically not significant. The number of follicles was significantly higher in Subgroup B. Endometrial thickness, miscarriages, ovarian hyperstimulation syndrome, and multiple pregnancies were not statistically significant. Lower cycle number independently and significantly predict clinical pregnancy, while body mass index has a modest effect.Conclusions: Letrozole alone or in combination with gonadotropin as a first-line treatment in PCOS may be reasonable since this approach may improve the success rate and minimize the overall costs and risks.

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“…Recombinant FSH (rFSH) used in combination with CC for CC-resistant PCOS was proven to be more effective in improving the ovulation rate than rFSH alone in a more recent study. 13 However, the results have been doubted for the inconsistent data on the ovulation rate. 14 In addition, CC use is associated with lower pregnancy rates because of its peripheral antiestrogenic effects.…”

Section: Introductionmentioning

confidence: 99%

Use of letrozole and clomiphene citrate combined with gonadotropins in clomiphene-resistant infertile women with polycystic ovary syndrome: a prospective study

Wei

Liu

Mao

et al. 2015

DDDT

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BackgroundGonadotropin has been used to stimulate ovulation in clomiphene-resistant infertile women with polycystic ovary syndrome (PCOS), but it is associated with overstimulated cycles with the development of many follicles. The aim of the study was to evaluate the effectiveness and efficacy of letrozole and clomiphene citrate (CC) combined with human menopausal gonadotropin (HMG) in CC-resistant infertile women with PCOS.MethodsNinety-four women received the letrozole + HMG, 90 women received CC + HMG, and 71 women received HMG only. All women received one treatment regimen in one treatment cycle. All patients were given HMG 75 IU on alternate days daily starting on day 3 or day 7 until the day of administration of human chorionic gonadotropin.ResultsThe rate of monofollicular development was 80.2% in the letrozole + HMG group, 65.3% in the CC + HMG group, and 54.7% in the HMG-only group (P<0.05 for letrozole + HMG vs the other two groups). The number of developing follicles (≥14 mm follicles) and the cycle cancellation rate due to ovarian hyperresponse were the lowest in the letrozole + HMG group, but the difference was not significant. The ovulation and pregnancy rate were similar among the three protocols. The HMG dose needed and the mean duration of treatment were significantly lower in the letrozole + HMG and CC + HMG groups compared with the HMG-only group.ConclusionLetrozole in combination with HMG is an effective protocol for reducing the risks of hyperstimulation for ovarian induction in CC-resistant women with PCOS. This combination may be more appropriate in patients who are particularly sensitive to gonadotropin.

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Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Abstract: CC co-administered during low dose HP uFSH versus uFSH for CC-resistant PCOS yields significantly higher ovulation rate and less consumption of FSH.

Cited by 16 publications

References 26 publications

Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization

Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization

Letrozole With or Without Gonadotropin as a First-Line Ovulation Induction in Anovulatory Infertile Women Due to Polycystic Ovary Syndrome

Use of letrozole and clomiphene citrate combined with gonadotropins in clomiphene-resistant infertile women with polycystic ovary syndrome: a prospective study

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