Clomiphene citrate for ovulation induction in patients with polycystic ovarian syndrome

Abstract

Objective: To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Design: Observational study. Place and duration of study: Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Intervention: Clomiphene citrate (50-150mg) was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Main outcome measures: Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Results: Forty-six patients (54.76%) ovulated in six cycles while twenty-seven (32.14%) remained anovulatory. Sixteen women (34.79%) conceived during the study period. Out of which ten women (62.5%) miscarried. Endometerial thickness did not differ (P>.50) between the conceived and non-conceived group but echogenic grade A pattern (75%) was observed during the conceived cycles (P<. 001). Conclusion: Clomiphene citrate (CC) is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome.