Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new clomid research articles will be listed here shortly after becoming available to us.
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Medical research on clomid
Obstet Gynecol Surv. 2008 Jul; 63(7): 472-479
Polyzos NP, Tzioras S, Mauri D, Tsappi M, Cortinovis I, Tsali L, Casazza G
Treatment of unexplained infertility is empiric and different regimens or protocols have been used so far. Clomiphene can be used alone or combined with gonadotrophins. Aromatase inhibitors may offer an alternative for first-line treatment. To compare the efficacy of aromatase inhibitors versus climiphene, we conducted a systematic review and meta-analysis for randomized controlled trials comparing the above regimens to estimate live pregnancy rates in women with unexplained infertility. Trials were located through PubMed and Cochrane Library searches. Methodological quality of included trials has been assessed. Then, 2 x 2 tables were constructed, and pooled odds ratios (ORs) were calculated. Ten arms (273 patients) were included in the meta-analysis. ORs were homogeneous between studies (heterogeneity chi(2) = 2.33, P = 0.676). No difference was observed for live pregnancies (pooled OR 0.87, 95% CI, 0.46-1.65, P = 0.666) for aromatase inhibitors versus clomiphene citrate; however, the definition of live pregnancy by the authors was clear only in one trial. Data regarding secondary outcomes were omitted, and methodogical quality of eligible trials did not reach high scores. Evidence from randomized data regarding the use of aromatase inhibitors is fragmented and weak. Aromatase inhibitors may have a role in the treatment of women with unexplained infertility desiring pregnancy. However, meticulous reporting and study design should be a priority in this field and large, registered, and properly designed randomized trials are essential to test whether aromatase inhibitors can be introduced as a first-line treatment in carefully selected subgroups of women with unexplained infertility. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to explain the methods currently used for ovulation induction in unexplained infertility, and the possible side-effects, advantages and disadvantages, underlying mechanisms, and success rates of each method.
Azoospermia after treatment with clomiphene citrate in patients with oligospermia.
Fertil Steril. 2008 Jun 12;
Pasqualotto FF, Fonseca GP, Pasqualotto EB
OBJECTIVE: To describe three cases of azoospermia in patients with oligospermia after clomiphene citrate (CC) intake. DESIGN: Case report. SETTING(S): Academic medical center. PATIENT(S): Three patients with oligospermia. INTERVENTION(S): Three oligospermic men used CC, resulting in azoospermia. MAIN OUTCOME MEASURE(S): Semen analysis after CC use and after discontinuation of CC. RESULT(S): Three patients were sent to our clinic for investigation of their azoospermia after use of CC. They had severe oligozoospermia (sperm concentrations of 3.4, 2.8, and 4.1 x 10(6)/mL, respectively) before treatment with CC. These patients were re-evaluated with two new semen analyses, showing azoospermia. After 3 months without use of the drug, the mean sperm concentration was 2.5 +/- 1.1 x 10(6)/mL. CONCLUSION(S): The benefits of empiric treatment with CC must be balanced with the possible undesirable effects, such as azoospermia.
Reprod Biomed Online. 2008 Jun; 16(6): 825-9
Badawy A, Allam A, Abulatta M
The purpose of this study was to test the effect of extended clomiphene citrate treatment compared with gonadotrophin therapy for the management of clomiphene-resistant women with polycystic ovary syndrome (PCOS). The study comprised 318 women (802 cycles) with clomiphene-resistant PCOS randomized to two treatment groups. Patients in the clomiphene citrate group were given 100 mg of clomiphene citrate daily starting on day 2 of menses for 9 days (160 patients, 405 cycles) while patients in the gonadotrophin group were given human menopausal gonadotrophin 75 IU intramuscularly daily for 5 days starting on day 3 of menses (158 patients, 397 cycles). The number of ovulating patients was significantly higher (P = 0.001) in the gonadotrophin group (57.6 versus 28.1%). The total number of follicles during stimulation was significantly greater (P = 0.01) in the gonadotrophin group (6.7 +/- 0.3 versus 4.1 +/- 0.4). Pregnancy occurred in 46/405 cycles in the clomiphene citrate group (11.4%) and in 80/397 cycles (20.2%) in the gonadotrophin group; the difference was statistically significant (P = 0.03). The extended clomiphene citrate regimen resulted in modest ovulation and pregnancy rates with no side effects. This therapy seems to offer economic, efficacy and safety advantages and it is worth undergoing before starting more expensive or sophisticated alternatives.
Effect of cetrorelix dose on premature LH surge during ovarian stimulation.
Reprod Biomed Online. 2008 Jun; 16(6): 772-7
Lin YH, Seow KM, Chen HJ, Hsieh BC, Huang LW, Tzeng CR, Hwang JL
Previous studies have shown that ovarian stimulation with clomiphene citrate (CC), human menopausal gonadotrophin (HMG), and multiple-dose gonadotrophin-releasing hormone (GnRH) antagonist is associated with a high rate of premature LH surge. This study assessed whether administration of the GnRH antagonist cetrorelix at an incremental dose or at a high dose (0.5mg) from the start could prevent premature LH surge. Couples with male factor or unexplained infertility who were going to undergo intrauterine insemination were randomized into two stimulation protocols. All women were stimulated with CC and HMG. In protocol A, cetrorelix was given at 0.25 mg per day when the leading follicles reached 14 mm, and increased to 0.5 mg when the leading follicles were 16 mm. With protocol B, cetrorelix was given at 0.5 mg per day when the leading follicles reached 14 mm. The primary outcome measure was the incidence of premature LH surge. Premature LH surge occurred in 21.6% of patients undergoing protocol A, and in 18.9% of patients undergoing protocol B. Cetrorelix at incremental dose or at 0.5 mg per day does not prevent premature LH surges associated with the CC/HMG/multiple-dose cetrorelix stimulation protocol.
Ovarian stromal blood flow following clomiphene citrate challenge test in infertile women.
J Clin Ultrasound. 2008 Jun 10;
Ng EH, Tang OS, Chan CC, Ho PC
PURPOSE.: To compare ovarian stromal blood flow indices in the follicular phase and after clomiphene citrate (CC) in infertile women. METHODS.: Pulsatility index (PI), resistance index (RI), and peak systolic blood flow velocity (PSV) of ovarian stromal vessels were determined by spectral Doppler analysis in the early follicular phase and on day 10 after CC. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol concentrations were determined. RESULTS.: A total of 69 infertile women were included in the analysis. No significant differences in the average PI, RI, and PSV of ovarian stromal blood flow were demonstrated in the follicular phase and after CC despite a significant increase in serum estradiol concentration after CC. Serum FSH concentration was similar in the follicular phase and after CC, while serum LH concentration was significantly higher after CC. In the right ovary, ovarian stromal blood flow was absent in 13 (18.8%) patients in the follicular phase and in 6 (8.7%) patients after CC, but the difference did not reach statistical significance. In the left ovary, ovarian stromal blood flow was absent in 13 (18.8%) and 12 (17.4%) patients in the follicular phase and after CC, respectively. CONCLUSION.: Ovarian stromal blood flow indices were similar in the follicular phase and after CC. (c) 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008.
Delusional belief induced by clomiphene treatment.
Prog Neuropsychopharmacol Biol Psychiatry. 2008 Jul 1; 32(5): 1338-9
Grimm O, Hubrich P
J Chromatogr A. 2008 Jul 4; 1196-1197C: 81-88
Claude B, Morin P, Bayoudh S, de Ceaurriz J
A molecular imprinted polymer (MIP) has been synthesized in order to specifically extract tamoxifen, a nonsteroidal antiestrogen, and its metabolites from urine by solid-phase extraction (SPE) before HPLC-UV analysis. Clomiphene, a chlorinated tamoxifen analogue, was selected as template for MIP synthesis. Polymerisation was achieved by thermal polymerisation of methacrylic acid (MAA) as functional monomer, ethylene glycol dimethacrylate (EDMA) as cross-linking agent and acetonitrile as porogen. The efficient elimination of the urinary matrix has been obtained by MIP-SPE but the elution recovery of tamoxifen was initially too low ( approximately 14%). This problem has been overcome following two ways. At first, a preliminary HLB-SPE of the urine has enabled to discard endogenous salts and to percolate an organic sample through the MIP cartridge. Extraction recoveries are equal to 56 and 74% for tamoxifen and 4-hydroxytamoxifen, respectively. Then, a second MIP has been prepared with styrene and MAA as functional co-monomers. Strong pi-pi interactions occurring between phenyl groups of styrene and tamoxifen promote rebinding of the analyte by the specific sites. The enhanced hydrophobic character of the imprinted polymer has enabled the direct percolation of urine through MIP-SPE and the easy elimination of endogenous salts from urine with only one aqueous washing step. HPLC-UV analysis has confirmed high extraction recoveries (85%) for tamoxifen and its metabolite with an enrichment factor of 8. This analytical protocol can selectively detect the presence of tamoxifen metabolites in urines and be useful as a proof of doping in competitive sports.
Drugs in infertility and fetal safety.
Fertil Steril. 2008 Jun; 89(6): 1595-602
Elizur SE, Tulandi T
OBJECTIVE: To evaluate the safety of drugs used in infertility treatment. DESIGN: Literature search using the keywords birth defect, congenital malformation, clomiphene, aromatase inhibitor, letrozole, gonadotropin, metformin, gonadotropin releasing hormone agonist and antagonist, progesterone, progestin, and estrogen. We conducted the search in Medline, EMBASE, and Cochrane Database of systematic reviews. RESULT(S): The available data suggest that clomiphene treatment, especially after several cycles, might be associated with a slightly higher risk of neural tube defects and severe hypospadias in the offspring. Letrozole and metformin do not appear to be teratogenic. The existing data concerning gonadotropin preparations suggest that there is no evidence of teratogenicity, yet, information after 1991 is lacking. Micronized progesterone, which is widely used in in vitro fertilization treatment, does not appear to increase the risk of nongenital birth defects; however, there might be a possible weak association between other progestational agents and hypospadias. CONCLUSION(S): Infertility per se is a risk factor for congenital anomalies. Repeated clomiphene treatment might be associated with a slightly higher risk of hypospadias and neural tube defect. However, the overall increased risk related to various fertility drugs is only 1% to 2%.
Theriogenology. 2008 May 30;
Khoza T, Hosie M
This study investigated the presence of carbohydrates N-acetyl-d-glucosamine and sialic acid oligosaccharides, in the uterine epithelium of pseudopregnant rats treated with ovarian hormones and Clomiphene citrate (CC) a commonly used fertility drug associated with low pregnancy rates. Ovariectomized sexually mature rats were given 0.25mg CC prior to the implantation-priming hormone sequence of 5mg progesterone for 3 days and a single dose of 0.5mug estradiol-17beta (E(2)) on day 3 (PP(PE)) and sacrificed 24h after the last hormone treatment. Uterine tissue was incubated with the lectin Triticum vulgare (wheat germ agglutinin, WGA), associated with avidin and subsequently labelled with biotinylated-ferritin for electron microscopy, a combined alcian blue/PAS technique for light microscopy and RT-PCR was run for progesterone-associated endometrial protein (PAEP) gene, a pregnancy related endometrial gene that is associated with the protein thought to express carbohydrates in the uterus and suppress immune function. The results indicate that CC administration decreases the expression of these carbohydrates both at a cellular level and genetic level when compared to the PP(PE) group. However, the lowest expression of N-acetyl-d-glucosamine and sialic acid was seen in the placebo group. The ovarian hormones were therefore shown to be important for the synthesis of these carbohydrates that are important in the implantation period and the maintenance of pregnancy. The results suggest that the effect of CC on the expression of N-acetyl-d-glucosamine and sialic acid is a significant reason why there are low pregnancy rates with CC use.
[Metformin therapy in polycystic ovary syndrome]
Ginekol Pol. 2008 Jan; 79(1): 8-11
Jakimiuk AJ
Polycystic ovarian syndrom (PCOS) affects 5% to 10% of women of reproductive age, and is the most common reason of anovulation in infertile women. It is multi-symptom disease. A drug which is used to induce ovulation in women with PCOS is clomiphene citrate. After clomiphene treatment, ovulation is achieved in 56%-73% of women. The rest of them has different level of opportunity to therapy. Clomiphene does not have influence on elementary factor in PCOS which seems to be opportunity to insulin. The drug which can have positive effect is metformin, derivative from biguanid. Its influence on percent of ovulation, pregnancy and live births was evaluated based on randomized trials. Many trials have reserched this so far, but their results are divergent. In this article, we are aiming to systemize results of randomized trials concerning the role of metformin in PCOS therapy.