scholarly journals The Effect of Estradiol Valerate with and without Oral Sildenafil on Endometrial Thickness and Pregnancy Rates in Infertile Women: A R.C.T

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A M F Kortam ◽  
H F Mohammad ◽  
M H Mobarak ◽  
A A I Bazazo
Keyword(s):  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Resistive Index ◽  
Estradiol Valerate ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Induction Of Ovulation ◽  
Infertile Women ◽  
Hcg Trigger

Abstract Objectives To evaluate the effect of sildenafil-estrogen combination compared to estrogen alone on endometrium thickness in infertile women received induction of ovulation by clomiphene citrate. Study design Randomized controlled clinical trial. Settings University hospital, Ain Shams University Maternity Hospital. Materials and methods 90 infertile women with unexplained infertility, were recruited and randomly allocated into two equal groups, 45 patients in each. Both groups received induction of ovulation with CC 100mg/d from 2nd to 6th day of cycle and oral estradiol valerate 2mg 12 hourly from 2nd day of the cycle till the day of trigger of ovulation. In study group oral sildenafil citrate 25mg every 8 h from 2nd day of the cycle till the day of HCG trigger was added. Endometrium was evaluated as regards both endometrial thickness and pattern, uterine artery resistive index (RI) was measured at the day of trigger. Qualitative serum B-hCG level was checked 14 days after ovulation to assess chemical pregnancy rate. Results Mean endometrial thickness at the time of hCG trigger was 9.8 mm in study group and 8.42 mm in control group (P value <0.001). 88.9% patients given sildenafil had trilaminar endometrium whereas 29% patients without sildenafil had bilaminar endometrial pattern (P value = 0.006). Mean uterine artery resistive index (RI) after adding sildenafil was non-significantly lower among study group than among control group, the value were 0.66 and 0.72 respectively (P = 0.078). Pregnancy rates in study group and control group was 17.8% and 11.1% respectively. Conclusion Sildenafil-estrogen combination has a potent effect on improving the endometrium (thickness and pattern) in patients undergoing induction of ovulation by clomiphene citrate. This improvement in endometrial development has a weak positive feedback on pregnancy rate.

TO COMPARE THE COMBINED EFFECT OF ORAL SILDENAFIL AND ESTRADIOL VALERATE TO ESTRADIOL VALERATE ALONE IN PATIENTS WITH CLOMIPHENE INDUCED CYCLES IN INFERTILE WOMEN ON ENDOMETRIAL THICKNESS.

2021 ◽  
pp. 13-16
Author(s):  
Rekha Rani ◽  
Shikha Singh ◽  
Sangita Sahu ◽  
Ruchika Garg ◽  
Urvashi Urvashi ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Randomized Study ◽  
Concomitant Administration ◽  
Combined Effect ◽  
Estradiol Valerate ◽  
Control Group ◽  
Negative Effects ◽  
Infertile Women ◽  
Medical College

Objective- Endometrial thickness <7 mm accepted as a reliable sign of suboptimal implantation potential. Clomiphene citrate (CC) has some negative effects on the endometrium. We evaluated the effect of concomitant administration of oral sildenal and estradiol valerate on endometrial thickness Aim- To compare the combined effect of oral sildenal and estradiol valerate to estradiol valerate alone in patients with clomiphene induced cycles in infertile women on endometrial thickness. Material And Method- This randomized study was conducted on infertile women attending infertility OPD in SN Medical College, Agra over a period of 2 years from January 2019 to December 2020. Infertile patients were randomly divided into two equal groups. In control group, 50 patients were given clomiphene citrate 50 mg daily from D2 to D6 along with estradiol valerate 2 mg thrice daily from 2nd day of the cycle till the day of trigger of ovulation. In study group, 50 patients were given clomiphene citrate 50 mg daily from D2 to D6 along with estradiol valerate 2mg 12 thrice daily plus oral sildenal citrate 25mg every 8 h from 2nd day of the cycle till the day of hCG trigger. Results- The results in this study conrm the superiority of using oral sildenal with estradiol for improving endometrial thickness, vascularity and pregnancy rates. Conclusion- Addition of oral sildenal citrate to estradiol valerate in ovulation induction cycles has better results in improving endometrial thickness, endometrial blood ow and pregnancy outcome as compared to estradiol valerate alone in women with anovulatory infertility

scholarly journals Effects of Letrozole-HMG and Clomiphene-HMG on Incidence of Luteinized Unruptured Follicle Syndrome in Infertile Women Undergoing Induction Ovulation and Intrauterine Insemination: A Randomised Trial

2015 ◽  
Vol 8 (4) ◽  
pp. 244 ◽  
Author(s):  
Azra Azmoodeh ◽  
Mansoureh Pejman Manesh ◽  
Firouzeh Akbari Asbagh ◽  
Azizeh Ghaseminejad ◽  
Zeinab Hamzehgardeshi
Keyword(s):  
Menstrual Cycle ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Randomised Trial ◽  
Induction Of Ovulation ◽  
Infertile Women ◽  
Significant Difference ◽  
Preovulatory Follicles ◽  
Luteinized Unruptured Follicle

<p><strong>BACKGROUND: </strong>Luteinized unruptured follicle (LUF) syndrome is considered a cause of ovulation failure and a subtle cause of infertility. Preovulatory injection of human chorionic gonadotropin (HCG) prevents or treats LUF syndrome, but it has also occurred after the induction of ovulation with clomiphene/HMG and HCG. This study was designed for evaluation and comparison of LUF incidence in eligible infertile women undergoing two stimulation protocols (clomiphene + HMG<strong> </strong>and letrozole + HMG) in addition to intrauterine insemination (IUI). Some related factors were compared between LUF and non-LUF cycles as secondary outcomes.</p> <p><strong>METHODS:</strong> The study was designed as a prospective randomized controlled trial. Patients were randomized using a table of random numbers into two equal protocol groups.<strong> </strong>For group A, (n = 90) clomiphene citrate was administrated orally in doses of 100 mg/day, and group B (n = 90) orally received letrozole 5 mg/day from day 3 to 7 of the menstrual cycle. Then HMG 75IU/day was administered intramuscularly in both groups on day 8 of the menstrual cycle and the dose was adjusted on the basis of ovarian response. The optimum size of preovulatory follicles for the injection of HCG (10,000 IU) was considered 18–23 mm. The number and size of preovulatory follicles were assessed by vaginal ultrasound 12 h before HCG (D0). Endometrial thickness was measured as well. IUI was performed on all patients 38–40 h after HCG. The second ultrasound examination was performed to observe the evidence of oocyte releasing at the time of IUI (D1). If the follicles were unruptured,<strong> </strong>a<strong> </strong>third sonography was performed on day 7 after HCG (D7) to observe LUF syndrome.</p> <p><strong>RESULTS: </strong>There was a significant difference between clomiphene-HMG and letrozole-HMG in LUF (p = 0.021) and pregnancy (p = 0.041). The complete LUF in letrozole-HMG was lower than the alternative group and the pregnancy rate was higher. The patients in the non-LUF group had higher midluteal progesterone and a thicker endometrium compared to LUF cycles (p = 0.039) and (p &lt; 0.001). The results of our multivariate logistic regression indicate that size 18–19.9 mm leads to the complete LUF  less than ≥22 mm [AOR: 0.25, P = 0.005], and  in size 20– 21.9 mm  as well [AOR: 0.17, P = 0.002].</p> <p><strong>CONCLUSION: </strong>Letrozole, with lower incidences of LUF, is more effective than clomiphene citrate for the induction of ovulation in IUI cycles. In our study, we illustrated that larger follicles of ≥22 mm diameter were associated with higher incidences of LUF. We recommend that further studies investigate and focus on the relationship between follicular size and/or full hormonal profiles and LUF.<strong></strong></p>

scholarly journals Comparison of Tamoxifen and Clomiphene Citrate for Ovulation Induction in Women with Polycystic Ovarian Syndrome: A Prospective Study

2021 ◽  
Author(s):  
Sangita Sharma ◽  
Manisha Choudhary ◽  
Vikas Swarankar ◽  
Vaibhav Vaishnav
Keyword(s):  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
P Value ◽  
Ovulatory Cycle ◽  
Chi Square ◽  
Once Daily ◽  
Induction Of Ovulation ◽  
Group A ◽  
Group B ◽  
Estradiol Levels

Background: The purpose of this study was to compare the efficacy of tamoxifen and clomiphene citrate in induction of ovulation in women with PCOS and anovulation. Methods: In this prospective cohort study, 104 women with PCOS and primary infertility were enrolled after fulfilling the inclusion and exclusion criteria. The patients were allocated in two groups; group A (n=54) received tamoxifen 40 mg once daily (Days 3-7) and group B (n=50) received clomiphene citrate 100 mg once daily (Days 3-7). Serial ultrasounds were done till the administration of human chorionic gonadotropin (hCG). The ovulation and pregnancy rates in both groups were compared. The number of dominant follicles, estradiol levels, and endometrial thickness were also studied. Comparison was done using chi-square and student’s t-test and a p-value of less than 0.05 was considered statistically significant. Results: The number of dominant follicles and serum estradiol levels were significantly higher in group B (p<0.05), whereas the endometrial thickness was significantly more in group A (p<0.05). The ovulation rates were similar in both groups (66.6% vs. 70%, p=0.715). Pregnancy rate per treatment cycle and per ovulatory cycle was marginally higher in group A (14.81% and 22.22%, respectively), as compared to group B (14% and 20%, respectively), but the difference was not statistically significant (p>0.05). Conclusion: Tamoxifen and clomiphene citrate are both equally effective in induction of ovulation and achieving a pregnancy in women with PCOS.

scholarly journals Role of endometrial thickness in natural and stimulated cycles in infertility

2020 ◽  
Vol 9 (7) ◽  
pp. 2872
Author(s):  
Vandana Dhama ◽  
Kiran Kumari ◽  
Rachna Chaudhary ◽  
Shakun Singh
Keyword(s):  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Uttar Pradesh ◽  
Sildenafil Citrate ◽  
Estradiol Valerate ◽  
Thin Endometrium ◽  
Infertile Women ◽  
Medical College

Background: The endometrium plays an important role in infertility. The growth of endometrium depends on serum oestradiol level and blood flow to the uterus. A thin endometrium is defined as a lining of less than 7 mm which is associated with infertility. The endometrium is best seen on Transvaginal scan (TVS). The purpose of this study was to evaluate the role of endometrial thickness and its outcome in natural and stimulated cycles in infertile women.Methods: This prospective cohort study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut, Uttar Pradesh, India. Total 150 infertile women of age less than 35 years presented with either primary or secondary infertility were enrolled. Each patient was undergoing transvaginal scan (TVS) to measure endometrial thickness follicular monitoring.Results: The endometrial thickness and pregnancy rate was higher in letrozole induced group as compared to clomiphene with estradiol valerate and clomiphene with sildenafil citrate induced group.Conclusions: Letrozole had better effect on endometrial thickness and pregnancy rate as compared to clomiphene citrate with estradiol valerate and clomiphene citrate with sildenafil citrate.

scholarly journals Clomiphene Citrate versus Letrozole for Induction of Ovulation in Infertile women having Polycystic Ovarian Syndrome (Randomized Controlled Trial)

2021 ◽  
Vol 4 (7) ◽  
pp. 01-09
Author(s):  
Abdel Rahman Mohammed Saleh ◽  
Mahmoud Youssef Ali Ahmed Abdalla ◽  
Nourhan Adel Abu Elfotouh Tantawy
Keyword(s):  
Menstrual Cycle ◽  
Polycystic Ovary Syndrome ◽  
Congenital Adrenal Hyperplasia ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
P Value ◽  
Adrenal Hyperplasia ◽  
Ovary Syndrome ◽  
Infertile Women

Background: Polycystic ovary syndrome is a disorder but with unclear etiology that its diagnosis depends on exclusion of other etiologies with ovulatory disorders and androgen excess as congenital adrenal hyperplasia, 21-hydroxylase deficient non classic congenital adrenal hyperplasia (NCAH), adrenal or ovarian androgen-secreting tumors, disorders of adrenocortical dysfunction as Cushing’s disease, and abuse of androgenic or anabolic drugs. Polycystic ovary syndrome affects approximately 6-15% of women in reproductive age and constitutes 50% of the causes of infertility in women. Aim of the Work: To compare the efficacy of letrozole on ovulation induction to that of clomiphene citrate in women suffering polycystic ovary syndrome and the effect on the follicular maturation, endometrial thickness and pregnancy rate. This study was carried in the outpatient infertility clinic of Ain-Shams Maternity Hospital during the period from November 2020 till April 2021. Patients and Methods: This study included 80 infertile women diagnosed as having polycystic ovary syndrome. Women were randomized into two groups. Letrozole group (1) included 40 women who were given the aromatase inhibitor (Letrozole) orally in a 5mg dose daily from day 3 to day 7 of the menstrual cycle. While Clomiphene citrate group (2) included 40 women who were given the clomiphene citrate orally in 100mg dose daily from day 3 to day 7 of the menstrual cycle. All women were counseled and informed consent was obtained before recruitment. Results: In this study, ovulation rate was significantly more frequent in the Letrozole group (82.5%, 33 women reached ovulation successfully) than in Clomiphene citrate group (60%, 24 women reached ovulation successfully) within P value=0.024. Clomiphene citrate at a dose of 100mg showed more efficacies in the number of follicle ≥18mm than Letrozole at a dose of 5mg. In Letrozole group, the number of follicles (≥18mm in diameter) ranged from 1 to 2 with a Mean±SD= 1.4±0.65 and in Clomiphene citrate group, the number of follicles (≥18mm in diameter) ranged from 1 to 3 with a Mean±SD= 1.9± 0.41 (P value=0.0001). Conclusion: Letrozole can be considered as a first line treatment of anovulation in polycystic ovary syndrome. But, moreover studies including larger number of cases will further confirm the efficacy of letrozole versus clomiphene citrate in induction of ovulation, reaching to the optimum doses for aromatases inhibitors, more observation on endometrial thickness, incidence of pregnancy outcomes, incidence of abortion and incidence of congenital fetal malformations.

scholarly journals COMPARISON OF EFFECT OF CLOMIPHENE CITRATE WITH ESTRADIOL VALERATE V/S LETROZOLE ON PREGNANCY RATE IN INFERTILE WOMEN WITH PCOS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Mendiratta Suman ◽  
Joshi Amit Kumar ◽  
Netra Harendra Kumar
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Pregnancy Rate ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Estradiol Valerate ◽  
Ovary Syndrome ◽  
Infertile Women ◽  
Group A ◽  
Group B

Background: Polycystic ovary syndrome is the commonest endocrinopathy in anovulatory infertility in young women. It is estimated that infertility affects 10 to 14% of the Indian population of which approximately 25-30% part occupied by PCOS. Methods: This prospective study enrolled 180 infertile women with PCOS, age 21-35 yrs who have taken 1 cycle of clomiphene citrate 100 mg, endometrial thickness <7 mm inspite of follicles greater than 18 mm. Half of them treated with clomiphene citrate with estradiol valerate and remaining half with letrozole. Results: In Group-A treated with clomiphene citrate with estradiol valerate 13 patients (16.3%) conceived and in Group-B treated with letrozole 26 patients (32.5%) conceived. Conclusion: Pregnancy rate is higher in group which treatment with letrozole in comparison with clomiphene citrate plus estradiol valerate. Keywords: Polycystic ovary syndrome, Infertility, Pregnancy rate

scholarly journals A comparative study of efficacy of letrozole and clomiphene citrate for ovulation induction

2018 ◽  
Vol 7 (10) ◽  
pp. 4133
Author(s):  
Shaveta Jain ◽  
Pushpa Dahiya ◽  
Jyoti Yadav ◽  
Nitin Jain
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Primary Treatment ◽  
Ovulation Rate ◽  
Control Group ◽  
Study Group ◽  
Follicle Size ◽  
And Control

Background: This study was conducted to evaluate the efficacy of letrozole as an ovulation inducing agent and to compare it with clomiphene citrate (CC) in infertile women.Methods: This study includes 100 women referred to gynecology OPD of Pt. B.D Sharma, PGIMS, Rohtak with   infertility due to dysovulation. The patients were divided in two groups each comprised of 50 patients, Alternate women were enrolled in study group (Letrozole). Ultrasonic follicular monitoring was done on day 10, 12, 14, 16 of menstrual cycle to measure the number, size of mature follicles. Endometrial thickness and trilaminar pattern of endometrium was compared in between the groups. Inj. Gonadotrophin (hCG) was given as a trigger intramuscularly when follicle size was between 18 to 21mm. After 36 hours of hCG administration ovulation was confirmed on ultrasound.Results: Mean age, parity, and the duration of infertility were similar in both groups. Ovulation rate was 81.6% in letrozole group and was higher than control group(p<.01). The average number of follicles in the control group was 1.90±0.77and 1.17±0.47 in the study group(p<.001). Endometrial thickness in the study group was 7.55±1.12mm and in the control group it was 6.06±0.87(p<.01). Pregnancy rate in study group was 48 % and control group 16%(p<.05).Conclusions: Aromatase inhibitors (Letrozole) is a new group of drugs to join the arsenal of infertility treatments. The result of this preliminary study suggests that letrozole is associated with higher ovulation rate, higher endometrial thickness and trilaminar pattern thus resulting in higher pregnancy rate. Clomiphene citrate may be replaced by letrozole as primary treatment for ovulation induction in infertile patients.

Effect of Sildenafil in Endometrial Ripening with Induction of Ovulation by Clomiphene Citrate in Polycystic Ovarian Syndrome; Double Blinded; Randomized Controlled Trial

2019 ◽  
Vol 2 (3) ◽  
pp. 01-10
Author(s):  
Dalia Mohammed Mohammed El-Khaldy ◽  
Mohamed Saeed Khallaf ◽  
Ahmed Mohamed Nour Eldin Hashad ◽  
Ibrahim Shazly Mohamed Amen Elshazly
Keyword(s):  
Randomized Controlled Trial ◽  
Polycystic Ovarian Syndrome ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Clinical Pregnancy ◽  
Sildenafil Citrate ◽  
Control Group ◽  
Induction Of Ovulation ◽  
Randomized Controlled ◽  
Ovarian Syndrome

Back ground: World Health Organization (WHO) defines infertility as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Worldwide, 8 to 12 percent of couples experience fertility problems. Causes of infertility in women were as follows: menstrual disorders (disorders of cycle length and flow) 62.6%, diseases (obesity, thyroid diseases, diabetes) 58.7%, impaired ovulation (hormonal disorders, oligoovulation and anovulation) 50.3%, uterine causes 16.7%, tubal factor 15.4%, and cervical causes 7.9%. In the male factor fertility there was semen abnormalities (44.6%), genetic factors (29.8%), anti-spermatogenesis agents (11%), and vascular disorders (17.2%). Aim of the Study: The purpose of this study is to evaluate the effect of sildenafil in endometrial ripening with induction of ovulation by clomiphene citrate in polycystic ovarian syndrome. Patients and methods: It is a randomized controlled trial on 65 infertile women with polycystic ovarian syndrome; patients were randomly divided into two equal groups. In control group, 31 patients were given oral sildenafil, one tablet every 12 hrs. From 2nd day of the cycle till 12th day and clomiphene citrate, one tablet every 12 hours, for 5 days from 3rd day of the menstrual cycle. In study group, 34 patients were given oral placebo, one tablet every 12 hrs. From 2nd day of the cycle till 12th day and clomiphene citrate, one tablet every 12 hours, for 5 days from 3rd day of the menstrual cycle. A transvaginal ultrasound was performed to evaluated the endometrial thickness before and after treatment, the follicularometeric was measured on day 11 and day13. Uterine artery Doppler was then measured. Qualitative serum B-hCG level was checked 14 days after ovulation to assess clinical pregnancy rate. Design: Prospective, Double blinded randomized controlled trial. Setting: Obstetrics & Gynecology outpatient clinic, Ain Shams University Hospital. Study duration: 3 months. Results: The present study was a double-blind, randomized, controlled study that was conducted on 65 women with PCOS who underwent induction of ovulation by Clomiphene citrate in outpatient clinic of Ain Shams University hospital. Conclusion: Our systematic review and meta-analysis showed that follicular supplementation of sildenafil citrate (oral or vaginal), alone or adjuvant therapy can be used for improving the EM and clinical pregnancy rate in women undergoing assisted reproduction. However, given the methodological limitations the current evidence does not support its use in clinical practice yet. Future high-quality RCT with large sample size to evaluate the sildenafil citrate effect in women undergoing assisted reproduction are needed. Future RCTs should focus on type of processing, stage of embryo, embryo quality, dosage, time of administration, type of control group, in order to identify the groups of patients who would benefit the most from this intervention and the most appropriate dosage, time, and type of sildenafil citrate which would have the most positive effect and the less possible side effects.

scholarly journals Maternal and fetal outcome in oligohydramnios after 34 weeks of gestation

2018 ◽  
Vol 7 (11) ◽  
pp. 4604
Author(s):  
Mahantappa A. Chiniwar ◽  
Joe Kaushik M. ◽  
Sharada B. Menasinkai
Keyword(s):  
Amniotic Fluid ◽  
Fetal Outcome ◽  
Morbidity And Mortality ◽  
Research Centre ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Perinatal Morbidity ◽  
Amniotic Fluid Index ◽  
Chi Square

Background: Oligohydramnios is one of the major causes of maternal and perinatal morbidity and mortality. It is a clinical condition characterized by Amniotic Fluid Index (AFI) ≤5 cm by sonographic assessment. The aim of present study is to know the maternal and fetal outcome in oligohydramnios after 34 weeks of gestation compared with women who had normal volume of amniotic fluid.Methods: Study was done for the period of 21 months from November 2014-July 2016 at Adichunchanagiri Institute of Medical Sciences, Hospital and Research Centre Bellur. 50 antenatal cases with > 34 weeks of gestation with AFI ≤5 cm by ultrasonographic estimation were included as study group and 50 women with normal AFI were included as control group. Maternal and fetal outcome of the women with oligohydramnios were analyzed and compared with control group.Results: Results were analyzed statistically using parameters like mean, SD, Chi Sq test, P value. Amniotic fluid was clear in 32% in study and 78% in control group, thin meconium stained in 30% in study group and 14%in control group and was thick meconium stained in 38% in study group and 8% in control group (Chi square =22.31, p<0.0001). Induction of labour was done in 54% in study group and 20% in control group. Cesarean delivery was done in 58% in study group women and 28% in control group women. Regarding the birth weight of babies 62% were < 2.5 kg in study group and 18% in control group with p<0.001. 10% of babies in study group required NICU admission and perinatal mortality was 2%.Conclusions: Due to increased perinatal morbidity and mortality and increased rate of LSCS, timely decision during labour is important to reduce perinatal morbidity and mortality.

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