A randomized study comparing IVF in the unstimulated cycle with IVF following clomiphene citrate

ISSN： 1460-2350

Source： Human Reproduction, Vol.16, Iss.4, 2001-04, pp. : 696-702

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Abstract

The efficiency of IVF in unstimulated cycles was compared with that following ovarian stimulation with clomiphene citrate in a simple protocol with ultrasound monitoring only. A total of 132 couples with no previous IVF attempts, selected by female age <35 years,="" indication="" for="" intracytoplasmic="" sperm="" injection="" or="" infertility="" caused="" by="" tubal="" factor="" or="" unexplained="" infertility="" were="" randomized="" to="" the="" two="" protocols.="" randomization="" yielded="" two="" comparable="" groups.="" the="" clomiphene="" group="" (68="" couples)="" performed="" significantly="" better="" than="" the="" unstimulated="" group="" (64="" couples)="" in="" terms="" of="" number="" of="" cycles="" with="" oocyte="" harvest="" (90/111="" or="" 81%="" versus="" 65/114="" or="" 57%;="">² = 9.21, P < 0.002),="" embryo="" transfers="" per="" started="" cycle="" (59/111="" or="" 53%="" versus="" 29/114="" or="" 25%;="">² = 18.14, P < 0.0001),="" live="" intrauterine="" pregnancy="" rate="" per="" started="" cycle="" (20/111="" or="" 18%="" versus="" 4/114="" or="" 4%;="">² = 12.42, P < 0.0001),="" live="" intrauterine="" pregnancy="" rate="" per="" embryo="" transfer="" (20/59="" or="" 34%="" versus="" 4/29="" or="" 14%;="">² = 3.96, P = 0.047), but not in terms of implantation rate (22/85 or 26% versus 4/29 or 14%; ² = 1.65). Only two twin pregnancies occurred. Modest side-effects were recorded following clomiphene. Accordingly, a simple clomiphene citrate protocol, but not IVF in unstimulated cycles, seems compatible with the concept of `friendly IVF', yielding a fair pregnancy rate both per cycle started and per embryo transfer in selected patients. The results do not substantiate any important negative anti-oestrogenic effects of clomiphene.