Comparison of human menopausal gonadotropin stimulation with and without clomiphene forin-vitrofertilisation in poor-responders

Abstract

This study aimed to determine the effectiveness of human menopausal gonadotropin (hMG) with and without clomiphene citrate (CC) for ovarian stimulation and oocyte retrieval in poor-responders. A total of 66 cycles in 13 patients met the inclusion criteria of 20 cycles of hMG stimulation and 46 cycles of CC + hMG stimulation. Mean total hMG dose per patient was significantly lower during the stimulation cycle with CC + hMG than with hMG alone. Mean oestradiol level at oocyte retrieval and mean number of oocytes retrieved per patient showed no significant differences between the two cycles. Four of the 13 patients achieved pregnancy with the CC + hMG cycles. The absence of a significant difference in oestradiol level at oocyte retrieval or in the number of oocytes retrieved between the two cycles, despite a significantly lower total hMG dose during the CC + hMG stimulation cycles, suggests a greater benefit of CC + hMG stimulation for poor-responders.

Effect of simultaneously started clomiphene citrate and gonadotropins in antagonist regimes, on cumulative live births, fresh‐cycle live births and cost of stimulation in IVF cycles

“…Gn in this study were started simultaneously with CC and continued till the penultimate day of hCG. This is in contrast to the previous studies that employ Gn sequentially after CC . To study the effect of simultaneous versus sequential addition of Gn to CC, Tavaniotou randomized 46 non‐PCOS, nonpoor responder women into receiving two regimes of CC with Gn addition in antagonist protocol in IVF.…”

“…Minimal stimulation regimes employing an oral agent like clomiphene citrate (CC) or letrozole and mild stimulation regimes employing an oral agent along with sequentially administered low‐dose gonadotropins (Gn) (75–150 IU) have proven to be cheaper and patient friendly by employing far fewer Gn ampoules administered over fewer days. They have also proven to be equally effective in terms of live birth rates in the subset of poor responders when compared with long agonist regimes, or even against conventional antagonist regimes . The logic perhaps remains that high‐dose Gn do not achieve much in terms of oocyte recovery (OCR) in poor responders, while minimal stimulation allows for quality over quantity.…”

Optimal individualization of patient‐oriented ovarian stimulation in Japanese assisted reproductive technology clinics, a review for unique setting with advanced‐age patients

“…23 There are a wide variety of mild stimulation protocols, such as 100-150 IU of hMG or FSH every day or 150-225 IU of hMG or FSH every other day from 3 to 5 days after the start of menstruation with or without clomiphene citrate or letrozole (aromatase inhibitor) as oral medicine. [24][25][26][27] GnRH antagonist is used for LH surge suppression as necessary. Recently, a novel ovarian stimulation protocol, progestinprimed ovarian stimulation with gonadotropin in combination with progestin for LH surge suppression, has been reported.…”

“…Mild stimulation protocol is defined as ovarian stimulation using a lower dose of gonadotropin or a shorter duration of gonadotropin administration, or both, compared with conventional stimulation protocols 23 . There are a wide variety of mild stimulation protocols, such as 100–150 IU of hMG or FSH every day or 150–225 IU of hMG or FSH every other day from 3 to 5 days after the start of menstruation with or without clomiphene citrate or letrozole (aromatase inhibitor) as oral medicine 24–27 . GnRH antagonist is used for LH surge suppression as necessary.…”