Function and Sexual Satisfaction of Women Treated with Two Types of Ovulation Stimulant Drugs: Clomiphene and Letrozole

Document Type : Original Article

Authors

1 M.Sc. student of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Assistant professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Introduction: Infertility is one of the factors which have a significant effect on the sexual performance of couples, especially women. Infertility can affect sexual activity in infertile couples. On the other hand, ovulation stimulation therapies for infertility treatment can inhibit estrogen and thus reduce women's sexual function and satisfaction. Therefore, this study was performed with aim to determine and compare the sexual performance and satisfaction of women treated with two types of ovulation stimulant drugs: clomiphene and letrozole.
Methods: This two-group analytical study was performed on 80 infertile women referred to infertility centers in Isfahan province in 2019. The research tools were the questionnaires of Beck, sexual function and sexual satisfaction, which were completed twice before and after receiving clomiphene and letrozole. Data were analyzed by SPSS software (version 22) and Independent t-test, Mann-Whitney, Chi-square, Paired t-test, Wilcoxon and Friedman tests. P<0.05 was considered statistically significant.
Results: In intra-group comparison, there was no statistically significant difference before and after drug administration in the variables of sexual satisfaction (p=0.053) and sexual function (p=0.057), but in inter-group comparison, there was a statistically significant difference in sexual function of the clomiphene group (P <0.001); lower sexual function was reported after clomiphene use than before its use, but in terms of sexual satisfaction in the clomiphene group, no significant difference was reported before and after receiving the drug (p>0.05). There was no significant difference in letrozole group before and after drug administration in both variables of sexual function and satisfaction (p=0.053).
Conclusion: The score of sexual performance decreased in the clomiphene group, but sexual satisfaction did not show any difference in any of the groups. In other words, women's sexual function is affected by many factors, one of which is the use of assisted reproductive drugs, including clomiphene. Clomiphene inhibits vaginal moisture by inhibiting estrogen, which can cause pain and reduce sexual arousal, orgasm, and libido in women. For this purpose, it is recommended that active people in the field of infertility pay attention to this issue.

Keywords


  1. Direkvand-Moghadam A, Delpisheh A, Direkvand-Moghadam A. Effect of infertility on the quality of life, a cross-sectional study. Journal of clinical and diagnostic research: JCDR 2014; 8(10):OC13.
  2. Cui W. Mother or nothing: the agony of infertility. World Health Organization. Bulletin of the World Health Organization 2010; 88(12):881.
  3. Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 8nd ed. lippincott Williams & wilkins; 2012.
  4. Mostafa AM, Khamis Y, Helmy HK, Arafa AE, Abbas AM. Prevalence and patterns of female sexual dysfunction among overweight and obese premenopausal women in Upper Egypt; a cross sectional study. Middle East Fertility Society Journal 2018; 23(1):68-71.
  5. Bokaie M, Simbar M, Yassini AS, Alavi MH. How infertility effects on sexual function of infertile couples? Advances in Nursing and Midwifery (Faculty of Nursing of Midwifery Quarterly) 2016; 25(91):47-56.
  6. Khodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R. Life experience with infertility; a phenomenological study. Journal of Reproduction & Infertility 2010; 10(4).
  7. Alirezaei S. Effects of infertility on female sexual function. Iran J Obstet Gynecol Infertil 2017; 19(40):91-101.
  8. Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BmJ 2011; 342.
  9. Bokaie M, Simbar M, Ardekani SM. Sexual behavior of infertile women: a qualitative study. Iranian journal of reproductive medicine 2015; 13(10):645-56.
  10. Faubion SS, Rullo JE. Sexual dysfunction in women: a practical approach. American family physician 2015; 92(4):281-8.
  11. Marci R, Graziano A, Piva I, Monte GL, Soave I, Giugliano E, et al. Procreative sex in infertile couples: the decay of pleasure?. Health and quality of life outcomes 2012; 10(1):1-7.
  12. Emre Seli, MDAydin Arici, MD up to date Literature review current through: Jun 2020. | This topic last updated: Jun 02, 2019
  13. Burstein HJ, Lacchetti C, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, et al. Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update on Ovarian Suppression. J Clin Oncol 2016; 34(14):1689-701.
  14. Berek JS. Berek & Novak's gynecology. 15nd ed. Lippincott Williams & Wilkins; 2012.
  15. Rohina SA, Vineet VM, Navin AP, Nital HP, Vrushali VD, Anil FJ. Incidence and Prevalence of Sexual Dysfunction in Infertile Females. Bangladesh Journal of Obstetrics & Gynaecology 2013; 28(1):26-30.
  16. Keskin U, Coksuer H, Gungor S, Ercan CM, Karasahin KE, Baser I. Differences in prevalence of sexual dysfunction between primary and secondary infertile women. Fertility and sterility 2011; 96(5):1213-7.
  17. Mofid V, Fatehizadeh M, Ahmadi A, Etemadi O. The effect of solution-focused counseling on sexual satisfaction and family function among women in isfahan. Knowledge & Research in Applid Psychology 2015; 17(3):73-80.
  18. Millheiser LS, Helmer AE, Quintero RB, Westphal LM, Milki AA, Lathi RB. Is infertility a risk factor for female sexual dysfunction? A case-control study. Fertility and sterility 2010; 94(6):2022-5.
  19. Shifren JL, Barbieri R, Falk S. Sexual dysfunction in women: Epidemiology, risk factors, and evaluation. UpToDate. Waltham, MA: UpToDate. 2018.
  20. Bakhshayesh AR, Mortazavi M. The relationship between sexual satisfaction, general health and marital satisfaction in couples. Journal of Applied Psychology 2010; 3(4):73-85.
  21. Daniluk JC. Keeping your Sexlife alive while coping with Infertility. J Sex Marital Ther 2002; 71(6):1241-3.
  22. De Mendonca CR, Arruda JT, Noll M, Paulo MD, do Amaral WN. Sexual dysfunction in infertile women: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2017; 215:153-63.
  23. Hashemi S, Ramezani Tehrani F, Noroozzadeh M, Rostami Dovom M, Azizi F. Infertility, the Most Adverse Outcome Among Sexual Function Outcome Affecting of Iranian Women with Polycystic Ovarian Syndrome. Iranian Journal of Endocrinology and Metabolism 2014; 16(3) :197-204
  24. Bakhtiari A, Basirat Z, Nasiri-Amiri F. Sexual dysfunction in women undergoing fertility treatment in Iran: prevalence and associated risk factors. Journal of reproduction & infertility 2016; 17(1):26.
  25. Tamanaei-Far S, Mohammadkhani P, Pourshahbaz A. Relationship between Comorbidity of Cluster Personality Disorders with Major Depression Disorder and Depression Relapse. jrehab 2008; 9(3 and 4):57-62
  26. Jazini S, Abdollahi N, Amanelahi A, Aslani K. Predicting the Sexual Function based on Attachment Styles, Self-Differentiation and Aducation among Married Female Students in Ahwaz. Journal of Psychological Studies 2018; 13(4):43-58.
  27. Bahrami N, Yaghoobzadeh A, Sharif Nia H, Soliemani M, Haghdoost A. Psychometric properties of the Persian version of Larsons sexual satisfaction questionnaire in a sample of Iranian infertile couples. Iranian Journal of Epidemiology 2016; 12(2):18-31.
  28. Masoumi SZ, Garousian M, Khani S, Oliaei SR, Shayan A. Comparison of quality of life, sexual satisfaction and marital satisfaction between fertile and infertile couples. International journal of fertility & sterility 2016; 10(3):290-96.
  29. Nourani S, Jonaidy E, Shakeri MT, Mokhber N. Sexual satisfaction in fertile and infertile women attending state clinics in Mashad. Journal of Reproduction & Infertility 2010; 10(4):269-77.
  30. Mirblouk F, Asgharnia M, Solimani R, Fakor F, Salamat F, Mansoori S. Comparison of sexual dysfunction in women with infertility and without infertility referred to Al-Zahra Hospital in 2013-2014. Int J Reprod BioMed 2016; 14(2):117-124.
  31. Alirezaei S, Ozgoli G, Majd HA. Evaluation of factors associated with sexual function in infertile women. International journal of fertility & sterility 2018; 12(2):125-29.
  32. Czyżkowska A, Awruk K, Janowski K. Sexual satisfaction and sexual reactivity in infertile women: the contribution of the dyadic functioning and clinical variables. International journal of fertility & sterility 2016; 9(4):465-76.
  33. Dahir M, Travers‐Gustafson D. Breast cancer, aromatase inhibitor therapy, and sexual functioning: a pilot study of the effects of vaginal testosterone therapy. Sexual medicine 2014; 2(1):8-15.
  34. Lemke EA, Madsen LT, Dains JE. Vaginal Testosterone for Management of Aromatase Inhibitor–Related Sexual Dysfunction: An Integrative Review. InOncology nursing forum 2017; 44(3):296-301.
  35. Morales L, Neven P, Timmerman D, Christiaens MR, Vergote I, Van Limbergen E, et al. Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients. Anti-cancer drugs 2004; 15(8):753-60.