Sequential Therapy with Clomiphene Citrate and Human Menopaus‐al Gonadotropin for Induction of Ovulation and Pregnancy

Clomiphene citrate (clomiphene) and human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG) were given sequentially to 18 patients who failed to ovulate with hMG-hCG treatment alone. The rates of ovulation with clomiphene-hMG-hCG treatment were 94.4% per patient and 76.5% per course. Pregnancy was induced in 14 courses (16.5%) and in 12 patients (66.7%). The incidences of the ovarian hyperstimulation syndrome per patient and per course were 27.8% and 7.1% respectively. The rates of abortion and multiple pregnancy by treatment with clomiphene-hMG-hCG were 16.5% and 21.4%, respectively. The present findings suggest that treatment with clomiphene before hMG-hCG induces ovulation and pregnancy in anovulatory patients who showed no response to hMG-hCG treatment. Clomiphene-hMG-hCG therapy, however, requires careful monitoring of follicle maturation, because the ovarian hyperstimulation syndrome is apt to occur.