The effect of clomiphene citrate treatment on cervical mucus and plasma estradiol and progesterone levels

The Potential Relationship Between Different Human Female Reproductive Disorders and Sperm Quality in Female Genital Tract

Spermatozoa should travel throughout the female reproductive tract to reach its ultimate goal, fertilization of the oocyte. At the ejaculation moment, millions of sperm within a few milliliters of the ejaculate are deposited at the cranial segment of vagina and make their journey to the fertilization site. This is done by means of various factors, such as sperm motility, the uterine and fallopian tubes contractility, and the ciliary movement of the lining cells. During this migration, spermatozoa interact with the female microenvironment both physically and molecularly. In this regard, the quality of the environmental conditions may affect this interaction. Therefore, some alterations in women's genital tract microenvironment, such as conditions that occur in female reproductive disorders, may have detrimental effects on sperm reproductive function. In this review, human sperm migration through the female tract is described, and the potential effects of different reproductive disorders at reproductive organs, such as vagina, uterine cervix, uterus, fallopian tubes, and ovary on sperm survival and quality, are also argued. The understanding of those conditions that may impair sperm fertility in the female genital tract can provide a more accurate diagnosis of the causes of infertility in couples. This can ultimately lead to the discovery of effective treatment approaches.

Clomiphene citrate or aromatase inhibitors combined with gonadotropins for superovulation in women undergoing intrauterine insemination: a prospective randomised trial

The objective of this study was to test the use of letrozole in combination with follicle-stimulating hormone (FSH) vs clomiphene citrate (CC) with FSH for ovarian hyperstimulation prior to intrauterine insemination (IUI). A prospective randomised trial in which 280 women with unexplained infertility were randomised to 100 mg of CC (141 patients, 219 cycles) or 5 mg of letrozole daily (139 patients, 215 cycles) for 5 days starting on day 3 of menses both combined with gonadotropins for ovarian stimulation prior to IUI. The primary outcome measures were the number of growing and mature follicles, the concentrations of serum E2 (pg/ml) and progesterone (ng/ml), and the endometrial thickness (mm). The secondary outcome measure was the occurrence of pregnancy and miscarriage. The total number of follicles was significantly greater in the CC group (4.1 +/- 0.46 vs 2.6 +/- 0.43). There was no significant difference in endometrial thickness between the two groups. Pregnancy occurred in 33 out of 139 patients (215 cycles) in the letrozole group (23.7% and 15.3%, respectively) and 37 out of 141 patients (219 cycles) (26.2% and 16.8%, respectively) in the CC group; the differences were not statistically significant. The allied use of either CC or letrozole, during ovarian stimulation to reduce the dose of gonadotropins prior to IUI is justified. This approach will reduce the cost of stimulation protocols without effect on the treatment outcome and letrozole has no advantage over CC in this respect.

Chronic low-dose follicle-stimulating hormone compared with clomiphene/human menopausal gonadotropin for induction of ovulation

Concurrent administration of clomiphene can reduce the amount of gonadotropins required for induction of ovulation. Recently, follicle-stimulating hormone (FSH) administered in a chronic, low-dose fashion has been reported to give satisfactory pregnancy rates. We compared the conventional clomiphene/human menopausal gonadotropin (hMG) with the chronic, low-dose FSH regimen for induction of ovulation in 87 patients over 110 cycles. The clomiphene/hMG regimen required half the amount of gonadotropin compared to the chronic FSH regimen to achieve follicular maturation. Despite the reduced amount of gonadotropin, the clomiphene/hMG regimen induced a mean fourfold higher level of estradiol production and was associated with significantly greater numbers of large and intermediate-sized follicles compared to the chronic FSH regimen. The proportion of clomiphene/hMG cases with multifollicular development and overstimulation was therefore high (30%). In contrast, the chronic FSH regimen, despite requiring larger amounts of gonadotropin and longer periods of treatment, resulted in unifollicular development, low rates of overstimulation and improved pregnancy rates. We conclude that although clomiphene can reduce the requirement for gonadotropins, the relative safety and effectiveness of the chronic low-dose FSH regimen makes it the method of choice for ovulation induction.