DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20192455

A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination

Ashok Verma, Shivani Sharma, Suresh Verma, Pankaj Sharma, Tenzin Tsamo Tenga, Indu Chauhan

Abstract


Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.

Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle.  Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.

Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.

Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.


Keywords


Clomiphene citrate, Follicle stimulating hormone, Intrauterine insemination, Unexplained infertility

Full Text:

PDF

References


Iyer M. The Times of India, New Delhi, Friday, July 14, 2017. Available at: https://timesofindia.indiatimes.com/2017/7/14/archivelist/year-2017,month-7,starttime-42930.cms. Accessed on 15 July 2017.

Gyaneshwar R, Raviraj P. Is the prevalence of infertility increasing? Insight into infertility management. 2012:1-5.

Vayena E, Rowe PJ, Griffin PD. Medical, ethical and social aspects of assisted reproduction. Current Practices and Controversies in Assisted Reproduction: report of WHO meeting, Geneva, Switzerland. 2001. Available at: academic.oup.com/humrep/article/19/1/3/690117. Accessed 15 April 2019.

Ganesh A, Goswami SK, Chattopadhya R, Chaudhury K, Chakravarty BN. Comparison of Letrozole with continuous gonadotrophins and comiphene-gonadotrophin combination for ovulation induction in1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial. J Assisted Reprod Genet. 2009;26:19-24.

Mitwally MF, Casper RF. Use of aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril. 2001;75:305-9.

Brzechffa PR, Daneshmand S, Buyalos RP. Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: the effect of patient age on clinical outcome. Hum Reprod. 1998;13(8):2110-4.

Romeu A, Monzo A, Peiro T, Diez E, Peinado A, Quintero A. Endogenous LH surge versus hCG as ovulation trigger after low dose highly purified FSH in IUI: A comparison of 761 cycles. J Assist Reprod Genet. 1997;14(9):518-24.

Gupta S, Tempe A, Sahu L. Supplementation with estradiol valerate and gonadotropins in clomiphene citrate stimulated IUI cycles. IJBAR. 2014;5(04):211-4.

Corsan G, Trias A, Trout S, Kemmann E. Ovulation induction combined with intrauterine insemination in women 40 years of age and older: is it worthwhile. Hum Reprod. 1996;11(5):1109-12.

Christin-Maitre S, Hugues JN. A comparative randomized multicentric study comparing the step up versus step down protocol in polycystic ovary syndrome. Hum Reprod. 2003;18(8):1626-31.

Homburg R. Clomiphene Citrate - the end of an era? A mini review. Hum Reprod. 2005;20:2043-51.

Turhan N, Pekel A, Onaran Y, Duvan ZCI, Bayrak O. Single or double sperm wash processing by density gradient centrifugation: Effect on clomiphene citrate induced intrauterine insemination cycle outcomes. Turk J Med Sci. 2011;41(1):39-44.

Akbari S, Roozbahani MA, Roozbahani FA. Comparing of letrozole versus clomiphene citrate combined with gonadotrophins in intrauterine insemination cycles. Iran J Reprod Med. 2012;10(1):29-31.

Chaudhary K, Suri V, Dhaliwal LK, Gainder S. Comparison of efficacy of letrozole and low dose gonadotrophins combination with clomiphene as a controlled ovarian stimulation regime prior to intrauterine insemination in patients with unexplained infertility. Fertil Sci Res. 2014;1(2):98-103.

Gupta K, Das B. Comparative evaluation of sequential regimes of gonadotropins with clomiphene citrate and letrozole for ovulation induction. Int J Phar Res Heal Sci. 2015;3(2):585-91.

Nuojua S, Tomas C, Bloigu R, Tumivaara L, Martikainen H. Intrautrine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999;14(3):698-703.

Shoham Z, Carlo CD, Patel A, Conway GS, Jacobs HS.. Is it possible to run a successful ovulation program based on ultrasound monitoring / The importance of endometrial monitoring. Fertil Steril. 1991;56:836-41.

Moradan S. Assessment of the relationship between endometrial thickness and number of dominant follicles in pregnancy rate among 361 intrauterine insemination cases. J Sem Univer Med Sci. 2008;9(3):217-22.

Mukherjee S, Sharma S, Chakarvarty BN. Comparitive evaluation of pregnancy outcome in gonadotrophin-clomiphene combination vs clomiphene alone in polycystic ovarian syndrome and unexplained infertility: a prospective clinical trial. J Hum Reprod Sci. 2010;3(2):80-4.

Chung MT, Chan TF, Loo TC, Tang HH, Lin lY, Tsai YC. Comparison of the effect of two different doses of recombinant gonadotropin for ovarian stimulation on the outcome of intrauterine insemination. Taiwa J Obst Gynecol. 2011;50(1):58-61.

Goverde AJ, McDonnell J, Vermeiden JP,Schats R, Rutten FFH, Schoemaker J. Intrauterine insemination or in vitro fertilization in idiopathic subfertility and male subfertility: A randomized trial and cost-effectiveness analysis. Lancet. 2000;355:13-8.

Santbrink V, Fauser BC. Is there a future for ovulation induction in the current era of assisted reproduction? Hum Reprod. 2003;18(12):2499-502.

Christin-Maitre S, Hugues JN. A comparative randomized multicentric study comparing the step up versus step down protocol in polycystic ovary syndrome. Hum Reprod. 2003;18(8):1626-31.

Balasch J, Fabregues F, Creus M. Follicular development and hormone concentrations following rFSH administration for anovulation associated with polycystic ovarian syndrome: a prospective, randomized comparison between low dose step-up and modified step-down regimens. Hum Reprod. 2001;16:652-6.

Hamilton. Ovarian hyperstimulation syndrome. 1991;689-924.

Stone BA, Vargyas JM, Ringer GE, Stein AL, Marrs RP. Determinants of outcome of intrauterine insemination: analysis of outcomes of 9,963 consecutive cycles. Am J Obstet Gynaecol. 1999;180(6):1522-34.

Brzechffa PR, Daneshmand S, Buyalos R. Female and male partner age and menotrophin requirements influence pregnancy rates with human menopausal gonadotrophin therapy in combination with intrauterine insemination. Hum Reprod. 1997;12(1):29-33.