| AIM: Ovulation dysfunction is one of the most common reason of infertility in women,.and CC is successful at inducing ovulation in 50%-75% of cases , but the number of pregnancies achieved after ovulation induction is much lower than expected ,which is about 30%. This discrepancy has been attributed to antiestrogenic nature of CC .Prognova(PGV) ,which is estradiol valerate and may have antiestrogenic action of CC. The aim of this article was to study the antiestrogenic effects in CC induced ovulation and how to improve pregnancy rate ,in addition .comparing with human menopausal gonadotropins of inducing ovuluation.METHODS: A total of 107 patients were randomly recruited in a double-blind manner in three groups .The inclusion criteria were age between 22 and 38 years, the average age was 28; average infertility years was 5.3 ,and the longest was 13 years . All patients were carefully examined before they entered the study and no patient had received fertility medications in the past. The patients were excluded whose husband had an abnormal semen analysis according to World Health Organization criteria or who had uterine or tubal abnormalities on hysterosalpingography or immunity in infertility. All of the patients underwent with the transvagial ultrasound to identify the endometrium thickness, type and uterocervical score and numbered the mature follicles;at the same time, used ELISA to determined the concentrations of serum estradiol (E2) and progesterone (P) at the maturate of corpus luteum. At last, the pregnancy rate of the three groups were compared.RESULTS: (1 ) In the periovulation phase, the thickness of endometrium and the uterocervical score about CC+PGV, HMG group were [( 11.8±2.3)mm, (10.8±0.9)] and [(11.2 ±1.8)mm ,(10.2±1.6)], while CC group [(8.2±1.2)mm, (8.7±1.5)] were obviously lower than that of other groups ( 7J<0.05 ); There were no difference about the eho endometrium type among the three groups; The number of mature follicles and the concentration of P at the maturate of corpus luteum in HMG group [(5.3±1.5) and (16.7±2.4) ug.L-1] were much more than CC, CC+PGV group [(3.9± 0.8), (3.1±1.7) and (12.9±0.8) ug.L-1, (14.6±1.7) ug.L-1](y<0.01) and compared with the latter, there were obviously different (P<0.05,P<0.01) ; Compared with the concentration of the E2, HMG group [(559± 187) ng.L-1 ] were obviously higher than CC, CC+PGV group [(189± 73) ng.L-1 and (226±107)ng. L-1] (P<0.01), The three groups of pregnancy rates were 11.1%, 31.6%, 39.4% , respectively; CC+PGV and HMG group were significantly higher than CC group(,P<0.05,P<0.01); Ovarian hyperstimulation syndrome (OHSS) cases taken place in the CC, CC+PGV, HMG group were 0,0,2, respectively; The incidence of miscarrige cases were 2,2,1; The number of unresponse were 2,1,1.CONCLUSION: The ability of CC to antagonize estrogen actions may prevent endometrial development and cervical mucus ,which may probably cause endometrial development not to keep pace with fertilized oocytes. This was the reason of the low pregnancy rate. CC comdined with PGV stimulate endometrial development and improve untercerical marks and endometrial receptivity in the CC induced cycles, which will be preparations of the implanation at some drgree. There is some useful of decreasing incident of luteal phase deficiency in association with PGV used in colmiphene citrate treatment and improved the pregnancy rate indeed: so a new way was found in clinical infertility treatment, which was safe .economical and effective one .
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