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Low dose clomiphene citrate as a mild stimulation protocol in women with unsuspected poor in vitro fertilization result can generate more oocytes with optimal cumulative pregnancy rate.
J Ovarian Res. 2018 May 04; 11(1):37.JO

Abstract

BACKGROUND

The use of long protocol during controlled ovarian stimulation for assisted reproduction attracts high dosage of gonadotropins. High dose of gonadotropins can be detrimental to oocyte development, which affects its quality and compromises the treatment outcome. Mild stimulation protocols that attract low dose gonadotropins could be useful alternative regimen to address such problems. This study evaluated the efficacy of low dose clomiphene citrate based protocol plus low dose gonadotropins on predicted normal responder patients who had unsuspected poor in vitro fertilization (IVF) result, following an initial stimulation with long gonadotropin-releasing hormone (GnRH) agonist protocol.

METHODS

This a retrospective study of 65 infertile women who underwent 130 cycles in our center from January 2011 to December 2014. The initial IVF cycle (Group 1) was treated with long GnRH-a protocol plus a high dose of gonadotropins (≥150 IU/d), while second IVF cycle (Group 2) had low dose clomiphene citrate based protocol plus low dose gonadotropins (75-112.5 IU/d).

RESULTS

The rate of cumulative pregnancy/started cycle (9.2% [6/65] vs. 51% [33/65]; P < 0001) was significantly better in CC protocol than the long GnRH agonist protocol. The number of oocytes retrieved was also higher in CC protocol compared to the long protocol (7.26 ± 1.95 vs. 5.98 ± 1.31; P = 0.03). There was a lower number of patients without embryos (12.31% vs. 33.85%; p < 0.0001) in CC protocol than long protocol.

CONCLUSIONS

This study showed a better cumulative pregnancy rate in the low dose CC based protocol. There was a higher number of oocytes retrieved after using a lower total dose of recombinant FSH in CC protocol. Thus, clomiphene treatment plus low dose rFSH can be an alternative option for such patients in second cycle stimulation instead of repeating long protocol regimen. Randomized controlled studies with larger number of patients will be needed for more accurate evidence.

Authors+Show Affiliations

Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China. jyliu_nj@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29728130

Citation

Ochin, Humphrey, et al. "Low Dose Clomiphene Citrate as a Mild Stimulation Protocol in Women With Unsuspected Poor in Vitro Fertilization Result Can Generate More Oocytes With Optimal Cumulative Pregnancy Rate." Journal of Ovarian Research, vol. 11, no. 1, 2018, p. 37.
Ochin H, Ma X, Wang L, et al. Low dose clomiphene citrate as a mild stimulation protocol in women with unsuspected poor in vitro fertilization result can generate more oocytes with optimal cumulative pregnancy rate. J Ovarian Res. 2018;11(1):37.
Ochin, H., Ma, X., Wang, L., Li, X., Song, J., Meng, Y., Shen, J., Cui, Y. G., & Liu, J. (2018). Low dose clomiphene citrate as a mild stimulation protocol in women with unsuspected poor in vitro fertilization result can generate more oocytes with optimal cumulative pregnancy rate. Journal of Ovarian Research, 11(1), 37. https://doi.org/10.1186/s13048-018-0408-x
Ochin H, et al. Low Dose Clomiphene Citrate as a Mild Stimulation Protocol in Women With Unsuspected Poor in Vitro Fertilization Result Can Generate More Oocytes With Optimal Cumulative Pregnancy Rate. J Ovarian Res. 2018 May 4;11(1):37. PubMed PMID: 29728130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low dose clomiphene citrate as a mild stimulation protocol in women with unsuspected poor in vitro fertilization result can generate more oocytes with optimal cumulative pregnancy rate. AU - Ochin,Humphrey, AU - Ma,Xiang, AU - Wang,Lin, AU - Li,Xuan, AU - Song,Jie, AU - Meng,Yan, AU - Shen,Jiandong, AU - Cui,Yu-Gui, AU - Liu,Jiayin, Y1 - 2018/05/04/ PY - 2018/01/19/received PY - 2018/04/20/accepted PY - 2018/5/6/entrez PY - 2018/5/8/pubmed PY - 2018/10/3/medline KW - Clomiphene citrate KW - Long GnRH-a protocol KW - Mild ovarian stimulation KW - Unsuspected poor IVF results SP - 37 EP - 37 JF - Journal of ovarian research JO - J Ovarian Res VL - 11 IS - 1 N2 - BACKGROUND: The use of long protocol during controlled ovarian stimulation for assisted reproduction attracts high dosage of gonadotropins. High dose of gonadotropins can be detrimental to oocyte development, which affects its quality and compromises the treatment outcome. Mild stimulation protocols that attract low dose gonadotropins could be useful alternative regimen to address such problems. This study evaluated the efficacy of low dose clomiphene citrate based protocol plus low dose gonadotropins on predicted normal responder patients who had unsuspected poor in vitro fertilization (IVF) result, following an initial stimulation with long gonadotropin-releasing hormone (GnRH) agonist protocol. METHODS: This a retrospective study of 65 infertile women who underwent 130 cycles in our center from January 2011 to December 2014. The initial IVF cycle (Group 1) was treated with long GnRH-a protocol plus a high dose of gonadotropins (≥150 IU/d), while second IVF cycle (Group 2) had low dose clomiphene citrate based protocol plus low dose gonadotropins (75-112.5 IU/d). RESULTS: The rate of cumulative pregnancy/started cycle (9.2% [6/65] vs. 51% [33/65]; P < 0001) was significantly better in CC protocol than the long GnRH agonist protocol. The number of oocytes retrieved was also higher in CC protocol compared to the long protocol (7.26 ± 1.95 vs. 5.98 ± 1.31; P = 0.03). There was a lower number of patients without embryos (12.31% vs. 33.85%; p < 0.0001) in CC protocol than long protocol. CONCLUSIONS: This study showed a better cumulative pregnancy rate in the low dose CC based protocol. There was a higher number of oocytes retrieved after using a lower total dose of recombinant FSH in CC protocol. Thus, clomiphene treatment plus low dose rFSH can be an alternative option for such patients in second cycle stimulation instead of repeating long protocol regimen. Randomized controlled studies with larger number of patients will be needed for more accurate evidence. SN - 1757-2215 UR - https://www.unboundmedicine.com/medline/citation/29728130/Low_dose_clomiphene_citrate_as_a_mild_stimulation_protocol_in_women_with_unsuspected_poor_in_vitro_fertilization_result_can_generate_more_oocytes_with_optimal_cumulative_pregnancy_rate_ L2 - https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-018-0408-x DB - PRIME DP - Unbound Medicine ER -