CLOMIPHENE CITRATE AND HMG - AN ALTERNATIVE STIMULATION PROTOCOL FOR SELECTED FAILED IN-VITRO FERTILIZATION PATIENTS

Purpose: This study was carried out to evaluate the potential role of the combination clomiphene citrate/human menopausal gonadotropin (CC/h MG) for patients who failed previous in vitro fertilization (IVF) atte mpts with gonadotropin-releasing hormone analogs (GnRH-a) and/or exoge nous 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, leng th of stimulation, and peak estradiol levels did not differ significan tly between the two regimens. Results: Although fewer oocytes were ret rieved 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 s uccessive cycles in those women who conceived with the CC/hMG stimulat ion, 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. Conclusio n: Selected patients who failed previous IVF attempts with gonadotropi ns with or without GnRH analogs may benefit from the addition of CC to their ovarian stimulation protocol.