Clinical and Experimental Reproductive Medicine

  • 제42권3호
  • /
  • Pages.106-110
  • /
  • 2015
  • /
  • 2233-8233(pISSN)
  • /
  • 2233-8241(eISSN)
대한생식의학회 (The Korean Society for Reproductive Medicine)
권호 표지
DOI QR코드

DOI QR Code

Clinical outcomes of three- or five-day treatment with clomiphene citrate combined with gonadotropins and a timed intercourse cycle in polycystic ovary syndrome patients

  • Bae, Sung-Ah (Pusan National University Medical Graduate School) ;
  • Joo, Jong-Kil (Department of Obstetrics and Gynecology, Medical Research Institute, Pusan National University School of Medicine) ;
  • Choi, Jong-Ryeol (Eroom Women's Clinic) ;
  • Kim, Sun-Suk (Department of Obstetrics and Gynecology, Medical Research Institute, Pusan National University School of Medicine) ;
  • Lee, Kyu-Sup (Department of Obstetrics and Gynecology, Medical Research Institute, Pusan National University School of Medicine)
  • 투고 : 2015.04.06
  • 심사 : 2015.07.06
  • 발행 : 2015.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: This study aimed to investigate the effect of a new clomiphene citrate (CC) regimen on preventing thin endometrial lining in polycystic ovary syndrome (PCOS) patients receiving CC plus gonadotropin treatment with a timed intercourse cycle. Methods: A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection. Results: Additional doses of human menopausal gonadotropin and the number of days of hCG administration were not significantly different between the two groups. Endometrial thickness on the day of hCG administration was significantly larger in group A than group B (4$9.4{\pm}2.1mm$ vs. $8.5{\pm}1.7mm$, p=0.004). The pregnancy rate was significantly higher in group A than in group B (38.4% vs. 21.7%, p=0.030). Conclusion: Three-day CC treatment resulted in a significantly higher pregnancy rate than the standard five-day CC treatment in a timed intercourse cycle in PCOS patients. Facilitating adequate endometrial growth via the early discontinuation of CC might be a crucial factor in achieving a higher pregnancy rate.

키워드

참고문헌

  1. Homburg R. Clomiphene citrate-end of an era? A mini-review. Hum Reprod 2005;20:2043-51. https://doi.org/10.1093/humrep/dei042
  2. Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update 1997;3:359-65. https://doi.org/10.1093/humupd/3.4.359
  3. Out HJ, Coelingh Bennink HJ. Clomiphene citrate or gonadotrophins for induction of ovulation? Hum Reprod 1998;13:2358-61. https://doi.org/10.1093/humrep/13.9.2358
  4. Dehbashi S, Parsanezhad ME, Alborzi S, Zarei A. Effect of clomiphene citrate on endometrium thickness and echogenic patterns. Int J Gynaecol Obstet 2003;80:49-53. https://doi.org/10.1016/S0020-7292(02)00341-7
  5. Haritha S, Rajagopalan G. Follicular growth, endometrial thickness, and serum estradiol levels in spontaneous and clomiphene citrate-induced cycles. Int J Gynaecol Obstet 2003;81:287-92. https://doi.org/10.1016/S0020-7292(02)00404-6
  6. Nakamura Y, Ono M, Yoshida Y, Sugino N, Ueda K, Kato H. Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium. Fertil Steril 1997;67:256-60. https://doi.org/10.1016/S0015-0282(97)81907-3
  7. Satirapod C, Wingprawat S, Jultanmas R, Rattanasiri S, Jirawatnotai S, Choktanasiri W. Effect of estradiol valerate on endometrium thickness during clomiphene citrate-stimulated ovulation. J Obstet Gynaecol Res 2014;40:96-101. https://doi.org/10.1111/jog.12130
  8. Esmailzadeh S, Faramarzi M. Endometrial thickness and pregnancy outcome after intrauterine insemination. Fertil Steril 2007;88:432-7. https://doi.org/10.1016/j.fertnstert.2006.12.010
  9. El-Toukhy T, Coomarasamy A, Khairy M, Sunkara K, Seed P, Khalaf Y, et al. The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles. Fertil Steril 2008;89:832-9. https://doi.org/10.1016/j.fertnstert.2007.04.031
  10. Unfer V, Casini ML, Costabile L, Mignosa M, Gerli S, Di Renzo GC. High dose of phytoestrogens can reverse the antiestrogenic effects of clomiphene citrate on the endometrium in patients undergoing intrauterine insemination: a randomized trial. J Soc Gynecol Investig 2004;11:323-8. https://doi.org/10.1016/j.jsgi.2003.12.007
  11. Shimoya K, Tomiyama T, Hashimoto K, Moriyama A, Kawamoto A, Tokugawa Y, et al. Endometrial development was improved by transdermal estradiol in patients treated with clomiphene citrate. Gynecol Obstet Invest 1999;47:251-4. https://doi.org/10.1159/000010116
  12. Mitwally MF, Casper RF. Aromatase inhibitors in ovulation induction. Semin Reprod Med 2004;22:61-78. https://doi.org/10.1055/s-2004-823028
  13. Barroso G, Menocal G, Felix H, Rojas-Ruiz JC, Arslan M, Oehninger S. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blinded clinical trial. Fertil Steril 2006;86:1428-31. https://doi.org/10.1016/j.fertnstert.2006.03.044
  14. Takasaki A, Tamura H, Taketani T, Shimamura K, Morioka H, Sugino N. A pilot study to prevent a thin endometrium in patients undergoing clomiphene citrate treatment. J Ovarian Res 2013; 6:94. https://doi.org/10.1186/1757-2215-6-94
  15. Mikkelson TJ, Kroboth PD, Cameron WJ, Dittert LW, Chungi V, Manberg PJ. Single-dose pharmacokinetics of clomiphene citrate in normal volunteers. Fertil Steril 1986;46:392-6. https://doi.org/10.1016/S0015-0282(16)49574-9
  16. Chae SJ, Kim JJ, Choi YM, Hwang KR, Jee BC, Ku SY, et al. Clinical and biochemical characteristics of polycystic ovary syndrome in Korean women. Hum Reprod 2008;23:1924-31. https://doi.org/10.1093/humrep/den239

피인용 문헌

  1. Kinderwunschtherapie in der gynäkologischen Praxis vol.14, pp.2, 2016, https://doi.org/10.1007/s10304-016-0069-z
  2. Comparison of Effectiveness of Different Protocols Used for Controlled Ovarian Hyperstimulation in Intrauterine Insemination Cycle vol.68, pp.1, 2015, https://doi.org/10.1007/s13224-017-1054-8