Opioid antagonists as a sole or adjunctive therapy in ovulation induction in PCOS cases resistant to clomiphene citrate

ABSTRACT

Patients who have eugonadotrophic hyperandrogenic anovulation with the presence of multiple small ovarian follicles - defined as PCOS - are offered many ovulation induction regimens. Some prove to be clomiphene resistant others develop complications as ovarian hyperstimulation syndrome when treated by gonadotrophins. To evaluate naltrexone - an opioid antagonist - as a simple and safe method for ovarian induction in PCOS patients resistant to clomiphene citrate as a sole or adjunct therapy. Forty PCOS patients resistant to clomiphene citrate were studied. They were randomly divided into 2 groups. Group I [20 cases] who received clomiphene citrate and naltrexone and group II [20 cases] in which naltrexone alone was administered. Estimation of serum level of FSH, LH and prolactin as well as vaginal ultrasonographic follicular tracking was done for all cases. Fifteen cases [75%] of group I achieved ovulation, while none of the patients of group II ovulated even after 21 days of naltrexone treatment. Ovulation can be successfully induced using naltrexone in combination with clomiphene citrate in PCOS cases resistant to clomiphene citrate alone. It is safe simple and inexpensive treatment modality