Sequential clomiphene citrate and human menopausal gonadotrophin for ovulation induction: comparison to clomiphene citrate alone and human menopausal gonadotrophin alone

Abstract

The need for frequent injections and monitoring, the possibility of multiple gestations, and the higher cost compared to clomiphene citrate, prevents many clinicians from using human menopausal gonadotrophin (HMG) for ovulation induction. A sequential medication regimen, in which HMG is taken after clomiphene, overcomes these problems. We retrospectively compared per cycle fecundity and birth rates in 119 cycles of clomiphene-HMG, 524 cycles of clomiphene alone, 57 cycles of HMG alone, and 79 cycles of concurrent HMG and clomiphene in patients receiving intra-uterine insemination (IUI), who were free of endometriosis or tubal disease. Per cycle fecundity for clomiphene-HMG was 22% [95% confidence interval (CI) 12-34%], double that of clomiphene alone (11%) (95% CI 8-14%) (P < 0.01), and equal to HMG alone (18%) (95% CI 7-29%) or HMG and clomiphene together (19%) (95% CI 10-28%). The multiple birth rate for clomiphene-HMG (7/21) equalled that for HMG alone (3/12) and HMG and clomiphene together (3/8). The average number of ampoules of HMG required [follicle stimulating hormone (FSH) 75 mIU, luteinizing hormone (LH) 75 mIU] was decreased by 65% from 24.5 +/- 1.0 for HMG or HMG and clomiphene together to 8.6 +/- 0.3 for clomiphene-HMG (P < 0.001). Per cycle fecundity was identical when one, two or three ampoules of HMG per day were administered after clomiphene. We conclude that ovulation induction with sequential clomiphene-HMG results in fecundity double that of clomiphene alone and equal to HMG alone or concurrent with clomiphene, thereby reducing the requirement for HMG.

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

“…It has been shown in many studies in the literature that the use of FSH and hMG is superior to CC use (24)(25)(26)(27). Although we observed that gestational rates were low in the CC group, we could not show the difference due to the small sample size.…”

Supplementation with estradiol valerate and gonadotropins in clomiphene citrate stimulated IUI cycles.

“…This is in agreement with other studies which show nearly doubling of estradiol levels per follicle in CC+HMG group compared with CC alone. 18 Good ovulation and pregnancy rates were achieved with CC with IUI in the current study. The overall ovulation rate was 91.3%.…”

“…Apparently, clomiphene regimen used in the current study does not have pronounced anti-estrogenic effects on the endometrium. A study carried out by Dickey et al 18 concluded that increased fecundity when HMG is administered after clomiphene compared to clomiphene alone is related to doubling of implantation rate per follicle. The estradiol level per follicle also nearly doubled for clomiphene-HMG compared to clomiphene alone.…”

“…There is also a controversy regarding supplementation with gonadotropins in CC stimulated IUI cycles, few authors have found increased pregnancy rates 18 while others have found no beneficial effect. 20,21 The current study attained higher pregnancy rates in gonadotropin supplemented groups but the results were not statistically significant.…”

Therapeutic Approach out of IVF of Ovulation Disorders in Sub-Saharian African

“…In our series we observed that 25.5% of our patients were overweight and 19.2% were obese. Authors like DICKEY [8] think that weight correction is essential and can alone restore ovulation.…”