In a nutshell
This study examined whether amlodipine (Norvasc) can improve blood flow to the ovaries in women with polycystic ovarian syndrome (PCOS). This study found that patients given amlodipine had improved blood flow and higher rates of pregnancy during treatment with clomiphene citrate (Clomid).
PCOS is a female metabolic disorder. It is a common cause of infertility in women that affects ovulation (release of eggs). PCOS may be related to insulin resistance, where the body's cells do not respond to insulin. Individuals with insulin resistance are at risk of hardening and narrowing of blood vessels, which reduces blood flow. Less blood flow to the ovaries and uterus may be one of the reasons PCOS causes infertility.
Infertility due to PCOS is often treated with clomiphene citrate (CC). CC is an estrogen-like medication which can cause ovulation. However, CC reduces the number of blood vessels reaching ovary follicles, where eggs are produced. It also thins the lining of the uterus, which can interfere with pregnancy. Amlodipine is a medication that widens blood vessels. It is unclear whether amlodipine can increase blood flow to the ovaries and uterus in women with PCOS during CC treatment.
Methods & findings
This study included 124 women with infertility and PCOS. These patients did not respond to previous treatment with CC. In this study, 62 patients received both CC and amlodipine. The other half (62 patients) received CC and a placebo (an inactive substance).
A special type of ultrasound was used to measure blood flow around the ovaries. How well blood flows is indicated by a value called the pulsatility index (PI). A high PI value indicates poor blood flow. The average PI value in the amlodipine group was significantly lower than the control group (1.36 vs. 1.82).
More women taking amlodipine developed at least one mature follicle compared to the control group (73% vs. 32%). The lining of the womb was significantly thicker in women taking amlodipine (8.99 vs. 7.00 mm). 8 days after the mature follicle was detected, women taking amlodipine had significantly higher levels of progesterone (14.78 vs. 8.94 ng/ml). Women taking amlodipine were significantly more likely to become pregnant (37% vs. 11%).
No women experienced overstimulation from CC. 11% of patients taking amlodipine reported dizziness.
The bottom line
This study found that adding amlodipine to CC made ovulation more likely, thickened the lining of the womb, and increased pregnancy rates among women with PCOS.
The fine print
Amlodipine was given after the dominant follicle was chosen, to reduce the risk of multiple follicles (polycystic ovaries). More studies are needed to confirm the benefits of amlodipine.
If you have not responded to previous cycles of CC, ask your doctor about blood pressure medications such as amlodipine.
Published By :
Archives of Gynecology and Obstetrics
Feb 29, 2020