Comparison between Two Methods of Ovulation Induction: Clomiphene alone and Clomiphene +Tamoxifen in PCOS Patients

Infertility affects about 10-15% of reproductive-age couples. About half the causes ofinfertility are female related and approximately 40% of the cases are caused by anovulation, mostlyin PCO women.

This study was conducted to determine and compare the effects of two drug treatmentregimens: higher dose of clomiphene and a combination of lower dose of clomiphene and tamoxifenin treating infertile women with PCO.

The study was a randomized clinical trial conducted on 100 infertilepatients who referred to Yazd-Iran Infertility Clinic between the years 2001-2003. The patientswere selected who had received at least 3 periods of clomiphene, but no pregnancy had occurred.They were randomly divided into two groups. In the first group, clomiphene was increased to 100mg and the second group 20 mg of tamoxifen was added to 50 mg of clomiphene from day 5-9 ofmenstruation cycle. Infertility duration, duration of medicine used, PCT score, endometrialthickness, ovulation, and pregnancy rate were studied in both groups.

Ovulation rate in clomiphene group was 54.9%; Tamoxifen + clomiphene group was73.5% without significant differences in both groups. (PV = 0.053). Positive pregnancy rate inclomiphene group was 39.2%; clomiphene + tamoxifen group was 61.2% (P value < 0.05), whichcould be concluded that pregnancy rate was higher in clomiphene/tamoxifen group than in theclomiphene group. The presence of a dominant follicle in the two treatment groups in womenbetween 18-24 was not significant, but in women between 25-39 years was significant (PV= 0.049)(Table III).

The recommendation is to add Tamoxifen to Clomiphene in 35-39 women with 20≤BMI ≤26.99 before the use of gonadotropins treatment in PCOS with or without IUI, because theseoptions have higher risk of multiple pregnancy and ovarian hyperstimulation syndrome.