Table of Contents

2019 Month : June Volume : 8 Issue : 23 Page : 1820-1824

STUDY ON OVULATION INDUCTION WITH CLOMIPHENE CITRATE, METFORMIN, HUMAN CHORIONIC GONADOTROPIN AND HUMAN MENOPAUSAL GONADOTROPIN IN FEMALE INFERTILITY.

Anuradha De Pati1, Selim Akhtar2, Nibedita Chattopadhyay3, Susanta Banerjee4

Corresponding Author:
Dr. Selim Akhtar,
Neel Diganta Enclave, Flat No. I-3, 3rd Floor, Block- B,
Sethpukur P. O. + P. S., Barasat-700124,
North 24 Parganas, West Bengal, India.
E-mail: s.akhtar19841984@gmail.com

ABSTRACT

BACKGROUND

Ovulatory disorders account for about 30-40% of all causes of female infertility. Normal ovulation requires co-ordination of neuro-endocrinal system at all levels. Clomiphene citrate, human chorionic gonadotropin, human menopausal gonadotropin, metformin are the commonly used drugs for ovulation induction. They are used alone or in combination with ultrasound monitoring. Ovulation is characterized by a decrease in the size of a monitored ovarian follicle and by the appearance of fluid in the cul-de sac by ultrasound. We wanted to evaluate the effects of ovulation inducing agents like ovulation rate (by ultrasound monitoring), viable pregnancy rate (≥28 weeks), abortion rate and side effects like multiple pregnancies & ovarian hyper stimulation syndrome (OHSS) in a case of primary or secondary infertility.

METHODS

Our study was an interventional study and was done to induce ovulation among 100 infertile women having oligo-ovulation or anovulation with clomiphene citrate alone, with metformin alone, with combination of clomiphene citrate & metformin, with combination of clomiphene citrate & HCG, with combination of clomiphene citrate, HMG & HCG. It was conducted at the department of Obstetrics & Gynecology, Calcutta National Medical College & Hospital, and Kolkata from February 2017 to August 2018.

RESULTS
In this study group of 100 cases of infertility, 80% were primary infertility and 20% were of secondary infertility and maximum number of cases belong to the age group 26-30 years (55%). The maximum number (70%) of cases presented within 7 years of marriage. In our study it was found that ovulatory response is better with combination of clomiphene & metformin (62.5%) than clomiphene alone (53.84%) or metformin alone (48.57%). Regarding pregnancy rate, metformin alone (42.85%) and combination of clomiphene & metformin (43.75%) are almost similar in efficacy but both are superior to clomiphene alone (35.38%). Total rate of ovulation with clomiphene & HCG was 66.66% and total rate of conception was 50%. With clomiphene, HMG & HCG ovulation rate was approximately 50% & conception rate 33.33 %. OHSS is an important iatrogenic side effect of ovulation inducing drugs specially clomiphene with HCG & HMG. In our study, the incidence of multiple pregnancies was 4% (4 out of 100 cases, among which 3 were twin and one triplet). 3 cases were found with the use of clomiphene citrate alone and one case was found with the use of combination of clomiphene & metformin. The incidence of pregnancy wastage in my study was 12% (Total 12 abortions in 100 patients).

CONCLUSIONS

Total 70 patients conceived out of total 100 patients studied and out of which 97 patients ovulated. Pregnancy rates were maximum with clomiphene with HCG (50%). Among 70 patients conceived, 12 aborted in early pregnancies during study time & 58 patients gave birth to term babies. Rate of OHSS and pregnancy wastage was 12% each. Multiple pregnancies occurred in 4 patients out of 100 patients. So, if there is a correct evaluation of cases, conveying psychological assurance, taking the couple into confidence and providing them a correct medical therapy, we can help them to become mother and have happy family.

KEY WORDS

Ovulation Induction, Infertility, Clomiphene Citrate, Metformin, Human Chorionic Gonadotropin, Human Menopausal Gonadotropin

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