scholarly journals Editor’s Note: Badawy A, Shokeir T, Allam AF and Abdelhady H. Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Acta Obstetricia et Gynecologica Scandinavica , 2009; 88:187–191

2021 ◽  
Keyword(s):  
Pregnancy Outcome ◽  
Aromatase Inhibitors ◽  
Ovulation Induction ◽  
Clomiphene Citrate ◽  
Unexplained Infertility

A Randomized Clinical Trial to Evaluate Optimal Treatment for Unexplained Infertility

2021 ◽  
pp. 246-250
Author(s):  
Stephanie Rothenberg ◽  
Joseph Sanfilippo
Keyword(s):  
Ovulation Induction ◽  
Treatment Approach ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Unexplained Infertility ◽  
Additional Benefit ◽  
Multiple Gestation ◽  
Time To Pregnancy ◽  
Vitro Fertilization

The treatment of unexplained infertility has traditionally been comprised of a stepwise treatment approach, first with ovulation induction combined with intrauterine insemination (IUI) and then with in vitro fertilization (IVF). Ovulation induction is first attempted with clomiphene citrate, and, if unsuccessful, injectable gonadotropins are used. The value of ovulation induction with injectable gonadotropins in couples with unexplained infertility has been questioned, however, given the high risk of multiple gestation and the increasing efficacy of IVF. To address this, the FASTT trial randomized couples with unexplained infertility to a treatment arm that either included or omitted gonadotropin/IUI. They found that an accelerated treatment approach that involved 3 cycles of clomiphene citrate/IUI and then progressed immediately to IVF resulted in a decreased time to pregnancy compared to the group who underwent gonadotropin/IUI for 3 cycles, as well as decreased cost per live birth. Therefore, it was concluded that treatment of couples with unexplained infertility with gonadotropin/IUI was of no additional benefit.

scholarly journals Aromatase Inhibitors for Ovulation Induction

2006 ◽  
Vol 91 (3) ◽  
pp. 760-771 ◽  
Author(s):  
Robert F. Casper ◽  
Mohamed F. M. Mitwally
Keyword(s):  
Side Effects ◽  
Aromatase Inhibitors ◽  
Ovulation Induction ◽  
Assisted Reproductive Technologies ◽  
Evidence Synthesis ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Significant Risk ◽  
Reproductive Technologies ◽  
Poor Responders

Abstract Context: For the last 40 yr, the first line of treatment for anovulation in infertile women has been clomiphene citrate (CC). CC is a safe, effective oral agent but is known to have relatively common antiestrogenic endometrial and cervical mucous side effects that could prevent pregnancy in the face of successful ovulation. In addition, there is a significant risk of multiple pregnancy with CC, compared with natural cycles. Because of these problems, we proposed the concept of aromatase inhibition as a new method of ovulation induction that could avoid many of the adverse effects of CC. The objective of this review was to describe the different physiological mechanisms of action for CC and aromatase inhibitors (AIs) and compare studies of efficacy for both agents for ovulation induction. Evidence Acquisition: We conducted a systematic review of all the published studies, both controlled and noncontrolled, comparing CC and AI treatment, either alone or in combination with gonadotropins, for ovulation induction or augmentation, identified through the Entrez-PubMed search engine. Evidence Synthesis: Because of the recent acceptance of the concept of using AIs for ovulation induction, few controlled studies were identified, and the rest of the studies were pilot or preliminary comparisons. Based on these studies, it appears that AIs are as effective as CC in inducing ovulation, are devoid of any antiestrogenic side effects, result in lower serum estrogen concentrations, and are associated with good pregnancy rates with a lower incidence of multiple pregnancy than CC. When combined with gonadotropins for assisted reproductive technologies, AIs reduce the dose of FSH required for optimal follicle recruitment and improve the response to FSH in poor responders. Conclusions: Preliminary evidence suggests that AIs may replace CC in the future because of similar efficacy with a reduced side effect profile. Although worldwide experience with AIs for ovulation induction is increasing, at present, definitive studies in the form of randomized controlled trials comparing CC with AIs are lacking.

scholarly journals Letrozole: an emerging array of hope for infertile women

2020 ◽  
Vol 9 (2) ◽  
pp. 891
Author(s):  
Manish Maladkar ◽  
Chitra Tekchandani ◽  
Akshata Karchodi
Keyword(s):  
Live Birth ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Unexplained Infertility ◽  
Birth Rates ◽  
Live Birth Rates ◽  
First Line Therapy ◽  
Estrogenic Action

Ovulation induction has been a major breakthrough in the management of female infertility since many decades. Letrozole, an aromatase inhibitor has been used as a potential therapy for ovulation induction. A large number of clinical evidences have been emerging which cite the beneficial role of Letrozole in conditions like anovulatory infertility, polycystic ovary syndrome (PCOS), unexplained infertility and an incipient role in endometriosis- related infertility with regards to higher live-birth rates. Letrozole is a superior alternative to Clomiphene citrate (CC) which has been used conventionally as ovulation inducer. Clomiphene citrate has certain well-defined disadvantages, whereas Letrozole overcomes these limitations to a reasonable extent. The peripheral anti-estrogenic effect of CC leads to prolonged depletion of estrogens receptors, adversely affecting endometrial growth and development as well as quantity and quality of cervical mucus. Persistent blockade of estrogen receptor leads to CC resistance and is associated with reduced ovulation and pregnancy rates. Available evidences suggest Letrozole is superior to CC owing to the lack of persistent anti-estrogenic action due to its short half- life and lack of action on estrogen receptors. This typically leads to monofollicular growth and also higher live birth rates. The current evidences suggest that Letrozole can be placed as first line therapy for the management of infertility due to PCOS and unexplained infertility.

Treatment of Unexplained Infertility With Aromatase Inhibitors or Clomiphene Citrate

2008 ◽  
Vol 63 (7) ◽  
pp. 472-479 ◽  
Author(s):  
Nikolaos P. Polyzos ◽  
Spyridon Tzioras ◽  
Davide Mauri ◽  
Maria Tsappi ◽  
Ivan Cortinovis ◽  
...  
Keyword(s):  
Aromatase Inhibitors ◽  
Clomiphene Citrate ◽  
Unexplained Infertility

scholarly journals Pre-treatment effect of myo-inositol and l-5, methyltetrahydrofolate in ovulation induction oocyte quality and pregnancy outcome in clomiphene resistance polycystic ovarian disease

2018 ◽  
Vol 7 (3) ◽  
pp. 532
Author(s):  
Ankit Bhardwaj ◽  
Anand Shukla ◽  
Sunita Singh ◽  
Rajni Agarwal
Keyword(s):  
Placebo Group ◽  
Treatment Group ◽  
Pregnancy Outcome ◽  
Treatment Effect ◽  
Ovulation Induction ◽  
Clomiphene Citrate ◽  
Oocyte Quality ◽  
Estradiol Level ◽  
Open Label

Background: This study was designed to assess the treatment effect of myo-inositol and l-5, methyltetrahydrofolate in oocyte quality, pregnancy outcome in clomiphene citrate resistance PCOS cases.Methods: Authors conducted prospective open label, randomized, parallel group study in SIMS Hapur, U.P. Eligible patients full filling inclusion criteria were randomized into two groups having 25 patients in each group using myo-inositol 580mg and l-5, methyltetrahydrofolate 800mcg in treatment group and tab folic acid 400mcg in placebo group for 12 weeks. The follow-up visits are on weeks 4, 8 and 12.Results: 12 weeks later, 21 patients in treatment group restored one spontaneous menstrual cycle and 19 patients maintained the normal ovulatory activity in follow up cycle. Ovulation induction done in 18 patients with clomiphene citrate at the dose of 50mg during treatment out of which 10 conceive, as compared with only 9 women out of the 25 women (36 percent) in the placebo group ovulate (P>0.001) out of which 4 conceived. There was significant decrease in Sr. testosterone, DHEA and AMH level and estradiol level, while statically significant increase in Sr. SHBG and FSH level seen in treatment group(p<0.001).Conclusions: In the study, more number of studied patients get back to normal menstrual cyclicity, insulin-lowering activity and its intracellular role in oocyte maturation. Significant Dec seen in serum estradiol level at the day of HCG administration.

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