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Human Reproduction, Vol. 8, No. 1, pp. 56-59, 1993
© 1993 European Society of Human Reproduction and Embryology

other

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

Richard P. Dickey1, Terry T. Olar, Steven N. Taylor, David N. Curole and Phillip H. Rye

The Fertility Institute of New Orleans and Tulane University School of Medicine New Orleans, LA 70128, USA

Correspondence: 1To whom correspondence should be addressed at: 6020 Bullard Avenue, New Orleans, LA 70128, USA

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.

Key words: clomiphene citrate/fecundity/human menopausal gonadotrophin/multiple pregnancy/ovulation induction


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