[Clomiphene as an inducer of multiple follicular growth]

In our IVF + ET & GIFT programs we gave 100 mg of clomiphene from cycle days 2 to 6 in 35 cycles of 32 infertile patients. Serum estradiol curves were made establishing 3 types of curves: 1. climbing curve which was subdivided in curve A (6 cycles) with more than 600 pg/mL of estradiol, more than 4 follicles of a mean size of 35 mm; curve B (13 cycles) with an estradiol range from 300 to 600 pg/mL, 2.9 follicles of 24 mm and curve C with less than 300 pg/mL of estradiol, 0.8 follicles of 22 mm. 2. Flat curve with minimum estradiol level and follicle size and 3. Irregular curve with atypic variations that probably reflect oocyte atresia and cyst formation. The progesterone level in the luteal phase was parallel to the estradiol. There was evidence of multiple follicular growth in 20 cycles (57%). Nine laparoscopies for ovum capture were made, collecting a mean of 1.2 oocytes per laparoscopy; they were fertilized in vitro and later transferred 4 embryos and 4 oocytes were transferred to the fallopian tubes. There was at most one mature oocyte per laparoscopy. No pregnancies were achieved. The clomiphene as a single agent, for its wide availability, might be choice for some women that show a good response, which might depend on several factors, but it cannot be considered the ideal single agent for programs that include ovum pick ups.