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At least 631 records · Page 35Linked to original sources
PubMed2004

A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation.

OBJECTIVE: To compare the effects of the aromatase inhibitor letrozole (7.5 mg) and clomiphene citrate (CC; 100 mg) in women undergoing superovulation and IUI. DESIGN: Prospective randomized trial. SETTING: University teaching hospital. PATIENT(S): We studied a total of 238 cycles of superovulation and IUI in women with idiopathic infertility. INTERVENTIONS: Patients were randomized into treatment with 7.5 mg of letrozole daily (74 patients, 115 cycles) or 100 mg of CC daily (80 patients, 123 cycles). MAIN OUTCOME MEASURE(S): Number of follicles, endometrial thickness, pregnancy rate, and miscarriage rate. RESULT(S): The mean age, parity, and duration of infertility in both groups of patients were similar. There was no significant difference between the total number of developing follicles in the letrozole (5.7 +/- 3.7) and in the CC groups (4.8 +/- 2.5). The number of follicles of > or =14 mm and of >18 mm were 2.1 +/- 1.2 and 1.4 +/- 0.7 in the letrozole group, and 1.7 +/- 0.9 and 1.1 +/- 0.5 in the CC group, respectively. No difference was found in the endometrial thickness between the two groups (7.1 +/- 0.2 mm in the letrozole group, 8.2 +/- 5.9 mm in the CC group). The pregnancy rate per cycle was 11.5% in the letrozole group and 8.9% in the CC group. Four of the 11 pregnancies in the CC group resulted in a miscarriage (36.6%). CONCLUSION(S): Superovulation and IUI with letrozole and CC are associated with similar pregnancy rates, but the miscarriage rate is higher with CC. The ideal dose of letrozole remains unknown and further study is needed.

Abortion, Spontaneous↗
PubMed2005

Women with ovulatory dysfunction undergoing ovarian stimulation with clomiphene citrate for intrauterine insemination may benefit from administration of human chorionic gonadotropin.

OBJECTIVE: To investigate factors that may affect pregnancy outcome following ovarian stimulation with clomiphene citrate (CC) combined with intrauterine insemination (IUI). DESIGN: Retrospective cohort study. SETTING: University teaching hospital. PATIENT(S): Three hundred and twenty women who underwent 691 ovarian stimulation cycles with CC for IUI. INTERVENTION(S): Ovarian stimulation with CC followed by a single IUI either 24 hours after a spontaneous serum LH surge (>25 mIU/mL) or 36 hours after intramuscular human chorionic gonadotropin (hCG) administration (10,000 IU) when the largest follicle had reached a diameter of 17 mm. MAIN OUTCOME MEASURE(S): Clinical pregnancies. RESULT(S): Women with ovulatory dysfunction who received hCG had significantly higher pregnancy rates (24.6%) compared with women with other types of infertility. There were no differences in pregnancy rates between the LH surge group and the hCG group (14.3% vs 12.4%). A spontaneous LH surge was noted in a variety of follicular sizes (14 to 35 mm). There was no correlation for age, body mass index, follicular diameter, number of mature follicles, other sperm characteristics, and pregnancy outcome in either group. CONCLUSION(S): After ovarian stimulation with CC, IUI is equally effective 24 hours after a spontaneous LH surge or 36 hours after administration of hCG. Spontaneous LH surges were observed at a variety of follicular sizes with comparable pregnancy rates. In women with ovulatory dysfunction, hCG administration before insemination may be beneficial.

Adult↗
PubMed2005

Treatment preferences and trade-offs for ovulation induction in clomiphene citrate-resistant patients with polycystic ovary syndrome.

OBJECTIVE: To investigate patient preferences and trade-offs for laparoscopic electrocautery of the ovaries relative to ovulation induction with recombinant FSH (rFSH) in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). DESIGN: Assessment of preferences and trade-offs in a randomized controlled trial. SETTING: Academic hospital. PATIENT(S): Thirty-two CC-resistant patients with PCOS who had been randomly assigned to either laparoscopic electrocautery of the ovaries or ovulation induction with rFSH and 32 control patients with PCOS under treatment with CC. INTERVENTION(S): Preference for laparoscopic electrocautery relative to rFSH was established during an interview. Trade-offs between treatment burden and effectiveness were evaluated by varying hypothetical pregnancy rates after laparoscopic electrocautery until patients switched in their initial preference. MAIN OUTCOME MEASURE(S): Preference for laparoscopic electrocautery of the ovaries; trade-off between burden and effectiveness of treatment. RESULT(S): The majority of the patients would prefer electrocautery of the ovaries over ovulation induction with rFSH if both treatment strategies resulted in similar pregnancy rates. However, most patients were willing to trade off their preference for increased effectiveness: the percentage of patients who preferred electrocautery over rFSH sharply declined when the difference in hypothetical pregnancy rates was more than 5% in favor of rFSH. CONCLUSION(S): Patients with polycystic ovary syndrome are well able to express an informed preference for laparoscopic electrocautery of the ovaries or ovulation induction with rFHS. Preferences are guided by features of the respective treatments but seem to be dominated by their effectiveness and safety.

Clomiphene↗
PubMed2006

Letrozole induction of ovulation in women with clomiphene citrate-resistant polycystic ovary syndrome may not depend on the period of infertility, the body mass index, or the luteinizing hormone/follicle-stimulating hormone ratio.

Letrozole induction of ovulation in clomiphene citrate-resistant women with polycystic ovary syndrome is associated with an ovulation rate of 54.6% and pregnancy rate of 25%. There was no significant difference between letrozole responders and nonresponders in age, period of infertility, body mass index, waist circumference, LH, FSH, or LH/FSH ratio.

Adult↗
PubMed2006

High frequency of iatrogenic monozygotic twins with administration of clomiphene citrate and a change in chorionicity.

The data of the population-based, prospective survey of multiple births in East Flanders, Belgium, show that a greater proportion of monozygotic twins is observed with clomiphene citrate as sole treatment compared with other ovulatory drugs. Among iatrogenic monozygotic twins, the ratio of monochorionic versus dichorionic pairs is higher compared with spontaneous twins.

Chorion↗
PubMed2006

Letrozole vs. clomiphene citrate in patients with ovulatory infertility.

OBJECTIVE: To compare the effectiveness of letrozole and clomiphene citrate (CC) in ovulatory patients with borderline male factor infertility, early stage endometriosis, and unexplained infertility. DESIGN: Prospective quasi-randomized trial. SETTING: University infertility clinic. PATIENT(S): Forty-six consecutive patients with ovulatory infertility were recruited. Twenty-five patients (67 cycles) were given CC and 21 patients (52 cycles) were given letrozole. Both drugs were given orally on days 3-7 of menses. INTERVENTION(S): Letrozole, CC, ovulation induction, IUI, timed intercourse. MAIN OUTCOME MEASURE(S): Number of follicles, endometrial thickness, and pregnancy rates. RESULT(S): The median serum E2 concentration on the day of hCG administration in the letrozole and CC groups were 191.5 pmol/L and 476.0 pmol/L, respectively. The median endometrial thickness on the day of hCG were 8 mm in both groups. Ovulation occurred in 81% (42/52) of the letrozole-treated and 85% (57/67) of the CC-treated patients. Pregnancy rate (PR) per cycle was 9% (5/52) in the letrozole group and 12% (8/67) in the CC group. CONCLUSION(S): Letrozole and CC have comparable effectiveness in ovulatory patients with borderline male factor infertility, early stage endometriosis, and unexplained infertility.

Administration, Oral↗
PubMed2006

Two weeks of metformin improves clomiphene citrate-induced ovulation and metabolic profiles in women with polycystic ovary syndrome.

OBJECTIVE: To determine if short courses of metformin (MET) administration in patients with polycystic ovary syndrome (PCOS) would reduce fasting insulin and improve the efficacy of clomiphene citrate (CC) to induce ovulation. DESIGN: A randomized prospective trial involving 31 subjects with PCOS and infertility. SETTING: University-based medical center. PATIENT(S): Obese patients (body mass index > 29 kg/m2) with PCOS. INTERVENTION(S): Patients with PCOS were treated either with CC or CC+MET for 2 weeks. MAIN OUTCOME MEASURE(S): Ovulation as determined by serum P, serum insulin, and total and free T. RESULT(S): In the CC/MET group, a significant increase in sex hormone-binding globulin (SHBG) levels, a decrease in fasting insulin, and an increase in fasting glucose/fasting insulin was detected on day 21 of the cycle. Of these parameters, only SHBG levels increased significantly in the CC group. In the CC/MET group, a significant increase in day 21 progesterone occurred, with 44% of subjects ovulating in the CC+MET group as compared with 6.7% in the CC group. Five subjects in the CC+MET group and none in the CC group conceived. Total and free testosterone levels did not change significantly for either group. CONCLUSION(S): In obese PCOS patients, 2 weeks of MET significantly reduces serum insulin and insulin resistance and increases SHBG levels, resulting in an improved response to CC. This regimen may be beneficial in noncompliant patients or those with intolerance to the side effects of MET.

Adult↗
PubMed2006

The clomiphene citrate challenge test versus the exogenous follicle-stimulating hormone ovarian reserve test as a single test for identification of low responders and hyperresponders to in vitro fertilization.

OBJECTIVE: This study was designed to compare the exogenous FSH ovarian reserve test (EFORT) versus the clomiphene citrate challenge test (CCCT), basal FSH, and basal inhibin B, with respect to their ability to predict poor and/or hyperresponders in an IVF population. DESIGN: Prospective randomized controlled trial. SETTING: Fertility center of a university hospital. PATIENT(S): One hundred ten patients undergoing their first IVF cycle, randomized into two groups. INTERVENTION(S): Fifty-six patients underwent a CCCT, and 54 patients underwent an EFORT. In all patients, the test was followed by an IVF treatment. MAIN OUTCOME MEASURE(S): Ovarian response, expressed by the total number of retrieved oocytes. RESULT(S): Univariate logistic regression showed that the best predictor for poor response is the CCCT (area under receiver operator characteristic curve [ROC-AUC] = 0.87), with maximal accuracy of 0.89. Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response. For hyper response, univariate logistic regression showed that the best predictor is the inhibin B increment in the EFORT (ROC-AUC = 0.92) but with a low maximal accuracy of 0.78. Again, multiple logistic regression analysis did not produce a better model in terms of predicting hyper response. CONCLUSION(S): Our study, the first which compares the CCCT with the EFORT for the prediction of poor and hyperresponders, shows that the CCCT is superior for identification of low responders. The EFORT (inhibin B increment) is superior for prediction of hyper response at the cost of a high rate of false positives. Neither of the two tests seems adequate to act alone for identification of both poor and hyperresponders.

Clomiphene↗
PubMed2006

Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles: a pilot study.

OBJECTIVE: To compare the clinical outcomes between letrozole and clomiphene citrate (CC) in gonadotropin-combined intrauterine insemination (IUI) cycles. DESIGN: Prospective pilot study. SETTING: One university hospital and two private infertility clinics. PATIENT(S): Ninety-three infertile couples eligible for superovulation and IUI. INTERVENTION(S): A letrozole dose of 2.5 mg/day (n = 66) or a CC dose of 100 mg/day (n = 27) was given on day 3-7 of the menstrual cycle, combined with human menopausal gonadotropin (hMG) at a dose 150 IU every other day starting on day 5. MAIN OUTCOME MEASURE(S): The number of mature follicles, serum estradiol (E2) and progesterone (P) levels, endometrial thicknesses on the day of human chorionic gonadotropin (hCG), and clinical pregnancy rates. RESULT(S): The patients' clinical characteristics were comparable between the two groups. The number of mature follicles (3.2 +/- 1.7 vs. 5.6 +/- 2.4) and serum E2 levels on the day of hCG (231.0 +/- 179.8 vs. 1,371.7 +/- 750.5 pg/mL) were significantly lower in the letrozole group. No significant differences were found in endometrial thickness measured on the day of hCG or clinical pregnancy rates (18.2% vs. 25.9%). The rate of patients with serum P levels > 1.0 ng/mL on the day of hCG was significantly lower in the letrozole group (4.5% vs. 25.9%). CONCLUSION(S): Letrozole produced a comparable pregnancy rate vs. CC in gonadotropin-combined IUI cycles. Our results should be confirmed in larger populations with proper randomization.

Adult↗
PubMed2006

Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate.

OBJECTIVE: To evaluate the incidence of congenital malformations among offspring of mothers who conceived with clomiphene citrate (CC) or with letrozole treatment for infertility. DESIGN: Retrospective study. SETTING: 5 fertility centers in Canada. PATIENTS: 911 newborns from women who conceived following CC or letrozole treatment. INTERVENTIONS: Examination of medical files of both mother and newborn, and cross-checked with the parents by telephone calls. MAIN OUTCOME MEASURES: Identified major and minor congenital malformations, birth weight, age of the mother, and type of treatment that led to the conception. RESULTS: Overall, congenital malformations and chromosomal abnormalities were found in 14 of 514 newborns in the letrozole group (2.4%) and in 19 of 397 newborns in the CC group (4.8%). The major malformation rate in the letrozole group was 1.2% (6/514) and in the CC group was 3.0% (12/397). One newborn in the letrozole group was found to have a ventricular septal defect (0.2%) compared to 4 newborns in the CC group (1.0%). In addition, the rate of all congenital cardiac anomalies was significantly higher (P: 0.02) in the CC group (1.8%) compared to the letrozole group (0.2%). CONCLUSION: There was no difference in the overall rates of major and minor congenital malformations among newborns from mothers who conceived after letrozole or CC treatments. However, it appears that congenital cardiac anomaly is less frequent in the letrozole group. The concern that letrozole use for ovulation induction could be teratogenic is unfounded based on our data.

Adult↗
PubMed2006

The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review.

OBJECTIVE: To systematically review the value of the clomiphene citrate challenge test (CCCT) in the prediction of poor ovarian response and pregnancy in IVF. DESIGN: Systematic review. SETTING: All studies that evaluated the CCCT in the prediction of poor ovarian response or pregnancy after IVF. PATIENT(S): Infertility population undergoing an IVF treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response, nonpregnancy. RESULT(S): From the literature we identified and analyzed 12 studies on the CCCT according to preset criteria. In predicting poor response, the sensitivity and specificity of the CCCT varied from 35% to 93% and 47% to 98%, respectively. In predicting nonpregnancy, the sensitivity and specificity varied from 13% to 66% and 73% to 97%, respectively. Because of heterogeneity among studies, a summary receiver operating characteristics (ROC) curve could not be estimated. Back-to-back comparison of the CCCT with basal FSH was possible in six studies. In predicting poor response, the sensitivity of the CCCT increased to some extent, whereas specificity did not increase or even diminished. In predicting nonpregnancy, the CCCT also showed an increase in sensitivity, counteracted by a decrease in specificity. CONCLUSION(S): Summary estimates of test accuracy for the CCCT in IVF are not possible, because of heterogeneity among individual studies. A subanalysis of studies comparing basal FSH and the full CCCT showed that the CCCT has hardly any additional value.

Adult↗
PubMed2006

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.

OBJECTIVE: To study the efficacy of the aromatase inhibitor letrozole as adjuvant to recombinant FSH (rFSH) in controlled ovarian hyperstimulation (COH). DESIGN: Prospective, randomized, and blinded clinical study. SETTING: Academic tertiary institute. PATIENT(S): Forty-one patients with unexplained infertility undergoing intrauterine insemination (IUI) therapy were randomized to receive either letrozole or clomiphene citrate (CC) as adjuvants to rFSH. INTERVENTION(S): From day 3 to 7 of the cycle 2.5 mg/d letrozole or 100 mg/d CC were administrated. All patients received 75 IU rFSH starting on day 7 of stimulation until the day of hCG administration. Ovulation was triggered with recombinant hCG (250 microg) when the leading follicle(s) reached 18 mm in diameter. A single IUI was performed 36 hours later. The luteal phase was supplemented with micronized progesterone vaginally. MAIN OUTCOME MEASURE(S): Ovarian stimulation response (E(2) levels and number of follicles) was our primary outcome. RESULT(S): There were no differences in demographic characteristics between groups. Although there was a significantly lower peak serum E(2) level in the group receiving letrozole + rFSH compared with CC + rFSH (914 +/- 187 vs. 1,207 +/- 309 pg/mL, respectively; P<.007), there were no differences in the number of mature (>16 mm) preovulatory follicles. A significantly higher endometrial thickness was observed at the time of hCG administration in patients that received letrozole (9.5 +/- 1.5 mm vs. 7.3 +/- 1.1 mm; P=.0001). The clinical pregnancy rate was similar between groups (23.8% vs. 20%, respectively). CONCLUSION(S): The aromatase inhibitor letrozole appears to constitute a good alternative to CC in patients with unexplained infertility undergoing gonadotropin-stimulated COH cycles combined with IUI therapy.

Adult↗
PubMed2006

Effects of metformin and clomiphene citrate on ovarian vascularity in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effects of metformin and of clomiphene citrate (CC) on the ovarian blood perfusion and on perifollicular and peri-corpus luteum (CL) vascularity in anovulatory women with polycystic ovary syndrome (PCOS). DESIGN: Prospective cohort study. SETTING: University "Magna Graecia" of Catanzaro. PATIENT(S): Forty anovulatory nonobese patients with PCOS who ovulated under treatment with metformin (850 mg twice daily) plus placebo (metformin group) and 38 under placebo plus CC (150 mg for 5 days; CC group). Another 30 healthy normal cycled women (control group). INTERVENTION(S): Serial transvaginal ultrasonographic examinations. MAIN OUTCOME MEASURE(S): Ovary artery blood flow impedance, dimensions, and vascularization of the dominant follicle and of the CL. RESULT(S): No difference was observed in all parameters in metformin ovulating cycles in comparison with healthy controls. In CC ovulating cycles, ovarian artery impedance, and perifollicular and peri-CL vascularization the results were significantly different from the metformin and control groups. After grouping the stimulated cycles for reproductive outcomes, perifollicular vascularization alone ended up being significantly lower only in CC-stimulated cycles with unfavorable outcome. CONCLUSION(S): In patients with PCOS who ovulate under treatment with metformin, the ovarian blood flows are similar to those observed in healthy women, whereas CC administration reduces the ovarian and, specifically, the perifollicular vascularization.

Adult↗
PubMed2006

Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction and achievement of pregnancy in 154 women with polycystic ovary syndrome.

OBJECTIVE: To determine which first-line medication is more effective in polycystic ovary syndrome (PCOS) patients for ovulation induction and pregnancy achievement and to verify whether any patient characteristic is associated with a better response to therapy. DESIGN: Observational comparative study. SETTING: Fertility clinic. PATIENT(S): One hundred fifty-four infertile women with oligomenorrhea and hyperandrogenism. INTERVENTION(S): Group 1 (56 patients) received clomiphene citrate (CC) 50 mg from days 5-9 of the cycle. Group 2 (57 patients) received 500 mg of metformin 3 times a day. Group 3 (41 patients) received both medications. MAIN OUTCOME MEASURE(S): Ovulation and pregnancy. RESULT(S): Patients receiving metformin alone had an increased ovulation rate compared with those receiving CC alone (75.4% vs. 50%). Patients on metformin had similar ovulation rates compared with those in the combination group (75.4% vs. 63.4%). Pregnancy rates were equivalent in the 3 groups. Response to metformin was independent of body weight and dose. Finally, nonsmoking predicted better ovulatory response overall as well as lower fasting glucose for CC and lower androgens for metformin. CONCLUSION(S): Metformin is better for ovulation induction than CC alone and equivalent for pregnancy achievement. We suggest that metformin can be used first for ovulation induction in patients with PCOS regardless of their weight and insulin levels because of its efficacy and known safety profile.

Adult↗
PubMed2006

Is the addition of metformin efficacious in the treatment of clomiphene citrate-resistant patients with polycystic ovary syndrome? A structured literature review.

OBJECTIVE: The aim of this literature search is to establish if metformin is efficacious when given to clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. DESIGN: Medline database was searched from 1 January 1980 to 1 January 2005. Inclusion criteria were prospective randomized control trials where metformin was randomized either with placebo or CC to induce ovulation in the CC-resistant patient. RESULT(S): Group 1: Four trials were prospective double-blind placebo controlled. When the data of the four trials were pooled, the overall effect of the addition of metformin in the CC patient was P=.0006 with a 95% confidence interval (CI) of odds ratio (OR) 1.81-8.84. Group 2: In two trials the randomization was only prospective. When the data of these two trials were pooled, the overall effect of the addition of metformin in the CC-resistant patient was P<.0001 with a 95% CI of OR 6.24-70.27. Groups 1 and 2: The combined data show an overall effect of P<.0001 with a 95% CI of OR 3.59-12.96. CONCLUSION(S): The addition of metformin in the CC-resistant patient is highly effective in achieving ovulation induction.

Clomiphene↗
PubMed2006

Evaluation of an existing nomogram for predicting the response to clomiphene citrate.

OBJECTIVE: To evaluate the ability of an existing nomogram to predict response to clomiphene citrate (CC) in infertile couples with World Health Organization group II ovulatory disorders, using the free androgen index, body mass index, and menstrual-cycle history. DESIGN: Retrospective case-notes study. SETTING: Reproductive medicine and fertility center at a university teaching hospital in the United Kingdom. PATIENT(S): One hundred four anovulatory women. INTERVENTION(S): One hundred four anovulatory women who had been treated with CC were studied retrospectively. Age, body mass index, free androgen index, and cycle history were used to assign a likelihood of response for each patient on the basis of a published nomogram. Predicted and observed responses were compared. MAIN OUTCOME MEASURE(S): Ovulation rate. RESULT(S): The diagnostic characteristics of the model on the basis of the optimal cutoff points were as follows: sensitivity, 96% (95% confidence interval [CI]: 90%-99%); specificity, 33% (95% CI: 18%-49%); positive predictive value, 73% (95% CI: 63%-82%); negative predictive value, 80% (95% CI: 60%-99%); likelihood ratio for ovulation, 1.34 (95% CI: 1.1-1.8); likelihood ratio for resistance, 0.13 (95% CI: 0.04-0.43); kappa, 0. 26 (95% CI: 0.09-0.44). CONCLUSION(S): The accurate prediction of response to CC would allow more rapid transfer of nonresponders to alternative treatments and may shorten the treatment to pregnancy interval. Although the current nomogram could identify 80% of nonresponders to CC, it was insufficiently accurate for use in the present clinical setting. Moreover, the nomogram could not identify the most appropriate dose to achieve ovulation. This nomogram should be tested on patients in other clinical settings, where it may perform better.

Body Mass Index↗
PubMed2006

Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis.

OBJECTIVE: To systematically compare hCG administration as a method for intrauterine insemination (IUI) timing with conservative urinary LH surge detection in infertility treatment. DESIGN: Meta-analysis of prospective and retrospective trials. SETTING: Tertiary fertility and IVF center. PATIENT(S): One thousand four hundred sixty-one patients who received hCG after a clomiphene citrate regimen, compared with 1,162 patients who had an LH surge detection for IUI timing. INTERVENTION(S): Both MEDLINE and Cochrane Collaboration were searched. References of retrieved articles were included in the search. The meta-analysis included all controlled trials examining the effectiveness of hCG administration before IUI on clinical-pregnancy rates in comparison with LH detection. Two independent reviewers performed data extraction. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): Seven studies with 2,623 patients were included in the meta-analysis (1,461 patients received hCG, and 1,162 had LH surge detection). When all studies were combined, patients who received hCG before IUI demonstrated lower clinical-pregnancy rates than did women who had IUI after spontaneous ovulation (odds ratio, 0.74; 95% confidence interval, 0.57-0.961). In subgroup analysis of studies that considered ovulatory dysfunction to be the infertility reason, the results favored women who received hCG. In contrast, across studies that reported male factor as the infertility reason, as well as across studies including women with unexplained infertility, results appeared to favor the LH surge detection approach. However, none of those subgroup analyses reached statistical significance. CONCLUSION(S): Available data do not demonstrate a consistent, clinically important benefit of hCG-induced ovulation compared with spontaneous ovulation for IUI timing.

Adult↗
PubMed2006

Time of initiation of clomiphene citrate and pregnancy rate in polycystic ovarian syndrome.

OBJECTIVE: To investigate whether the timing of clomiphene citrate (CC) administration affects hormonal levels, follicular growth, endometrial thickness, and ovulation and pregnancy rates in women with polycystic ovarian syndrome (PCOS). METHODS: Of the 78 infertile women with PCOS who participated in this prospective, double-blind, randomized clinical trial, 37 collectively underwent 71 cycles of CC (100 mg/day) on days 1 through 5 of the menstrual cycle (group 1) and 41 collectively underwent 73 cycles of CC at the same concentration on days 5 through 9 (group 2). Hormonal levels, follicular growth, endometrial thickness, and ovulation and pregnancy rates were compared. RESULTS: The mean number of follicles and the maximum follicular size were greater in group 2. However, ovulation rates were 72.8% in group 1 and 70.8% in group 2 (P=.78), and pregnancy rates were 40.5% in group 1 and 19.5% in group 2 (P=.04). CONCLUSION: Treatment with CC is associated with higher rates of pregnancy if started early (days 1-5) in the menstrual cycle.

Adult↗