Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Iman Ibrahim Khalil Abdel-Mohsen, Hazem Elashmwi, Amal Darwish and Sherif Mohamed Khattab
Objective: To compare Clomiphene Citrate (CC) and lower dose of Human chorionic Gonadotropins (HMG) plus Gonadotropins Releasing Hormone (GnRH) antagonist with conventional mid-luteal long agonist GnRH with higher dose of HMG in women with poor ovarian response, undergoing Intracytoplasmic Sperm Injection (ICSI). Poor ovarian response was defined as the development of less than 3 follicles ≥ 17 mm on HCG day in a previous midluteal GnRH agonist-IVF/ICSI cycle or women with age >35 years old.
Method: Pilot non blind two arms parallel randomised controlled. Seventy women with a history of previous poor ovarian response undergoing controlled ovarian hyperstimulation (COH) for ICSI. Interventions: The control group (n=35) received a conventional mid-luteal long GnRH agonist treatment with daily injections of HP HMG, starting on day 2 of the cycle at a dose of 300 IU /day. In the study group (n=35), pre-treatment with luteal E2 supplementation was administrated followed by clomiphene citrate for 5 days, starting on day 2 of the cycle followed by daily injections of 225 IU HP HMG and GnRH antagonist from cycle day 6 onward.
Results: There was no evidence of statistically significant difference between both groups regarding the clinical pregnancy rate per women randomized (5/35 (14%) versus 3/35 (9%); 95% CI: 0.39-8.09, p=0.43). The cost of ovarian stimulation per cycle worked out to be USD 208, 8 and 557.3 for CC ovarian stimulation group and conventional ovarian stimulation group respectively.
Conclusion: CC and a lower dose of HMG plus GnRH antagonist preceded by mid-luteal E2 supplementation is as effective as the conventional ovarian stimulation in producing similar ICSI outcomes at lower cost in women with poor ovarian response.