Infertility, Female
Conditions
Keywords
Anovulatory, Clomiphene
Brief summary
The purpose of this study is to match the genetic component and clinical attributes of anovulatory patients with response to clomiphene treatment. By improving our understanding on patient-specific clomiphene response will allow optimization of treatment, reduction of side-effects and shorten the time-to-pregnancy.
Detailed description
Anovulation is the commonest cause for infertility, with clomiphene being the standard treatment. Pharmacogenetic causes of variability in the pharmacokinetics and pharmacodynamics of clomiphene is not well characterized in anovulatory Asian women. Although recent findings suggest that the pharmacokinetics and pharmacodynamics of clomiphene may be influenced by several polygenic pathways involving genes regulating its metabolism (CYP3A4, CYP3A5, CYP2B6, CYP2C8, CYP2C19, CYP2D6), thus contributing significantly to the wide variability in dose-response relationships observed in clinical practice. There has not been objective evidence thus far from an unbiased genome-wide perspective. It is likely that polymorphisms at the CYP cluster of genes encoding for their respective cytochrome proteins may not explain all of the variability with regards to clomiphene's dose-response relationship. The investigators hypothesize that the pharmacokinetics and pharmacodynamics of clomiphene is under strong control by genetic loci and that these genetic variants could also strongly determine the therapeutic outcome in Asian normogonadotrophic anovulatory patients. The contribution by candidate genes mentioned above will also be clarified in a definitive manner by this study.
Interventions
None listed
Sponsors
National Cancer Centre, Singapore
KK Women's and Children's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
21 Years to 43 Years
Healthy volunteers
No
Inclusion criteria
* Women of reproductive age with ovulatory dysfunction desiring pregnancy, * Willing to discontinue any form of herbal or traditional chinese medicines for at least three weeks before starting Clomiphene * Ability to provide written and informed consent taken from participating patients, and * Willingness to cooperate with study instructions
Exclusion criteria
* Pregnant at the time of recruitment, * Ovarian cysts more than 5cm, * Abnormal menorrhagia at the time of study recruitment, * Abnormal liver function or active liver disease, * Presence of neoplastic lesions of any type, * Primary pituitary or ovarian failure (Type I and III World Health Organisation \[WHO\] Infertility) * Patients with previous treatment with ovulation inducing agents such as follicle stimulating hormone (FSH) and luteinising hormone releasing hormone-analogues (LHRH-analogues); * Infertility due to other endocrine abnormalities such as hyperprolactinaemia, hypo/hyperthyroidism, premature ovarian failure, diabetes or male factor * Allergy to clomiphene. * Fallopian tubal pathology (hydrosalpinges, previous salpingectomies) * Patients on any drugs with potential to interact with CYP2D6 such as the selective serotonin receptor uptake inhibitors (ex. Venlafaxine, paroxitene, fluoxetine)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Achievement of successful ovulation | Day 20-23 of menses cycle | Successful ovulation is defined as a mid-luteal phase serum progesterone level of \>20 nmol/L. |
Countries
Singapore
Outcome results
None listed