[Comparison of efficacy of letrozole and clomiphene citrate in the treatment of infertility induced by ovulation disorder in patients with polycystic ovarian syndrome]

According to side effects of clomiphen citrate [cc], especially on thendometrium, it was replaced with letrozole, an aromatase inhibitor, for induction of ovulation. In this study, effects of these drugs on ovulation and fertility were compared in patients with polycystic ovarian [PCO] syndrome. In a randomized clinical trial, women with PCO and history of infertility referred to gynecology clinic of Rasoul Akram hospital and private office between 2007 and 2008 were studied. Subjects were randomly assigned to two groups of clomiphen citrate and letrozole. In CC group, subjects were received 100 milligram per day clomiphen citrate between 3rd and 7th day of each cycle for 3 cycles. In letrozole group, women treated with letrozole 2.5 mg daily between 3 and 7 day of each for 3 cycles. Number of follicles in days of 12-16 of cycle, diameter of the greatest one, pregnancy and outcome of pregnancy were compared in two groups. 40 patients in each group were studied. Numbers of follicles, mean diameter of the greatest one were not significantly different in two groups. Pregnancy was occurred in 15 patients [37.5%] of letrozole group Vs 13 patients [32.5%] of CC group. There was no abortion in letrozole group Vs 3 abortion in CC group. Preterm labor was significantly lower in letrozole treated patients [p=0.04]. This study showed that letrozole could be proper substitution of clomiphen citrate for induction of ovulation in patients with PCO and infertility

Heterotopic abdominal pregnancy following ovulation induction with clomiphene citrate

Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges. A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy [IUP]. Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra-or post-procedural complications, but the IUP was aborted spontaneously on the second postoperative day. Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively, if they are clinically stable and the abdominal pregnancy is recognized early in gestation

[Evaluation of the risk factors for ectopic pregnancy in laparotomy patients during 1991-2001]

Ectopic pregnancy [EP] is one of the major causes of maternal death during pregnancy. This study was designed to determine the risk factors of EP in Mahdiyeh Hospital over 10 years. This case-control study included 200 women who underwent laparotomy with the diagnosis of EP in Mahdiyeh Hospital between the years 1991 and 2001. Also, 400 randomly selected pregnant women with normal vaginal delivery were included as controls. A direct relationship was found between EP and history of abortion, previous EP, PID, pelvic surgery, appendectomy, infertility, using clomiphene, current IUD and IVF. The chance of developing an EP [odds ratio with 95% confidence interval] was 26.7 [9.01-79.06] in women using clomiphene, 21.16 [2.71-164.8] in women with a previous history of EP, 3.29 [1.94-5.58] in those with prior appendectomy, and 9.63 [5.24-17.67] times greater in women who got pregnant while having an IUD. It is concluded that among outpatients, previous abdominal or pelvic surgery, current IUD, history of previous EP, and history of using clomiphene increase the risk of developing an EP. This study did not find any association between EP and previous usage of IUD, mini-pill or age

intra-uterine missed abortion with a simultaneous tubal ectopic pregnancy

A case of heterotopic pregnancy is reported. This case was a 25 years old woman with a chief complain of vaginal bleeding which was spotting in following pregnancy after using clomiphene. An ultra-sonography report showed a missed abortion about 8 weeks of gestation. After a few days, she returned with an acute abdomen. A tubal pregnancy with a missed abortion was suggested as a differential diagnosis. Laparatomy and D and C were performed. Pathologic report also confirmed simultaneous intra-uterine and extra-uterine pregnancy within recent years. The use of reproductive technology and ovulation stimulation has increased the prevalence of this type of rare pregnancy. Thus, heterotopic pregnancy should be considered in the presence of ectopic pregnancy signs and symptoms even if a normal intra-uterine pregnancy was confirmed

Perseveración visual fotofobia y fenómenos entópticos crónicos consecutivos a la administración de clomifeno: descripción de un caso / Visual perseveration photophobia and chronic entopic phenomens consecutive a the administration of clomifene: description of a case

Transcurridos tres años de matrimonio, una mujer de 26 años consultó a su ginecólogo por infertilidad. Debido a que presentaba ciclos anovulatorios, iniciando en marzo de 1996, se le prescribió tratamiento con 50 mg de citrato de clomifeno en los cinco primeros días de cada mes con incrementos progresivos. En relación temporal con su administración y desde el inicio, comenzó a experimentar extraños síntomas visuales: Poliopsia y perseveración visual, y fenómenos entópticos relacionados con cambios en la luminosidad ambiental (luces giratorias, zigzag brillantes, "ráfagas oscuras" periféricas simulando animales, auras alrededor de objetos y personas). Aunque comentó a su médico al respecto sin obtener una respuesta, sólo al cabo de tres meses, la paciente estableció la relación de sus quejas con el inicio de la medicación. El clomifeno, un antiestrógeno, ha sido reiteradamente culpado de producir síntomas visuales transitorios. En nuestra paciente, como en otros escasos casos informados en la literatura, se han mantenido por espacio de dos años, afectando notablemente su vida emocional y de relación. Se revisa la literatura al respecto

Valoración de riesgo genotóxico de exposición a citrato de clomifeno, con diferentes sistemas de prueba bacterianos / Genotoxic risk evaluation of exposure to clomiphene citrate with different bacterial test systems

Empleando el sistema de prueba de Salmonella typhimurium de Ames, se muestra que los metabolitos del citrato de clomifeno (CC), inducido in vitro, con la fracción hepática de rata S9, producen mutaciones por corrimiento de formato, en las cepas de S. typhimurium TA1538, TA97 y TA98. Utilizando la prueba de Escherichia coli PolA-/PolA+, se demostró que el fármaco o sus derivados son capaces de inducir daño genoletales. Estos daños inducen la depresión del sistema SOS, lográndose la expresión de los genes de profago lamda en la prueba de DeMarini o la expresión de genes de estructurales de colicina E1. Estos datos sugieren que el CC puede actuar como un formador de grandes aductos, induciendo daños de distorsión de la doble hélice y mutaciones por corrimiento de formato, así como lesiones severas que impiden la replicación cuando hay deficiencia de DNA polimerasa, pudiendo inducir los genes regulados por lexA. Consecuentemente, el empleo del CC puede constituir un riesgo genotóxico para el paciente, por lo que es aconsejable realizar una evaluación de riesgo-beneficio, en cada caso particular.

Evaluación del factor cervical en la mujer con inducción de la ovulación / Evaluation of cervical factor in women with ovulation induction

Se estudiaron 66 pacientes que acudieron por esterilidad a quienes de les realizó prueba de penetración espermática poscoito (PPE) con el fin de valorar el efecto de los inductores de la ovulación en la calidad del moco cervical y la penetración espermática. Fueron divididas en tres grupos: 1) 28 mujeres con evidencias de ovulación espontánea (grupo testigo), 2) 26 pacientes a las cuales se les indujo ovulación con citrato de clomifeno (CC) y 3) 12 pacientes en quienes se indujo ovulación con menotropinas. Los resultados mostraron que el CC tiene un efecto adverso sobre el moco cervical (p< 0.001), mientras que en las pacientes tratadas con menotropinas la calidad del moco cervical no se alteró. La penetración espermática en las pacientes con CC mostró una tendencia a valores menos que en las mujeres del grupo testigo, pero fue significativamente menor que en las pacientes estimuladas con menotropinas (p< 0.05). Estos resultados ponen de manifiesto el efecto adverso del CC y el efecto benéfico de las gonadotropinas sobre el moco cervical y la penetración espermática

Is there any relation between estrogen level and poor cervical mucus in patients receiving clomiphene citrate?

Clomiphene citrate [CC] has an adverse effect on the quality and quantity of cervical mucus [CM]. Poor cervical mucus has been reported in 15% of CC-treated women. CC exhibits estrogen agonist and antagonist activities. Antiestrogenic activity affecting the endocervical glands is theorized to cause a decrease in cervical mucus quality and quantity. An experimental study was performed to assess if there is any relation between poor CM and the level of estrogen in those to whom the drug is administered. We used CC on 50 subjects and evaluated CM and measured serum E2 levels simultaneously. We concluded that there is no relation between the level of estrogen and the quality or quantity of CM in these patients

Resultado del tratamiento con citrato de clomifeno en 412 pacientes estériles / Result of treatment with clomphene citrate in 412 sterile patients

Se describen los resultados del tratamiento con citrato de clomifeno en 412 pacientes estériles anovuladoras. Se realizaron 1.108 ciclos de tratamiento y se logró un total de 135 embarazadas, 122 de ellos sencillos y 8 gemelares (59,9%). El síndrome de hiper-estimulación ovárica se presentó en 6 pacientes (4,4%) y 5 abortaron precozmente (3,7%). Presentaron amenorrea 110 pacientes; de ellas 73(65,9%) respondieron a la terapéutica com menstruaciones regulares y 17 embarazos (23;6%)