Tamoxifen for ovulation induction in infertile PCOS women who did not conceive with 3 or more cycles of clomiphene citrate: A prospective clinical study

Abstract

Objectives: To assess the ovulatory, pregnancy rates and side effects of tamoxifen (TMX) in women who are infertile with polycystic ovarian syndrome (PCOS) and who did not conceive with three cycles of clomiphene citrate (CC). Study Design: A prospective interventional study. Population: Seventy-four women who were infertile with PCOS and who did not achieve pregnancy after a minimum of three cycles of CC were included in the study. Materials and Methods: TMX was given orally from Day 2 to Day 6 of the menstrual cycle, with a dose of 40 mg in the 1st cycle and 80 mg in the subsequent two cycles. Transvaginal ultrasound was used for follicular monitoring from Day 10 and on every alternate day till the day of ovulation or till the 20th day of the cycle. Statistical Analysis: Ovulation rates with different doses were compared using McNemar test. Kruskal–Wallis test was used to find out differences in maximum follicular diameter and endometrial thickness (ET) between 3 cycles. Results: The mean maximum follicular diameter was 16 ± 5.2 mm, and the mean ET was 8.9 ± 1.7 mm with an ovulatory rate of 41.90% with 40 mg of TMX. Mean increase in the maximum follicular diameters with 80 mg of TMX was higher when compared with 40 mg (P value − 0.000) of TMX. Increasing the dose of TMX in cycles 2 and 3 resulted in a statistically significant increase in the ovulatory rates; however, it was not so with ET. There were no clinical pregnancies, and minor side effects occurred in 14.1% of the participants. Conclusion: TMX induced ovulation only in 56% of the participants, and optimum ET was achieved in 92.7% of the participants; in addition, there were no pregnancies. Hence, TMX is not a useful ovulation inducing agent for CC failure/CC-resistant PCOS.