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[PMID]:29215516
[Au] Autor:Jones T; Ho JR; Gualtieri M; Bruno-Gaston J; Chung K; Paulson RJ; Bendikson KA
[Ad] Endereço:Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
[Ti] Título:Clomiphene Stair-Step Protocol for Women With Polycystic Ovary Syndrome.
[So] Source:Obstet Gynecol;131(1):91-95, 2018 Jan.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare time to ovulation, ovulation rates, and side effect profile of traditional and the stair-step protocol for ovulation induction using clomiphene citrate in women with polycystic ovary syndrome (PCOS). METHODS: We performed a retrospective study of women seeking care for infertility with a diagnosis of PCOS at a university-based infertility clinic from July 2012 to July 2014. We included patients who were resistant to the initial starting dose of 50 mg clomiphene. The primary outcome was time to ovulation. Secondary outcomes included ovulation rates, clinical pregnancy rates, and mild and moderate-to-severe side effects based on dose. For the traditional protocol, higher doses of clomiphene were used each subsequent month if no ovulation occurred. For the stair-step protocol, higher doses of clomiphene were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. Our study had 80% power to detect a 20% difference in ovulation. RESULTS: One hundred nine patients were included in the analysis with 66 (60.6%) in the traditional and 43 (39.4%) in the stair-step protocol. Age and body mass index were similar between groups. The time to ovulation was decreased in the stair-step protocol group compared with the traditional protocol group (23.1±0.9 days vs 47.5±6.3 days). Ovulation rates were increased in the stair-step group compared with the traditional group at 150 mg (16 [37%] vs 8 [12%], P=.004) and at 200 mg (9 [21%] vs 3 [5%], P=.01). Pregnancy rates were similar between groups once ovulation was achieved (12 [18.1%] vs 7 [16.3%], P=.08). The stair-step protocol had an increased incidence of mild side effects (vasomotor flushes, headaches, gastrointestinal disturbance, mastalgia, changes in mood; 18 [41%] vs 8 [12%]), but there was no difference in the incidence of severe side effects (headaches, visual disturbances). CONCLUSION: For women with PCOS, the stair-step clomiphene protocol is associated with decreased time to ovulation and increased ovulation rates at higher doses when compared with the traditional protocol.
[Mh] Termos MeSH primário: Clomifeno/administração & dosagem
Fármacos para a Fertilidade/administração & dosagem
Indução da Ovulação/métodos
Síndrome do Ovário Policístico/tratamento farmacológico
Taxa de Gravidez
[Mh] Termos MeSH secundário: Adulto
Análise de Variância
Clomifeno/efeitos adversos
Estudos de Coortes
Relação Dose-Resposta a Droga
Esquema de Medicação
Feminino
Fármacos para a Fertilidade/efeitos adversos
Seguimentos
Hospitais Universitários
Seres Humanos
Ovulação/efeitos dos fármacos
Síndrome do Ovário Policístico/diagnóstico por imagem
Gravidez
Estudos Retrospectivos
Medição de Risco
Estatísticas não Paramétricas
Fatores de Tempo
Resultado do Tratamento
Ultrassonografia Doppler/métodos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fertility Agents); 1HRS458QU2 (Clomiphene)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002418


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[PMID]:28965550
[Au] Autor:Haas J; Casper RF
[Ad] Endereço:Division of Reproductive Sciences, University of Toronto; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital; and TRIO Fertility, Toronto, Ontario, Canada.
[Ti] Título:In vitro fertilization treatments with the use of clomiphene citrate or letrozole.
[So] Source:Fertil Steril;108(4):568-571, 2017 Oct.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There has been increasing interest in combining the oral agents clomiphene citrate (CC) and letrozole with gonadotropins in IVF: for poor responders to reduce the amount of gonadotropins used, and in normal responders to reduce the incidence of ovarian hyperstimulation (OHSS). In normal responders, mild stimulation with the use of CC and gonadotropins was found to decrease the number of oocytes retrieved and result in good pregnancy rates, but in most studies the cumulative pregnancy rate was lower compared with conventional ovarian stimulation when frozen embryo transfers were considered. Coadministration of letrozole and gonadotropins has mainly been used in patients with breast cancer to prevent the massive elevation of serum E concentrations with the use of standard controlled ovarian hyperstimulation. CC and letrozole have both been used with gonadotropins in poor responders and have been shown to reduce the amount of gonadotropin used without reducing the pregnancy rate. Letrozole use with gonadotropins in IVF cycles may increase endometrial receptivity by increasing integrin expression in the endometrium and by lowering estrogen concentrations to more physiologic levels.
[Mh] Termos MeSH primário: Clomifeno/administração & dosagem
Fármacos para a Fertilidade Feminina/administração & dosagem
Fertilização In Vitro/métodos
Infertilidade Feminina/terapia
Nitrilos/administração & dosagem
Triazóis/administração & dosagem
[Mh] Termos MeSH secundário: Clomifeno/efeitos adversos
Quimioterapia Combinada/métodos
Feminino
Fármacos para a Fertilidade Feminina/efeitos adversos
Fertilização In Vitro/efeitos adversos
Gonadotropinas/administração & dosagem
Seres Humanos
Nitrilos/efeitos adversos
Síndrome de Hiperestimulação Ovariana/etiologia
Síndrome de Hiperestimulação Ovariana/prevenção & controle
Indução da Ovulação/métodos
Gravidez
Triazóis/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fertility Agents, Female); 0 (Gonadotropins); 0 (Nitriles); 0 (Triazoles); 1HRS458QU2 (Clomiphene); 7LKK855W8I (letrozole)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE


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[PMID]:28886024
[Au] Autor:Pelusi C; Giagulli VA; Baccini M; Fanelli F; Mezzullo M; Fazzini A; Bianchi N; Carbone MD; De Pergola G; Mastroroberto M; Morselli Labate AM; Pasquali R
[Ad] Endereço:Division of Endocrinology and Center for Applied Biomedical Research, Department of Medical & Surgical Sciences, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
[Ti] Título:Clomiphene citrate effect in obese men with low serum testosterone treated with metformin due to dysmetabolic disorders: A randomized, double-blind, placebo-controlled study.
[So] Source:PLoS One;12(9):e0183369, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CONTEXT: Low testosterone (T) levels are often found in obese men with impaired glucose tolerance (IGT) and overt type 2 diabetes (T2DM); however, the mechanisms underlying this condition and its correct therapy are still under debate. OBJECTIVE: To evaluate the effectiveness of clomiphene citrate (CC) in increasing endogenous T levels in obese men with low serum T and with IGT or T2DM treated with metformin (MET). DESIGN: Cross-over, randomized, double-blind, placebo-controlled study. METHODS: 24 obese men, aged 47.3 ±. 6.3 (range 35-55 years), with low T level (≤3 ng/mL) and naïve diagnosis of IGT or T2DM were included. Subjects were randomized to CC 25 mg/day or placebo (Plac) with MET 2 g/day for 3 months. After a 6-week wash-out period, subjects were moved to the alternative arm for additional 3 months. Clinical evaluation and blood exams performed prior to and at the end of treatment. RESULTS: Of 24 randomized, 21 were evaluable, classified as IGT (n = 11) or T2DM (n = 10). Compared to baseline levels, T levels increased significantly after 3 months of CC treatment (3.03±0.80 to 5.99±1.67 ng/mL P<0.001) but not after the Plac treatment (2.87±0.78 to 3.09±0.84 ng/mL P<0.001 between the treatments). T changes were similar in IGT and T2DM subjects. Gonadotropins as well raised significantly after CC treatment (LH 3.83±1.45 to 8.53±6.40 mU/mL; FSH 4.84±1.67 to 10.15±5.08 mU/mL P<0.001 respectively), whereas no changes for LH (3.51±1.59 to 3.63±1.39 mU/mL) but a smooth increased for FSH (4.61±2.49 to 5.39±2.65 mU/mL; P = 0.004) were shown after Plac treatment (LH P = 0.001 and FSH P = 0.002 between treatments). Furthermore, fasting glucose (106.8±23.2 to 101.1±25.7 mg/dL; P = 0.004), insulin (19.3±12.1 to 15.6±10.1 µU/mL; P = 0.010) and HOMA-IR (4.94±2.89 to 3.69±2.12; P = 0.001) decreased significantly during the CC treatment period, whereas no significant changes were observed in any of these parameters in the Plac treatment. CONCLUSIONS: A low dose of CC therapy was able to significantly increase serum T levels in all participants with mild modifications of clinical and metabolic parameters. TRIAL REGISTRATION: EudraCT 2011-000439-10.
[Mh] Termos MeSH primário: Clomifeno/uso terapêutico
Hipoglicemiantes/uso terapêutico
Metformina/uso terapêutico
Obesidade/sangue
Obesidade/tratamento farmacológico
Moduladores Seletivos de Receptor Estrogênico/uso terapêutico
Testosterona/sangue
[Mh] Termos MeSH secundário: Adulto
Biomarcadores
Pesos e Medidas Corporais
Clomifeno/administração & dosagem
Clomifeno/efeitos adversos
Metabolismo Energético/efeitos dos fármacos
Hormônios/sangue
Seres Humanos
Hipoglicemiantes/administração & dosagem
Hipoglicemiantes/efeitos adversos
Masculino
Metformina/administração & dosagem
Metformina/efeitos adversos
Meia-Idade
Obesidade/diagnóstico
Moduladores Seletivos de Receptor Estrogênico/administração & dosagem
Moduladores Seletivos de Receptor Estrogênico/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Biomarkers); 0 (Hormones); 0 (Hypoglycemic Agents); 0 (Selective Estrogen Receptor Modulators); 1HRS458QU2 (Clomiphene); 3XMK78S47O (Testosterone); 9100L32L2N (Metformin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0183369


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[PMID]:28845935
[Au] Autor:Bozhedomov VA; Lipatova NA; Bozhedomova GE; Rokhlikov IM; Shcherbakova EV; Komarina RA
[Ad] Endereço:Polyclinic 3 of the ADP of the RF, 2N.A. Semashko Railroad Hospital, 3I.M. Sechenov First MSMU, 4City Polyclinic 68, Moscow Health Department, Moscow, Russia.
[Ti] Título:[Using L- and acetyl-L-carnintines in combination with clomiphene citrate and antioxidant complex for treating idiopathic male infertility: a prospective randomized trial].
[So] Source:Urologiia;(3):22-32, 2017 Jul.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:The most common cause of male infertility is idiopathic oligo-, and or astheno-, and /or teratozoospermia. In such cases, anti-estrogens, antioxidants (vitamins and trace elements) or carnitines are used, but the evidence on their effectiveness is inconsistent; there are currently no published studies exploring their concurrent use. AIM: To investigate the efficacy and safety of the L- and acetyl-L-carnitine complex, vitamins A, E, C, selenium, zinc and other antioxidants ("SpermActin" + "More than vitamins") in combination with clomiphene citrate (CC) in managing male idiopathic infertility in the form of oligo, and/or astheno-, and/or teratozoospermia. MATERIALS AND METHODS: The study comprised 173 men from infertile couples aged 25-45 years who were divided into two groups - the study group (n=88) and control group (n=85). All the patients were examined according to the WHO recommendations. Patients of the study group received L-carnitine fumarate (1 g), acetyl-L-carnitine (0.5 g) twice daily, a complex of vitamins and microelements and CC 25 mg twice daily orally. Patients of the control group were administered the same dosages of CC and a complex of vitamins. Ejaculate was evaluated before and after 3-4 months of treatment. Six months after the start of treatment, information about the onset or absence of pregnancy over the last six months was collected via telephone or online survey. RESULTS: Co-administration of L- and acetyl-L-carnitines concurrently with CC and antioxidant complex (vitamins and minerals) in patients with idiopathic oligo- and/or asteno- and/or teratozoospermia provides some additional positive effect on the concentration of spermatozoa, more pronounced in patients with multiple impaired semen parameters - oligoasthenoteratozoospermia, but does not improve the morphology, progressive sperm motility and pregnancy rates compared to patients receiving basic treatment.
[Mh] Termos MeSH primário: Acetilcarnitina/uso terapêutico
Antioxidantes/uso terapêutico
Astenozoospermia/tratamento farmacológico
Clomifeno/uso terapêutico
Oligospermia/tratamento farmacológico
Teratozoospermia/tratamento farmacológico
[Mh] Termos MeSH secundário: Acetilcarnitina/administração & dosagem
Acetilcarnitina/farmacologia
Adulto
Antioxidantes/administração & dosagem
Antioxidantes/farmacologia
Clomifeno/administração & dosagem
Clomifeno/farmacologia
Quimioterapia Combinada
Seres Humanos
Masculino
Meia-Idade
Minerais/administração & dosagem
Minerais/farmacologia
Minerais/uso terapêutico
Selênio/administração & dosagem
Selênio/farmacologia
Selênio/uso terapêutico
Sêmen/efeitos dos fármacos
Motilidade Espermática/efeitos dos fármacos
Espermatozoides/efeitos dos fármacos
Vitaminas/administração & dosagem
Vitaminas/farmacologia
Vitaminas/uso terapêutico
Zinco/administração & dosagem
Zinco/farmacologia
Zinco/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antioxidants); 0 (Minerals); 0 (Vitamins); 1HRS458QU2 (Clomiphene); 6DH1W9VH8Q (Acetylcarnitine); H6241UJ22B (Selenium); J41CSQ7QDS (Zinc)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE


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[PMID]:28796038
[Au] Autor:Jiang S; Kuang Y
[Ad] Endereço:Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
[Ti] Título:Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization.
[So] Source:Medicine (Baltimore);96(32):e7540, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to explore the effect of clomiphene citrate (CC) on the cycle characteristics and outcomes of obese women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization (IVF).This is a retrospective cohort study, and it was conducted at the tertiary-care academic medical center.This study included 174 obese PCOS patients undergoing IVF.In the study group (n = 90), CC and human menopausal gonadotropin (HMG) were administered simultaneously beginning on cycle day 3, while in control group (n = 84) HMG was used only. Both of the 2 groups used medroxyprogesterone acetate (MPA) for preventing premature luteinizing hormone (LH) surges. Ovulation was cotriggered by a GnRH agonist and hCG when dominant follicles matured.The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the number of top-quality embryos, maturation rate, fertilization rate, cleavage rate, incidence of premature LH surge, and OHSS.The study group received obviously lower total HMG dose [1650 (975-4800) vs 2025 (1350-3300) IU, P = 2.038E-4] but similar HMG duration. While the antral follicle count (AFC) is higher in study group, the number of oocytes retrieved and top-quality embryos are remarkably less [5 (0-30) vs 13 (0-42), P = 6.333E-5; 2 (0-14) vs 3.5 (0-15), P = .003; respectively]. The mature oocyte rate is higher in study group (P = .036). No significant differences were detected in fertilization rate and cleavage rate between 2 groups.CC has a positive influence on cycle characteristics, but might be correlated with the impaired IVF outcomes (less oocytes retrieved and top quality embryos, lower oocyte retrieval rate) in obese PCOS patients undergoing IVF, when HMG and MPA are used simultaneously.
[Mh] Termos MeSH primário: Clomifeno/uso terapêutico
Fármacos para a Fertilidade Feminina/uso terapêutico
Infertilidade Feminina/complicações
Infertilidade Feminina/tratamento farmacológico
Obesidade/complicações
Síndrome do Ovário Policístico/complicações
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Feminino
Fertilização In Vitro/métodos
Seres Humanos
Acetato de Medroxiprogesterona/administração & dosagem
Menotropinas/administração & dosagem
Oócitos/efeitos dos fármacos
Indução da Ovulação/métodos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Fertility Agents, Female); 1HRS458QU2 (Clomiphene); 61489-71-2 (Menotropins); C2QI4IOI2G (Medroxyprogesterone Acetate)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170827
[Lr] Data última revisão:
170827
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007540


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[PMID]:28655015
[Au] Autor:Wu XK; Stener-Victorin E; Kuang HY; Ma HL; Gao JS; Xie LZ; Hou LH; Hu ZX; Shao XG; Ge J; Zhang JF; Xue HY; Xu XF; Liang RN; Ma HX; Yang HW; Li WL; Huang DM; Sun Y; Hao CF; Du SM; Yang ZW; Wang X; Yan Y; Chen XH; Fu P; Ding CF; Gao YQ; Zhou ZM; Wang CC; Wu TX; Liu JP; Ng EHY; Legro RS; Zhang H; PCOSAct Study Group
[Ad] Endereço:Committee of Reproductive Medicine, World Federation of Chinese Medicine Societies, Beijing, China2Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China.
[Ti] Título:Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial.
[So] Source:JAMA;317(24):2502-2514, 2017 06 27.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome, without supporting clinical evidence. Objective: To assess whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with polycystic ovary syndrome. Design, Setting, and Participants: A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 21 sites (27 hospitals) in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups. Interventions: Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity. Main Outcomes and Measures: The primary outcome was live birth. Secondary outcomes included adverse events. Results: Among the 1000 randomized women (mean [SD] age, 27.9 [3.3] years; mean [SD] body mass index, 24.2 [4.3]), 250 were randomized to each group; a total of 926 women (92.6%) completed the trial. Live births occurred in 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group, 66 of 236 (28.0%) in the control acupuncture plus clomiphene group, 31 of 223 (13.9%) in the active acupuncture plus placebo group, and 39 of 232 (16.8%) in the control acupuncture plus placebo group. There was no significant interaction between active acupuncture and clomiphene (P = .39), so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo (135 of 471 [28.7%] vs 70 of 455 [15.4%], respectively; difference, 13.3%; 95% CI, 8.0% to 18.5%) and not significantly different between women treated with active vs control acupuncture (100 of 458 [21.8%] vs 105 of 468 [22.4%], respectively; difference, -0.6%; 95% CI, -5.9% to 4.7%). Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture (diarrhea: 25 of 500 [5.0%] vs 8 of 500 [1.6%], respectively; difference, 3.4%; 95% CI, 1.2% to 5.6%; bruising: 37 of 500 [7.4%] vs 9 of 500 [1.8%], respectively; difference, 5.6%; 95% CI, 3.0% to 8.2%). Conclusions and Relevance: Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women. Trial Registration: clinicaltrials.gov Identifier: NCT01573858.
[Mh] Termos MeSH primário: Terapia por Acupuntura
Clomifeno/uso terapêutico
Fármacos para a Fertilidade Feminina/uso terapêutico
Infertilidade Feminina/terapia
Nascimento Vivo/epidemiologia
Síndrome do Ovário Policístico/terapia
[Mh] Termos MeSH secundário: Terapia por Acupuntura/efeitos adversos
Terapia por Acupuntura/estatística & dados numéricos
Adulto
Índice de Massa Corporal
Clomifeno/efeitos adversos
Terapia Combinada/métodos
Contusões/etiologia
Diarreia/etiologia
Método Duplo-Cego
Esquema de Medicação
Feminino
Fármacos para a Fertilidade Feminina/efeitos adversos
Seres Humanos
Infertilidade Feminina/tratamento farmacológico
Infertilidade Feminina/etiologia
Síndrome do Ovário Policístico/complicações
Síndrome do Ovário Policístico/tratamento farmacológico
Gravidez
Método Simples-Cego
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Fertility Agents, Female); 1HRS458QU2 (Clomiphene)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7217


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[PMID]:28397981
[Au] Autor:Helmy MEE; Maher MA; Elkhouly NI; Ramzy M
[Ad] Endereço:Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
[Ti] Título:A randomized trial of local endometrial injury during ovulation induction cycles.
[So] Source:Int J Gynaecol Obstet;138(1):47-52, 2017 Jul.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the effect of endometrial injury on pregnancy outcomes among infertile women taking clomifene citrate. METHODS: A prospective randomized trial was undertaken at an Egyptian hospital between January 26, 2015, and July 17, 2016. Eligible women (≥1 year primary/secondary/unexplained infertility, aged 20-35 years, day-2 follicle-stimulating hormone <12 IU/L, normal prolactin/thyroid function/uterine cavity, ≥1 patent tube, male partner with normal semen count and motility, 3 cycles of clomifene citrate without success) were randomly allocated (1:1) using computer-generated numbers into intervention (received endometrial injury on cycle day 15-24) or control groups (sham procedure). Women began ovulation induction on days 3-5 of the following cycle. Participants and investigators were not masked to group assignment. The primary outcomes were clinical pregnancy, spontaneous abortion, and multiple pregnancy rates. Women who completed follow-up were included in analyses. RESULTS: The intervention group included 52 women and the control group 53 women. The clinical pregnancy rate was significantly higher in the intervention group (37% [n=19]) than in the control group (13% [n=7]; P=0.006). No differences between the intervention and control groups were noted for spontaneous abortion rate (11% [2/19] vs 29% [2/7]; P=0.287) or multiple pregnancy rate (11% [2/19] vs 14% [1/7]; P=0.790). No adverse effects were reported. CONCLUSION: Endometrial injury before ovulation induction could improve chances of pregnancy and its outcomes. CLINICALTRIALS.GOV: NCT02345837.
[Mh] Termos MeSH primário: Clomifeno/uso terapêutico
Endométrio/lesões
Fármacos para a Fertilidade Feminina/uso terapêutico
Infertilidade Feminina/terapia
Indução da Ovulação/métodos
Resultado da Gravidez
[Mh] Termos MeSH secundário: Adulto
Endométrio/cirurgia
Feminino
Seres Humanos
Infertilidade Feminina/tratamento farmacológico
Infertilidade Feminina/fisiopatologia
Infertilidade Feminina/cirurgia
Fase Luteal/fisiologia
Ovulação/fisiologia
Gravidez
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Fertility Agents, Female); 1HRS458QU2 (Clomiphene)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12178


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[PMID]:28349511
[Au] Autor:Skalkidou A; Sergentanis TN; Gialamas SP; Georgakis MK; Psaltopoulou T; Trivella M; Siristatidis CS; Evangelou E; Petridou E
[Ad] Endereço:Department of Women's and Children's Health, Uppsala University, Kvinnokliniken, Akademiska Sjukhuset, Uppsala, Sweden, 75185.
[Ti] Título:Risk of endometrial cancer in women treated with ovary-stimulating drugs for subfertility.
[So] Source:Cochrane Database Syst Rev;3:CD010931, 2017 Mar 25.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Medical treatment for subfertility principally involves the use of ovary-stimulating agents, including selective oestrogen receptor modulators (SERMs), such as clomiphene citrate, gonadotropins, gonadotropin-releasing hormone (GnRH) agonists and antagonists, as well as human chorionic gonadotropin. Ovary-stimulating drugs may act directly or indirectly upon the endometrium (lining of the womb). Nulliparity and some causes of subfertility are recognized as risk factors for endometrial cancer. OBJECTIVES: To evaluate the association between the use of ovary-stimulating drugs for the treatment of subfertility and the risk of endometrial cancer. SEARCH METHODS: A search was performed in CENTRAL, MEDLINE (Ovid) and Embase (Ovid) databases up to July 2016, using a predefined search algorithm. A search in OpenGrey, ProQuest, ClinicalTrials.gov, ZETOC and reports of major conferences was also performed. We did not impose language and publication status restrictions. SELECTION CRITERIA: Cohort and case-control studies reporting on the association between endometrial cancer and exposure to ovary-stimulating drugs for subfertility in adult women were deemed eligible. DATA COLLECTION AND ANALYSIS: Study characteristics and findings were extracted by review authors independently working in pairs. Inconsistency between studies was quantified by estimating I . Random-effects (RE) models were used to calculate pooled effect estimates. Separate analyses were performed, comparing treated subfertile women versus general population and/or unexposed subfertile women, to address the superimposition of subfertility as an independent risk factor for endometrial cancer. MAIN RESULTS: Nineteen studies were eligible for inclusion (1,937,880 participants). Overall, the quality of evidence was very low, due to serious risk of bias and indirectness (non-randomised studies (NRS), which was reflected on the GRADE assessment.Six eligible studies, including subfertile women, without a general population control group, found that exposure to any ovary-stimulating drug was not associated with an increased risk of endometrial cancer (RR 0.96, 95% CI 0.67 to 1.37; 156,774 participants; very low quality evidence). Fifteen eligible studies, using a general population as the control group, found an increased risk after exposure to any ovary-stimulating drug (RR 1.75, 95% CI 1.18 to 2.61; 1,762,829 participants; very low quality evidence).Five eligible studies, confined to subfertile women (92,849 participants), reported on exposure to clomiphene citrate; the pooled studies indicated a positive association ( RR 1.32; 95% CI 1.01 to 1.71; 88,618 participants; very low quality evidence), although only at high dosage (RR 1.69, 95% CI 1.07 to 2.68; two studies; 12,073 participants) and at a high number of cycles (RR 1.69, 95% CI 1.16 to 2.47; three studies; 13,757 participants). Four studies found an increased risk of endometrial cancer in subfertile women who required clomiphene citrate compared to a general population control group (RR 1.87, 95% CI 1.00 to 3.48; four studies, 19,614 participants; very low quality evidence). These data do not tell us whether the association is due to the underlying conditions requiring clomiphene or the treatment itself.Using unexposed subfertile women as controls, exposure to gonadotropins was associated with an increased risk of endometrial cancer (RR 1.55, 95% CI 1.03 to 2.34; four studies; 17,769 participants; very low quality evidence). The respective analysis of two studies (1595 participants) versus the general population found no difference in risk (RR 2.12, 95% CI 0.79 to 5.64: very low quality evidence).Exposure to a combination of clomiphene citrate and gonadotropins, compared to unexposed subfertile women, produced no difference in risk of endometrial cancer (RR 1.18, 95% CI 0.57 to 2.44; two studies; 6345 participants; very low quality evidence). However, when compared to the general population, an increased risk was found , suggesting that the key factor might be subfertility, rather than treatment (RR 2.99, 95% CI 1.53 to 5.86; three studies; 7789 participants; very low quality evidence). AUTHORS' CONCLUSIONS: The synthesis of the currently available evidence does not allow us to draw robust conclusions, due to the very low quality of evidence. It seems that exposure to clomiphene citrate as an ovary-stimulating drug in subfertile women is associated with increased risk of endometrial cancer, especially at doses greater than 2000 mg and high (more than 7) number of cycles. This may largely be due to underlying risk factors in women who need treatment with clomiphene citrate, such as polycystic ovary syndrome, rather than exposure to the drug itself. The evidence regarding exposure to gonadotropins was inconclusive.
[Mh] Termos MeSH primário: Clomifeno/efeitos adversos
Neoplasias do Endométrio/induzido quimicamente
Fármacos para a Fertilidade Feminina/efeitos adversos
Gonadotropinas/efeitos adversos
Infertilidade Feminina/tratamento farmacológico
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Gonadotropina Coriônica/administração & dosagem
Gonadotropina Coriônica/efeitos adversos
Clomifeno/administração & dosagem
Quimioterapia Combinada/efeitos adversos
Neoplasias do Endométrio/epidemiologia
Feminino
Fármacos para a Fertilidade Feminina/administração & dosagem
Hormônio Liberador de Gonadotropina/administração & dosagem
Hormônio Liberador de Gonadotropina/efeitos adversos
Seres Humanos
Infertilidade Feminina/complicações
Indução da Ovulação
Estudos Retrospectivos
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Chorionic Gonadotropin); 0 (Fertility Agents, Female); 0 (Gonadotropins); 1HRS458QU2 (Clomiphene); 33515-09-2 (Gonadotropin-Releasing Hormone)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170720
[Lr] Data última revisão:
170720
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010931.pub2


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[PMID]:28260524
[Au] Autor:Venkatesh R; Gujral GS; Gurav P; Tibrewal S; Mathur U
[Ad] Endereço:Department of Retina and Vitreous, Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India. vramesh80@yahoo.com.
[Ti] Título:Clomiphene citrate-induced visual hallucinations: a case report.
[So] Source:J Med Case Rep;11(1):60, 2017 Mar 06.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Polycystic ovary syndrome is a common cause of chronic anovulation and infertility in otherwise healthy fertile couples. Clomiphene citrate is used as a first-line ovulation induction therapy in patients with polycystic ovary syndrome. Clomiphene citrate can cause both systemic and ocular side effects. We report a rare side effect of illusory palinopsias in a patient with polycystic ovary syndrome treated with ovulation induction therapy with clomiphene citrate, and emphasize the need for gynecologists and their patients to be aware of this rare ocular side effect. CASE PRESENTATION: A 30-year-old Asian woman complained of persistent visual afterimages following treatment with 100 mg clomiphene citrate for anovulation. Her symptoms started on the fourth day after commencing the treatment and would last for 5 to 10 minutes. Similar visual symptoms were noted during her second cycle of treatment with clomiphene citrate. The severity of her symptoms reduced following the stoppage of the medication; however, the symptoms have persisted for more than 1 year since she stopped taking the drug. CONCLUSIONS: Clomiphene citrate can cause disturbing illusory palinopsias. These afterimages persist even after stopping the infertility medication. It is a side effect not frequently seen by gynecologists or ophthalmologists. Gynecologists should make their patients aware of this rare ocular side effect when their patients start treatment with clomiphene citrate for infertility.
[Mh] Termos MeSH primário: Clomifeno/efeitos adversos
Antagonistas de Estrogênios/efeitos adversos
Alucinações/induzido quimicamente
Indução da Ovulação/efeitos adversos
Síndrome do Ovário Policístico/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Anovulação
Clomifeno/administração & dosagem
Antagonistas de Estrogênios/administração & dosagem
Feminino
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Estrogen Antagonists); 1HRS458QU2 (Clomiphene)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-017-1228-0


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[PMID]:28246376
[Au] Autor:Wang L; Qi H; Baker PN; Zhen Q; Zeng Q; Shi R; Tong C; Ge Q
[Ad] Endereço:Department of Reproduction Health and Infertility, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).
[Ti] Título:Altered Circulating Inflammatory Cytokines Are Associated with Anovulatory Polycystic Ovary Syndrome (PCOS) Women Resistant to Clomiphene Citrate Treatment.
[So] Source:Med Sci Monit;23:1083-1089, 2017 Mar 01.
[Is] ISSN:1643-3750
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND Polycystic ovary syndrome (PCOS) is a common gynecological disease characterized by chronic oligoanovulation, clinical/biochemical hyperandrogenism, polycystic ovaries, and insulin resistance. Accumulating evidence has shown that PCOS-related ovarian dysfunction is the main cause of anovulatory infertility. Clomiphene citrate (CC) is the first-line therapy for PCOS patients; however, approximately 15-40% PCOS patients are resistant to CC treatment. It has been demonstrated that PCOS is a chronic pro-inflammatory state, as some pro-inflammatory cytokines were elevated in the peripheral circulation of PCOS patients, but whether altered inflammatory cytokines expression in PCOS patients is associated with blunted response to CC remains unknown. MATERIAL AND METHODS We recruited 44 CC-resistant PCOS patients, along with 55 age and body mass index (BMI)-matched CC-sensitive PCOS patients. Ovulation was induced by administrating 50-100 mg/day CC on days 5 to 9 of each menstrual cycle. The cytokine profiles were detected by cytokine antibody microarrays and further validated by ELISAs. RESULTS CC-resistant patients had higher levels of high-sensitivity C-reactive protein (hsCRP) than the CC-sensitive individuals. A growth factor, angiopoietin-2, was significantly reduced [1.64 (0.93-1.95) vs. 1.08 (0.85-1.34), p<0.05], while a chemokine CXCL-16 was significantly increased (9.10±2.35 vs. 10.41±2.82, p<0.05) in CC-resistant patients compared to the CC-sensitive subjects. CXCL-16 was positively correlated with hsCRP (r=0.33, p<0.01). Logistic regression analysis showed that angiopoietin-2 and CXCL-16 are associated with CC resistance. CONCLUSIONS Circulating cytokines are disturbed in CC-resistant PCOS patients. Altered angiopoietin-2 and CXCL-16 levels might compromise the responsiveness of the ovary to CC through up-regulating angiogenesis and inflammation.
[Mh] Termos MeSH primário: Clomifeno/uso terapêutico
Citocinas/sangue
Síndrome do Ovário Policístico/sangue
Síndrome do Ovário Policístico/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Angiopoietina-2/sangue
Proteína C-Reativa/metabolismo
Quimiocina CXCL16
Quimiocinas CXC/sangue
Resistência a Medicamentos
Feminino
Seres Humanos
Ovário/efeitos dos fármacos
Ovário/metabolismo
Receptores Depuradores/sangue
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Angiopoietin-2); 0 (CXCL16 protein, human); 0 (Chemokine CXCL16); 0 (Chemokines, CXC); 0 (Cytokines); 0 (Receptors, Scavenger); 1HRS458QU2 (Clomiphene); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170302
[St] Status:MEDLINE



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