CLOMIPHENE CITRATE FOR INDUCTION OF OVULATION

Abstract

The present prospective and retrospective follow-up study on [02 nOlllogonuctotropic ol igoamenorrh eic infenile female subjects (WHO group 2) regis tered at Federal Government ServiL'es Hospital. Islamabad and Islamabad Clinic Scn'ing Infe rtile Couples in 1s1~n13bacl Prinlle Hospital p\.t. Ltd Islnmabad. The subjects selected \\"ere both \\ ilh primary inrertilit)· (5".9%) and secondary infertili ty (45.1%) with polycystic and normal ovaries. The study was undertaken to determine whether clin ica l. endocrine and - ultrasound characteri stics could predict the chances of ovulation and conception III the " subjects undergoing ovulation induction with Clomiphene Citrate (CC) medicatiot:\ Additional inclusional criteria's were normal semen analysis and negative hi story for <lny ! , tubal disease. All subjects underwent spontaneous or progestin intlilced withdrawall bleeding. In itial CC doses were 50l11g dai ly for 5 days starling on da~m§~iIai' cycle. In case of an absent ovarian response doses were inc reased to 100, 150 and 200mg dai ly in subsequent menst rual cycles. The study was followed-up to four treatment cycle with dai ly CC doses of 200mg in 276 treatment cycles, 102 (36.9%) were ovulatory cycles. A cumulative conception rate of 33.3% was attained. The conception rate in case of subjects with pol ycystic ovaries was 40.6% while with normal ovaries was 30%. The subjects who conceived were young and with early menarche (P<0.05). The subjects who conceived had shorter duration of infert ility (P<O.04). Those who conceived did so in the first 2-3 cycles. Patients with elevated day 3 serum LH concentration (>8mIU/ml) had a higher probability of conceiving. The LH: FSH ratio was <1.65 in the subjects who conceived. Serum FSH levels on day 3 were within normal limits (1-IOmIU/ml). The mean folli cular number and follicu lar size assessed by Transvaginal Ultrasound (TVS) were significant (P<O.00002) and (P<O.0006) in the subjects who conceived than in the CC fail me. Subjects who did not conceive with higher doses of CC are Clomiphene resistant and uu nut ovulate (eRA). Follicular gwwth and fo ll icular number improved during induction of ovulation wi th CC. These observations suggest that there is more to be gained from CC ovulation induction in young subjects present ing with infertility (WHO group 2). It can be concluded that increased serum LH and LH ; FSH ratio along with age. duration of infert ility and cycle hi story predict chances of conception in WHO group 2. It is a step forward in deci sion making in the treatment of these subjects.