Effect of Late Luteal Phase Clomiphene Citrate on Ovulation Induction and Endometrial Blood Flow in Patients with Polycystic Ovary Syndrome
Year: 2014
Type: article
Abstract: BACKGROUND: Clomiphene citrate (CC) is the most commonly used drug for treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS), have shown a discrepancy between ovulation and pregnancy rates. This may be partly explained by the peripheral antiestrogenic effects at the level of the endometrium and cervical mucus, by hypersecretion of LH, or due to negative effects of CC on oocytes or granulosa cells (GC). It can be argued that these negative effects are augmented by the relatively long half-life of CC which is known to be 5 days. If treatment is started late in the cycle preceding the induced cycle, those negative effects are more likely to extend into the sensitive peri-implantation period. In the present study we compare the effect of late luteal phase CC administration to early follicular phase day 3 on induction of ovulation and several ultrasonographic markers of uterine receptivity in PCOS patients. METHODS: The present study is designed as a prospective clinical study. Two hundred (200) infertile women aged 20-35 years old with the diagnosis of PCOS with oligo-hypomenorrhea were be examined at Faculty of Medicine Al-Azhar University, Damietta in department of Obstetrics and Gynecology at the Infertility Outpatient Clinic. Group I (study group, late luteal phase CC): included 100 PCO patients to whom 100 mg of clomiphene citrate were administered daily for five days starting the next day after finishing medroxyprogesterone acetate (MPA) 10 mg tablets for 5 days. Group II (control group, early follicular phase CC): included 100 PCO patients to whom 100 mg of clomiphene citrate were administered daily for five days starting in day 3 of withdrawal bleeding induced by medroxyprogesterone acetate (MPA) 10 mg tablets for 5 days. RESULTS: The proportion of women who had more than one mature follicle was significantly higher in women in study group when compared to women in control group (P=0.009).The mean endometrial thickness at day of human chorionic gonadotropin (hCG) administration was significantly higher among women in study group when compared to women in control group (P<0.001). The mean endometrial and subendometrial resistance index (RI) at day of hCG administration and midluteal was significantly lower (denoting higher subendometrial blood flow) among women in study group when compared to women in control group (P<0.05). CONCLUSIONS: Late luteal phase clomiphene citrate results in significant growth of more than one mature follicle and improve endometrial blood flow compared to early follicular phase CC.
Authors: Samia Eid, Mostafa Mohammad Shakweer
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W106151901