Ovulation induction with tamoxifen and alternate-day gonadotrophin in patients with thin endometrium.
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.
Wang
Chia-Woei
CW
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan, Taiwan. cwwang@adm.cgmh.org.tw
Horng
Shang-Gwo
SG
Chen
Chun-Kai
CK
Wang
Hsin-Shih
HS
Huang
Hong-Yuan
HY
Lee
Chyi-Long
CL
Soong
Yung-Kuei
YK
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D004717:Endometrium / Q000002:abnormalities* / Q000473:pathology; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008297:Male; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods; D013629:Tamoxifen / Q000494:pharmacology*
D004965:Estrogen Antagonists; D005300:Fertility Agents, Female; D006062:Gonadotropins; D013629:Tamoxifen; D002996:Clomiphene