ORAL OVULOGENS IN CURRENT SCENERIO

Abstract

Objectives:- Oral ovulogens are the most commonly used intervention in a subfertile couple. A reproductive endocrinologist or infertility specialist commonly performs ovulation induction. Infertility affects up to 15% of couples in their reproductive years around the world. The overall prevalence of primary infertility in India is estimated to be between 3.9 and 16.8%, according to the World Health Organization. Infertility rates vary by state in India, ranging from 3.7 percent in Uttar Pradesh, Himachal Pradesh, and Maharashtra to 5% in Andhra Pradesh and 15% in Kashmir, and incidence differs by tribe and caste within the same region. Anovulation, polycystic ovarian syndrome (PCOS), thyroid disorders (both hyperactive and underactive thyroid glands can inhibit ovulation), and premature ovarian failure are the most common causes of infertility in females. Overall, the prevalence of anovulatory cycles ranged from 3.4 percent to 18.6 percent.Anovulatory infertility is caused by polycystic ovarian syndrome in 80 percent of patients. Its an endocrine and reproductive condition that affects 0.6-3.4 percent of infertile couples. Subclinical hypothyroidism (SCH), 0.2–4.5 percent for overt hypothyroidism (OH), 0.3–1 percent for hyperthyroidism, and 5–10 percent for thyroid autoimmunity are the most common thyroid disorders in women aged 20–45 years. Premature ovarian failure affects 1 to 5.5 percent of women. The most often used medications for ovulation induction are oral ovulogens like Clomiphene citrate, third generation aromatase inhibitors like letrozole and anastrozole, and selective oestrogen receptor modulators like tamoxifen. Trials have been undertaken in women with anovulatory PCOS to examine if clomiphene citrate and metformin benefit from one another. Metformin has been used as an adjuvant to treat polycystic ovarian syndrome for a long time (PCOS). Sitagliptin has recently been shown to improve ovarian cycles and ovulation in PCOS patients. Both have ovulation rates of 70-80% and a pregnancy rate of 20-25 percent per cycle. Dexamethasone is a fertility supplement that helps with raised DHEAS androgen levels and is a highly successful adjuvant to clomiphene citrate in women with PCOS. Methods:- This systematic review comprises of articles from pubmed, cohrane, google scholar, medline. Results:.- A total of 20 articles from 2016 to 2021 were included .Infertility causes modification at both endocrine and immune system at both cellular and tissue level. Conclusion:- Clomiphene citrate plays an important role in mildly stimulating infertile patients because it has the property of preventing premature LH surges. Aromatase inhibitors such as letrozole and anastrozole have also had limited success in the use of IVF. Tamoxifen may be an option for clomiphene citrate in some patients who do not ovulate or become pregnant due to its beneficial effects on cervical mucus and endometrium. Recently, sitagliptin has been reported to improve the ovarian cycle and ovulation of PCOS. Dexamethasone is an additional drug for infertility and is beneficial for elevated DHEAS and androgen levels. This review describes the science behind anovulation and treatment guidelines for promoting follicle recruitment and ovulation using multiple oral ovulogens.