Clomiphene-induced quintuplets with a failed attempt at delayed-interval delivery

Clomiphene citrate is widely used for ovulation induction. It is associated with a 6 to 17% incidence of multiple gestation. We report on a 27-year-old para 0010 patient who, after an initial evaluation for secondary infertility of 2 years' duration, was deemed to have oligo-ovulation. She conceived during the second cycle of clomiphene citrate administration. An early obstetric sonogram identified five fetuses with cardiac activity. The patient experienced preterm premature rupture of the membranes at 19 weeks gestation. A delayed-interval delivery was attempted, but all five fetuses were born over a period of 15 days. No maternal complications occurred. Multiple pregnancies of high order are commonly associated with human menopausal gonadotropins but rarely with clomiphene citrate. This is the seventh reported case of quintuplets related to clomiphene citrate, and possibly the first on whom no other fertility-enhancing medication was utilized. In this case, attempted delayed-interval delivery was not successful.