Tamoxifen: an alternative approach in clomiphene resistant polycystic ovarian syndrome patients.

Twenty patients with ultrasound diagnosed polycystic ovaries and high luteinizing hormone levels who failed to respond to clomiphene citrate were given tamoxifen to induce ovulation. Tamoxifen 20 mg daily (group 1, n = 10) and 40 mg daily (group 2, n = 10) was given for 5 consecutive days from the third to seventh day of the cycle. Treatment was monitored by serial ultrasound scans and assessment of serum estradiol. Human chorionic gonadotrophin (hCG) was administered when at least one follicle was > 16mm and serum estradiol level was > 300 pg/ml per follicle. Ovulation was confirmed with detection of the follicular rupture ultrasonographically 2 days after hCG and midluteal progesterone levels. The ovulation rate achieved in group 2 patients was significantly higher (p = 0.01) than group 1. Three pregnancies were achieved in group 2 patients while there was no pregnancy in group 1. The only side effect was ovarian cyst formation in one patient in group 1. As a result, tamoxifen might be a good choice for clomiphene resistant patients prior to treatment with surgery or hMG.