Ultrasonographic and clinical correlates of menotropin versus sequential clomiphene citrate: menotropin therapy for induction of ovulation

Forty-six women remaining infertile with clomiphene citrate (CC) with or without human chorionic gonadotropin (hCG) were treated by either human menopausal gonadotropin (hMG, 44 cycles) or CC+hMG (33 cycles) and monitored by serum estradiol (E 2 ) and ultrasonography. Ovarian hyperstimulation syndrome (OHS) and pregnancy outcome were compared in both regimens. In the presence of dominant follicles (≥ 18mm) alone or with a single secondary follicle (14 to 16mm) at hCG administration, OHS did not develop. A significant increase in OHS was noted when three or more secondary follicles were observed. Overall pregnancy rates were similar in both regimens but significantly higher when hCG was injected before rather than after the E 2 peak. The results suggest (1) secondary follicles rather than dominant follicles are a valuable sign of possible OHS development; and (2) CC+hMG should be considered in CC-failure patients.