Clomiphene citrate in LH surge suppression for women undergoing ICSI

Objective

To evaluate the effect of adding clomiphene citrate (CC) in the mid-to-late follicular phase as an adjuvant to gonadotropins to suppress luteinizing hormone (LH) surge in women undergoing intracytoplasmic sperm injection (ICSI).

Methods

Prospective non-randomized study of 108 women undergoing ICSI and subjected to ovarian stimulation with gonadotropins with addition of CC (50?mg 3 times per day) when a leading follicle reached 14?mm in diameter and continued till the day of human chorionic gonadotropin (HCG) administration. Women subjected to controlled ovarian stimulation (COS) with the gonadotropin-CC protocol (n?=?50) were compared with a group of women were to COS with the flexible gonadotropin releasing hormone antagonist (GnRH-ant) protocol (n?=?58).

Results

Serum LH level on day HCG administration was significantly higher in CC group than in GnRH-ant group and the incidence of LH surge was higher in CC group than in GnRH-ant group (10% vs 3.4%, respectively) but without statistically significant difference (P?=?.246). The oocyte maturation and fertilization rates, the biochemical and clinical pregnancy rates, the implantation rate and the ongoing pregnancy rate were comparable in both groups.

Conclusion

Adding CC in the mid-to-late follicular phase as an adjuvant to gonadotropins represents a less costly COS which is effective in eliminating the occurrence of premature LH surge without compromising the cycle outcomes in women undergoing ICSI.