Perbandingan hasil stimulasi ovarium dengan kombinasi klomifen sitrat gonadotropin dan klomifen sitrat pada inseminasi intra uteri

https://doi.org/10.22146/jkr.35939

Farida Indriani(1*), Shofwal Widad(2), Sulchan Sofoewan(3)

(1) Departemen Obstetri dan Ginekologi, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan (FKKMK) UGM
(2) Departemen Obstetri dan Ginekologi, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan (FKKMK) UGM
(3) Departemen Obstetri dan Ginekologi, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan (FKKMK) UGM
(*) Corresponding Author

Abstract


Background: Infertile couple with the cause of unexplained infertility and male factor can follow intrauterine insemination (IUI) program as a cheap and easy method for infertility therapy. Ovarian stimulation by combination of clomiphene citrate and gonadotropin and also clomiphene citrate alone was done as a superovulation mode to get higher number of mature follicle to gain higher pregnancy rate. 

Objective : To compare the amount of mature follicles and  endometrial thickness as an outcome of ovarian stimulation between combination drug of clomiphene citrate and gonadotrophin with clomiphene citrate alone.

Methods: Observational retrospective cohort. Subject is one cycle intrauterine insemination stimulated either by combination CC gonadotrophin or CC alone, eligible in inclusion criteria and exclusion criteria. Statistic test used was independent t-test, chi-square and logistic regression.

Location of study: Infertility Clinic of  Permata Hati, dr. Sardjito Hospital, Yogyakarta.

Result: A total of 142 cycle from 98 couples followed IUI and stimulated by combination CC gonadotrophin (n=72) or CC alone (n=70). Multiple mature follicle number was different and statistically significant 77% vs 54%, RR 1,433 (IK95% 1,118-1,836), p=0,005, while endometrial thickness > 7mm was more frequent in combination group but not statistically different with percentage 81,9% vs 74,3%, RR 1,103 (CI95% 0,926-1,315), p=0,367.

Conclusion: Ovarian stimulation by combination CC gonadotropin resulting of more multiple mature follicle number while  good endometrial thickness was more in combination group but not statistically significant.

Keywords: ovarian stimulation, clomiphene citrate, gonadotrophin, multifollicular, endometrial thickness


Keywords


ovarian stimulation; clomiphene citrate; gonadotrophin; multifollicular; endometrial thickness

Full Text:

PDF


References

Speroff L, Fritz MA. Induction of Ovulation. In: Clinical Gynecology Endocrinology and Infertility. 7nd ed. Baltimore New York London: Lippincott Williams & Wilkins; 2005. P. 1175-1213

van Rumste MME, Custers IM, van der Veen F, van Wely M, Evers JLH, Mol BWJ, 2008 The Influence of the number of Follicles on Pregnancy Rates in Intrauterine Insemination with Ovarian Stimulation: a meta analysis, Hum Reprod vol 14 No.6 pp 563-570

Soria M., Pradillo G., Garcia J., Ramon P., Castillo A., Jordana C., 2012, Pregnancy predictors after intrauterine insemination: analysis of 3012 cycles in 1201 couples, J Reprod Infertil, 13(3): 158-166

Plosker SM, Jacobson W, Amato P, 1994 Predicting and optimizing success in an intra-uterine Insemination programme, hum reprod, 9(11)2014-21

Ragni G, Caliari I, Nicolosi AE; Arnoldi M, Somigliana E, Crosignani PG, 2006, Preventing high-order multiple pregnancies during controlled ovarian hyperstimulation and intrauterine insemination: 3 years' experience using low-dose recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril 85(3):619-24.

Al-Azemi M., Omu FE, Omu AE, 2004, The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome, Arch Gynecol Obstet; 270: 205-210

Bedaiwy A., Macklon N.S., Al Inany H.G. , 2008, Oral agents for ovulation induction:Old drugs revisited and new drugs re-evaluated, a thesis for PhD degree, published in http://www.scribd.com/doc/107137594/Ovulation-induction

Dickey et al 2010 Manual of Intra Uterine Insemination and Ovulation Induction.Cambridge University Press

Tomlinson M.J., Amissah-Arthur J.B., Thompson K.A., Kasraie J.L., bentick B.1996 Prognostic Indicators for Intrauterine Insemination (IUI): statistical model for IUI success Hum Rep Vol 11 no.9 pp 1892-1896

Chung MT, Chan TF, Loo TC, Tang HH, Lin LY, Tsai YC, 2010, Comparison of the effect of two different doses of recombinant gonadotropin for ovarian stimulation on the outcome of intrauterine insemination, Taiwanese Journal of Obstetrics & Gyenecology 50 (2011) 58-61

Dankert T, Kremer JA, Cohlen BJ, Hamilton CJ, Pasker-de Jong PC, Straatman H, van Dop PA. , 2007, A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility, Hum Reprod. Mar;22(3):792-7.

Ben Rafael, Levy T, Schoemaker J., 1995, Pharmacokinetics of follicle stimulating hormone: clinical significance, Fertil Steril;63:689-700

Lewis CG, Warnes GM, Wang XJ, Matthews CD, 1990, Failure of body mass index or body weight to influence markedly the response to ovarian hyperstimulation in normal cycling women, Fertil Steril, 53(6): 1097-9

Zhiqin B, Wei D,Yihong G, Yingchun S, Jun Z, and Yingpu S, 2013, Overweight and Obesity adversely affect outcomes of assisted reproductive technology in polycystic ovarian syndrome, Int J Clin Exp Med.; 6(10): 991–995.

Huang J, Ni R, Chen X, Huang L, Mo Y, Yang D, 2010, Metabolic abnormalities in adolescents with polycystic ovary syndrome in South China, Reprod Biol Endocrinol;8:142

NICE, 2004. Fertility: Assessment and treatment for people with fertility problem. Clinical Guidelines, RCOG Press

Streda R., Mardesic T.,Sobotka V.,Koryntova D., Hybnerova L.,Jindra M. 2012 Comparison of different starting gonadotropin doses (50, 75, and 100 IU daily) for ovulation induvtion combined with intrauterine insemination Arch Gynecol Obstet 286:1055-1059

Loxley CR., Harriott JA. , Dacosta VE., Wynter SH., Everett DM., Foster RA.,2011, Intrauterine insemination in Jamaica as a low-cost subfertility treatment in a low-resource region International Journal of Gynecology and Obstetrics 112 (2011) 208–210



DOI: https://doi.org/10.22146/jkr.35939

Article Metrics

Abstract views : 2282 | views : 5218

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Jurnal Kesehatan Reproduksi



Jurnal Kesehatan Reproduksi Indexed by:

 

 



SEKRETARIAT JURNAL KESEHATAN REPRODUKSI
Departemen Obstetri dan Ginekologi, FK-KMK, UGM/RS Dr. Sardjito
Jl. Kesehatan No. 1, Sekip Utara, Yogyakarta 55281
Tlp: (0274) 511329 / Faks: (0274) 544003
Email: jurnal.kesehatanreproduksi@ugm.ac.id
Cp: Dwi Astuti +6281802698043