Tamoxifen and Clomiphene Citrate in Mild Stimulation IVF

NCT ID: NCT02690870

Last Updated: 2016-02-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

210 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2019-03-31

Brief Summary

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The purpose of this prospective cohort study is to compare IVF outcome between tamoxifen and clomiphene citrate in mild stimulation.

Detailed Description

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The reported prevalence of poor ovarian responders amongst patients undergoing IVF-ET is 9%-24%, and morbidity must be higher nowadays. For these women, Mild stimulation has been an important ovulation induction protocol. Clomiphene citrate(CC) and tamoxifen(TMX) are commonly used in mild stimulation protocol. It's reported that CC has adverse effect on growth of endrometrium and results in thin endrometrium(≤7mm) which maybe affect pregnancy rate. However, TMX has estrogen-like effect on the endrometrium that may be helpful to increase endormetrial thickness. The reported results about comparing CC with TMX showed that they had similar ovulation rate. Prospective study is necessary to confirm whether TMX is superior to CC on the IVF outcome.

Conditions

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Infertility

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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tamoxifen

All patients will have serum hormone examination and be monitored by transvaginal ultrasound for ovaries on the day 3 of the menses(D3).Patients in the tamoxifen group will take 20 mg of tamoxifen oral tablets daily from D3 for 5 days.All patients will check serum E2 and be monitored by transvaginal ultrasound for the mean follicular diameter and endometrial thickness on the day 8 of the cycle. The investigators will add HMG and GnRH-ant according to follicular diameter,E2 and LH. Human chorionic gonadotropin(hCG) (5000-10000 IU IM) will be given when one follicle measured at least 18 mm is found. IVF or ICSI will be performed 34-36 h after hCG administration. All patients will receive luteal phase support with progesterone 60 mg im qd for 2 weeks.

Group Type EXPERIMENTAL

Tamoxifen

Intervention Type DRUG

Patients in the tamoxifen group will take 20 mg of tamoxifen oral tablets daily from day 3 of the menses for 5 days.

clomiphene

All patients will have serum hormone examination and be monitored by transvaginal ultrasound for ovaries on the day 3 of the menses(D3).Patients in clomiphene group will take 100 mg of CC oral tablets daily from D3 for 5 days.All patients will have sexual hormone determination and be monitored by transvaginal ultrasound for the mean follicular diameter and endometrial thickness on the day 8 of the cycle.The investigators will add HMG and GnRH-ant according to follicular diameter,E2 and LH. Human chorionic gonadotropin(hCG) (5000-10000 IU IM) will be given when one follicle measured at least 18 mm is found. IVF or ICSI will be performed 34-36 h after hCG injection. All patients will receive luteal phase support with progesterone 60 mg im qd for 2 weeks.

Group Type ACTIVE_COMPARATOR

Clomiphene

Intervention Type DRUG

Patients in clomiphene group will take 100 mg of CC oral tablets daily from day 3 of the menses for 5 days.

Interventions

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Tamoxifen

Patients in the tamoxifen group will take 20 mg of tamoxifen oral tablets daily from day 3 of the menses for 5 days.

Intervention Type DRUG

Clomiphene

Patients in clomiphene group will take 100 mg of CC oral tablets daily from day 3 of the menses for 5 days.

Intervention Type DRUG

Other Intervention Names

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CAS RN:10540-29-1 clomiphene citrate

Eligibility Criteria

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Inclusion Criteria

1. age between 37 and 42;
2. BMI≤23kg/m2;
3. ≤3 oocytes with a conventional stimulation protocol;
4. AFC\<5 follicles or AMH\<1.1 ng/ml on the day 1 to 5 of the menses;
5. Cause of Infertiity: tubal factor, male factor, diminished ovarian reserve.

Exclusion Criteria

1. endormetrial polyp, endormetrial cancer,intrauterine adhesions,uterine fibroids that affects uterine cavity
2. Endometriosis, adenomyosis
3. The diameter of Hydrosalpinx \>2cm
Minimum Eligible Age

37 Years

Maximum Eligible Age

42 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Sun Yat-sen University

OTHER

Sponsor Role collaborator

Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

OTHER

Sponsor Role lead

Responsible Party

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Haiyan Lin

attending doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Qingxue ZHANG

Role: STUDY_DIRECTOR

Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

Central Contacts

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Haiyan LIN

Role: CONTACT

0018615913154456

References

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Boostanfar R, Jain JK, Mishell DR Jr, Paulson RJ. A prospective randomized trial comparing clomiphene citrate with tamoxifen citrate for ovulation induction. Fertil Steril. 2001 May;75(5):1024-6. doi: 10.1016/s0015-0282(01)01749-6.

Reference Type BACKGROUND
PMID: 11334921 (View on PubMed)

Revelli A, Casano S, Salvagno F, Delle Piane L. Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization. Reprod Biol Endocrinol. 2011 Feb 16;9:25. doi: 10.1186/1477-7827-9-25.

Reference Type BACKGROUND
PMID: 21324155 (View on PubMed)

Badawy A, Gibreal A. RETRACTED: Clomiphene citrate versus tamoxifen for ovulation induction in women with PCOS: a prospective randomized trial. Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):151-154. doi: 10.1016/j.ejogrb.2011.07.015. Epub 2011 Aug 9. No abstract available.

Reference Type BACKGROUND
PMID: 21831503 (View on PubMed)

Wang CW, Horng SG, Chen CK, Wang HS, Huang HY, Lee CL, Soong YK. Ovulation induction with tamoxifen and alternate-day gonadotrophin in patients with thin endometrium. Reprod Biomed Online. 2008 Jul;17(1):20-6. doi: 10.1016/s1472-6483(10)60288-x.

Reference Type BACKGROUND
PMID: 18616885 (View on PubMed)

Reynolds K, Khoury J, Sosnowski J, Thie J, Hofmann G. Comparison of the effect of tamoxifen on endometrial thickness in women with thin endometrium (<7mm) undergoing ovulation induction with clomiphene citrate. Fertil Steril. 2010 Apr;93(6):2091-3. doi: 10.1016/j.fertnstert.2009.08.038. Epub 2009 Sep 22.

Reference Type BACKGROUND
PMID: 19775686 (View on PubMed)

Brinton LA, Westhoff CL, Scoccia B, Lamb EJ, Trabert B, Niwa S, Moghissi KS. Fertility drugs and endometrial cancer risk: results from an extended follow-up of a large infertility cohort. Hum Reprod. 2013 Oct;28(10):2813-21. doi: 10.1093/humrep/det323. Epub 2013 Aug 13.

Reference Type BACKGROUND
PMID: 23943795 (View on PubMed)

Ozcan Cenksoy P, Ficicioglu C, Kizilkale O, Suhha Bostanci M, Bakacak M, Yesiladali M, Kaspar C. The comparision of effect of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients. Gynecol Endocrinol. 2014 Jul;30(7):485-9. doi: 10.3109/09513590.2014.893571. Epub 2014 Mar 5.

Reference Type BACKGROUND
PMID: 24592985 (View on PubMed)

Pourmatroud E, Zargar M, Nikbakht R, Moramazi F. A new look at tamoxifen: co-administration with letrozole in intrauterine insemination cycles. Arch Gynecol Obstet. 2013 Feb;287(2):383-7. doi: 10.1007/s00404-012-2556-3. Epub 2012 Sep 25.

Reference Type BACKGROUND
PMID: 23008110 (View on PubMed)

Mazzarino M, Biava M, de la Torre X, Fiacco I, Botre F. Characterization of the biotransformation pathways of clomiphene, tamoxifen and toremifene as assessed by LC-MS/(MS) following in vitro and excretion studies. Anal Bioanal Chem. 2013 Jun;405(16):5467-87. doi: 10.1007/s00216-013-6961-7. Epub 2013 Apr 23.

Reference Type BACKGROUND
PMID: 23604525 (View on PubMed)

Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E. Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD002249. doi: 10.1002/14651858.CD002249.pub4.

Reference Type BACKGROUND
PMID: 19821295 (View on PubMed)

Zakherah MS, Nasr A, El Saman AM, Shaaban OM, Shahin AY. Clomiphene citrate plus tamoxifen versus laparoscopic ovarian drilling in women with clomiphene-resistant polycystic ovary syndrome. Int J Gynaecol Obstet. 2010 Mar;108(3):240-3. doi: 10.1016/j.ijgo.2009.10.004. Epub 2009 Nov 26.

Reference Type BACKGROUND
PMID: 19944418 (View on PubMed)

Steiner AZ, Terplan M, Paulson RJ. Comparison of tamoxifen and clomiphene citrate for ovulation induction: a meta-analysis. Hum Reprod. 2005 Jun;20(6):1511-5. doi: 10.1093/humrep/deh840. Epub 2005 Apr 21.

Reference Type BACKGROUND
PMID: 15845599 (View on PubMed)

Wang HS, Wang TH, Soong YK. Cyclic changes in serum levels of insulin-like growth factor binding protein-1 in women treated with clomiphene citrate and tamoxifen. Gynecol Endocrinol. 2000 Aug;14(4):236-44. doi: 10.3109/09513590009167687.

Reference Type BACKGROUND
PMID: 11075292 (View on PubMed)

Mazzarino M, Bragano MC, de la Torre X, Molaioni F, Botre F. Relevance of the selective oestrogen receptor modulators tamoxifen, toremifene and clomiphene in doping field: endogenous steroids urinary profile after multiple oral doses. Steroids. 2011 Nov;76(12):1400-6. doi: 10.1016/j.steroids.2011.06.005. Epub 2011 Jun 30.

Reference Type BACKGROUND
PMID: 21745489 (View on PubMed)

Other Identifiers

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20160220

Identifier Type: -

Identifier Source: org_study_id

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