Roumen, F. J., Doesburg, W. H., & Rolland, R. (1984). Treatment of infertile women with a deficient postcoital test with two antiestrogens: clomiphene and tamoxifen. Fertility and Sterility, 41(2), 237-243. https://doi.org/10.1016/s0015-0282(16)47597-7
Roumen FJ, Doesburg WH, Rolland R. Treatment of infertile women with a deficient postcoital test with two antiestrogens: clomiphene and tamoxifen. Fertil Steril. 1984;41(2):237-243. doi:10.1016/s0015-0282(16)47597-7
Roumen, Frans J. M. E., et al. "Treatment of infertile women with a deficient postcoital test with two antiestrogens: clomiphene and tamoxifen." Fertility and Sterility, vol. 41, no. 2, 1984, pp. 237-243.
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Tamoxifen may be preferable to clomiphene for poor postcoital tests
A randomized study of 22 women with repeated deficient postcoital tests concluded that tamoxifen may be preferable to clomiphene for women with this mucus problem. An earlier study found these women had lower estradiol before ovulation and higher FSH and prolactin than fertile controls. Mucus pH was lower on clomiphene, especially around ovulation. Tamoxifen did not change it significantly.
Key Findings
Ten women received clomiphene and 12 received tamoxifen. On clomiphene, estradiol was overproduced (P < 0.01) and endocervical mucus pH was lower (P < 0.01), mainly around ovulation.
Clomiphene did not significantly change overall mucus or sperm penetration scores (P > 0.1). The mucus score was lower from 3 to 2 days before the luteinizing hormone peak.
On tamoxifen, mean estradiol was higher (P < 0.05), prolactin was lower before and around ovulation (P = 0.001), and mucus pH did not change significantly (P > 0.1).
Tamoxifen did not significantly change overall mucus or sperm penetration scores (P > 0.1). Sperm penetration scores were frequently higher 3 to 2 days and 1 to 0 days before the peak.
Tamoxifen cycles and luteal phases were longer than placebo cycles (P < 0.05 for each). Clomiphene cycle length (P > 0.05) and luteal phase length (P > 0.5) did not change significantly.
Interpretation
This randomized study at one Dutch university hospital assigned the women to clomiphene or tamoxifen, with each woman also serving as her own placebo control. Semen analyses of the women's partners were normal. The authors note the lower tamoxifen dose may explain the hormone findings. The results support larger studies of tamoxifen for women with deficient postcoital tests.
RRM Context
Fertility awareness-based methods chart cervical mucus as a sign of the cycle. The women in this study had a routine infertility workup that showed nothing except the deficient postcoital test. Hormone measurements across the cycle then showed a pattern linked to the mucus problem. The finding fits the restorative principle of evaluating the cycle before treating.
Our editorial summary of this paper, not the article's abstract.
Abstract
Twenty-two infertile women with repeated deficient results in the postcoital test received clomiphene citrate or tamoxifen. The patterns of luteinizing hormone, follicle-stimulating hormone, prolactin, 17 beta-estradiol (E2), and progesterone were examined during the follicular and periovulatory phases of the menstrual cycle, as were the cervical mucus characteristics. Under clomiphene treatment, an overproduction of E2 was observed (P less than 0.01), which did not result in an improvement of the cervical mucus characteristics. The pH of the endocervical mucus was lower (P less than 0.01). Under tamoxifen treatment, the serum E2 levels were higher (P less than 0.05) and normalized. Higher spermatozoa penetration meter scores were observed during the preovulatory and periovulatory periods, whereas the pH of the endocervical mucus was not lowered. These data support that tamoxifen may be preferential to clomiphene in treating this kind of infertile woman.
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