DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150709

Comparison between tamoxifen and clomiphene citrate for induction of ovulation and successful conception in polycystic ovarian syndrome

Zhyan Baker Hassan

Abstract


Background: Being a selective estrogen receptor inhibitor (SERM) tamoxifen may be used an alternative to clomiphene citrate for ovulation induction in women with anovulatory infertility. This study was conducted to evaluate the safety and efficacy of tamoxifen as compared to clomiphene citrate in women with primary or secondary anovulatory infertility due to Polycystic Ovarian Syndrome (PCOS).

Methods: One hundred women suffering from anovulatory infertility and attending the infertility clinic and were recruited for the study. Patients were randomized to receive either clomiphene citrate (100-150 mg) or tamoxifen treatment (40-80 mg). The ovulation was monitored from day 5 to day 9 of menstrual cycle followed up by transvaginal ultrasound from day 11 every alternate day for 10 days. Ovulation and pregnancy rates were calculated.

Results: The baseline characteristics of mean age, weight, proportion of patients with primary and secondary infertility and mean duration of infertility were comparable between both the study groups.  Out of 50 patients who received clomiphene citrate, 37 showed successful ovulation (ovulation rate of 64%) and 16 patients conceived (pregnancy rate of 32%). In tamoxifen group 41 women showed successful ovulation (ovulation rate of 82%) and 18 women conceived (pregnancy rate of 36%). The difference was not significantly different (p > 0.05). No major adverse effects were noted in both the study groups.

Conclusions: Tamoxifen has shown comparable efficacy and safety as compared to clomiphene citrate and it can be a good alternative to clomiphene citrate in patients of primary or secondary anovulatory infertility with PCOS.


Keywords


Anovulation, Clomiphene, Induction of ovulation, Polycystic ovary syndrome, Tamoxifen

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References


Balen AH and Michelmore K. What is Polycystic Ovary Syndrome (PCOS)? Are national views important? Women. Human reprod. 2002;17:2219-27.

Clark JH, Markaverich BM: The agonistic-antagonistic properties of clomiphene: A review. Pharmacol Ther. 1982;15:467.

Kettal LM, Roseff SJ, Berga S et al: Hypothalamic-pituitary-ovarian response to clomiphene citrate women with polycystic ovary syndrome. 1993;59:532.

Brown J, Farquhar C, Beck J, Boothroyd C, Proctor M, Hughes E. Oral anti-estrogen and medical adjuncts for subfertility associated with anovulation. Cochrane Database Syst Rev. 2009;1CD002249.

Eden JA, Place J, Carter GD, Jones J, Alaghband-Zadeh, Pawson ME. The effect of clomiphene citrate on follicular phase increase in endometrial thickness and uterine volume. 1989;73:187–90.

Whittemore AS, Harris R, Ignore J et al. Characteristics relating to ovarian risk: Collaborative analysis of 12 US case-control studies. Am J Epidemiol. 1992;136:1184.

Williamson JG and Ellis JD The induction of ovulation by tamoxifen. J Obstet Gynaecol Br Cmnwlth. 1973;80:844–7.

Steiner AZ, Terplan M, Paulson RJ. Comparison of tamoxifen and clomiphene citrate for ovulation induction: a meta-analysis. Hum Reprod. 2005;20(6):1511-5.

Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf). 1999;51:779–86.

Lobo RA, Gysler M, March CM, Goebelsmann U, Mishell. Jr Clinical and laboratory predictors of clomiphene response. Fertil Steril. 1982;37:168–74.

Wu CH. A practical approach to clomiphene therapy. Clin Obstet Gynecol. 1984;27:953–65.

Messinis IE, Nillius SJ. Comparison between tamoxifen and clomiphene therapy for induction of ovulation. Acta Obstet Gynaecol Scand. 1982;61:377–9.

Fukushima T, Choshin T, Keizo F, Masao M. Tamoxifen in the treatment of infertility associated with luteal phase deficiency. 1982;37:755–61.

Gulekli B, Ozaksit G, Turhan NO, Senoz S, Oral H, Goakman O. Tamoxifen: An alternative approach in clomiphene resistant polycystic ovarian syndrome patients. J Pak Med Assoc. 1993;43:89–91.

Seyedoshohadaei F, Zandvakily F, Shahgeibi S. Comparison of the effectiveness of clomiphene citrate, tamoxifen and letrozole in ovulation induction in infertility due to isolated unovulation. Iranian Journal of Reproductive Medicine. 2012;10(6):531-6.