Objectives: The current study aimed at comparing the efficacy of Clomiphene Citrate (CC) for the expectant management of unexplained infertility in females over 3 successive cycles.Materials: The present randomized, controlled, clinical trial was carried out at Ain Shams University Maternity Hospital. Females with unexplained infertility for at least 12 months of unprotected regular marital life were enrolled. Eligible females were randomly assigned into one of the 2 following groups: group 1 received 100 mg CC once a day for 5 days, and group 2 was expectantly followed up without induction of ovulation. The primary outcome was the clinical pregnancy rate. Results: A total of 113 females were enrolled in the current trial. The mean age of the subjects was 25.3±3.1 years; ranged 20 to 33. The clinical pregnancy rate was slightly, but significantly, higher in CC group compared with the controls; both per case (7/57 vs. 4/56, 12.3% vs. 7.1%, respectively; P=0.357; Relative Risk (RR)=1.72; 95% Confidence Interval (CI)=0.53, 5.55; Number Needed to Treat (NNT)=19) and per cycle (7/163 vs. 4/160, 4.3% vs. 2.5%, respectively; P=0.374; RR=1.72; 95% CI=0.51, 5.75; NNT=56).Discussion: CC seems to be not effective in improving clinical pregnancy outcome compared with observation alone in females with unexplained infertility. |
- The Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertility and Sterility. 2006; 86:111â4. doi: 10.1016/j.fertnstert.2006.07.1475
- Definitions of infertility and recurrent pregnancy loss. Fertility and Sterility. 2008; 90(5):S60. doi: 10.1016/j.fertnstert.2008.08.065
- Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HWG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Human Reproduction Update. 2009; 16(3):231â45. doi: 10.1093/humupd/dmp048
- Collins JA, Crosignani PG. Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management. International Journal of Gynecology & Obstetrics. 1992; 39(4):267â75. doi: 10.1016/0020-7292(92)90257-j
- Templeton AA, Penney GC. The incidence, characteristics, and prognosis of patients whose infertility is unexplained. Fertility and Sterility. 1982; 37(2):175â82. doi: 10.1016/s0015-0282(16)46035-8
- Hamada A, Esteves SC, Nizza M, Agarwal A. Unexplained Male infertility: diagnosis and Management. International Brazilian Journal Of Urology. 2012; 38(5):576â94. doi: 10.1590/s1677-55382012000500002
- Hatasaka H. New Perspectives for Unexplained Infertility. Clinical Obstetrics and Gynecology. 2011; 54(4):727â33. doi: 10.1097/grf.0b013e3182353e54
- Jose-Miller AB, Boyden JW, Frey KA. Infertility. American Family Physician. 2007; 75(6):849-56. PMID: 17390595
- Kamath MS, Bhattacharya S. Demographics of infertility and management of unexplained infertility. Best Practice & Research Clinical Obstetrics & Gynaecology. 2012; 26(6):729â38. doi: 10.1016/j.bpobgyn.2012.08.001
- Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained subfertility in women. Hughes E, editor. Cochrane Database of Systematic Reviews. 2010; (1):CD000057. doi: 10.1002/14651858.cd000057.pub2
- Crosignani PG, Walters DE, Soliani A. The ESHRE multicentre trial on the treatment of unexplained infertility: a preliminary report. 1991; 6(7):953â8. doi: 10.1093/oxfordjournals.humrep.a137468.
- Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. New England Journal of Medicine. 1999; 340(3):177-83. doi: 10.1056/NEJM199901213400302
- Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000; 355(9197):13â8. doi: 10.1016/s0140-6736(99)04002-7
- Aboulghar MA, Mansour RT, Serour GI, Al-Inany HG. Diagnosis and management of unexplained infertility: an update. Archives of Gynecology and Obstetrics. 2003; 267(4):177-88. doi: 10.1007/s00404-002-0300-0
- Rossing MA, Daling JR, Weiss NS, Moore DE, Self SG. Ovarian tumors in a cohort of infertile women. New England Journal of Medicine. 1994; 331(12):771â6. doi: 10.1056/nejm199409223311204
- Harris R, Whittemore AS, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 us case-control studies. American Journal of Epidemiology. 1992; 136(10):1204â11. doi: 10.1093/oxfordjournals.aje.a116428
- Glazener CMA, Coulson C, Lambert PA, Watt EM, Hinton RA, Kelly NG, et al. Clomiphene treatment for women with unexplained infertility: placebo-controlled study of hormonal responses and conception rates. Gynecological Endocrinology. 1990; 4(2):75â83. doi: 10.3109/09513599009012324
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