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At least 883 records · Page 49Linked to original sources
PubMedDate not supplied

A prospective, double-blind, randomized, placebo-controlled clinical trial of bromocriptine in clomiphene-resistant patients with polycystic ovary syndrome and normal prolactin level.

OBJECTIVE: To evaluate the effects of administration of bromocriptine combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCOS) and normal prolactin (PRL) level. DESIGN: Prospective double-blind, placebo-controlled, randomized. SETTING: Referral university hospitals. PATIENTS: One hundred women with PCOS and normal PRL who failed to ovulate with a routine protocol of CC. INTERVENTIONS: Treatment group received 150 mg of CC from day 5 to 9 and 7.5 mg bromocriptine continuously, with hCG 10,000 units on day 16 or 17. Control group received the same protocol of CC combined with placebo. MAIN OUTCOME MEASURES: Follicular development, hormonal changes, ovulation rate, pregnancy rate. RESULTS: Follicular development (follicular size greater than 15 mm) was observed in 12 (25.5%) and 8 (15.1%) women in the treatment and placebo group, respectively (p = 0.29). The serum prolactin level was within normal limits in all patients before treatment. After 3 and 6 months of treatment with bromocriptine, there was a significant decrease in serum level of prolactin (p = 0.000001). No significant differences were seen in ovulation, pregnancy rate, or serum levels of FSH, LH, DHEAS, and progesterone between treatment and placebo groups after treatment. CONCLUSIONS: The only significant effect of long-term bromocriptine therapy in CC-resistant women with PCOS was to lower the serum PRL concentration. It is also concluded that 10%-15% of patients with PCOS experienced occasional ovulatory cycles and pregnancy whether or not they were on treatment.

Adult↗
PubMed1992

[Use of GnRH analog for induction of gonadotropin ovulatory surge in cycles stimulated by clomiphene citrate and menopausal gonadotropin in an in vitro fertilization program].

In 23 women treated for sterility by the in vitro fertilization method the gonadotropins ovulatory surge was stimulated by applying a GnRH analogue (Busereline). The authors showed that a single injection of GnRH analogue in the cycles stimulated with clomiphene citrate and menopausal gonadotropin causes pituitary output of both LH and FSH which is sufficient for morphological and functional maturity of the oocytes. After such treatment two patients conceived and delivered healthy babies.

Buserelin↗
PubMedDate not supplied

Combined therapy with bromocriptine and clomiphene citrate for patients with normoprolactinemic amenorrhea.

The purpose of this study was to investigate the combined effect of bromocriptine (Brc) and clomiphene citrate (Cl) treatment on 40 patients with normoprolactinemic amenorrhea who failed to respond to Cl alone. The ovulation rate in this treatment was 57.3% (23/40) in the 40 cases, 55.6% (99/178) in 178 cycles; the pregnancy rate was 26.7%. This treatment was effective in 14 of 21 women with polycystic ovary-like syndrome (66.7%). Among those women who responded to treatment, prolactin (PRL) and LH levels were significantly decreased. Estradiol and progesterone levels were significantly increased in the patients who responded. Before treatment, the responsiveness of LH to LHRH among responders to Brc/Cl therapy was significantly higher than among the nonresponders. After treatment, the LH-releasing response following a conjugated estrogen injection in the patients who responded to the treatment was significantly greater than that in the patients who did not respond. The results suggest that the therapeutic effect of this treatment may be primarily due to the restoration and improvement of the impaired hypothalamo-pituitary axis.

Adolescent↗
PubMed1992

[Luteinization of unruptured follicles during clomiphene treatment].

Twenty-eight anovulatory, infertile patients under clomiphene (cc) treatment were studied. Ovarian function was ascertained through BBT, cervical score (cs) and serial hormonal assays. Follicular development and ovulatory events were monitored by serial ultrasonography. Of a total of 66 treatment cycles, 49 presented ovulatory responses, but only 28 cycles showed actual ovulation (42.4% of total; 57.1% of ovulatory response cycles); follicles in 21 cycles were unruptured but luteinized (LUF) (31.8% of total; 42.9% of ovulatory response cycles); deficient follicular development occurred in 17 cycles. With analysis of parameters investigated and hormonal assays, the characteristics of LUF and some factors involved in its development are discussed.

Adult↗
PubMed1992

Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles of in vitro fertilization.

OBJECTIVE: To compare luteal phase leuprolide acetate (LA) initiated pituitary down regulation followed by human menopausal gonadotropins (hMG) versus clomiphene citrate (CC) and hMG for follicular recruitment and oocyte maturation before in vitro fertilization (IVF). DESIGN: Randomized, prospective comparison in first cycles of IVF. SETTING: University Hospital, a tertiary referral center offering assisted reproductive technologies. PARTICIPANTS: Participants were couples undergoing their first ever cycle of IVF and consenting to participation in the trial. RESULTS: Luteal phase initiated LA/hMG was associated with a lower probability of cycle cancellation, improved folliculogenesis, and a higher probability of embryo transfer (ET) compared with CC/hMG alone. Implantation rates were not different. CONCLUSION: A higher rate of ET with LA/hMG suggests that gonadotropin-releasing hormone agonist for the induction of folliculogenesis before IVF may be appropriate.

Clomiphene↗
PubMed2005

[Clinical study of ganshao capsule in treating clomiphene-resistant polycystic ovarian syndrome].

OBJECTIVE: To assess the efficacy and safety of Ganshao Capsule (GSC) in treating clomiphene (CC)-resistant hyperandrogenemic polycystic ovarian syndrome (PCOS), and to explore the feasibility of using CC for improving ovulation induction after withdrawal of GSC. METHODS: Twenty-seven PCOS patients were given GSC for 8 weeks (2 cycles). Changes in serum reproductive hormone, body mass index (BMI), adverse reaction, as well as pelvic ultrasonographic feature were observed before treatment, at the end of 4 weeks and 8 weeks after treatment. After stopping GSC medication, CC was used to induce ovulation in patients whose serum testosterone (T) < (2.1+/-0.8) nmol/L but without ovulation. Condition of follicle growth and effect of GSC were monitored. RESULTS: After 4 weeks of treatment, serum reproductive hormones were significantly changed. At the end of 8 weeks, bilateral ovarian volume, number of follicles, and diameter of follicles were significantly reduced, and endometrium obviously thinned. Within 2 months after stopping medication, 6 in the 27 patients got natural ovulation, and 2 natural pregnancy. In the other 19 patients who received ovulation induction during the 37th cycles, 17 had ovulation in the 25th cycles, 7 got pregnancy, the ovulation rate being 89.5%, ovulation cycle rate 67.6%, pregnant rate 36.8%, and pregnant cycle rate 28.0%. CONCLUSION: Endometrium, ovarian morphology and BMI got significant improvement in PCOS patients with CC- resistance and hyperandrogenemia. The sensitivity to ovulation induction with CC were also improved.

Adult↗
PubMedDate not supplied

Qualitative differences in estrogenic/antiestrogenic effects of clomiphene and zuclomiphene.

Depending upon the rat assay end point, the estrogenic or antiestrogenic activity of clomiphene (CC) or its isomer, zuclomiphene (Zu), varies considerably. For uterine/body weight ratio, Zu = estradiol greater than CC; for the estrogenic effect on uterine epithelium, Zu greater than estradiol = CC; higher CC doses were antiestrogenic. For endometrial stroma, Zu = estradiol much greater than CC. In the effect of estrogen receptor, low-dose CC = estradiol; high-dose CC was antiestrogenic. For Zu, both doses were about equal and highly antiestrogenic. Essentially the same was seen with progesterone receptor. For plasma LH suppression, Zu much greater than CC much greater than estradiol; but for plasma FSH, estradiol much greater than CC = Zu. The intrinsic estrogenicity of these compounds was made more apparent by the castrate status of the rats. This spectrum of activities may make it possible to select estrogenic or antiestrogenic activities for clinical purposes, depending upon the end-organ effect desired.

Animals↗
PubMed1992

Subclinical pregnancy loss in clomiphene citrate-treated women.

OBJECTIVE: To ascertain the subclinical pregnancy loss rate in clomiphene citrate (CC)-treated infertile women compared with women of normal fertility. DESIGN: Following a prospective format, serum samples were taken during the luteal phase of 92 menstrual cycles associated with CC treatment and 47 cycles in normal women. Human chorionic gonadotropin (hCG) assay sensitivity was 0.25 IU/L. Human chorionic gonadotropin assay was validated against 95 nonpregnant cycles. Criterion for pregnancy was a single serum sample greater than or equal to 0.5 IU/L. SETTING: All subjects were under clinical management at the University of Virginia Health Sciences Center. PATIENTS AND PARTICIPANTS: Patients undergoing CC induction of ovulation with satisfactory ovulatory response were candidates for the study group (n = 34). Control subjects of proven normal fertility were recruited (n = 22). Nonpregnant control subjects were sexually abstinent or had been surgically sterilized (n = 89). INTERVENTION: A serum sample was taken during the late luteal phase of all subjects. RESULTS: Thirteen percent of CC-treated cycles and 4.3% of normal control cycles were subclinical losses (P = 0.09). Fifty percent of CC-induced pregnancies were subclinical losses compared with 16.6% of normal control pregnancies (P = 0.05). Of CC patients who had at least one subclinical loss 47.6% later conceived a term pregnancy compared with 15.3% who did not have a subclinical loss (P = 0.06). CONCLUSION: Subclinical pregnancy loss is more common in CC-treated women than normal women and may be a predictor of subsequent normal conception.

Abortion, Spontaneous↗
PubMed1992

Histology of midluteal corpus luteum and endometrium from clomiphene citrate-induced cycles.

OBJECTIVE: To determine the histologic development of midluteal corpus luteum (CL) and endometrium in normal fertile women after induction of ovulation with clomiphene citrate (CC). DESIGN, PATIENTS, INTERVENTIONS: Twelve normally cycling women planning to undergo an elective tubal ligation were treated with 50 to 150 mg of CC daily on days 5 through 9 of the cycle. Luteectomy and endometrial biopsy were performed simultaneously 7 days after the urinary luteinizing hormone surge. RESULTS: Because polyovulation occurred in 10 of the 12 women, 22 CL and 12 endometrial biopsies were studied. Ten women had luteal and endometrial histology that were within 2 days of the ovulation to biopsy interval. The 2 remaining women had endometrial histology that lagged 3 days behind the chronological postovulatory date. In these women, out-of-phase endometrium occurred despite polyovulatory cycles in which two and three histologically normal CL lutea were present and associated with elevated progesterone concentrations. CONCLUSIONS: In CC-induced ovulatory cycles: (1) midluteal CL histology is normal and (2) apparently out-of-phase preimplantation endometrium occurs in midluteal phase.

Adult↗
PubMed1992

Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles.

OBJECTIVE: To determine characteristics associated with pregnancy and multiple gestation after clomiphene citrate (CC)-intrauterine insemination (IUI). DESIGN: Prospective study of all patients undergoing CC-IUI between January 1, 1983 and December 31, 1989. SETTING: Private fertility clinic. PATIENTS: Eight hundred forty-nine patients undergoing 1,974 cycles of CC-IUI. MAIN OUTCOME MEASURES: Relationship between number and size of preovulatory follicles, age, additional infertility diagnosis, medication, and initial semen quality to fecundity, birth, and multiple gestation. RESULTS: Uncorrected, per cycle fecundity was 7.2%. The number of follicles greater than or equal to 12 mm (r = 0.055, P less than 0.05) was and the number greater than or equal to 15, 18, and 21 mm was not correlated with fecundity. Endometriosis with (P = 0.013) or without (P less than 0.0005) tubal adhesions and tubal adhesions alone (P = 0.005), decreased fecundability by 50%. Initial semen quality did not affect fecundity, unless semen concentration was less than 5 x 10(6)/mL or motility was less than 20%. Multiple pregnancy was not associated with the dose of CC, use of human chorionic gonadotropin, or number of follicles. CONCLUSIONS: Multiple pregnancy was unrelated to follicle numbers or to CC dose. The highest birth rates after CC-IUI occurred when initial sperm concentration was greater than or equal to 5 x 10(6)/mL, motility was greater than or equal to 20%, and no endometriosis or adhesions were present.

Clomiphene↗
PubMed1991

[Effect of microsurgical resection of the ovary on fertility in patients with polycystic ovary resistant to clomiphene citrate].

Thirteen patients with clomiphene citrate resistant polycystic ovary syndrome (PCO-CR) were documented by clinical and endocrine profile. Exogenous gonadotropins (HMG, hFSH, hCG), or gonadotrophin releasing hormone agonist (GnRHa) plus gonadotropins represent a new approach to induce ovulation in these (PCO-CR) patients. 92% of these patients ovulated with exogenous gonadotropin, nevertheless the pregnancy rate was only 53%. Five out seven PCO-RC patients did not achieve pregnancy with exogenous gonadotrophins, but they did after ovarian wedge resection. It is interesting to note that four of these patients achieved their second and third pregnancy without any therapy. The authors conclude that the ovarian wedge resection may had to improve in the quality of ovulation in this very selective group of infertile patients.

Adult↗
PubMed1991

Effect of clomiphene citrate upon periovulatory endometrial development in the baboon.

Endometrial histology in baboons (Papio cynocephalus anubis) was evaluated after five days of clomiphene citrate (CC) treatment initiated on either cycle day six (n = 8) or ten (n = 4). Biopsies performed before and after a human chorionic gonadotropin (hCG) induced ovulation were compared to non-CC treated controls. Although CC had a definite antiestrogenic effect on perineal skin, no significant effect of endometrial proliferation was demonstrable.

Animals↗
PubMedDate not supplied

The effects of normal aging on the response of the pituitary-gonadal axis to chronic clomiphene administration in men.

Serum androgens decline with age in normal men, despite normal or elevated bioactive serum gonadotropins, suggesting that primary testicular dysfunction occurs with aging. The authors further assessed the question of age-related testicular dysfunction by evaluating whether raising serum gonadotropins above the normal serum range for an extended time in healthy elderly men might result in bringing their gonadal function to a level similar to that found in young adult men. Five elderly (65 to 85 years old) and five young adult men (26 to 33 years old) were given 50 mg of clomiphene citrate (CC) twice a day for 8 weeks to stimulate gonadotropin production. During that time, testosterone (T), non-sex hormone-binding globulin bound T, and estradiol increased significantly in both age groups, while serum inhibin increased significantly only in the young adult men. The increases in serum androgens with CC administration were significantly greater in the young adult men than in the elderly men. These hormone changes occurred in the setting of serum gonadotropins that increased significantly in both age groups, although there was a tendency for the elderly men to have a smaller increase in luteinizing hormone. Despite 8 weeks of stimulation of the pituitary-gonadal axis by CC administration, the elderly men demonstrated significantly diminished testicular responses compared with the young adult men. Sertoli cell function, as determined by inhibin production, was more diminished in the elderly men than was Leydig cell function. These data strengthen the hypothesis that normal aging in men is accompanied by a decline in testicular function.

Adult↗
PubMedDate not supplied

Biochemical studies following ovulation induction with clomiphene citrate and human menopausal gonadotropin in infertile Indian women.

Biochemical studies were done in 65 anovulatory women before and following induction of ovulation with ethinyl estradiol/clomiphene citrate/human chorionic gonadotropin and also clomiphene citrate/human menopausal gonadotropin/human chorionic gonadotropin to determine the metabolic adverse effects, if any, of such therapy. Significant increases occurred in lipids and lipoprotein levels, while minor changes were seen in liver function enzymes and fasting blood sugar. Sialic acid decreased significantly after therapy in both the regimens, and both induction therapies seem to be free of adverse metabolic effects of hormones. On comparison with normal ovulatory women, this study suggests that some of the biochemical parameters can serve as reliable indicators of ensuing ovulation.

Adult↗
PubMed1990

[Preliminary study on 4 indices of basal body temperature in the evaluation of luteal phase insufficiency after clomiphene treatment].

The luteal phase insufficiency after Clomiphene treatment in 90 patients with polycystic ovary syndrome (PCOS) and other menstrual disorders was evaluated by four indices of BBT. The four indices of BBT are (1) BBT curve classification; (2) High phase score (HPS); (3) Planimetric nidation index (PNI); (4) Length of follicular phase. 90 patients (248 cycles) were divided into two groups: non-pregnant group (214 cycles) and pregnant group (34 cycles). The result indicated that 70% cycles of non-pregnant group, the types of BBT are type III-VI, HPS is less than 9; the mean value of PNI is 45.7; the follicular phase lists beyond 17 days, with a mean of 18.6 days. More than two-thirds of the study cycles are abnormal at least in two indices. In all cycles of the pregnant group, BBT curve are of type I, II, HPS greater than 9, PNI greater than 57. The results suggest that measurement of the four indices of BBT is a simple method which could be widely used for the evaluation of luteal phase insufficiency.

Body Temperature↗
PubMed1990

Exogenous estrogen therapy for treatment of clomiphene citrate-induced cervical mucus abnormalities: is it effective?

Clomiphene citrate (CC) may have an adverse effect on cervical mucus (CM) quality and quantity. A placebo-controlled study was performed to assess the effect of exogenous follicular phase estrogen (E) on CM. Subjects qualified for inclusion by repeated demonstration of poor CM while on CC therapy as judged by spinnbarkeit, quantity, and viscosity. Subjects were treated by a randomized, placebo-controlled format using: (1) oral micronized estradiol (E2), 2 mg; (2) conjugated Es, 5 mg, or (3) placebo administered on cycle days 9 to 14. Cervical mucus was scored blindly during therapy within 48 hours before ovulation. Twelve subjects were observed through 36 treatment cycles with mean (+/- SD) CM scores: micronized E2, 4.2 +/- 1.8; conjugated Es, 4.3 +/- 1.7; and placebo, 4.7 +/- 2.9. There was no significant difference in mean values (P = 0.96, analysis of variance) or frequency of CM score greater than 4 (P = 0.85, Fisher exact test). We conclude that therapy with the E preparations tested did not improve the quality or quantity of CM in CC-treated patients.

Cervix Mucus↗
PubMed1990

A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis.

This study was initiated to test the hypothesis that treatment with clomiphene citrate (CC) and intrauterine insemination (IUI) results in increased fecundity when compared with periovulatory intercourse in couples with either unexplained infertility or surgically corrected endometriosis. Sixty-seven couples entered a randomized, prospective trial comparing CC/IUI with observation. During the study, there were 14 pregnancies in 148 treated cycles (fecundity = 0.095) compared with 5 pregnancies in 150 untreated cycles (fecundity = 0.033). Using life-table analysis and the log-rank test, the difference in fecundities was statistically significant. Pregnancy outcome was not significantly different between the two groups. When comparing conception with nonconception cycles during treatment, no differences between the size of the lead follicle or the number of dominant follicles was detected. We conclude that treatment with CC/IUI improves fecundity in couples with unexplained infertility or surgically corrected endometriosis.

Clomiphene↗