In present study, it was investigated the effect of clomiphene citrate on the ovaries reproductive hormones and embryos of mature female mice, were studied. Female mice treated with (5, 10,50 mg/kg ) daily for 7 days. Results cleared that cross section showed a significant increase (p<0.05) in multi follicular (different numbers )on the right and left ovaries of female mice. In other hand; there were a significant elevation (p<0.05) in the follicle stimulation hormone(FSH), estrogens and progesterone concentration, while, no significant changes were noticed in luteinizing (LH). Conclusions: Clomiphene citrate is the best initial treatment especially in relevance with ovulatory problems (dysfunction), and has a super stimulatory effect on ovulation, thereby increasing the number of recruited follicles in albino female mice rather than affecting the follicular steroidogenic function, and its induce multi follicle ovum forming. Similarly, it has positive affection on gonadotropene hormones, eventually it leads to a twin pregnancy. Combined c with appropriately timed IUI, Clomiphene citrate treatment also increases cycle fecundity in couples with unexplained infertility.
Background: Both clomiphene citrate and tamoxiphene citrate, as an anti estrogen, is the most common prescribed medication for male infertility.In humans, ant estrogens interfere with the normal negative feedback of sex steroids at the hypothalamus and pituitary, thereby increasing endogenous gonadotropin releasing hormone (GnRH) secretion from the hypothalamus and follicle stimulating hormone (FSH) and luteinizing hormone (LH) secretion directly from the pituitary. Objective: The objective of this study was to investigate the effect of clomiphene citrate (CC) and tamoxiphene citrate (TC) administered to male mice on quality of sperm motility and activity. Materials and Methods: Ninety six male mice were divided into two major groups, and every one of these groups was subdivided into three minor groups involving control and two treated groups. In the CC study, 48 mice were administrated orally 0, 0.0125 mg and 0.025 mg as control (G 1), low dose (G 2) and high dose (G 3) for 42 days. While, in the TC study, 48 mice were administrated orally 0, 0.01 mg and 0.02 mg as control (G 1), low dose (G 2) and high dose (G 3) for 42 days. Then, the male mice were sacrificed, both vas deferens were collected and assessment sperm motility and activity. Results: The results of present study appeared that the use high dose of CC or TC significantly increment (P<0.05) sperm motility and activity as compared to control groups. Conclusions: Based on the results of this study, it can be concluded that the administration of high dose of either CC or TC increases sperm motility and activity.
Background: Leptin is an adipocyte —secreted protein that participates in the regulation of energy homeostasis. It prevents the body from storing fat, controls hunger and cravings, regulates food intake and energy expenditure, provides the body with an index of nutritional status and controls the whole body fat metabolism. Leptin is a product of ob gene created by adipocytes. It seems to signal metabolic information to the reproductive system. Objective: The aim of this study to evaluate the relationship between serum leptin and infertility in oligozoospermic men. Materials and Methods: Seventy men were investigated; fertile normozoospermic as a control (n=35) and infertile oligozoospermic (n=35). The patients underwent estimation of body weight (kg), height body mass index (BMI), semen analysis, serum FSH, LH, testosterone and leptin, lipid profile and serum malondialdehyde (MDA). The infertile group was given a treatment course of clomiphene citrate (50 mg) and vitamin E (400mg) and then all the previous parameters were reevaluated after 3 months. Results: Mean body weight was significantly higher in infertile oligozoospermia compared to controls. The height showed no significant difference between the groups. Hormonal profile revealed significant (P=0.0001) difference in FSH between control group and oligozoospermic group (7.04±4.20 versus 3.35±1.47 mIU/ml), but after treatment with clomiphene citrate and vitamin E there is a slight non-significant (P=0.231) decrease in the level of FSH in oligozoospermic group. The level of testosterone showed a statistically significant (P=0.0001) difference between fertile normozoospermic (5.52 ±1.29 ng/ml) and infertile oligozoospermic. This hormone showed a significant (P<0.0001) increase in its level after treatment with clomiphene citrate and vitamin E (3.48±1.56 ng/ml). Other hormone showed non significant difference between the two groups pre and post treatment. Lipid profile showed no significant difference between the two groups. There was no significant (P=0.477) difference in serum MDA between the control and the infertile groups (4.69±1.32 vs. 5.18±1.19 µmol/L) respectively, but after treatment the results showed a mild significant (P=0.026) decrease in comparison to the level in the control group and also a significant (P=0.0001) decrease in comparison to the level before treatment. Infertile oligozoospermic had significantly higher serum leptin level (8.03±1.22 ng/ml) than control (3.62 ± 1.00 ng/ml). Conclusion: Serum leptin demonstrated a significant positive correlation with age, body weight, BMI and a significant inverse correlation with serum testosterone. It had nonsignificant correlation with the height and sperm concentration. These results are suggestive of a link between the adipocyte derived hormone leptin and male reproduction.
Background:Ovulation disorders, usually presents as menstrual disturbance, are the cause of infertility in around 25% of couples who have difficulty to conceive. The drug most commonly prescribed for the induction of ovulation is clomiphene citrate (CC). If the patient does not ovulate after the use of CC, the choice was to add gonadotropins. Gonadotropin therapy is very expensive with significant risks of high order multiple gestations and ovarian hyperstimulation syndrome. Human chorionic gonadotropin hCG can function as a surrogate for LH and oc-cupies LH receptors for more than 24 hours allowing prolonged stimulation also it has longer half-life and greater affinity for the LH receptor. Objective: The purpose of this study was to compare the effectiveness of low-dose human chorionic gonadotropin (hCG) in the late follicular phase to induce ovulation in clomifene citrate resistant patients who had previously failed to ovulate on clomiphene citrate (CC) alone. Subjects,Materials and Methods: A total of 71 patients who attend infertility clinic in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, where prospectively randomly assigned into two groups. hCG Group received 100 mg dose of CC from day 5 of men-strual cycle for 5 days, then each patient received 200 IU hCG (DICLAIR®) subcutaneous injection daily when the largest follicle mean diameter was 12 mm or larger starting on day twelve of menstrual cycle. Non-hCG group received 150 mg dose of CC from day 5 of menstrual cycle for 5 days, and both groups were monitored with transvaginal ultrasound. Ultrasound measurements of follicle number and growth, ovulation, endometrial thickness and pattern were recorded and compared between the two groups. Student t test and fisher exact test were used for statistical comparison between the two groups. Results: The low-dose hCG group had significantly higher percentage of ovula-tory cycles (80% vs 44.4% P value 0.006). There was no significant difference in the endometrial thickness between the groups but it appears higher in hCG group (10.55±1.82 vs. 9.62 ± 1.87 in non-hCG group, p value 0.056). Non significant but higher incidence of echogenic (luteinized) endometrium 48 hour post ovula-tion in hCG group (36/40 (90%) vs. 20/25 (80%) for non-hCG group p-value = 0.288). Conclusions: The use of low-dose hCG after CC in the late follicular phase re-sults in continued follicle growth, higher ovulation rate. This treatment offers an efficient and cost-effective alternative before gonadotropin therapy for this type of patients.
It was observed that embryos from oocytes resulting from well-vascularized follicles had a higher implantation rate than those from oocytes developed in poorly vascularized follicles. Neovascularization was recognized as primary in terms of ovulatory follicles growth and selection. Vascular endothelial growth factor serum level has a positive correlation with perifollicular blood flow. The 2D Color and Pulsed Doppler ultrasounds that allow visual observation of the flux of the blood in a limited part of the wall of the preovulatory follicles can be easily measured. To study the preovulatory follicle's blood flow parameters in infertile women undergoing different ovulation induction protocols. 50 infertile female patients who had undergone Intrauterine Insemination (IUI) procedures were classified into two groups which were letrozole or clomiphene citrate groups as induction protocol. Another ultrasound was performed on cycle day 11, 12, or 13 to evaluate growth follicles, also a Doppler study was done to measure perifollicular blood flow and endometrial thickness at the same time blood sample to measure vascular endothelial growth factor were taken. Human chorionic gonadotropin was injected and then after 36-40 hrs. IUI Procedure is done and follows up with the patient to do a pregnancy test after 14 days. The number of dominant follicles, endometrial thickness at HCG trigger, Perifollicular doppler blood flow vascular endothelial growth factor level, pregnancy rates were all measured in both groups. There were significant differences in Perifollicular RI (p<0.001) but there were no significant differences in Perifollicular PI (p=0.476). Regarding pregnancy rate, the letrozole group has a higher although not significant pregnancy rate (32%), if compared with those using CC (20%).
Background: The evaluation of ovarian reserve has been, and still, the focus of substantial clinical research. The assessment of ovarian reserve is valuable for determining stimulation protocols, and because of limited predictive value of age alone, or other passive hormonal analysis in estimating response to the exogenous stimulation, Dynamic research was done on serum inhibin B. Objective: Measurement of serum inhibin B as a predictive evaluation of early ovarian response following ovulation induction program in intrauterine insemination(IUI). Materials and Methods: Thirty couples were involved in IUI program. They divided into two groups: group (1) 15 women were treated by Gonadotropin(Gn) recombinant follicle -stimulating hormone (rFSH). While group (2), 15 women were treated by Clomiphene citrate (CC). Treatment started at day 3 of the menstrual cycle. Serial hormonal profile tests namely; Inhibin B, Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) were done at days 3, 7 of the menstrual cycle and the day of human chorionic gonadotropin hormone (hCG) injection with recurrent ultrasonography (US) to confirm the number and development of the follicles. Results: There was a significant difference in the level of inhibin B (P< 0.05) between day 3 and 7 of the cycle with the mean of the follicle number 1.67±0.18 in group(1), while in group (2) there was a non significant difference (P>0.05) in the level of inhibin B between day 3 and 7 of the cycle with the mean of the follicle number 2.14±0.17. Percentage of pregnancy rate in IUI in this study was 19.23%. Percentage of pregnancy rate in group (1) was 25%,while in group (2) was 14.28%,but there is a significant difference (P<0.05) in the pregnancy rate between the two groups. Conclusion: It was concluded that serum inhibin B obtained at day 7(day 5 of (Gn) therapy) offers an early and accurate prediction of ovarian response to (Gn) stimulation while there was no significant change in the level of inhibin B between day 3 and 7 of the cycle in patients treated by CC.
Background: Fibrillin- 3 is a recently discovered hormone.However, there are no studies till now regarding the role of fibrillin-3 hormone on fertilization capacity in infertile pregnant and non-pregnant women. Objectives: The goals of this study are concentrated on the fertilization capacity parameters by examining the effect of in vivo concentration of fibrillin-3 hormone on the ovarians status at different menstrual cycle phases and to elucidate the correlation between the levels of this hormone with pregnant and non -pregnant women following Intrauterine insemination (IUI) outcome or through natural pregnancy. Methods: Sixty infertile couples were involved in this prospective study. The couples were divided according to the type of insemination and ovulation induction program into two groups Group(1): Thirty spouses were subjected to induced ovulation stimulation by using clomiphene citrate(CC) and recommended for natural coitus. Group(2): Thirty couples, the females were induced ovulation stimulation by CC, Gonal F-751U /ml and Fostimon 50IU/ml with IUI. Measurements of Fibrillin-3 with other reproductive hormones were done at different phases of menstrual cycle and for pregnant and non-pregnant women following natural coitus and IUI. Results: The mean of fibrillin-3 hormone level at day 2 of menstrual cycle was 3.7ng/ml (ranged from 3.50 to3.91) in the two groups. The mean of fibrillin-3 hormone at cycle day 13 was 6.6ng/ml( ranged from 5.83to 7.0). Whereas, The basal level of Fibrillin-3 at 14 days post insemination was 3.3ng/ml. The range is from 2.76,395 to 3.29 ng/ml. There was no significant difference in the mean of Fibrillin -3hormone between pregnant and non-pregnant women through the phases of menstrual cycle or between the two groups, but there is a significant value between fibrillin-3 post insemination and E2 day 2 and day 13 P<0.05. Conclusion: The present study concluded that Fibrillin -3 hormone has no role in pregnancy, but it may have a main relationship with estrogens reaction in folliculogenesis, oocyte maturation and follicular contents. Therefore, this hormone may be one of the new hormones that interfere with fertilization capacity.
Background: The intra uterine insemination (IUI) still an easy, simple and effective method to overcome the infertility that resulted from different causes. Although the equipments and methods of assisted reproductive technologies (ART) were highly developed, the percentage of successful IUI live-birth not exceed 20-30%. Objective: The present study was aimed to elucidated the cut off values of in vitro sperm preparation technique, follicular number and size, endometrial thickness and hormonal profile that lead to successful pregnancy rate (PR)following IUI. Materials and Methods: In retrospective study, one hundred cases of infertile couples were in who were became pregnant following IUI at the Institute of Infertility Diagnosis and Assisted Reproductive Technologies, through the period from January 2007 to January 2010. Depending on the results of retrospective study, IUI was achieved for 100 infertile patients between August 2010and June 2011. The mean of significant prognostic variables were measured in both studies namely: age, type of infertility, type of sperm activation techniques, the protocol of ovulation induction medicine, the mean of hormonal status of Luteinizing Hormone (LH), Estradiol(E2), and number with diameter of follicles, endometrial thickness a cycle day before hCG injection. Results: The protocol of ovulation induction in IUI cycles by using clomiphene citrate(CC) and recombinant gonadotropin (rFSH) was significantly(p<0.05) improve the IUI results compared to CC alone or CC with PergonalS. The mean values obtained by ultrasonography namely; two follicles, and dominant follicle of 19.5mm in size with endometrium thickness of >9.5mm were gave significantly successful IUI outcome compared to other values. In prospective study similar results were obtained, therefore the overall pregnancy rate was 37% per cycle. Conclusion: The calculated data of successful IUI outcome from retrospective study gave a best pregnancy rate in prospective study which was 37%. Consequently, these results can be considered as guideline for physician who interest in assisted reproduction to have a success in IUI.