Ovulation induction with tamoxifen and alternate-day gonadotrophin in patients with thin endometrium

Abstract

Tamoxifen has been reported to be oestrogenic on the lower genital tract. To evaluate its potential positive effect on the endometrium, and consequently early miscarriage and ongoing pregnancy rate, a prospective study was employed in patients for intrauterine insemination who failed to develop an adequate endometrial thickness in a previous ovulatory cycle. Ovarian stimulation was initiated with tamoxifen 40 mg/day from day 3 of the menstrual cycle for 7 days or clomiphene 100 mg/day for 5 days, in combination with 150 IU of human menopausal gonadotrophin on alternate days starting on day 4. Human chorionic gonadotrophin (HCG) was administered when at least one leading follicle was larger than 20 mm. Intrauterine insemination was accomplished 24-36 h after HCG injection and luteal phase supplement was achieved with micronized progesterone 200 mg transvaginally per day. It was found that tamoxifen-treated patients required more stimulation days and used more gonadotrophin, but recruited less follicles larger than 14 mm than clomiphene-treated patients. However, a significantly increased endometrial thickness (P < 0.001) and pregnancy rate (P = 0.015), decreased early miscarriage rate (P = 0.001) and thus improved ongoing pregnancy (P < 0.001) rate were noted in tamoxifen-treated patients. These results suggest that although tamoxifen may not be a first-line treatment in patients with adequate endometrium, it may be a promising alternative for patients with thin endometrium.

The Relationship between Duration of Infertility and Intrauterine Insemination: A Multi-Centers Study

“…Intra-uterine insemination is practicing widely as an empirical treatment for male factor infertility and as a mean to bypass defects in sperm-cervical mucus interaction [18]. In the present study IUI was performed for 152 couples with mild male factor infertility.…”

“…An increment in the duration of infertility to more than 10 years results in reduction in the testicular blood supply especially in the older infertile males and this affects the normal physiology of the testes and epididymis which results in marked elevation of the serum FSH and LH levels [27]. Furthermore there is an increase in the number of pathological spermatozoa which linked to an increase in both age and duration of infertility [18]. Therefore, in this study least positive IUI with 10 years duration of infertility and age ≥ 50 years.…”

Intrauterine Insemination: Fundamentals Revisited

“…The rate of clinical pregnancy was significantly higher in the 20-39-min group (18.3%) than in the 0-19-, 40-59-, and 60-80-min groups (12.7, 11.4 and 9.1%) (all P \ 0.05). The (10-20) 9 10 6 group achieved a remarkably higher pregnancy rate (16.7%) than the (0-9), (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and [ 30 9 10 6 groups (0, 11.4, and 8.3%) (all P \ 0.05). Logistic multivariate analysis showed that the rate of clinical pregnancy was decreased with the increased age of the women (OR 0.89, 95% CI 0.83-0.94) but significantly elevated in the 20-39-min group (OR 2.11, 95% CI 1.34-3.13) and of (10-20) 9 10 6 group (OR 2.06, 95% CI 1.32-3.46).…”

“…gonadotropins, or gonadotropins alone in terms of comparable if not higher CPR/cycle and take home baby rates. Significantly higher serum levels of LH, endometrial thickness, and progesterone at the time of hCG administration have been observed despite a significantly lower serum E2 level [29][30][31] with significantly lower costs, risks, and patient inconvenience in patients with unexplained infertility [29,30,32,33] endometriosis, and combined indications [34], and lower FSH dose requirement and IUI cancelation rates in patients with ovulatory infertility [35] and older infertile women [31].…”

“…This study involved 191 AIH-IUI cycles with the same ovulation induction protocol. After Percoll density gradient centrifugation, they divided the sperm into four groups based on the incubation time: 0-19, 20-39, 40-59, and 60-80 min, and again into another four groups according to the total progressively motile sperm count (TPMC): (0-9), (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and [ 30 9 10 6 . They analyzed the correlation of the clinical pregnancy rate with the time interval from the end of sperm processing to AIH-IUI and with other influencing factors, such as maternal age, infertility duration, and semen quality.…”