Use of Clopidogrel combined with Intrauterine Insemination and Ovulation Induction in Treatment of Unexplained Infertility: Randomized Control Trial

Abstract

Conclusion T he strengths of the current study include the double blind randomization design which disabled all personnel involved in the study to know the group allocation, the measurement of Doppler flow indices of uterine and subendometrial vessels. Pulsed Doppler ultrasonography is technically difficult especially with tiny vessels like subendometrial signals and spiral arteries and operator dependant. This may be a limitation to the wide spread use of this technique. In the current study all of the measurements have the operator was blinded to the groups and this may be considered as a positive effect on objective evaluation. Most of the Doppler studies were performed by a specified operator but some were done by other operators which might have led to difference in PI and RI values. Mid-luteal or peri-implantation period Doppler measurements as well as endometrial thickness and pattern should be considered in infertility patients and if impedance to uterine vasculature is found to be high or abnormal endometrial thickness and pattern these patients may become candidates for therapies increasing the luteal blood flow like aspirin or Clopidogreal in unexplained infertility and IVF patients. The current study showed no improvement in pregnancy rates or uterine blood flow from using Clopidogrel. However, the non significant difference may be due to the case number limitation. A larger case series is necessary to clarify the real value of Clopidogrel on improving pregnancy rate. On the other hand clearly there is definite benefit from using Clopidogreal in improving subendometrial blood flow and subsequently improving endometrial thickness and endometrial pattern. This positive effect on endometrial thickness was not demonstrated in previous studies using aspirin.