Clomiphene Citrate For Ovulation Induction Research Articles

Strong Early Impact of Letrozole on Ovulation Induction Outperforms Clomiphene Citrate in Polycystic Ovary Syndrome.

Polycystic ovary syndrome is a common endocrine disorder, characterized by hyperandrogenism and/or chronic oligo/anovulation, which leads to infertility. The aim of this systematic review and meta-analysis was to explore the efficacy of letrozole compared with clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome. The study protocol has been registered with PROSPERO (registration number CRD42022376611). The literature search included randomized clinical trials. We conducted our systematic literature search across three medical databases: MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Embase. The data synthesis employed a random effects model. Out of the 1994 articles screened, 25 studies fulfilled the inclusion criteria. The letrozole group exhibited a significant increase in endometrial thickness (mean difference = 1.70, confidence interval: 0.55-2.86; I2 = 97%, p-value = 0.008). The odds of ovulation (odds ratio = 1.8, confidence interval: 1.21-2.69; I2 = 51%, p-value = 0.010) and pregnancy (odds ratio = 1.96, confidence interval: 1.37-2.81; I2 = 32%, p-value = 0.002) were significantly higher. The resistance index of the subendometrial arteries showed a significant decrease (mean difference = -0.15, confidence interval: -0.27 to -0.04; I2 = 92%, p-value = 0.030). Women diagnosed with polycystic ovarian syndrome and treated with letrozole for ovulation induction had increased ovulation and pregnancy rates and increased endometrial thickness. The lower resistance index of subendometrial arteries can enhance intrauterine circulation, creating more favorable conditions for embryo implantation and development.

Letrozole and Clomiphene Compared With Letrozole Alone for Ovulation Induction in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis [ID 2683666

INTRODUCTION: Nearly 70% of patients with polycystic ovary syndrome (PCOS) have anovulatory infertility. One therapeutic option is letrozole; however, its comparative efficacy and safety when compared with the association of letrozole and clomiphene citrate are unclear. Therefore, we aimed to compare letrozole and the combined use of letrozole and clomiphene citrate for ovulation induction in PCOS. METHODS: We systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing letrozole and clomiphene citrate versus letrozole alone in patients with PCOS. The primary endpoints rate of mature follicles and ovulation were calculated via a random-effects meta-analysis. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used. RESULTS: Two RCTs and one observational study comprising 223 patients (mean age, 28.7 years; 49.3% combined therapy) were included. The combined therapy was associated with a higher number of women with mature follicles (>15 mm) (odds ratio [OR] 2.94; 95% CI, 1.66–5.21; P=.0002; I2=0) and ovulations (OR 3.31; 95% CI, 1.91–5.73; P<.0001; I2=0). There was no significant difference between groups in the number of pregnancies and thickness of the endometrial lining. Adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups. CONCLUSION: In women with PCOS and anovulatory infertility, letrozole and clomiphene citrate combined therapy promoted a significant benefit for the maturation of follicles and ovulation, with a similar safety profile compared to letrozole alone.

Effect of Coenzyme Q10a and Clomiphene Citrate for Ovulation Induction in Patients with PCOS as Compared to Clomiphene Citrate alone

To evaluate the effects of coenzyme Q10A and clomiphene citrate taken in addition to other drugs to stimulate ovulation in people with polycystic ovarian syndrome. The Department conducted the study of Obstetrics and Gynecology, Pakistan Ordinance Factory (POF), Wah Cantonment, Rawalpindi from Mar 2019 to Feb 2021 By using a lottery, all of the patients were split into two random groups. Group A was given Coenzyme Q10A 60mg daily from day 1 of the cycle thrice a day and clomiphene citrate 150mg/day from days 2-6 of the cycle, and Group B was given only clomiphene citrates 150mg/day from 2-6 day of cycle for 5 days. The follicular growth and maturation were observed on days 10, 12, and 14 of the cycle with transvaginal ultrasound. Ovulation was confirmed by measuring serum progesterone level on day 21 of the cycle. Patients were followed for 3 cycles.The mean number of mature follicles in Group A was 1.63+0.49 and 1.3+0.47 in Group B (p-value=0.01). The analysis of either of the groups' ovulation statuses revealed that in 70% of patients (n=21) in Group A and 36.67% (n=11) in Group B, ovulation was initiated (p value= 0.01). We concluded that the outcome of combined coenzymeQ10A and clomiphene citrate is significantly better for patients with polycystic ovarian syndrome; inducing ovulation is more effective with clomiphene citrate alone.

Efficacy of Letrozole vs Clomiphene Citrate for induction of ovulation in women with polycystic ovarian syndrome.

To compare the efficacy of letrozole vs Clomiphene citrate for ovulation induction in PCOS women. This double blind randomized controlled trial was conducted at Services Hospital, Lahore, from January 2016 to December 2020. Total 220 patients, diagnosed with PCOS according to Rotterdam criteria were randomly assigned into two groups after taking informed consent. The women were followed for ovulation, pregnancy and live birth rates in the next five consecutive menstrual cycles with either clomiphene citrate or letrozole. Letrozole had significantly better pregnancy rate (29.0% vs 15.4% p-value 0.015), monofollicular development (77.2% vs 52.7% p-value 0.000) and live birth rate (25.4% vs 10.9% p-value 0.005) as compared to clomiphene citrate. There was no difference between the two groups in ovulation rate (68.1% vs 63.6%, p-value 0.477), early pregnancy loss (3.6% vs 4.5% p-value 0.734), and twin pregnancy (0.0% vs 1.81% p-value 0.155). There was no ectopic pregnancy and no congenital anomalies in both groups. Hot flushes were higher in clomiphene group (31.8% vs 12.7% p-value 0.001) while fatigue (30.9% vs 8.1% p-value 0.000) and dizziness (21.8% vs 10.0% p-value 0.029) was higher with letrozole but these were well tolerated. Letrozole is better treatment choice than clomiphene citrate in PCOS women with infertility in terms of pregnancy and live birth rate.ClinicalTrials.gov Identifier: NCT05702957.

Retraction Note: Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome.

Retraction Note: Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome.

Clomiphene Supported Ovulation Induction in Subfertile Polycystic Ovary Syndrome Women: Role of Different Insulin Sensitizers

Objective: To compare Clomiphene Citrate, ovulation induction efficacy following using insulin sensitises, Metformin versus Myo-inositol in subfertile women with polycystic ovary syndrome.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Jun to Nov 2021.
 Methodology: A total of 316 patients with polycystic ovary syndrome and infertility who were included in the study. Group-A was administered Metformin, whereas Group-B as given Myo-inositol. Both groups were given clomiphene citrate for ovulation induction and were followed for six months.
 Results: There were 316 patients (158 in each Group). The mean age was 29.2±0.5 years, and the BMI of 23.2±1.7 Kg/m2 in both. Ovulation recorded in Group-A (Metformin) was 141(44.6%) versus Group-B (Myo-inositol), 103(32.6%). The pregnancy test was positive 33(21.1%) patients of Group-A versus 29(18.4%) of Group-B. The common complaints seen in both groups were nausea and vomiting 2(0.6%), while headache 1(0.3%) and dizziness 2(0.6%) occurred only in Group-B.
 Conclusion: Clomiphene citrate with Metformin, as first-line therapy for sub-fertile women with polycystic ovary syndrome, improved ovulation and had fewer side effects than Myo-inositol.

Treatment of ovarian cyst after clomiphene citrate ovulationinduction

Infertility is a commen problem around the world . About one in six of all couples have some problem in getting pregnant and that includes some trying for a second or subsequent baby!) . The most common causes of it is ovulation defects and the famous treatment of this cause is by ovulation induction drugs especially clomiphene citrate which used for long period , but this treatment is not without side effects and one of the side effects is ovarian cyst . The aim of this study is to assess the effect of oral contraceptive pills , provera tablets (medroxyprogesterone acetate tablets) and expectant management in the resolution of ovarian cysts induced by clomiphene citrate ovulation induction Study design : a prospective randomized study Setting: patients complained of ovarian cyst more than 2.5 mm were diagnosed by ultrasound
 after clomiphene citrate ovulation induction and randomized into 3 groups . Group ( !) received oral contraception , group ( 2) received oral progesterone tablets treatment and group ( 3) had expectant management. Follow up of patients were done monthly by ultrasound
 and resolution of cyst was observed as a main out come measure .

Therapeutic impact of letrozole and clomiphene citrate for ovulation induction in Iraqi female patients with polycystic ovary syndrome

Therapeutic impact of letrozole and clomiphene citrate for ovulation induction in Iraqi female patients with polycystic ovary syndrome

A Comparative Study of Letrozole Versus Clomiphene Citrate in Ovulation Induction in Patients with the Polycystic Ovarian Syndrome

A Comparative Study of Letrozole Versus Clomiphene Citrate in Ovulation Induction in Patients with the Polycystic Ovarian Syndrome

Emulating a target trial of the comparative effectiveness of clomiphene citrate and letrozole for ovulation induction.

What are the comparative pregnancy outcomes in women who receive up to six consecutive cycles of ovulation induction with letrozole versus clomiphene citrate? The risks of pregnancy, livebirth, multiple gestation, preterm birth, neonatal intensive care unit (NICU) admission and congenital malformations were higher for letrozole compared with clomiphene in participants with polycystic ovarian syndrome (PCOS), though no treatment differences were observed in those with unexplained infertility. Randomized trials have reported higher pregnancy and livebirth rates for letrozole versus clomiphene among individuals with PCOS, but no differences among those with unexplained infertility. None of these trials were designed to study maternal or neonatal complications. We emulated a hypothetical trial of the comparative effectiveness of letrozole versus clomiphene citrate for ovulation induction among all women, then stratified by PCOS and unexplained infertility status. We used real-world data from a large healthcare claims database in the USA (2011-2015). We analyzed data from 18 120 women who initiated letrozole and 49 647 women who initiated clomiphene during 2011-2014, and who were aged 18-45 years with no history of diabetes, thyroid disease, liver disease or breast cancer and had no fertility treatments for 3 months before trial initiation. The treatment strategies were clomiphene citrate or letrozole for six consecutive cycles. The outcomes were pregnancy, livebirth, multiple gestation, preterm birth, small for gestational age (SGA), NICU admission and major congenital malformations. We estimated the probability of each outcome under each strategy via pooled logistic regression and used standardization to adjust for confounding and selection bias due to loss to follow-up. The estimated probabilities of pregnancy, livebirth and neonatal outcomes were similar under each strategy, both overall and among individuals with unexplained infertility. Among women with PCOS, the probability of pregnancy was 43% for letrozole vs 37% for clomiphene (risk difference [RD] = 6.0%; 95% CI: 4.4, 7.7) in the intention-to-treat analyses. The corresponding probability of livebirth was 32% vs 29% (RD = 3.1%; 95% CI: 1.5, 4.8). In per protocol analyses, the risk of multiple gestation was 19% vs 9%, the risk of preterm birth was 20% vs 15%, the risk of SGA was 5% vs 3%, the risk of NICU admission was 22% vs 16% and the risk of congenital malformation was 8% vs 2% among those with a livebirth. We cannot completely rule out the possibility of residual confounding by body mass index or duration of infertility. However, we adjusted for proxies identified in administrative data and results did not change. Our findings suggest that for women with unexplained infertility, the two treatments result in comparable probabilities of a livebirth. For women with PCOS, letrozole appears slightly more effective for attaining a livebirth. Neonatal outcomes were similar for the two treatments among women with unexplained infertility; we did not confirm the hypothesized higher risk of adverse neonatal outcomes for clomiphene versus letrozole. The risks of adverse neonatal outcomes were slightly greater among women with PCOS who were treated with letrozole versus clomiphene. It is likely that these effects are partially mediated through an increased risk of multiple gestation among women who received letrozole. This work was supported by the National Institute of Child Health and Human Development (R01HD088393). Y.-H.C. reports grants from the American Heart Association (834106) and NIH (R01HD097778). P.R. reports grants from the National Institutes of Health. J.H. reports grants from the National Institutes of Health, the Agency for Healthcare Research and Quality, and the California Health Care Foundation during the conduct of the study; and consulting for several health care delivery organizations including Cambridge Health Alliance, Columbia University, University of Southern California, Community Servings, and the Delta Health Alliance. S.H.-D. reports grants from the National Institutes of Health and the US Food and Drug Administration during the conduct of the study; grants to her institution from Takeda outside the submitted work; consulting for UCB (biopharmaceutical company) and Roche; and being an adviser for the Antipsychotics Pregnancy Registry and epidemiologist for the North American Antiepileptics Pregnancy Registry, both at Massachusetts General Hospital. M.A.H. reports grants from the National Institutes of Health and the U.S. Veterans Administration during the conduct of the study; being a consultant for Cytel; and being an adviser for ProPublica. N/A.

Sildenafil citrate as an adjuvant to clomiphene citrate for ovulation induction in polycystic ovary syndrome: crossover randomized controlled trial.

IntroductionTo evaluate sildenafil citrate as an adjuvant to clomiphene citrate (CC) for ovulation induction (OI) in women with polycystic ovary syndrome (PCOS).Material and methodsA total of 595 infertile PCOS women were randomly assigned into either clomiphene/sildenafil (C/S) group or CC group. Transvaginal (TVS)-Doppler studies were done for participants when the dominant follicle reach 16 mm, to measure the resistance index, pulsatility index, and maximum velocity of sub-endometrial, uterine, and ovarian vessels. Participants were examined using TVS on the 21st day of the cycle to detect ovulation or, after a positive pregnancy test, for documentation of pregnancy. Participants with negative pregnancy tests were given 2 months’ rest without OI, followed by crossover of OI medication between the 2 studied groups. The crossover results were assessed by TVS, TVS-Doppler, and pregnancy test.ResultsThe endometrial thickness was significantly higher among the C/S than the CC group during the first 3 months (9.6 ±1.2 vs. 8.7 ±1.0 mm, respectively, p = 0.003) and after crossover of OI (9.1 ±1.3 vs. 8.2 ±1.0 mm, respectively, p = 0.007).The chemical and clinical pregnancy rates were significantly higher among the C/S compared to the CC group (39.8% and 36.6% vs. 25% and 18.98%, respectively) (p = 0.01 and 0.001, respectively) during the first 3 months and after crossover of OI (36.6% and 33.1% vs. 23.8% and 20.6%, respectively) (p = 0.02 and 0.01, respectively).ConclusionsSC as an adjuvant to CC for OI in PCOS women increases the chemical and clinical pregnancy rates. It also improves the endometrial thickness and ovulation rate through improved endometrial and ovarian Doppler indices.

The efficiency of low-dose letrozole plus clomiphene citrate for ovulation induction in intrauterine insemination cycles: Arandomized clinical trial.

To investigate if combination therapy with clomiphene citrate (CC) plus letrozole (L) was associated with a higher efficacy than L and CC alone in patients undergoing ovarian induction plus intrauterine insemination. The present multicenter randomized controlled clinical trial was performed between 2018 and 2020. Participants were randomized into three groups: L (n=167; 5mg/day), CC (n=167; 100mg/day), and L+CC (n=167) (2.5mg/day+50mg/day) from day 3. Ovarian stimulation was continued with the appropriate dose of gonadotropins daily starting from day 8 and continued until follicular size was 20mm or more followed by administration of human chorionic gonadotropin (10000IU). Semen samples were prepared by direct swim-up technique. In the CC group, gonadotropin dose was significantly higher but endometrial thickness was significantly lower compared with other groups. Number of follicles of 18mm or more was significantly lower in the L group compared with the other two groups. Number of follicles less than 15mm was meaningfully higher in the CC group compared with the other groups. In the L+CC group, total and largest follicular size, and the rates of chemical, clinical, and ongoing pregnancy, and live birth were significantly higher compared with other groups. Combination therapy with L+CC was superior to either L or CC for achieving pregnancy in women undergoing ovarian induction plus intrauterine insemination.

Editorial Expression of Concern: The efficacy of vitamin D combined with clomiphene citrate in ovulation induction in overweight women with polycystic ovary syndrome: a double blind, randomized clinical trial.

Editorial Expression of Concern: The efficacy of vitamin D combined with clomiphene citrate in ovulation induction in overweight women with polycystic ovary syndrome: a double blind, randomized clinical trial.

Efficacy and Side Effects of Letrozole Over Clomiphene citrate for Ovulation Induction of the Patients with PCOS: A Randomized Controlled Trial

Clomiphene citrate (CC) has been the drug of choice for the treatment of anovulatory subfertility in women with polycystic ovarian syndrome (PCOS) for a long time. Despite high ovulation rate of CC, its pregnancy rate is low. Letrozole, an aromatase inhibitor has been considered as an alternative of CC but its effectiveness is yet controversial. Our aim was to compare the efficacy and side effects of Letrozole over CC. This randomized control clinical trial was conducted in Diabetic Association Medical College and Hospital, Faridpur, Bangladesh from January 2018 to December 2019. A total of 160 women diagnosed as PCOS by Rotterdam criteria seeking treatment of subfertility were included in the study. Participants were randomly divided into two groups. Group A got Letrozole and Group B got CC as treatment. Transvaginal ultrasonogram (TVS) was performed on 12 to 13th day of the cycle to see the details of the follicles and the endometrium. The demographic information of the participants and the side effects of the drugs were recorded. Successful pregnancies were followed up for 12 weeks. Ovulation rate was almost similar among the participants of both of the groups. But monofo licular development and pregnancy rate were significantly higher among the Letrozole group (p = 0.004 and p = 0.008 respectively). Multifo licular development, multiple pregnancy, and abortion rate were significantly higher in the CC group. Patients who took Letrozole had significantly higher endometrial thickness than CC group. Both of the groups reported relatively similar incidence of side effects. Due to the higher pregnancy rate and lower incidence of abortion or multiple pregnancy, Letrozole can be an effective alternative to CC for the treatment of anovulatory subfertility of the PCOS patients.
 Faridpur Med. Coll. J. 2020;15(2): 69-73

Ovulation induction with clomiphene citrate or letrozole following laparoscopy in infertile women with minimal to mild endometriosis: a prospective randomised controlled trial

We conducted a prospective randomised controlled trial to explore the efficacy of clomiphene citrate (CC) and Letrozole (LTZ) for improving fecundity in infertile women with minimal to mild endometriosis after operative laparoscopy. We found that the ovulation rate of LTZ (88.7%) and CC (84.5%) were significantly higher than that of Control (70.5%) (p < .001). However, there was no significant difference in cumulative clinical pregnancy rates at 3, 6, 12 months after laparoscopy among the three groups (LTZ: 30%, 34.3%, 38.6% vs CC: 28.6%, 42.9%, 50.0% vs Control: 18.6%, 24.3%, 31.4%, respectively). No significant difference was observed in live-birth rate among the three groups (p = 1.125). For infertile women with minimal to mild endometriosis, ovulation induction with letrozole or clomiphene citrate after laparoscopy significantly increases ovulation rate, which are comparable between them; but does not demonstrate a significant advantage on improving pregnancy rate and live-birth rate when compared to laparoscopy alone. Impact statement What is already known on this subject? Endometriosis significantly decreases fecundity of women. Operative laparoscopy was recommended as an effective option to increase spontaneous pregnancy rate in infertile women with minimal to mild endometriosis. However, there is still no optimum treatment strategy for improving fertility of women with endometriosis. What do the results of this study add? For infertile women with minimal to mild endometriosis, ovulation induction with letrozole or clomiphene citrate after laparoscopy significantly increases ovulation rate, which are comparable between them; but does not demonstrate a significant advantage on improving pregnancy rate and live-birth rate when compared to laparoscopy alone. What are the implications of these findings for clinical practice and/or further research? Our results suggest that operative laparoscopy in conjunction with ovulation induction may improve fertility of women with minimal to mild endometriosis. Further research could focus on prolonging cycles of ovulation induction or choosing alternative ovarian stimulation protocols. More RCTs are still needed to compare the efficacy of letrozole with CC in ovulation induction.

Comparison of Tamoxifen and Clomiphene Citrate for Ovulation Induction in Women with Polycystic Ovarian Syndrome: A Prospective Study.

Background:The purpose of this study was to compare the efficacy of tamoxifen and clomiphene citrate in induction of ovulation in women with PCOS and anovulation.Methods:In this prospective cohort study, 104 women with PCOS and primary infertility were enrolled after fulfilling the inclusion and exclusion criteria. The patients were allocated in two groups; group A (n=54) received tamoxifen 40 mg once daily (Days 3–7) and group B (n=50) received clomiphene citrate 100 mg once daily (Days 3–7). Serial ultrasounds were done till the administration of human chorionic gonadotropin (hCG). The ovulation and pregnancy rates in both groups were compared. The number of dominant follicles, estradiol levels, and endometrial thickness were also studied. Comparison was done using chi-square and student’s t-test and a p-value of less than 0.05 was considered statistically significant.Results:The number of dominant follicles and serum estradiol levels were significantly higher in group B (p<0.05), whereas the endometrial thickness was significantly more in group A (p<0.05). The ovulation rates were similar in both groups (66.6% vs. 70%, p=0.715). Pregnancy rate per treatment cycle and per ovulatory cycle was marginally higher in group A (14.81% and 22.22%, respectively), as compared to group B (14% and 20%, respectively), but the difference was not statistically significant (p>0.05).Conclusion:Tamoxifen and clomiphene citrate are both equally effective in induction of ovulation and achieving a pregnancy in women with PCOS.

The Efficacy of phytoestrogens with Clomiphene Citrate for Ovulation Induction in Women with Polycystic Ovary Syndrome

The Efficacy of phytoestrogens with Clomiphene Citrate for Ovulation Induction in Women with Polycystic Ovary Syndrome

Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: A randomized controlled trial.

To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women with polycystic ovarian syndrome (PCOS). In this assessor blind, randomized controlled trial, 90 infertile women with PCOS were randomized to receive either letrozole or CC for ovulation induction in incremental doses for a maximum of three cycles. Main outcome measures studied were endometrial thickness, ovulation rate, pregnancy rate, rate of monofollicular development, and time to conception. Mean endometrial thicknesses were 9.86±2.32mm and 9.39±2.06mm with letrozole and CC, respectively (P=0.751). Cumulative ovulation rates were 86.7% and 85.2% with letrozole and CC, respectively (P=0.751). Pregnancy was achieved in 42.2% of women in the letrozole group and 20.0% of women in the CC group (P=0.04). Monofollicular development was seen in 68.4% of ovulatory cycles in the letrozole group compared with 44.8% in the CC group (P=0.000). Mean time to achieve pregnancy was significantly shorter (log rank P=0.042) with letrozole (9.65weeks) than with CC (11.07weeks). Letrozole is a better alternative for ovulation induction in anovulatory women with PCOS as pregnancy rates are higher, time to pregnancy is shorter, and chances of multiple pregnancy are less because of high monofollicular growth.

The efficacy of vitamin D combined with clomiphene citrate in ovulation induction in overweight women with polycystic ovary syndrome: a double blind, randomized clinical trial.

The aim of this study was to assess the effect of vitamin D supplementation on ovulation rate in overweight subfertile women with PCOS undergoing ovulation induction. This was a single center, parallel-groups, double-blind, and placebo-controlled randomized trial involving 186 eligible women undergoing induction of ovulation with clomiphene citrate (Clomid®, Aventis) 50 mg tablet twice daily starting from the third day of menstrual cycle and for 5 days combined with either oral Vitamin D (ossofortin®, EVA PHARMA) 10,000 IU twice weekly and calcium (calciprex®, Marcyrl Pharmaceutical Industries) 1250 mg twice daily or to receive a placebo with calcium for three successive induction cycles. The vitamin D or placebo supplementation started 1 month before induction cycles (total four cycles). Cycles were monitored with ultrasound follicle tracking and mid-luteal serum progesterone measurement. The primary outcome was the ovulation rate after three induction cycles. The study was performed during the period between January 2018 and September 2018, Eighty six (92.5%) women in the treatment group and 73 (78.5%) in the control group had successful ovulation (p = 0.007). The absolute and relative risk reduction was 14% and 65% respectively. Biochemical and clinical pregnancy occurred in 61.3 and 50.5% in the treatment group, and in 49.5 and 39.8% in the control group (p = 0.105 and 0.141 respectively). In subfertile women with PCOS undergoing induction of ovulation, vitamin D supplementation significantly improved the ovulation rate; however, there was no effect on clinical or biochemical pregnancy.

Levothyroxine with Clomiphene Citrate for Ovulation Induction in Patients with Polycystic Ovary Syndrome and Subclinical Hypothyroidism

Levothyroxine with Clomiphene Citrate for Ovulation Induction in Patients with Polycystic Ovary Syndrome and Subclinical Hypothyroidism