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Dr. khaled salim :: Publications:

Title:
Tamoxifen versus letrozole in combination with clomiphene citrate to stimulate ovulation in clomiphene-resistant PCOS women
Authors: Ibrahiem Sowedan, Khaled Salama and Ossama El Shaer
Year: 2015
Keywords: Not Available
Journal: Not Available
Volume: Not Available
Issue: Not Available
Pages: Not Available
Publisher: Not Available
Local/International: International
Paper Link: Not Available
Full paper Not Available
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Abstract:

Objectives AQ4 The aim of the study was to evaluate the ovulation stimulatory effect of a combination of clomiphene citrate (CC) and tamoxifen (T) or letrozole (L) in CC-resistant polycystic ovary syndrome women. Patients and methods The study included 120 polycystic ovary syndrome women who were randomly allocated into three equal groups. All enrolled patients received CC (100mg/day) as a fixed therapy in addition to either tamoxifen citrate at 20mg twice daily (group T) or letrozole at 5 or 7.5mg once daily (groups L5 and L7.5, respectively) for 5 days. Vaginal ultrasound was performed on day 11 of the cycle to evaluate the growth of follicles, and Gonal-f was given to complete the follicle growth. Ovulation was monitored by measuring serum progesterone concentration on day 21 of the menstrual cycle. Serum progesterone levels of at least 25 nmol/l were used to indicate ovulation, which was confirmed using transvaginal ultrasonography for evident ovulation with a dominant follicle size greater than 18mm. The appearance of these follicles was considered as successful ovulation. AQ5 Timed intercourse was assigned and pregnancy was diagnosed chemically and confirmed bytransvaginal ultrasonography, and the pregnancy rate was calculated. Results Both tamoxifen and letrozole successfully induced ovulation. Throughout the 3-month study period, the proportion of trials/patients that achieved ovulation was significantly AQ6 higher in group L5 compared with groups T and L7.5, with significantly higher frequency in group T compared with group L7.5. Ovulation was achieved in 88, 83, and 85 trials in groups T, L5, and L7.5, respectively, with an ovulatory success rate of 83.8, 74.8 and 86.7%, respectively. The frequency of successful ovulatory trials in group L5 was significantly lower than that in groups T and L7.5, which showed nonsignificant difference. From the total ovulatory cycles, 50 women became pregnant, resulting in a total pregnancy rate of 19.5% cycles and 41.7% patients. The frequency of pregnancy as outcome/patient was significantly lower in group L5 compared with groups T and L7.5, with nonsignificantly lower pregnancy rate in group T compared with group L7.5. Conclusion Letrozole successfully induced dose-dependent ovulation and pregnancy rate per cycle and per patient. Tamoxifen also successfully induced ovulation and pregnancy rates with a frequency significantly higher than that of letrozole at 5 mg/day and nonsignificantly lower than that of letrozole at 7.5 mg/day. Combination of CC with either tamoxifen or letrozole at a dose of 7.5 mg/day is equally effective and could be prescribed according to the patient’s condition and physician’s preference.

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