Abstract
Purpose
This study was carried out to evaluate the potential role of the combination clomiphene citrate/human menopausal gonadotropin (CC/hMG) for patients who failed previous in vitrofertilization (IVF) attempts with gonadotropin-releasing hormone analogs (GnRH- a) and/ or exogenous 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, length of stimulation, and peak estradiol levels did not differ significantly between the two regimens.
Results
Although fewer oocytes were retrieved 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 successive cycles in those women who conceived with the CC/hMG stimulation, 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.
Conclusion
Selected patients who failed previous IVF attempts with gonadotropins with or without GnRH analogs may benefit from the addition of CC to their ovarian stimulation protocol.
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References
Benadiva CA, Ben-Rafael Z, Strauss JF, Mastroianni L Jr, Flickinger GL: Ovarian response of individuals to different doses of human menopausal gonadotropin. Fertil Steril 1988;49:997
van Hoof MHA, Alberda AT, Huisman GJ, Zeilmaker GH, Leerentveld RA: Doubling the human menopausal gonadotropin dose in the course of an in-vitro fertilization treatment cycle in low responders: a randomized study. Hum Reprod 1993;8:369
Lejeune B, Barlow P, Puissant F, Delvigne A., Vanrysselberge M, Leroy F: Use of buserelin acetate in an in vitro fertilization program: a comparison with classical clomiphene citrate-human menopausal gonadotropin treatment. Fertil Steril 1990;54:475
Tummon IS, Daniel SAJ, Kaplan BR, Nisker JA, Yuzpe AA: Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles of in vitro fertilization. Fertil Steril 1992;58:563
Dor J, Ben-Shlomo I, Levran D, Rudak E, Yunish M, Mashiach S: The relative success of gonadotropin-releasing hormone analogue, clomiphene citrate, and gonadotropin in 1,099 cycles of in vitro fertilization. Fertil Steril 1992;58:986
Liu H-C, Lai Y-M, Davis O, Berkeley AS, Graf M, Grifo J, Cohen J, Rosenwaks Z: Improved pregnancy outcome with gonadotropin releasing hormone agonist stimulation is due to the improvement in oocyte quantity rather than quality. J Assist Reprod Genet 1992;9:338
Diamond MP, Hill GA, Webster BW, Herbert CM, Rogers BJ, Osteen Kg, Maxson WS, Vaughn KW, Wentz AC: Comparison of human menopausal gonadotropin, clomiphene citrate, and combined human menopausal gonadotropin-clomiphene citrate stimulation protocols for in vitro fertilization. Fertil Steril 1986;46:1108
Ron-El R, Caspi E, Golan A, Nachum H, Herman A, Soffer Y, Weinraub Z: A comparison of clomiphene/menotropins andd-Trp6-LH-RH/menotropins cycles of IVF-ET in the same patient. Int J Fertil 1991;36:157
Pellicer A, Lightman A, Diamond MP, Russell JB, de Cherney A: Outcome of in vitro fertilization in women with low response to ovarian stimulation. Fertil Steril 1987;47:812
Ben-Rafael Z, Strauss JF III, Mastroianni L Jr, Flickinger GL: Differences in ovarian stimulation in human menopausal gonadotropin treated women may be related to follicle-stimulating hormone accumulation. Fertil Steril 1986;46:586
Tanbo T, Dale PO, Abyholm T, Stokke KT: Follicle-stimulating hormone as a prognostic indicator in clomiphene citrate/human menopausal gonadotropin-stimulated cycles for in-vitro fertilization. Hum Reprod 1989;4:647
Ferrier A, Rasweiler JJ IV, Bedford JM, Prey K, Berkeley AS: Evaluation of leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins for in vitro fertilization or gamete intrafallopian transfer. Fertil Steril 1990;54:90
Adashi E: Clomiphene citrate: mechanism(s) and site(s) of action—a hypothesis revisited. Fertil Steril 1984;42:331
Sato F, Marrs RP: Effect of ovarian hyperstimulation on chromosome aberration and sister chromatid exchange in in vitro fertilization. Fertil Steril 1984;41:24S
Sato F, Marrs RP: Effect of ovarian hyperstimulation on chromosome aberration and sister chromatid exchange on in vivo fertilized oocytes. Fertil Steril 1984;41:60S
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Benadiva, C.A., Davis, O., Kligman, I. et al. Clomiphene citrate and hMG: An alternative stimulation protocol for selected failed in vitro fertilization patients. J Assist Reprod Genet 12, 8–12 (1995). https://doi.org/10.1007/BF02214121
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DOI: https://doi.org/10.1007/BF02214121