Abstract
Purpose: Our experience with IVF using low-dose clomiphene citrate for stimulation in “non-” and “poor” responders was reviewed and the treatment outcomes with the previous controlled ovarian stimulation cycles in which hMG and GnRH agonist were used were compared.
Methods: The treatment outcome in 11 non- and 20 poor responders having 30 and 53 clomiphene citrate IVF treatment cycles, respectively, were compared with the treatment outcome in the previous long-protocol buserelin/hMG cycles.
Results: The clinical pregnancy rates per oocyte collection achieved in the first clomiphene citrate cycle in non (9.1%)- and poor (10%) responders were comparable to those achieved by poor responders (11.9%) who had buserelin/hMG using the long protocol. Although the numbers were small, a similar pregnancy rate could still be achieved in poor responders up to the third attempt using clomiphene citrate.
Conclusions: IVF using long-protocol buserelin/hMG is more successful than using clomiphene citrate stimulation. However, this advantage may not be significant in those women with a previous poor response to buserelin/hMG. It is suggested that for such poor responders, three attempts of IVF in a clomiphene citrate cycle may offer a viable therapeutic alternative before reverting to more stressful, expensive, and time-consuming treatment.
Similar content being viewed by others
REFERENCES
Jenkins JM, Davies DW, Devonport H, Anthony FW, Gadd SC, Watson RH, Masson GM: Comparison of “poor” responders with “good” responders using standard buserelin/human menopausal gonadotropin regime for in vitro fertilization. Hum Reprod 1991;6:918–921
McKenna KM, Foster P, McBain J, Martin M, Johnston WI: Combined treatment with gonadotrophin releasing hormone agonist and gonadotrophins in poor responders hyperstimulation for in vitro fertilization (IVF): Clinical and endocrine results. Aust NZ J Obstet Gynecol 1989;29:428–432
Karande VC, Rinehatt J, Miller EC, Pratt DE, Morris R, Levrant S, Rao R, Balin M, Bricksin M, Gleicher N: The value of stimulating poor responders using “flare” protocol in cycles with low basal FSH concentrations during IVF. 12th Annual Meeting of the EHSRE, Maastricht, Belgium. Hum Reprod 1996;11:200 (abstract T031)
Dor J, Seidman DS, Amudai E, Bider D, Levran D, Mashiach S: Adjuvant growth hormone therapy in poor responders to in-vitro fertilisation: A prospective randomised placebo-controlled double blind study. Hum Reprod 1995;10:40–43
Steinkampf MP, Kretzer PA, McElroy E, Conway-Myers BA: A simplified approach to in vitro fertilisation. J Reprod Med 1992;37:199–204
Hoult IJ, de Crespigny LC, O'Herlithy C, Speirs AL, Lopata A, Kellow G, Johnstone I, Robinson HP: Ultrasound control of clomiphene/human chorionic gonadotrophin stimulated cycles for oocyte recovery and in vitro fertilization. Fertil Steril 1981;36:316–319
Lindheim SR, Vidali A, Ditkoff E, Sauer MV: Poor responders to ovarian hyperstimulation may benefit from an attempt at natural-cycle oocyte retrieval. J Reprod Med 1997;14:174–176
Sathanandan M, Warnes GM, Kirby CA, Petrucco OM, Matthews CD: Adjuvant leuprolide in normal, abnormal, and poor responders to controlled ovarian hyperstimulation for in vitro fertilisation/gamete intrafallopian transfer. Fertil Steril 1989;6:998–1006
Rysselberge MV, Puissant F, Barlow P, Lejeune B, Delvigne A, Leroy F: Fertility prognosis in IVF treatment of patients with cancelled cycles. Hum Reprod 1989;4:663–666
van-Hooff MH, Alberda AT, Hursman GJ, Zeilmaker GH, Leerentveld RA: Doubling the human menopausal gonadotropin dose in the course of an IVF treatment cycle in low-responders: A randomized study. Hum Reprod 1993;8:369–373
Dor J, Seidman DS, Ben-Shlomo I, Levran D, Karasik A, Mashiach S: The prognostic importance of the number of oocytes retrieved and estradiol levels in poor and normal responders in in vitro fertilisation (IVF) treatment. J Assist Reprod Genet 1992;9:228–232
Tasdernir M, Tasdernir I, Kodama H, Fukuda J, Tanaka T: Short protocol of gonadotropin releasing hormone agonist administration gave better results in long protocol poor-responders in IVF-ET. J Obstet Gynaecol Res 1996;1:73–77
Serafini P, Stone B, Kerin J, Batzofin J, Quinn P, Marrs RP: An alternative approach to controlled ovarian hyperstimulation in “poor” responders: pre-treatment with gonadotrophin-releasing hormone analogue. Fertil Steril 1988;49:90–95
Ben-Rafael Z, Feldberg D: The poor-responder patient in an in vitro fertilization-embryo transfer program. J Assist Reprod Genet 1993;2:118–120
Ibrahim ZHZ, Marson PL, Buck P, Lieberman BA: The use of biosynthetic growth hormone to augment ovulation induction with buserelin acetate/human menopausal gonadotrophin during controlled ovarian hyperstimulation for in vitro fertilization in women with a poor ovarian response. Fertil Steril 1991;55:202–204
Cohen J, Alikani M, Trowbridge J, Rosenwaks Z: Implantation enhancement by selective assisted hatching using zona drilling of human embryos with poor prognosis. Hum Reprod 1992;7:685–691
Schoolcraft WB, Schlenker T, Gee M, Jones GS, Jones HW: Assisted hatching in the treatment of poor prognosis in vitro fertilisation candidates. Fertil Steril 1994;62:551–554
Navot D, Bergh PA, Williams MA, Garrisi GJ, Guzman I, Sandler B, Grunfeld L: Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility. Lancet 1991;337:1375–1377
Paulson RJ, Sauer MV, Francis MM, Macaso TM, Lobo RA: In vitro fertilisation in unstimulated cycles: The University of Southern California experience. Fertil Steril 1992;57:290–293
Seibel MM, Kearnan M, Kiessling A: Parameters that predict success for natural cycle in vitro fertilisation-embryo transfer. Fertil Steril 1995;63:1251–1254
Daya S, Gunby J, Hughes EG, Collins JA, Sagle MA, YoungLai EV: Natural cycles in-vitro fertilisation: Cost-effectiveness analysis and factors influencing outcome. Hum Reprod 1995;10:1719–1724
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Awonuga, A.O., Nabi, A. In Vitro Fertilization with Low-Dose Clomiphene Citrate Stimulation in Women Who Respond Poorly to Superovulation. J Assist Reprod Genet 14, 503–507 (1997). https://doi.org/10.1023/A:1021171225322
Issue Date:
DOI: https://doi.org/10.1023/A:1021171225322