Use of clomiphene to prevent premature luteinizing hormone surge during controlled ovarian hyper stimulation

Authors

  • Shilpa Bhandari Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and PG Institute, Indore, MP, India
  • Ishita Ganguly Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and PG Institute, Indore, MP, India
  • Priya Bhave Chittawar Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and PG Institute, Indore, MP, India
  • Pallavi Agarwal Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and PG Institute, Indore, MP, India
  • Aparna Singh Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and PG Institute, Indore, MP, India
  • Nitika Gupta Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and PG Institute, Indore, MP, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20161695

Keywords:

Clomiphene citrate, LH surge, In vitro fertilization, Ovarian stimulation

Abstract

Background: This study seeks to evaluate concurrent use of clomiphene to block spontaneous LH surge in controlled ovarian stimulation in patients with good ovarian reserve.

Methods: Thirty five fertile donors with good antral count were stimulated from day 1 or 2 of spontaneous or withdrawal bleeds with clomiphene citrate and recombinant FSH. Transvaginal oocyte retrieval was done after 34 hours of trigger.   An LH surge was defined as an LH level ≥10 mIU/ml with progesterone elevation (≥1.0 ng/ml). Fertilization and Embryo quality was assessed from day 2 onwards. Each recipient was transferred a maximum of 3 embryos and remaining were cryopreserved.

Results: After an average stimulation of 8.65 days, 15.4 oocytes were retrieved per stimulation. LH surge was noted in 3 cases (9.68%) though oocyte retrieval was done in all cases. Fresh embryo transfer was done in respective recipients of all cases with an implantation rate of 61.29% and a cumulative live birth rate of 42%.

Conclusions: Controlled ovarian stimulation using clomiphene and gonadotropin is a viable option to prevent LH surge without additional use of antagonist.

References

Ahmed RY, Mohamed BA, Hesham G, Al- Inany. Clomiphene-acetyl cysteine combination as a new protocol to a friendly IVF cycle. Middle East Fertil Soc J. 2005;10(2):130-4.

Frederikke BL, Gitte JA, Svend L. Low Ovarian Stimulation Using Tamoxifen/FSH Compared to Conventional IVF: A Cohort Comparative Study in Conventional IVF Treatments. Reprod Sys Sexual Disorders. 2013;S2:005

Gibreel A, Maheshwari A, Bhattacharya S. Clomiphene citrate in combination with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilization. Cochrane Database Syst Rev. 2012;11:CD008528.

Hojgaard A, Ingerslev HJ, Dinesen J. Friendly IVF: patient opinions. HumReprod. 2001;16(7):1391-6.

Li TC, Warren MA, Murphy C, Sargeant S, Cooke ID. A prospective, randomised, cross-over study comparing the effects of clomiphene citrate and cyclofenil on endometrial morphology in the luteal phase of normal, fertile women. Br J ObstetGynaecol. 1992;99(12):1008-13.

Matsunaga R, Kamihata M, Watanabe S, Kuwahata A,Ochi M. Comparison of embryo developmental competence derived from letrozole and clomiphene citrate for ovarian stimulation in elderly infertile women.FertilSteril. 2013;100(3):S250.

Segawa T, Kato K, Miyauchi O, Kawachiya S, Takehara Y, Kato O. Evaluation of minimal stimulation IVF with clomiphene citrate and hMGSegawa. Fertil Steril. 2007;88(1):S286.

ShrutiG, Ruma S, Abha M, Shweta M, Neeti T.(2015). Clomiphene based ovarian stimulation in commercial donor program.Journal of Human Reproductive Sciences.8(3):142-145

Teramoto S, Kato O. Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective study. Reproductive BioMedicine Online. 2007;15(2):134-48.

Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15:5-12.

Williams SC, Toner JP, Oehninger S, Donahue J, Jones D, Muasher SJ. Minimal Controlled Ovarian Hyperstimulation (COH) Using Clomiphene Citrate/Gonadotropin for IVF/ET: Equivalent Results Compared to the Standard Long Stimulation Protocol with a Significant Reduction in Cost. Fertility and Sterility. 2000;74(3):S230-1.

Zhang J, Chang L, Sone Y, Silber S. Minimal ovarian stimulation (mini-IVF) for IVF utilizing vitrification and cryopreserved embryo transfer. Reproductive BioMedicine Online. 2010;21:485-95.

Downloads

Published

2017-01-05

Issue

Section

Original Research Articles