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  • Title: Minimal stimulation IVF using clomiphene citrate and oral contraceptive pill pretreatment for LH suppression.
    Author: Branigan EF, Estes MA.
    Journal: Fertil Steril; 2000 Mar; 73(3):587-90. PubMed ID: 10689017.
    Abstract:
    OBJECTIVE: To determine if oral contraceptive pill (OC) pre-treatment prior to minimal stimulation IVF using clomiphene citrate (CC) would make the procedure easier to perform by preventing the LH surge and result in pregnancy rates (PRs) comparable to stimulated IVF. DESIGN: Prospective cohort study. SETTING: Private tertiary infertility center. PATIENT(S): Thirty-two women with tubal or pelvic adhesive disease as the cause of their infertility, ovulatory cycles, under the age of 40, and no male factor. INTERVENTION(S): Two-month ovarian-hypothalamic-pituitary axis suppression with OC followed by CC 100 mg on day 3 of the cycle for 8 days, hCG administration midcycle, follicle aspiration, IVF, and embryo transfer. MAIN OUTCOME MEASURE(S): Oocytes retrieved, serum LH and estradiol levels, maturity of oocytes, fertilization rates, embryo number and quality, and PRs. RESULT(S): Thirty-six patients completed 71 stimulation cycles and 64 follicle aspirations. No LH surges occurred with a mean mature oocytes retrieved of 3.2, 90% fertilization rate, and mean 2.5 embryos transferred. Twenty-one of the 64 cycles resulted in a clinical pregnancy (32.8% PR per retrieval) with 2 other biochemical pregnancies and 3 twin gestations. This was not significantly different from the matched cohort stimulated IVF. CONCLUSION(S): Minimal stimulation IVF is a simple, low-cost, and low-risk alternative to stimulated IVF with comparable PRs. This prospective cohort study examines the efficacy of minimal stimulation IVF (in vitro fertilization) using clomiphene citrate (CC) and oral contraceptive (OC) pretreatment for luteinizing hormone (LH) suppression in comparison with stimulated IVF. About 32 women with tubal or pelvic adhesive disease as the cause of their infertility, ovulatory cycles, aged under 40 years, and with no male factor attending a private tertiary infertility center were included in the study. These subjects received a 2-month ovarian-hypothalamic-pituitary axis suppression with OC, followed by CC 100 mg on day 3 of the cycle for 8 days, human chorionic gonadotropin administration midcycle, follicle aspiration, IVF, and embryo transfer. After 71 stimulation cycles and 64 follicle aspirations on 36 patients, it was observed that no LH surges occurred, with a mean number of mature oocytes retrieved of 3.2, a 90% fertilization rate, and a mean of 2.5 embryos transferred. About 21 of the 64 cycles resulted in clinical pregnancy (32.8% pregnancy rate per retrieval) with 2 biochemical pregnancies and 3 twin gestations. Results were insignificantly different from the matched cohort stimulated IVF. The study confirms the efficacy of OC use for ovarian-hypothalamic-pituitary axis suppression followed by minimal stimulation IVF using CC as a simple, low-cost and low-risk alternative to stimulated IVF with comparable pregnancy rates.
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