Supplementation with estradiol valerate and gonadotropins in clomiphene citrate stimulated IUI cycles.

Abstract

Introduction: Clomiphene, a selective estrogen receptor modulator, has been used to induce ovulation in patients suffering from chronic oligo-anovulation and ovulatory dysfunction with ovulation rates of 60-85% and pregnancy rates of 15-50% per woman. Anti-estrogenic effects of clomiphene on the endometrium are likely to be one of the causes of suboptimal pregnancy rates in spite of good ovulation rates. Methodology: The study comprised of one hundred and fifteen infertile women who were divided into three groups- group 1 receiving clomiphene (CC 100 mg) from day 3-7, group 2(CC+estradiol valerate 2 mg TDS from day 8 onwards till next menstruation or through 12 weeks of pregnancy) and group 3(CC+HMG 75 IU from day 7-9). The patients were monitored by ultrasonological follicle and endometrial thickness measurement and serum estradiol levels. A single IUI was performed 24-36 hours after the administration of HCG trigger. Results: Clomiphene is a reasonably good agent for ovulation induction with overall ovulation rate of 91.3% and pregnancy rate of 17.14%, 17.14% in clomiphene group, 14.28% in estradiol valerate group and 20% in gonadotropin group. Conclusion: Supplementation with estradiol valerate or gonadotropins in CC stimulated IUI cycles did not have any positive effect on the endometrium on the dayof trigger. The study failed to show statistical significant difference in pregnancy rates, however abortion rates were decreased marginally in estradiol or gonadotropin supplemented group.