Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women.
OBJECTIVE
This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.


METHODS
A comparative prospective study.


METHODS
Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10-14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.


RESULTS
There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].


CONCLUSIONS
The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.
Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt. dr.ibrahimanwar@gmail.com
Ibrahim A
IA
Abdelazim
Hanan H
HH
Makhlouf
D000328:Adult; D002996:Clomiphene / Q000191:economics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D008596:Menotropins / Q000191:economics / Q000627:therapeutic use*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D005300:Fertility Agents, Female; D002996:Clomiphene; D008596:Menotropins