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PubMed2001

Effects of testosterone and clomiphene on spectral EEG and visual evoked response in a young man with posttraumatic epilepsy.

The effects of testosterone and clomiphene on epilepsy was studied in a young man with posttraumatic seizures. In the control period, digital EEG and visual evoked potentials (VEPs) were recorded under carbamazapine therapy. After testosterone (T), seizures lessened and almost disappeared; the theta, delta, alpha, and beta powers decreased; VEPs increased. After clomiphene, VEPs considerably increased in size; clinical picture slightly improved; EEG power spectrum remained unchanged. It was suggested that T may be beneficial for epilepsy treatment by suppressing the EEG synchronization (slow wave activity) and attenuating the entropy state of the epileptic brain.

Adolescent↗
PubMedDate not supplied

Changes in seminal plasma transferrin concentration following administration of clomiphene citrate.

This study was designed to investigate the functional changes in Sertoli cells following clomiphene citrate administration to patients with idiopathic infertility. The agent was administered to 44 oligozoospermic patients. Patients with improvement in sperm concentration after treatment (improvement group) showed significantly lower pretreatment follicle-stimulating hormone (FSH) levels in serum. Serum FSH and testosterone levels significantly increased in the improvement group after treatment (both p < 0.05). Seminal transferrin concentration significantly increased in the improvement group after treatment (p < 0.05), although there was no significant difference between pretreatment seminal transferrin concentration in the improvement group and that in patients with no improvement in sperm concentration. Seminal plasma transferrin concentration in patients in whom pretreatment luteinizing hormone level in serum was below 10 mIU/mL, and in those in whom the ratio of post- to pretreatment values was 1.5 or more, tended to increase after treatment. This group also contained a few more patients with improvement in sperm concentration than the other groups. The patients showing low pretreatment FSH levels and a high ratio of post- to pretreatment values demonstrated a significant increase in seminal plasma transferrin concentration after treatment (p < 0.01), and this group contained more patients with improvement than the other groups. It would appear that Sertoli cell stimulation may induce an increase in sperm concentration after clomiphene citrate administration, and the elevated transferrin secretion seems to be associated with the increase of serum FSH level after treatment.

Adult↗
PubMed1990

Effects of estrogens, clomiphene and castration in a male transsexual with as compared to those without hypersecretion of gonadotropins.

A 24-year-old male-to-female transsexual with hypersecretion of gonadotropins was studied with regard to his recovery from sex steroid hormone treatment before his sex change operation and the effects of castration, clomiphene tests and estrogens on the hypersecretion of gonadotropins. Computer-assisted tomography and X-ray results indicated that the possibility that the hypersecretion of gonadotropins was not associated with a pituitary adenoma could not be ruled out. After a period of recovery from previous sex steroid hormone therapy, inappropriately high FSH and LH levels in the presence of normal male levels of testosterone and estradiol were found. The latter normal levels failed to suppress both the FSH and LH levels. From the clomiphene challenge tests carried out before and after the sex reassignment operation, the estradiol infusion studies and treatment with ethinyl estradiol after the sex reassignment operation, it appears that the hypersecretion of gonadotropins was responsive to the negative feedback effect of estrogens. However, the sensitivity, especially that of FSH, was very attenuated. Even after 23 weeks of ethinyl estradiol treatment FSH remained well above the upper limit for normal men. The results showed that before his sex change operation the hypersecretion of gonadotropins in the patient was probably under autonomous control. Testicular factors at normal male concentrations appear to have a minimal negative feedback effect on the hypersecretion of gonadotropins. However, hypersecretion of gonadotropins can be suppressed by prolonged exposure to estrogens.

Administration, Oral↗
PubMed1996

The effects of 3-day clomiphene citrate treatment on endocrine and ovulatory responses.

A prospective cohort, paired clinical trial was carried out to test a shorter clomiphene citrate regimen of 3 days, measuring the endocrine outcomes and ovulatory responses. The trial took place at Gazi University Medical School Department of Obstetrics and Gynecology. The 28 infertile patients were newly accepted to the clinic with hypothalamopituitary disorder according to WHO classification Group II. They were treated with 50 mg/day clomiphene citrate (CC) for 3 days in 63 cycles. The control group of 28 paired patients were treated with 50 mg/day CC for 5 days in 40 cycles. The main outcome measures were: serum estradiol levels on day 11 (E-11), 14 (E-14) and postovulatory day 7 (E+ 7); serum progesterone levels on postovulatory day 7 (P+ 7); endometrial thickness on day 14 of the cycle; mean follicular phase length; and ovulation rates. The mean ages, gravidas, paritas, menstrual histories, E-11, P+ 7 levels, mean follicular phase length and luteal phase length were similar in both groups. E-14 (229.76 +/- 156.05 pg/ml vs. 338.25 +/- 350.60 pg/ml) and E+ 7 (217.30 +/- 114.95 pg/ml vs. 310.6 +/- 11.05 pg/ml) were significantly lower, whereas mean endometrial thickness on day 14 (10.30 +/- 1.39 mm vs. 9.52 +/- 1.96 mm) were significantly higher in the study group compared to controls (p < 0.05). Ovulation occurred in 82.53% of cycles in the study group and 95% in controls. In the study group, pregnancy was achieved in 17.3% of the ovulatory cycles; this rate was 10.5% in the control group. To decrease the peripheral antiestrogenic effects of CC, a regimen of 50 mg/day for 3 days may be used as a starting dose instead of the standard 5-day regimen.

Adult↗
PubMed1999

Hormone patterns after induction of ovulation with clomiphene citrate: an age-related phenomenon.

Since the introduction of clomiphene citrate (CC), more than three decades ago, a discrepancy has been observed between ovulation and pregnancy rates for which as yet no explanation exists. To investigate if ovulation disorders or abnormal hormonal patterns occur more often in CC-stimulated seemingly ovulatory cycles, we performed hormonal and sonographic monitoring in first cycles of oligo- or amenorrheic patients who were stimulated with 50 mg CC, and compared the hormonal patterns to those in natural cycles of age-matched proven fertile women. Twenty-four first CC cycles were monitored. Twelve cycles appeared to be ovulatory, eleven showed no follicle development and one cycle exhibited the luteinized unruptured follicle (LUF) phenomenon. Ten ovulatory cycles were compared with 27 unstimulated control cycles. In four cycles stimulated by CC, a temporary decline in estradiol levels was apparent. In these cycles, estradiol reached a higher level on cycle day (CD) 7 or 8 compared to cycles without a decline. Such an estradiol decline was seen in only one control cycle. Furthermore, the estradiol levels on CD 7 or 8 appeared to be age-related. We conclude that the estradiol decline in CC-stimulated ovulatory cycles may be a consequence of a sharp rise after CC stimulation, and such a rise may be age-related and coincide with a diminished follicle quality. If this phenomenon is associated with a suboptimal cycle, and so contributes to the suboptimal pregnancy rates after ovulation-induction treatment with clomiphene citrate, is still unknown.

Adult↗
PubMed1999

[Heterotopic pregnancy following ovulation induction by clomiphene citrate and prednisone. Report of a case].

Heterotopic pregnancy (HP) is a very rare pathologic event. The incidence of ectopic pregnancy has increased as the consequence of assisted reproduction and the wider use of ovulation induction agents. The diagnosis of HP is frequently done not as earlier as it should be, and it has serious repercussions. The concept of screening, to find relevant rise factors and the correct diagnosis of HP should be pursued as early as possible. In this report we describe an unusual case of a female patient with therapeutic failure to clomiphene citrate. She was treated with two cycles of combined clomiphene citrate and prednisone, and ovulation induction assent. The after she developed HP. Overall, we conclude that the possible association observed could be an accident. The land of investigation is open, to fill cover. The holes on understanding that we still have.

Adult↗
PubMed1997

Less miscarriage in pregnancy following Tamoxifen treatment of infertile patients with luteal phase dysfunction as compared to clomiphene treatment.

OBJECTIVES: To compare the efficacy and the reproductive outcomes of Tamoxifen (TMX) vs. clomiphene citrate (CC) treatment in infertile women with luteal phase dysfunction. METHODS: Eighty-seven consecutive infertile women with luteal phase dysfunction were randomly assigned to two treatment groups as: group 1 (TMX followed by CC) and group 2 (CC followed by TMX). The medications administered in the initial and the subsequent cross-over phase were given for 4 to 6 cycles except in those patients who achieved pregnancy within the first three cycles of treatment. The rates of pregnancy, spontaneous abortion and live-birth were calculated for comparison. Demographic profile and the frequency of other infertility factors between the two groups were comparable. RESULTS: The pregnancy rates were similar between TMX and CC treatment (initial treatment phase: TMX, 50.0% vs. CC, 56.4%; subsequent treatment phase: CC, 33.3% vs. TMX, 47.1%), but the abortion rates were significantly lower (p < 0.05) in TMX treatments (initial treatment phase: 8.3% and subsequent treatment phase: 12.5%) than that of CC treatments (initial treatment phase: 22.7% and subsequent treatment phase: 62.5%). When the rates were calculated by pooling the patients according to the medication they received, the miscarriage rate was significantly lower (p < 0.05) if the patients conceived during the TMX treatment (9.4% vs. CC, 33.3%). CONCLUSIONS: Tamoxifen and clomiphene citrate seem to be similarly effective in achieving pregnancy in patients with luteal phase dysfunction. However, Tamoxifen therapy is associated with a lower incidence of spontaneous abortion; thus Tamoxifen may be the better choice for the therapy of infertile women with luteal phase dysfunction.

Abortion, Spontaneous↗
PubMedDate not supplied

[Clomiphen-test in anovulatory sterility (author's transl)].

Twenty women with sterility due to an anovulatory cycle, were submitted to a load of hundred milligramms by day of clomiphene citrate during five days. The test was always performed between the 10th and the 14th day of the cycle. Before and after the clomiphene administration, FSH and LH in plasma and total estrogens and pregnanediol in 24 hours urine, were estimated. The results, are compared with those of ten normal women and the observed results may schematically been classified into three groups: A) Normal response. -- B) Week gonadotropic response. -- and C) High LH baseline. This results seem to indicate three main origines for the anovulatory cycle syndrome: hypothalamic, pituitary and ovarian.

Adult↗
PubMedDate not supplied

Heterotopic pregnancy following ovulation stimulation with clomiphene: a report of three cases.

Heterotopic pregnancy was a medical rarity, prior to the use of ovulation inducing drugs and advent of assisted reproduction technology. Three cases were encountered in the course of clinical practice in a teaching hospital, over a period of six and a half years. Two of them occurred in association with ovulation induction with CLOMIPHENE and the third case with no identifiable underlying cause. We postulate dizygotic twinning, highest among the Yoruba race of Nigeria as a possible aetiological factor. One of the two cases following CLOMIPHENE has been highlighted in more details, together with a review of literature. Diagnosis in all cases was made in retrospect following surgical intervention for the ruptured ectopic components. All the patients presented with persistent pregnancy symptoms, with sonographic confirmation of viable intrauterine fetuses which were carried to term.

Adult↗
PubMed2000

[Results of clomiphene citrate ovarian stimulation vs laparoscopic electrocoagulation of the ovaries in infertile women with PCOS].

OBJECTIVE: To assess the results of clomiphene citrate ovarian stimulation vs laparoscopic electrocoagulation of the ovaries in infertile women with PCOS. DESIGN: 47 women with PCOS were included into the study. 25 of them had ovarian stimulation using clomiphene citrate (100 mg for 5 consecutive days, during 6 cycle) and 22 underwent laparoscopic electrocoagulation of the ovary (6 cycle follow-up) No significant differences were detected between age and body mass index. RESULTS: In the first group ovulatory cycles were confirmed in 68% of women, pregnancy rate was 28%. In the second group ovulations were observed in 90.9% of women and pregnancy rate was 63.6%. There were statistically significant differences. CONCLUSION: In summarising, the results showed lower, statistically significant differences in pregnancy rate in the treatment of infertility associated with PCOS. It seems that the much more successful result of the PCOS therapy may be achieved after laparoscopic ovarian diathermy in comparison with stimulation of the ovaries with CC.

Clomiphene↗
PubMed2001

Hope for clomiphene citrate resistant ovaries.

OBJECTIVE: To assess the presentation, different surgical modalities and their outcome in the treatment of polycystic ovarian disease. METHODS: A retrospective study was carried out on 66 patients with polycystic ovarian disease. The majority of the cases had a history of infertility for at least 2 years and were known to be clomiphene citrate resistant in the Saudi German Hospital, Jeddah between 1994 and 1998 undergoing laparoscopic ovarian drilling. RESULTS: More than 80% of the patients were below 30 years of age. The majority of cases below 30 years had primary infertility. Irregular cycle was the main clinical presentation in 75% of cases; ovarian volume was more than 5.5cm3 in all of the cases. Diathermy drilling was carried out for 50 patients, laser for 12 patients and wedge resection for 4 patients. The follow-up treatment showed that pregnancy rate was 23%, 38% and 0% in the 3 groups. Cases that failed to conceive had significantly higher luteinizing hormone level. CONCLUSION: Laparoscopic ovarian drilling using diathermy or laser is effective during the induction of ovulation and increases the pregnancy rate in cases of polycystic ovarian disease resistant to clomiphene citrate.

Adult↗
PubMed2001

Ovarian hyperstimulation syndrome associated with clomiphene citrate.

Ovarian hyperstimulation is a recognized complication of ovulation induction with gonadotrophins. The syndrome is becoming more common as the number of women undergoing in-vitro fertilization increases. It is rarely seen in conjunction with clomiphene citrate usage. This case report is of moderate to severe ovarian hyperstimulation in a patient who was treated with clomiphene citrate because of infertility secondary to anovulation. She presented with amenorrhoea for five weeks, lower abdominal pain and a positive urinary human chorionic gonadotrophin (hCG) test. Pelvic ultrasonography was suggestive of a possible ectopic pregnancy with a differential diagnosis of a ruptured ovarian cyst. Diagnostic laparoscopy was done followed by laparotomy. Oophorectomy was performed because the ovary was thought to be complex with solid areas. However, conservative management with avoidance of laparotomy is the recommendation in confirmed cases of ovarian hyperstimulation but this requires a high level of suspicion in patients who have ovulation induction.

Adult↗
PubMed1975

[Treatment of anovulatory sterility using clomiphen].

74 patients with anovulatory sterility were treated with clomiphene for 5 consecutive days starting on the 5th day of the cycle. The dosage was in the first course of treatment 50 mg daily. The patients, who did not conceive after this dosage, were treated with higher doses of clomiphene (100 and 150 mg daily). In 66% of the cases ovulation and in 32% (49% of induced ovulation) pregnancies were achieved. In the first treatment cycle with 50 mg/day for 5 days ovulation was obtained in 27 out of 74 patients. 14 patients, who failed to ovulate after this dosage, did ovulate after they were treated with 100 mg/day in the second treatment cycle. In 8 cases was a third treatment cycle with 150 mg/day needed to chieve a positive result. The conception rate per ovulatory cycle decreased with increasing dosage. The ovulation as judged on the basis of the temperature curve and pregnandiol excretion occured between the 4th and 25th day of treatment, whereas ovulation which were followed by pregnancy occured only between the 11th and 25th day.

Adolescent↗
PubMed1976

Clomiphene-regulated ovulation for donor artificial insemination.

Seventeen couples with male-caused infertility requested donor artificial insemination between January 1, 1973, and December 31, 1974. All of the women were evaluated prior to the inseminations and were found to be ovulatory. They were treated with clomiphene, citrate 50 mg/day for 5 days beginning on day 4,5, or 6 of a menstrual cycle, and scheduled for two inseminations on the 5th and 7th days after completion of the clomiphene regimen. Fresh semen placed in cervical cups was used for the inseminations. The procedure was repeated in the following months until conception occurred.

Clomiphene↗
PubMedDate not supplied

[The role of the endogenous opioid system in the pathogenesis of polycystic ovary syndrome: the altered neuroendocrine regulation of GnRH-LH is corrected after clomiphene therapy].

To investigate whether inappropriate LH secretion in Polycystic Ovary Syndrome (PCO) was related to a reduction of inhibitory opioid control on the GnRH-LH system, 23 women affected by PCO (12 obese, BMI: 37.1 +/- 3.9 and 11 non obese, BMI: 21.5 + 2.4) and 19 fertile women (10 obese, BMI: 38.8 + 1.8 and 9 non obese, BMI: 20.1 + 1.5) were studied. Plasma levels of Beta-Endorphin (B-Ep) in basal condition and LH and FSH serum levels following acute administration of naloxone (0.1 mg/kg e.v.) were evaluated in the PCO and control groups. Moreover, in order to investigate whether the neuroendocrine abnormalities in PCO are a primary hypothalamic defect or secondary to an inappropriate feedback of gonadal steroids, the LH response following Naloxone administration was evaluated again after two months of clomiphene therapy (50 mg p.os ones a day for 5 days). The women affected by PCO had increased LH/FSH ratio, testosterone levels (P < 0.001, P < 0.01) and significantly decreased T/E2 ratio, SHBG levels compared to the normal women (P < 0.01, P < 0.001). B-Ep plasma levels in PCOs OB and PCOs nOB (6.13 + 1.2 Pmol/L, 4.8 + 0.4 Pmol/L) were similar to those observed in obese and non obese control women (7.2 + 2.5 Pmol/L, 4.2 + 1.3 Pmol/L), respectively. In the PCO and control groups naloxone induced a significant increase of FSH and LH levels. Thus the area under the curve of LH and FSH was significant higher after naloxone, than following saline infusion both in PCO (P < 0.01, P < 0.05) and controls (P < 0.001, P < 0.001). However, in PCO the post naloxone FSH increase was similar to that found in fertile women, while the LH increase post naloxone was lower than that observed in controls (50 + 32.4% vs 101.6 + 36.7%; P < 0.01). Particularly in PCO with LH/FSH ratio equal or higher than 3, no significant variation of LH levels was found after naloxone. Moreover the LH increase post naloxone was similar in PCO OB (46 + 19.8%) and in PCO nOB (49.9 + 13.1%), correlated negatively with LH basal levels (P < 0.02), LH/FSH (P < 0.005), E1/E2 (P < 0.005) and was independent of T/E2, BMI and duration of the disease. Following clomiphene treatment, the LH response after naloxone was significantly higher than that observed before treatment (from 9.4 + 4.2 mUI/ml to 16.5 + 3.9 mUI/ml, P < 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2003

Minireview: Up-date management of non responder to clomiphene citrate in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in which chronic anovulation is a common feature despite the presence of multiple micro- structures in the ovaries. A growing body of evidence has suggested that serum hyperinsulinemia contributes to the excess ovarian androgen secretion observed in women with PCOS. The standard therapy for anovulatory women with PCOS is oral administration of clomiphene citrate (CC). However, a significant proportion of women with PCOS fail to ovulate with the use of standard dosage of CC and are called CC-resistant PCOS. The recent introduction of the insulin-sensitizing agents as adjuvants to clomiphene citrate and gonadotropins has changed the treatment strategy. This is a comprehensive review of the literature, with an emphasis on the role of hyperinsulinemia in the pathogenesis of PCOS and on randomized controlled trials of the medical and surgical treatment options for women with CC-resistant PCOS. Although both standard and novel treatments were addressed in the present review, special attention was paid to the evidence in support of the recent introduction of insulin-sensitizing agents in the management of anovulatory woman with CC-resistant PCOS.

Anovulation↗
PubMedDate not supplied

Minilaparotomy and ovarian diathermy drilling for clomiphene resistant poly cystic ovarian disease.

BACKGROUND: This study was carried out to determine the effectiveness and safety of minilaparotomy and ovarian drilling for sub fertile women with clomiphene resistant polycystic ovarian syndrome. METHODS: During a 2 year period (August 2000 to August 2002) 16 patients with polycystic ovarian disease were managed by minilaparotomy and ovarian drilling by diathermy. All the patients underwent full infertility workup and then treated with cyclical clomiphene citrate for 6 months. RESULTS: Six patients (37.5%) presented in age group 15-25 years. Eight patients (50.0%) were in age group 26-35 years. Only 2 (12.5%) patients presented in age group 36-44 years. Eleven (68.75%) patients had primary infertility. Five (31.25%) patients presented with secondary infertility. After treatment and 6 months follow up, ovulation occurred in 14 (87.5%) patients. Eleven (68.75%) women conceived pregnancy. CONCLUSION: Ovarian drilling is a powerful tool in the treatment of polycystic ovarian disease.

Adolescent↗
PubMed2004

A randomised prospective trial of intrauterine insemination versus timed intercourse in superovulated cycles with clomiphene.

BACKGROUND & OBJECTIVES: Despite its wide use, the benefits of intrauterine insemination (IUI), its over timed intercourse (TI) in couples with unexplained infertility is a matter of debate. Studies in Indian couples with unexplained infertility showing benefit of IUI over TI are not available. The present study was done with the objective of comparing TI and IUI with husband's sperm in couples with unexplained infertility undergoing superovulation with clomiphene. METHODS: A total of 140 couples with unexplained infertility were subjected to controlled ovarian hyperstimulation (COH) with clomiphene and prospectively randomized to receive either TI (group A) or IUI (group B). Complete follow up was available for 113 couples only. RESULTS: The pregnancy rate and cycle fecundity rate after COH/TI was 41 and 8.8 per cent and after COH/IUI 18 and 3.4 per cent respectively. The difference was statistically not significant. INTERPRETATION & CONCLUSION: The findings of the present study showed that in women with unexplained infertility addition of IUI to ovulation induction does not improve conception rates. COH/TI can help to achieve good results and save the expense and discomfort due to a invasive procedure.

Clomiphene↗