The Effect of Oxytocin (OT) and Oxytocin Plus Human Chorionic Gonadotropin (hCG), in Cycles Induced by Letrozole or Clomiphene Citrate

The specific aims of this study were to assess whether letrozole as an aromatase inhibitor plus hCG or OT alone, or in combination compared with CC, improves ovarian response.Ethical design of this study is based on the ethical guidelines of the Iranian Medical and Health Ministry which is accepted by Tabriz medical university ethical committee .

Study Overview

• Status: Completed
• Conditions: Ovarian Response
• Intervention / Treatment: Drug: letrozole , oxytocin,hCG,clomiphene citrate

Detailed Description

In a randomized controlled prospective clinical study, a total of 177 infertile women with CC+hCG-resistant PCOS included. The candidates were selected for this study in the clinics of Tabriz University of Medical Sciences, East Azarbayejan Province, North West of Iran, from Oct. 2006 to Sep. 2007. Infertile women who had chronic anovulation and classical PCOS with CC+hCG failure were age <40 y , had patent tubes on hysterosalpingography, and no other pelvic pathology, participated in this study. The patients who had hypersensivity to any oxytocic medications, history of cardiovascular disease, and took anti-hypertensive medications were excluded. In addition, women with blood pressure less than 90/60 mmHg, abnormal spermogram, anxiety, excess prolactin levels, and other causes of infertility were excluded. All participants were given adequate information, and consent was obtained from each participant.

The candidates were randomly divided into five groups including; letrozole + hCG (36 patients) (group 1), letrozole + OT (35 patients) (group 2), letrozole +OT + hCG (35 patients) (group 3), CC + OT (35 patients) (group 4), and CC + OT + hCG (36 patients) (group 5). Participants received letrozole 2.5mg at first month and 5mg at the second and third month. Also, CC was used 50 mg at the first month, to 150 mg at the third month to stimulate follicular growth. Oxytocin (OXYTIP; manufactured by IPDIC, Rasht, Iran), 5 IU and hCG (Choriomon; manufactured by IBSA Institute Biochimique SA, CH-6903 Lugano), 5000 IU were also administrated to induce ovulation. All patients underwent transvaginal sonography on day 13 to document the numbers of follicles and endometrial thickness. Participants were evaluated for three courses of intervention. Oxytocin was injected intramuscularly after CC or letrozol stimulation had induced enlarged ovarian follicles ( >18 mm in diameter to 30 mm). Decision to give a 5 IU dose of OT was made according to the pilot study (30). The patients who had larger follicles (more than 30mm in diameter), were withdrawn. The patients, who achieved pregnancy at the first or second month, were also withdrawn. All participants were evaluated for the levels of plasma progesterone one week after the injection of OT, hCG, or combination of them. A follow-up visit was arranged for each group every month at the second day of menstruation until 3 months after recruitment or at any time during the trial if pregnancy was achieved.

• Study Type: Interventional
• Enrollment (Actual): 177
• Phase: Phase 2

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 38 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• infertile women who had chronic anovulation
• classical PCOS with CC+hCG failure
• age <40 y
• had patent tubes on hysterosalpingography
• no other pelvic pathology
• participated in this study

Exclusion Criteria:

• hypersensitivity to any oxytocic medications
• history of cardiovascular disease
• took anti-hypertensive medications were excluded.
• women with blood pressure less than 90/60 mmHg
• abnormal spermogram
• anxiety
• excess prolactin levels
• other causes of infertility were excluded

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: letrozole+hCG	Drug: letrozole , oxytocin,hCG,clomiphene citrate
No Intervention: letrozole+oxytocin	Drug: letrozole , oxytocin,hCG,clomiphene citrate
No Intervention: letrozole+oxytocin+hCG	Drug: letrozole , oxytocin,hCG,clomiphene citrate
No Intervention: clomiphene citrate +oxytocin	Drug: letrozole , oxytocin,hCG,clomiphene citrate
No Intervention: clomiphene citrate +oxytocin+hCG	Drug: letrozole , oxytocin,hCG,clomiphene citrate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
number of follicles, endometrial thickness, and clinical pregnancy rate	first ,second and third month

Collaborators and Investigators

• Sponsor: Tabriz University

Study record dates

Study Major Dates

• Study Start: October 1, 2006
• Primary Completion (Actual): September 1, 2007
• Study Completion (Actual): October 1, 2007

Study Registration Dates

• First Submitted: February 13, 2009
• First Submitted That Met QC Criteria: February 13, 2009
• First Posted (Estimate): February 16, 2009

Study Record Updates

• Last Update Posted (Estimate): February 16, 2009
• Last Update Submitted That Met QC Criteria: February 13, 2009
• Last Verified: February 1, 2009

More Information

Terms related to this study

• Keywords: Oxytocin; Letrozole; Induction of ovulation
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Hormones, Hormone Substitutes, and Hormone Antagonists; Hormone Antagonists; Aromatase Inhibitors; Steroid Synthesis Inhibitors; Estrogen Antagonists; Reproductive Control Agents; Fertility Agents, Female; Fertility Agents; Selective Estrogen Receptor Modulators; Estrogen Receptor Modulators; Oxytocics; Letrozole; Oxytocin; Clomiphene; Enclomiphene; Zuclomiphene
• Other Study ID Numbers: 8725