Clomiphene citrate versus tamoxifen for ovulation induction in women with PCOS: a prospective randomized trial.
Author(s): Badawy A, Gibreal A
Affiliation(s): Department of Obstetrics & Gynecology, Mansoura University, Mansoura, Egypt.
Publication date & source: 2011-11, Eur J Obstet Gynecol Reprod Biol., 159(1):151-4. Epub 2011 Aug 9.
OBJECTIVE: To reevaluate the efficacy of induction of ovulation with CC versus TMX in a group of anovulatory subfertile women with PCOS in a randomized controlled trial. STUDY DESIGN: A prospective randomized controlled study in which 371 PCOS patients were randomly allocated into two treatment groups: group A (187 patients) where women received CC and group B (184 patients) where they received Tamoxifen for one treatment cycle. The outcome measures were number of growing and mature follicles, serum E(2) (pg/ml), serum progesterone (ng/ml) and endometrial thickness, the occurrence of pregnancy and miscarriage. RESULTS: The number of stimulated follicles reaching >/=16mm diameter was significantly more in the CC group compared to Tamoxifen stimulated group (2.1 SD+/-0.1 vs. 1.1 SD+/-0.7, p<0.0001). The endometrium at the time of hCG administration was significantly thicker in the TMX group (10.1+/-0.1mm vs. 9.3+/-0.4mm, p<0.0001). Ovulation occurred in 120/187 cycles (64%) in the CC group and 95/184 cycles (51.6%) in the TMX group with a significant difference between two groups in favors of clomiphene (p=0.01). Serum E(2), on the day of hCG administration, was significantly higher in the clomiphene group (p<0.0001). Pregnancy occurred in 35/187 cycles in group A (18.7%) and 20/184 cycles (10.8%) in group B and the difference was statistically significant (p=0.04). CONCLUSIONS: Clomiphene citrate is more successful than tamoxifen as a first line therapy for ovulation induction in women with PCOS. Copyright (c) 2011 Elsevier Ireland Ltd. All rights reserved.