Clomiphene is a widely prescribed drug for the treatment of infertility. Visual symptoms that occur as a side effect of this drug are uncommon. Some doctors may neglect to mention this side effect when prescribing clomiphene. Thus these visual disturbances can be very alarming to the patient and may also pose a hazard if the patient is doing activities such as driving or operating machinery. The patient should be told to stop taking clomiphene and ophthalmologic evaluation should be performed. Although visual disturbances generally cease on stopping clomiphene, some women may experience persistent visual disturbances.
A 23 year old Indian lady, gravida 1 para 0, with Clomid induced pregnancy was admitted to the University Hospital on 29 August 1981 with signs and symptoms of pregnancy and intraperitoneal bleed. Period ofamenorrhoea at time of admission was eight weeks. Emergency laparotomy revealed a right leaking ectopic pregnancy and an enlarged gravid uterus. Ultrasound done on the 7th post operative day confirmed concurrent intrauterine pregnancy which progressed normally to term, ending with a normal healthy baby at 39 weeks through an assisted breech delivery.
Polycystic ovary syndrome (PCOS) has been linked to aberrant folliculogenesis and abnormalities in the aromatase enzyme (Cyp19a1) and the steroidogenic enzyme, 17-alpha-hydroxylase (Cyp17a1) expression. It has been demonstrated that Kelulut honey (KH) improves both female and male reproductive system anomalies in animal studies. Here, we examined the effects of isolated and combined KH, metformin, and clomiphene in improving folliculogenesis, aromatase, and steroidogenic enzyme profiles and ovarian histomorphology in letrozole-induced PCOS rats. Letrozole (1 mg/kg/day) was administered to female Sprague-Dawley (SD) rats for 21 days to induce PCOS. PCOS rats were subsequently divided into six experimental groups: untreated, treatment with metformin (500 mg/kg/day), clomiphene (2 mg/kg/day), KH (1 g/kg/day), combined KH (1 g/kg/day) and metformin (500 mg/kg/day), and combined KH (1 g/kg/day) and clomiphene (2 mg/kg/day). All treatments were given orally for 35 days. We found that KH was comparable with clomiphene and metformin in improving the expression of Cyp17a1 and Cyp19a1, apart from enhancing folliculogenesis both histologically and through the expression of folliculogenesis-related genes. Besides, the combination of KH with clomiphene was the most effective treatment in improving the ovarian histomorphology of PCOS rats. The effectiveness of KH in restoring altered folliculogenesis, steroidogenic, and aromatase enzyme profiles in PCOS warrants a future clinical trial to validate its therapeutic effect clinically.
Introduction : Ovarian cancer accounts for approximately 4% of all cancers occurring in women and ranks the fourth most frequent cause of cancer-related death in women. Despite aggressive treatment modalities the 5 year survival rate remains less than 30%'. Almost 2.5% of all live births/ year result from assisted reproductive techniques (ARD2. Concern has been expressed that exposure to fertility drugs (FD) might be associated with a risk of ovarian tumors. Given the grave prognosis of ovarian cancer and the increasing use of ART, for the past several years this has been a subject of much scientific debate. The likely magnitude of risk may be 2 - 3 times that of the general population, which is at most 4-5% in a woman's lifetime. Several case control and cohort epidemiological studies have attempted to address this issue but failed to specifically look at drug treatment as risk factor and research to date demonstrates conflicting results.
Review of literature : Ovulation induction (Ol) agents are commonly used in the treatment of infertility in patients with or without ovulatory disturbances. These agents include clomiphene citrate (CC), bromocryptine, gonadotropins (Gn), Gonadotropin releasing hormone (GnRH) and its analogues. In in vitro fertilization (IVF), combinations and different drug dosages of FD are given to stimulate production of multiple oocytes. Fertility drugs were first marketed since the 1960's. The first to hit the market was CC in 1967 followed 2 years later by human Menopausal Gonadotropin (hMG) & human Chorionic Gonadotropin (hCG)'. Until 1987, most IVF cycles used CC in combination with HMG followed by hCG. From 1987, GnRH agonists were introduced to replace Cc. From 1990, the main drug regimen was GnRH agonist in combination with HMG or Follicular Stimulating Hormone (FSH) followed by hCG.
An alternative superovulator to replace clomiphene citrate (CC) is needed as it is unsuitable for women with polycystic ovarian syndrome and is associated with low pregnancy rates. Anastrozole is an effective superovulator, but has not been well researched. The aim of this study was to determine the optimal dose of anastrozole as a superovulator and ascertain its effects on implantation and uterine ultrastructure during early pregnancy in Wistar rats using scanning electron microscopy. The uterine morphological characteristics which were studied in day 1 and 6 pregnant rats include microvilli density, length, surface "beads", surface glycocalyx, cell borders and apices, uterine surface fording and large surface protrusions. A significant increase in implantation sites is seen in the 15 mg/kg anastrozole group, compared to control. Day 1 and 6 anastrozole groups have similar morphology to the control and different to the CC group. At day 6, large surface protrusions are mostly noted but not limited to anastrozole-treated rats; anastrozole also appears to retain glycocalyx to some extent. The increased number of implantation sites in the 15 mg/kg anastrozole group suggests that this dose superovulates and favors implantation. Anastrozole is probably dose-/species-specific and additionally the surface uterine morphology suggests that anastrozole is implantation friendly.
A survey in 1996 of our female patients suggest that the three commonest causes of infertility were endometriosis, anovulation and idiopathic which comprises of about 70% of all the patients. In the male patients, sperm morphology evaluation by critical criteria showed that abnormal morphology was present in 71% while 87% of all the semen analysis were abnormal. The objective of this study was to assess the status of IUI before proceeding to formulate patient protocols for IVF in a tertiary infertility referral unit. A retrospective study of patients data was done from Jan 1995 to Dec 1996. Ovarian stimulation by clomiphene for anovulatory and idiopathic patients was performed on couples with at least one patent fallopian tube. Ovulation induction was by an intramuscular injection of 5000 i.u of HCG after follicular maturation. IUI was performed approximately 36-40 hours later. A total of 74 couples received 114 treatment cycles producing a total of 9 conceptions. The conception rate of IUI was therefore 7.89% per cycle and 12.16% per couple with the cumulative pregnancy rate of 28.21%. Associated success features of IUI found in this study were the age of the woman and the semen parameters of the husband.
To determine the first-line medication to be used in anovulatory patients with polycystic ovary syndrome (PCOS) for ovulation induction and pregnancy achievement.