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Conception rate, term pregnancy rate (PR), and pregnancy complications, such as spontaneous miscarriage and multiple gestation.
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CC was given alone or in combination with EB.
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Consecutively treated patients attending our infertility clinic for superovulation induction with IUI who had been unsuccessfully treated by clomiphene citrate (CC).
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A 30-year-old, Somali woman, gravida 3, para 1021, was referred for evaluation after trying unsuccessfully to conceive for 19 months. She was diagnosed with unexplained infertility and prescribed clomiphene citrate for ovulation induction. The patient took the medication in 2 consecutive cycles and each time developed intense right upper quadrant pain. During the second episode she presented to the emergency room with transaminitis. Acute and chronic viral hepatitis were ruled out, and she had not ingested any other medications; ultimately, no other etiology was discovered. The transaminitis resolved over 2 months and, in the absence of further treatment with clomiphene citrate, did not recur.
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Ovulatory cycles and pregnancies.
To assess the effect of clomiphene citrate (CC) on endometrial epithelial integrins and P receptors (PR) during the window of implantation.
An investigation of the effects on follicular development of clomiphene citrate and its two isomers En clomiphene and Zu clomiphene given separately was carried out on 19 normally cycling women being treated with donor insemination. All women received clomiphene citrate in the first cycle and, following a washout control cycle, were treated with either En clomiphene or Zu clomiphene alone. The number of follicles present, follicular phase oestrogen secretion and luteal phase pregnanediol excretion were not significantly different when Zu clomiphene cycles were compared with control cycles, but were significantly increased in En clomiphene and clomiphene citrate cycles. It is concluded that the En isomer, which has largely antioestrogenic properties, is the isomer active in inducing follicular development. The oestrogenic properties of Zu isomer did not appear to protect it from the possibly detrimental effects on sperm-cervical mucus interaction observed in both isomers and in the combined preparation.
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The effect of two antiestrogens, enclomiphene and tamoxifen, on luteal function in the guinea pig was compared to that of estradiol, a known luteolysin. Enclomiphene caused premature luteolysis when administered during the early or mid-luteal phase of the cycle, but was not as potent as estradiol. Tamoxifen had no effect. The luteolytic effect of enclomiphene was mediated by the uterus, as has been shown for estradiol.
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In the ovariectomized (ovx) rat, the nonsteroidal antiestrogens, clomiphene (CLO) and tamoxifen (TAM), at dose levels that prevent development of osteopenia to a degree approaching that of 17beta-estradiol are, in contrast to 17beta-estradiol, only weakly uterotrophic. Metabolites of CLO and TAM might contribute differentially to these effects. Thus, we have evaluated bone protective and uterine effects in ovx rats of two such metabolites: 4-hydroxy CLO, produced by p-hydroxylation of CLO; and 4HTA, produced from TAM by stepwise replacement of its dimethylaminoethyl side chain with an acetic acid moiety, accompanied by p-hydroxylation. Also reported are effects of D4HTA, the dihydrodesethyl derivative of 4HTA previously characterized as a full estrogen mimetic in vitro. Administration of 4-hydroxy CLO (2.5 mg/kg subcutaneously) 5 days/week for 5 weeks to 3-month-old ovx rats resulted in complete prevention of bone loss and suppression of bone turnover to levels comparable to those of intact controls and to those of ovx animals similarly receiving 17beta-estradiol (10 microg/kg). However, uterine weight in animals receiving 4-hydroxy CLO was 64% less than that in 17beta-estradiol-treated animals. Although 4HTA (3.7 mg/kg s.c.) had a modest uterotrophic effect, it did not prevent bone loss associated with ovariectomy. In contrast, D4HTA (3.6 mg/kg s.c.) partially reduced bone turnover indicators and cancellous bone loss in a manner similar in many ways to that observed in TAM-treated ovx animals, but it had no uterotrophic effect. These results suggest that, although 4HTA does not contribute to the bone-protective effect of TAM, 4-hydroxy CLO might augment that of CLO.
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Academic medical center.
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In this prospective study, 40 patients with previous at least three times CC cycle failure were evaluated. Half of them received 2.5 mg letrozole on days 3-7 of the menstrual cycle and recombinant follicle stimulating hormone (rFSH) starting on day 5. The other half of the patients received only rFSH starting on day 3. Groups were compared according to the OI duration, gonadotropin dosage, endometrial thickness, estradiol (E2) levels on day of human chorionic gonadotropin (HCG) administration and follicle count.
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Randomized, double-blind, placebo-controlled trial.
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One hundred four anovulatory women who had been treated with CC were studied retrospectively. Age, body mass index, free androgen index, and cycle history were used to assign a likelihood of response for each patient on the basis of a published nomogram. Predicted and observed responses were compared.
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Although fertility drugs stimulate ovulation and raise estradiol levels, their effect on breast cancer risk remains unresolved.
Elevated levels of serum and follicular fluid prolactin occur in women undergoing ovulation induction with both clomiphene citrate and gonadotropin therapy. Prolactin's effect on oocyte fertilization and embryo cleavage has not been fully characterized. Using a murine model, we investigated the effect of prolactin on in vitro fertilization and subsequent embryo cleavage in media containing 150, 400, and 600 ng/ml purified mouse prolactin. No difference was found in fertilization rates when compared with control rates. Culture of both in vivo and in vitro fertilized two-cell embryos in murine prolactin at 150, 400, and 600 ng/ml showed no significant difference in blastocyst, morula, or embryo degeneration rates when compared with control rates. An assay for binding of murine prolactin to spermatozoa, oocytes, and the embryo at various cleavage stages revealed no specific murine prolactin binding. These in vitro experimental results fail to show a role for murine prolactin in effecting mature oocyte fertilization or subsequent embryo cleavage. The lack of binding of murine prolactin to the gametes and early developing embryo supports the in vitro findings.
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The possibility of a correlation between biological (E2) and morphological (U.S.) parameters, in view of obtaining a correct prevision of follicular maturation and ovulation is discussed. In this study normal patients with a tubal sterility were treated with clomiphene citrate and clomiphene plus H.M.G. The statistical analysis was performed by means of the linear correlation (r) and the relative test of significance (Student T.). The data obtained in this study show that notwithstanding that the rising plasma concentration of E2, which precedes ovulation, is the first and more constant marker of follicular maturation, because of its wide range of variability its usefulness in prediction of ovulation is nearly limited to spontaneous cycles. In fact in stimulated cycles the rising plasma-E2 concentration is rather an independent variable regarding the growth of single follicles (F.D.).
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A pilot study.
There is no statistically significant difference between flexible and rigid catheters for IUI.
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The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group (P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40x10(6)) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (> or =40x10(6)) (25.7% versus 22.7%, P=0.671).
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All women underwent a clomiphene citrate (CC) challenge test to assess their ovarian reserve before IVF treatment. One hundred and eighteen women (84%) had normal basal follicle stimulating hormone (FSH) levels (3.1-10.0 IU/l) and 22 women (16%) had elevated FSH levels (> 10.0-24.0 IU/l). The FSH levels measured on cycle day 10 showed that 106 (76%) of the women could be regarded as having a normal ovarian reserve and 34 (24%) a diminished ovarian reserve.
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To evaluate the influence of female age on clomiphene citrate (CC) with IUI therapy and to compare the efficacy of this therapy between patients with ovulatory and anovulatory infertility.
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A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection.
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The increase in the incidence rates of clomiphene citrate use among women aged 30 to 44 years indicates a growing demand for fertility treatments in this population and may have contributed to the increase in multiple births.
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Human chorionic gonadotropin (HCG) and luteinizing hormone (LH) each cross react with the other in urine or serum determinations. Recent assay systems for the beta subunit of HCG may make it possible to test for this hormone alone. This will be of use in the early diagnosis of pregnancy, and in following the response to treatment of HCG-producing tumors. LH may be decreased subsequent to treatment with oral contraceptives or phenothiazine tranquilizers and in a few other conditions. LH is increased to over 25 mIU/ml during the preovulatory surges, in pregnancy, in menopause, with polycystic ovaries, and in HCG-treated patients. 3 case reports illustrate the value of LH determinations in diagnosing the absence or presence of pregnancy. In diet courses, where injectable HCG has been given, or when given to anovulatory patients, HCG may be detected in sera up to 12 days following injections. Those receiving clomiphene therapy because of delayed periods may sometimes be shown to have been pregnant.
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The records of patients who received clomiphene citrate 100 mg/day plus human menopausal gonadotropin 150 IU/day from day 3 and received frozen-thawed embryo transfers were reviewed. Patients were divided into three groups: group A (E2 ≤30 pg/ml), group B (30< E2 ≤50 pg/ml), and group C (E2 >50 pg/ml). A total of 1080 cycles from 941 patients were included.
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To determine the effectiveness of clomiphene citrate given to women with unexplained subfertility, in a dose range of 50-250 mg for up to 10 days. The primary outcome was clinical pregnancy.