Outcome of in-vitro fertilization and embryo transfer after different regimens of ovarian stimulation.
Sixty-eight women with bilateral tubal disease and fertile male partners underwent ovarian stimulation in 187 cycles for IVF after randomization to different ovulation induction regimens. All patients initially received 150 mg clomiphene citrate on days 5-9, this regimen induced sufficient stimulation in a smaller proportion of patients than the two other regimens used subsequently which included clomiphene in combination with human menopausal gonadotrophins (hMG). The fertilization rate was significantly reduced (52.4%) in oocytes collected from cycles stimulated with hMG alone (in a small sub-group of poor responders) compared with a rate of 64.1-66.4% in cycles stimulated with clomiphene alone or in combination with hMG. Embryonic development 44-48 h after insemination was significantly retarded when clomiphene alone was utilized but a higher proportion of fragmented or abnormal embryos was observed after stimulation with hMG alone. In 118 cycles embryo transfer was performed and 20 pregnancies were established, a pregnancy rate of 16.9%. All but two pregnancies were established when two or more embryos were transferred and when the embryos were at the 4-cell or later stage of development. The regimen of clomiphene in combination with 150 i.u. hMG resulted in significantly greater numbers of oocytes recovered and embryos available per patient for transfer than the other two regimens studied.
Imoedemhe
D A
DA
Academic Department of Obstetrics and Gynaecology, Royal Free Hospital School of Medicine, London.
Shaw
R W
RW
Bernard
A
A
Inglis
M
M
D006063:Chorionic Gonadotropin / Q000494:pharmacology; D002996:Clomiphene / Q000494:pharmacology; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D010062:Ovulation Induction / Q000379:methods*; D011897:Random Allocation
D006063:Chorionic Gonadotropin; D002996:Clomiphene