Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium

Yasuhiko Nakamura; Mioko Ono; Yutaka Yoshida; Norihiro Sugino; Kazuyuki Ueda; Hiroshi Kato

doi:10.1016/S0015-0282(97)81907-3

Diagnostics Endometrial Assessment

Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium

Nakamura Y, Ono M, Yoshida Y, Sugino N, Ueda K, Kato H

Published February 1997 Fertility and Sterility, 67(2), 256-260

DOI 10.1016/S0015-0282(97)81907-3 PMID 9022599

RRM Academy Synopsis

Clomiphene alters the ultrasound pattern of the uterine lining

A retrospective study of 79 infertile women who ovulated on their own found that clomiphene changed how the uterine lining looks on ultrasound. Of 18 women who got pregnant on clomiphene, about 7 out of 10 had a grade 3 lining in the cycle they conceived. About 4 out of 10 had it in their first clomiphene cycle.

Key Findings

Lining thickness before ovulation was 7.6 mm on clomiphene and 8.5 mm in the control cycle (n = 79, P < 0.01). Mid-luteal thickness, 10.8 and 11.2 mm, did not differ significantly.
Almost 70% of women showed a grade 4 lining in the mid-luteal phase of the control cycle. The grades shifted significantly lower during the clomiphene cycle (P < 0.005).
Eighteen women (22.8%) got pregnant during the clomiphene cycle. Grade 3 appeared in 72.2% of conceived cycles and 38.9% of not-conceived cycles (P < 0.05).
Before ovulation, serum estradiol was significantly higher on clomiphene (P < 0.05, n = 16 against 48). Lining estradiol receptor content was significantly lower (P < 0.05, n = 13 against 15).
Progesterone receptor content was lower in the clomiphene cycle, and the difference was not significant.

Interpretation

This is a retrospective, single-center study in which each woman served as her own control, comparing a natural cycle with her first clomiphene cycle. All 79 women ovulated spontaneously and had normal luteal function, so the results describe that group. The authors conclude that clomiphene affected the echogenic pattern. They suggest the best lining for an embryo may differ from that of a natural cycle, and they note it is unclear whether grade 3 is best.

RRM Context

Clomiphene lowered estradiol receptor content in the lining while serum estradiol rose. Ovulation can happen without pregnancy. Restorative reproductive medicine asks why conception fails, and the lining is part of that answer.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To study the effects of clomiphene citrate (CC) on the endometrium by ultrasound and to reveal the echogenic difference between the control cycle and the CC cycle.

Design

Retrospective study of patients before and during a CC treatment.

Setting

Department of Obstetrics and Gynecology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.

Patients

Seventy-nine infertile women who had a spontaneous ovulation and a normal luteal function.

Interventions

Patients received 50 mg/d CC between days 5 and 9 of the menstrual cycle.

Main Outcome Measures

Endometrial thickness, echogenic pattern of the endometrium, serum E2 content, and E2 and P receptor contents in the endometrium.

Results

Endometrial thickness was significantly thinner during the CC cycle (7.6 +/- 1.4 mm, mean +/- SD, n = 79) than during the control cycle (8.5 +/- 1.7 mm, n = 79) on late proliferative days, but there was no significant difference on midsecretory days (10.8 +/- 2.2 mm during the CC cycle, n = 79; 11.2 +/- 2.2 mm during the control cycle, n = 79). The echogenic patterns, however, were different between the two cycles on midsecretory days. Moreover, the incidence in which patients showed a grade 3 endometrium on midsecretory days was significantly higher during the conceived CC cycle compared with the not-conceived CC cycle. Serum E2 levels were significantly higher, but E2 receptor contents in the endometrium were significantly lower during the CC cycle (67 +/- 46 fmol/mg, n = 13) compared with the control cycle (123 +/- 89 fmol/mg, n = 15) on late proliferative days.

Conclusions

Clomiphene citrate affected the echogenic pattern of the endometrium, and most of the endometrium showed a grade 3 pattern on midsecretory days during the conceived CC cycle. Under the CC treatment, the comfortable endometrium for embryos might be different from the control cycle.

Topics

Diagnostics › Endometrial Assessment › Receptivity Testing · Therapeutics › Ovulation Agents › Selective Estrogen Receptor Modulators · Reproductive Endocrinology › Ovarian Hormones › Estrogen

Yasuhiko Nakamura, Mioko Ono, Yutaka Yoshida, Norihiro Sugino, Kazuyuki Ueda, Hiroshi Kato

Y Nakamura, M Ono, Y Yoshida, N Sugino, K Ueda, H Kato

PMID 9022599 9022599 DOI 10.1016/S0015-0282(97)81907-3 10.1016/S0015-0282(97)81907-3 Nakamura et al. 1997, Nakamura 1997

Keywords

Adult, Clomiphene/pharmacology, Endometrium/diagnostic Imaging/drug Effects/metabolism, Female, Humans, Receptors, Estradiol/metabolism, Receptors, Progesterone/metabolism, Reference Values, Ultrasonography, Receptors, Estradiol, Receptors, Progesterone, Clomiphene

Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium

Clomiphene alters the ultrasound pattern of the uterine lining

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords