Adding the phytoestrogen Cimicifugae Racemosae to clomiphene induction cycles with timed intercourse in polycystic ovary syndrome improves cycle outcomes and pregnancy rates - a randomized trial

• Published in: Gynecological endocrinology Vol. 30; no. 7; pp. 505 - 510
• Main Authors: Shahin, Ahmed Y., Mohammed, Safwat A.
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01.07.2014; Taylor & Francis
• Subjects: Adult; Black cohosh; Chi-Square Distribution; Cimicifuga - chemistry; cimicifugae racemosae; clomiphene; Clomiphene - administration & dosage; Estradiol - blood; Female; Fertility Agents, Female - administration & dosage; Follicle Stimulating Hormone - blood; Humans; Infertility, Female - blood; Infertility, Female - drug therapy; Luteinizing Hormone - blood; Male; Ovulation Induction - methods; Ovulation Induction - standards; phytoestrogens; Phytotherapy - methods; Phytotherapy - standards; Plant Extracts - administration & dosage; polycystic ovary; Polycystic Ovary Syndrome - blood; Polycystic Ovary Syndrome - drug therapy; Pregnancy; Progesterone - blood; cimicifugae racemosae; phytoestrogens; clomiphene; Black cohosh; polycystic ovary
• ISSN: 0951-3590; 1473-0766
• DOI: 10.3109/09513590.2014.895983

Abstract Background: Owing to their potential to act as estrogen receptor modulators and interfere with aromatase enzyme in animal studies, phytoestrogens (PE) may be useful as part of ovulation induction for polycystic ovary syndrome (PCOS). Patients and methods: Patients <35 years, presenting with infertility and PCOS, were included and randomly allocated to either group I (clomiphene citrate; CC) or group II (CC plus Cimicifugae racemosae; CR). Primary outcome was pregnancy rate. Secondary outcomes included ovulation, midcycle serum estradiol and luteinizing hormone (LH) as well as mid-luteal serum progesterone. Results: Analysis included 98 patients in group I versus 96 patients in group II. Both groups were matched regarding demographics and basic data. Significant differences were elicited when comparing days until HCG injection (15.0 ± 1.7 versus 12.0 ± 1.9, p = 0.91), endometrial thickness (mm) (8.5 ± 1.9 versus 12.5 ± 1.9, p < 0.001), serum levels of mid-luteal and midcycle estradiol (p < 0.001; Figure 2), LH (IU/ml) (p < 0.001) as well as mid-luteal progesterone (p < 0.001). PE plus CC group had significantly higher clinical pregnancies per cycle (33/192 (17.2%) versus 71/204 (34.8%), p < 0.01), compared to the CC only group. Conclusions: Adding CR to clomiphene-induction cycles with timed intercourse in polycystic ovarian syndrome improves cycle outcomes and pregnancy rates.