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Oral agents for ovulation induction:Old drugs revisited and new drugs re-evaluated

By A.M.M. Badawy


The aim of this thesis was to address a number of questions regarding oral agents used for ovulation induction. We were motivated to run the presented trials because of many reasons. Firstly, although oral agents, namely CC, have been in the market for decades, many basic aspects regarding the application of oral agents have been taken for granted without a real evidence base. These include when to start CC, at what dose and for how many days therapy should continue. Some of the early studies about CC date back to up to 35 years or more. Although these were pioneering studies, most of them were underpowered observational trials without trustworthy conclusions. So we presented extended and novel luteal-pahse CC protocol. Secondly, the widespread use of CC showed the existence of 10-40% of patients who were either resistant to CC or failed to achieve pregnancy. Second line therapies for these patients include gonadotropin ovulation induction and laparoscopic ovarian drilling. These approaches have disadvantages related to costs and risk of ovarian hyperstimuation, multiple pregnancies or pelvic adhesions. For many women, particularly in developing countries, the cost of therapy is very decisive. Hence, before announcing the failure of cheap and safe drug like CC and moving forwards to another therapy, we tried to improve its performance by manipulating its start or duration of use and by addition of N-acetyl cysteine. Lastly, there has been a growing interest in the new group of aromatase inhibitors e.g letrozole and anastrozole as ovulation induction agents because of their theoretical advantages over CC. It is well known that assessing the efficacy of any new treatment ideally should be undertaken within a randomised controlled trial with sufficient power. Unfortunately, there was paucity of comparative RCTs to indicate the drug of first choice in this condition

Topics: Geneeskunde, ovulation induction, clomiphene citrate, aromatase inhibitors, N-acetyl cysteine, pregnancy outcome
Publisher: Utrecht University
Year: 2008
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