An inexpensive way for ovarian stimulation with only clomiphene citrate in women with diminished ovarian reserve

Abstract

Objective: Clomiphene citrate (CC) is commonly used for various indications related to ovarian stimulation in assisted reproductive technology. There is limited information on the effectiveness of clomiphene for ovarian stimulation when used alone in women with diminished ovarian reserve (DOR). Methods: This retrospective analysis included women stimulated with CC only; a total of 840 cycles from 381 couples were analyzed. Results: The median age was 39 years. All women had an antral follicle count <5, and the median anti-M & uuml;llerian hormone was 0.34 ng/mL. CC was given for 5 days, and stimulation lasted for 8 days. Among 840 cycles, 344 (%) cycles were cancelled. The reasons for cancellation were: premature ovulation, 119 (14.2%); no follicular growth, 98 (11.7%); no oocyte yield at oocyte pick-up, 66 (7.9%); and no metaphase II oocyte yield, 61 (7.3%). The number of cycles with no embryos was 2 (0.4%). The remaining 494 cycles (58.8%) proceeded to embryo transfer (ET). The median numbers of oocytes collected, mature oocytes, and 2 pronuclei embryos were each 2. Frozen ET was performed in 443 (89.1%) cycles, and fresh ET was performed in 51 (10.3%) cycles. The pregnancy test was positive in 131 cycles; there were 96 live births (one twin birth), and the live birth rate per ET was 19.5%. Conclusion: CC alone seems capable of preventing a premature luteinizing hormone surge in the majority of women with severely DOR. CC-only stimulation is an effective and inexpensive approach to ovarian stimulation in women with severely DOR.