A reduction in multiple pregnancies following the use of a clomiphene citrate: human gonadotrophin sequence

The results of stimulation with gonadotrophins at the Sterility Clinic (Crown Street) are presented. Two different techniques have been employed involving 86 patients. All patients have similar indications for treatment. All have received the same preliminary investigations and all have been treated previously with a minimum of three cycles of Clomiphene Citrate without satisfactory response (i.e. "clomid failures). Technique (1) involved 51 patients and consisted of daily injections of Human Pituitary Gonadotrophin (H.P.G.) followed by an ovulating injection of Human Chorionic Gonadotrophin (H.C.G.) and a follow up injection of H.C.G. on post-ovulatory Day 7 or 8. This technique had a pregnancy rate of 64 per cent and a multiple pregnancy rate of 34 per cent. Technique (2) involved 35 patients and consisted of 5 days priming with Ethinyl Oestradiol and Clomiphene Citrate together, followed immediately by daily injections of H.P.G., then an ovulating injection of H.C.G. and a follow up injection of H.C.G. on post-ovulatory Day 7 or 8. The results of this variation in technique were a pregnancy rate of 69 percent, a multiple pregnancy rate of 8 percent. It is suggested that the use of Clomiphene Citrate in the latter technique acts as a "buffer" against the more extreme ovarian responses to H.P.G. acting alone and has the apparent advantage of a higher pregnancy rate, a lower multiple pregnancy rate and a reduction in the number of foetuses in each of the multiple pregnancies.