Role of Adding Phytoestrogen to Clomiphene Citrate in Improving Endometrial Thickness in Woman with Unexplained Infertility

Abstract

Background: Unexplained infertility is failure to conceive after 1 year in couples with normal semen samples and no abnormality found during an infertility work-up. Clomiphene citrate (CC) induces ovulation.

Objective: The aim was to evaluate the effect of follicular phase oral phytoestrogens (PES) in patients with unexplained infertility, managed by clomiphene ovulation induction, triggered by HCG injection and timed intercourse, in terms of pregnancy rate, follicular maturation and endometrial thickness.

Patients and Methods: This study included 56 infertile patients seeking for pregnancy. Clomiphene was given orally at a dose of one tablet twice per day (tablet 50 mg), from day 3 to day 7 for all patients (group I and group II), while phytoestrogens were given at a dose of two tablets one shot per day (tablet 20 mg), from day 1 to day 12 only for group I, followed by HCG injection on attaining mature follicle(s) by trans-vaginal US scan with diameter ≥ 18 mm in both group. The study was conducted in Department of Obstetrics and Gynecology, Zagazig University Hospitals.

Results: The number of days till HCG injection were significantly lower in group I (13.8 ± 1.8 days) than in group II (14.9 ± 2.1 days), which indicates a better ovulation. As for the endometrial thickness, it was significantly higher in group I than in group II. The number of ovulatory follicle(s) as single, two or three showed no significant difference between the studied groups.

Conclusion: Adding PES to CC induced cycles, improved the endometrial thickness, promoted follicular maturation in a shorter time and also, improved pregnancy rates.