Cost-effective Treatment of Unexplained Infertility

Batterjee Medical College

Status and phase: Completed; Phase 4

Conditions: Unexplained Infertility

Treatments: Drug: Clomiphene Citrate.; Drug: Sildenafil Citrate; Procedure: Intrauterine Insemination

Study type: Interventional

Funder types: Other

Identifiers

NCT06178523

RES/2024/1

Details and patient eligibility

About

The issue of unexplained infertility that Southam brought up in 1960 is still a problem today. Despite improvements in infertility assessment, many couples still don't know why they are infertile. Even with the use of the most advanced ovulation detectors, fallopian tube patency tests, and semen evaluations, competency cannot identify every potential flaw in the intricate processes leading to conception. Unexplained infertility will be a challenge for both biological and clinical researchers since it results from these gaps in our understanding of fertilization and from our incapacity to use all of the current evidence-based information.

Full description

For the treatment of unexplained infertility, Clomiphene Citrate (CC) is frequently used either alone or in conjunction with intrauterine insemination (IUI). Its combined oestrogenic and anti-oestrogenic characteristics serve as the basis for the mechanism of action. When clomiphene citrate is used, the uterine blood flow is reduced during the peri-implantation stage of early luteal phase. About 80% of women experience ovulation, which has a cumulative effect over 6 to 8 months, yet the pregnancy rate in these women can still be relatively low. The endometrial and cervical mucus-level anti-oestrogenic actions of CC are the potential culprits. Without a doubt, one of the biggest obstacles in treating infertility is the endometrial impact. If the endometrial thickness (ET) is less than 6 mm, the pregnancy rate may be extremely low.

Sildenafil citrate promotes endometrial thickness and uterine blood flow. The capacity of the blastocyst to penetrate the endometrium and establish a lasting blood supply is crucial for successful implantation. To do this, the blastocyst needs genes in order to create the required proteins for breaking down the endometrial cellular matrix, control cell development, and trigger angiogenesis.

It can be difficult to understand the evidence on the efficacy and security of therapy for unexplained infertility. Given the substantial proportion of unaided pregnancies with expectant management, it is problematic that most studies do not include a placebo or untreated control group.

Enrollment: 900 patients

Sex: Female

Ages: 18 to 35 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Saudi women.
• Married women in a stable, continuous, unprotected heterosexual relationship (cohabitating with their husbands).
• Aged between 18 to 35 years old.
• Non-smoking.
• Non-alcohol drinking.
• With a body mass index < 30 Kg/M2,
• Who are looking healthy (all their infertility-workup investigations including male partners' seminal analysis were within normal range)
• Failed to conceive spontaneously within 2 years of marriage without evident cause (cases with primary infertility).

Exclusion criteria

• All non-Saudi women,
• Saudi unmarried women (not yet engaged in sexual activity),
• Married women with age less than 18 or more than 35 years old,
• Patients with secondary infertility,
• Cigarette smokers.
• Alcohol drinking.
• BMI > 30 Kg/M2,
• Pregnant women.
• Breastfeeding women.
• With known pathological cause (either male or female factor),
• With hypersensitivity to any of medication planned to be used in the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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900 participants in 3 patient groups, including a placebo group

Sildenafil & Clomiphene Group

Active Comparator group

Description:

Sildenafil Acetate (Viagra®) 25 mg as a vaginal tablet 6 hourly for 10 days starting from the fifth day of the menstrual cycle + Clomiphene Citrate (Clomid®) 100 mg for 5 days starting from the second day of the menstrual cycle. Follow-up by resistance index (RI), pulsatility index (PI), and maximum velocity (T-max) of sub-endometrial, uterine, and ovarian vessels measured by using TVS Colour Doppler ultrasound.

Treatment:

Drug: Sildenafil Citrate

Drug: Clomiphene Citrate.

IUI & Clomiphene Group

Active Comparator group

Description:

Clomiphene Citrate (Clomid®) 100 mg for 5 days starting from the second day of the menstrual cycle + Intrauterine insemination (IUI) 42 hours after human chorionic gonadotropin (Pregnyl®) 10,000 IU injection IM. Follow-up by resistance index (RI), pulsatility index (PI), and maximum velocity (T-max) of sub-endometrial, uterine, and ovarian vessels measured by using TVS Colour Doppler ultrasound.

Treatment:

Procedure: Intrauterine Insemination

Drug: Clomiphene Citrate.

Clomiphene only Group

Placebo Comparator group

Description:

Clomiphene Citrate (Clomid®) 100 mg for 5 days starting from the second day of the menstrual cycle. Follow-up by resistance index (RI), pulsatility index (PI), and maximum velocity (T-max) of sub-endometrial, uterine, and ovarian vessels measured by using TVS Colour Doppler ultrasound.

Treatment:

Drug: Clomiphene Citrate.