Clomiphene citrate is the treatment of first choice in the management
of infertility in normally oestrogenized, anovulatory women (WHO group
II). The majority of women with 'pure' anovulatory infertility respon
d to treatment with clomiphene citrate. The rates of pregnancy and mis
carriage are close to those expected in a normal fertile population. B
asal hormone concentrations do not predict outcome. An increased body
mass index is the only factor which is consistently associated with a
decreased response to clomiphene citrate; it follows therefore, that w
eight reduction should be an important part of therapy in anovulatory
women. According to our data, only an increased luteinizing hormone va
lue immediately post clomiphene citrate predicted an adverse pregnancy
outcome in women who conceived. Clomiphene citrate, along with other
ovulation induction therapies, can cause multiple follicular developme
nt, with a risk of ovarian hyperstimulation and multiple pregnancy. Ul
trasound monitoring of treatment is important in order to choose the a
ppropriate dose of clomiphene citrate in subsequent cycles and to mini
mize the risks of hyperstimulation and multiple pregnancy. When couple
s with other factors contributing to subfertility are excluded, the cu
mulative conception rate continues to rise after 6 months of treatment
with clomiphene citrate, reaches a plateau by treatment cycle 12 and
approaches that of the normal population. It has been reported that pr
olonged use of clomiphene citrate mag be associated with an increased
risk of a borderline or invasive ovarian tumour. Taking into considera
tion these observations, we recommend that anovulatory women responsiv
e to clomiphene citrate should be treated for at least 6 cycles before
considering more complex or invasive methods of ovulation induction,
and that treatment should probably be limited to a maximum of 12 cycle
s.