Combined Clomiphene Citrate and Recombinant FSH Ovarian Stimulation of PCOS Infertile Women Improves Outcome of Intrauterine Insemination
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ABSTRACT Objectives : To compare the effect of combined clomiphene citrate (CC) and recombinant follicle stimulating hormone (rFSH) ovarian stimulation versus CC alone in polycystic ovary syndrome (PCOS) infertile women assigned for intrauterine insemination (ILK Patients & Methods : The study included 60 PCOS infertile women received oral CC (50 mg twice daily) starting on day 2 after a withdrawal bleeding using medroxyprogesterone acetate. Women were randomly allocated into 2 equal groups: Group A received rFSH (150 IU/day) for 6 days from day-3 after withdrawal bleeding and Group B who did not receive rFSH. For both groups ovulation was monitored and assured sonographically for evident ovulation with a dominant follicle size >18 mm. Women of both groups received KG 10,000 ILI and 1111 was performed 34-36 hours thereafter. The primary outcome was the clinical pregnancy rate. Results : Group A women showed significantly higher serum E2 and shorter duration till 1:CG injection with non-significantly higher number of follicles of >18 inni compared to group B. Chemical and clinical pregnancy rates were 23.3% and 16.7%, respectively with significantly higher rates in group A compared to group B. In both groups, clinical pregnancy rate showed a negative significant correlation with patient's age, while showed a positive significant correlation with number of mature follicles of >18 inn:, endometrial thickness and serum E2 at time of hCG injection. Regression analysis defined number of mature follicle >18mm, serum E2 and patient's age as significant predictors for occurrence of clinical pregnancy. Conclusion : Ovarian stimulation using CC and rFSH of PCOS patients followed by 1111 36-h after KG injection significantly improved clinical pregnancy rate compared to stimulation using CC alone. Outcome is significantly affected by patient's age and number of resultant mature follicle >18 sum. Keywords: Intrauterine insemination, rFSH, clomiphene citrate, hCC, PCOS.