Dergiler / GORM:Gynecology Obstetrics & Reproductive Medicine / 2003 / Cilt: 9 - Sayı: 1
Clomiphene in combination with tamoxifen for ovulation induction. Can it be the first line treatment?
- Sayfa
- 19–22
- DOI
- —
Özet
Klomifen sitrat 1960 yılındanberi ovulasyon indüksiyonunda kullanılan önemli bir ilaçtır ve WHO grup II anovulatuvar hastalarda genellikle ilk tedavi seçeneği olarak kullanılır. Ovulatuvar etkisi yüksek olmasına rağmen gebelik oranları beklenildiği kadar değildir. Tamxifen ise bir başka ovulatuvar ajandır. Biz bu çalışmada kombine tamoxifen ve klomifen tedavisinin grup II anovulatuvar hastalarda etkini prospektif ve randomize olarak inceledik. Total 60 grup II anovulatuvar hasta 2 gruba ayrıldı.Komifen grubunda 50mg/gün başlangıç dozu ovulasyon olana kadar 150/mg kadar artırıldı. Klomifen+tamoxifen grubunda 20mg/gün tamoxifen eklendi. Kombine grupda endometrial kalınlık istatistiksel anlamlı olarak yüksek bulundu (8.8±1.9mm-7.2±2.3mm). Servikal mukus skorları da kombine grupta fazla bulundu. Gebelik oranları açısından istatistiksel olarak anlamlı olmayan bir fark tespit edildi (%30.7 Klomifen grup-%41.0 kombine grup). Sonuç olarak klomifen ve tamoksifen birlikte anovulatuvar infertilite tedavisinde ilk basamak tedavi olarak kullanılabilir.
Abstract
OBJECTIVE: Since its introduction in 1960 Clomiphene Citrate (CC) has been one of the most important drugs in ovulation and generally accepted as the first line of treatmant in WHO Group II Anovulatory patients. It has been noted that in contrast to its high efficacy in ovulation induction, pregnancy does not ensue as frequently as expected. On the other hand Tamoxifen (TMX) is an other ovulation induction agent. We decided to study the safety and efficacy of a combined CC and Tamoxifen regimen in Group II anovulatory patients in a randomized prospective study. STUDY DESING: Anovulatory Group II patients divided into two groups as CC and CC+TMX. In CC only group an initial dose of 50 mg/day CC was given and doses increased up to 150 mg with 50 mg increments if pregnancy could not achieved in previous cycle. In CC+TMX group CC doses were same but 20 mg/day tamoxifen were added. RESULTS: We found that endometrial thickness were significantly higher in CC+TMX group (8.8±1.9 mm versus 7.2±2.3mm; p<0.05). Servical mucus score were also found to be higher in CC+TMX group (7.1±3.4 versus 9.8±2.7; p<0.05). The ovulation rate was 69% in the CC group compared to 83% in combination treatment group and pregnancy rates were 30.7% versus 41% respectively both of these values did not reach statistically significant levels due to relatively small sample size. CONCLUSION: Although the pregnancy rates were statistically insignificant we achieved better servical mucus scores, higher endometrial thickness and in the combination group patients ovulated with lower doses of CC we propose that CC combined with tamoxifen can be used as a first line treatment in anovulatory infertility.