Clomiphene citrate and hMG: an alternative stimulation protocol for selected failed in vitro fertilization patients.
OBJECTIVE
This study was carried out to evaluate the potential role of the combination clomiphene citrate/human menopausal gonadotropin (CC/hMG) for patients who failed previous in vitro fertilization (IVF) attempts with gonadotropin-releasing hormone analogs (GnRH-a) and/or exogenous gonadotropins.


METHODS
Patients were stimulated with CC/hMG (n = 93) after unsuccessfully undergoing 182 gonadotropin cycles with (n = 106) or without (n = 76) luteal-phase GnRH-a. Cancellation rate, length of stimulation, and peak estradiol levels did not differ significantly between the two regimens.


RESULTS
Although fewer oocytes were retrieved when the CC/hMG combination was used, 16 patients were able to successfully achieve a pregnancy (26.2% delivery rate/transfer). When daily follicle stimulating hormone (FSH) levels were measured in two successive cycles in those women who conceived with the CC/hMG stimulation, baseline levels did not differ when compared with a previous GnRH-a/hMG cycle. Nevertheless, serum FSH levels rose rapidly and remained higher in the GnRH-a/hMG cycle, reaching significantly higher levels on day of human chorionic gonadotropin (hCG) administration.


CONCLUSIONS
Selected patients who failed previous IVF attempts with gonadotropins with or without GnRH analogs may benefit from the addition of CC to their ovarian stimulation protocol.
Benadiva
C A
CA
New York Hospital-Cornell Medical Center, Department of Obstetrics and Gynecology, New York 10021, USA.
Davis
O
O
Kligman
I
I
Liu
H C
HC
Rosenwaks
Z
Z
D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage / Q000494:pharmacology*; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage / Q000494:pharmacology; D008596:Menotropins / Q000008:administration & dosage / Q000494:pharmacology*; D010062:Ovulation Induction / Q000379:methods*; D010903:Pituitary Gland, Anterior / Q000187:drug effects; D011247:Pregnancy; D018873:Pregnancy Rate; D013480:Superovulation / Q000187:drug effects*; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone; D016729:Leuprolide