Induction Of ovulation.YS Nandanwar, AA Shinde, NM Mayadeo
Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Parel, Mumbai, India., India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 0010734340
Source of Support: None, Conflict of Interest: None
Sixty-one patients with anovulation as a cause of infertility were selected for our study. Various ovulation-inducing drugs were used like clomiphene citrate, human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG), bromergocryptine and leptadene. The response of the different drugs was observed by serial sonography for ovulation. Indeed there was a good response to clomiphene citrate, but those patients who failed to respond to clomiphene citrate and were frustrated with the use of hMG and hCG due to the cost and the complications of the therapy were put on Aloe compound and leptadene - an ayurvedic drug which enhances fertility in different ways.
Keywords: Clomiphene, pharmacology,Female, Fertility Agents, Female, pharmacology,Human, Ovulation Induction,
Anovulation is a significant and a treatable cause of infertility. Clomiphene citrate gives good results in carefully selected patients. In patients who failed to respond to clomiphene citrate, human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) were tried in various combinations. Their high cost and dangerous hyperstimulation syndrome needs close monitoring with well-equipped laboratories. These are the two important facts that come in the way of their wide spread use Aloe compound and Leptadene, ayurvedic drugs has given good results and our experience with these drugs in comparison to other drugs is limited to 40 cases only.
This study was carried out on the infertile patients attending the infertility clinic at tertiary hospital. Sixty-one patients with anovulation were selected for this study and were all started on clomiphene citrate. Forty other patients who were referred from different corners of the country and who had received treatment in the form of clomiphene citrate, hMG and hCG but had failed to conceive were started on Aloe compound and Leptadine.
After a detailed examination to rule out any gross gynaecological problems, these patients were started on clomiphene citrate with a dose of 50 to 200 mg. from day 2 to day 5 and were observed from day 9 onwards with cervical mucus score, basal body temperature charting and daily or alternate day transvaginal sonography to detect ovulation from day 10 onwards. Simultaneously planned relations was advised along with post coital test done as and when necessary. The end point of observation was rupture of ovarian follicle by sonography i.e. ovulation.
Forty of the 61 fresh patients responded to clomiphene citrate. Different patients responded to various doses and in different cycles of the study as shown in [Table - 1].
Failure with clomiphene citrate was considered when these patients failed to ovulate with a dose of 200 mg for an extended period of eight days for three consecutive cycles.
In nine cases with only clomiphene citrate on sonographic studies, the follicle grew up to a size of 25 x 26 mm or more but did not rupture. These cases were considered as luteinised unruptured follicle (LUF) syndrome. These patients were treated with injection hCG in the dose of 5000 to 10,000 IU. Four out nine of these patients ovulated. In the remaining hCG and hMG in combination were required to achieve ovulation. 12 patients, who did not respond to clomiphene citrate two had clinical galactorrhoea and one had borderline raise serum prolactin. Both were put on bromergocryptine in the dose of 2.5 mg. twice a day for a period of two to three months with simultaneous follicular studies who responded positively.
The remaining 10 patients were helped by hMG and clomiphene citrate. Six out of 10 responded to hMG + clomiphene citrate. Remaining required hMG + hCG.
Those patients who were put on hMG + hCG were monitored very strictly for the danger of hyperstimulation. The follicular size and corresponding oestrogen levels were monitored. Despite this, three patients developed hyperstimulation syndrome who were treated appropriately.
Infertility is a relatively common problem, it is estimated that at anytime, approximately 10% of those who wish to have children can be considered infertile and about 30 to 40% of them present with ovarian dysfunction. Clomiphene citrate was the first line of treatment in case of anovulation. In this study 40 out of the 61 fresh patients responded to clomiphene citrate by ovulation. Nausea, vomiting, vasomotor flushes, abdominal distension, bloating sensation were the adverse effects of clomiphene citrate therapy. Higher rates of miscarriage, teratogenecity, and multiple pregnancies reported with clomiphene citrate therapy. hCG, hMG and bromergocryptine are the modalities of treatment reserved for patients with anovulation who failed to respond to clomiphene citrate. The factors that limit their wide spread uses are prohibitively high cost of hMG and hCG, the low socio-economic conditions, hyperstimulation syndrome, absent specialities and lack of sophisticated laboratories in rural areas.
Aloe compound and Leptadine, which was used in 40 patients referred from different places of the country after failure with different modalities of treatment has shown to help in infertility. Aloe compound 100 mg twice a day from day one to day 14 followed by leptadine at a dose of 200 mg. thrice daily. As shown in [table:2], six patients started ovulating after two cycles and eight patients ovulated after three cycles of start of therapy. This indicated the significant role of leptadine in ovulation induction. Among these, six patients have conceived and are continuing to follow-up in antenatal clinic.
Out of the remaining 26 patients, 20 are following up and six are lost to follow-up. This modality is very safe, simple, easy to monitor at primary health centre set up like ours where 80% of the population dwells.
[Table - 1]