Factors influencing pregnancy rates with a combined clomiphene citrate/gonadotropin protocol for non-assisted reproductive technology fertility treatment

Objective: To determine the effectiveness of a combined clomiphene citrate/gonadotropin protocol in a general infertility population and to evaluate factors influencing pregnancy rates obtained with this protocol. Design: A retrospective chart review. Setting: University-based infertility clinic. Patient(s): Two hundred forty-eight patients undergoing 658 cycles of minimal stimulation (MS) protocol from 1996-2000. Intervention(s): Patients underwent treatment with clomiphene citrate and gonadotropin, often followed by intrauterine insemination. Main Outcome Measure(s): Clinical pregnancy rates. Result(s): Overall, the clinical pregnancy rate was 7.1% per cycle (n = 248 patients and 658 cycles). The age range of the patients was 24-47 years (mean +/- SD = 36.5 +/- 4.9) with 8.7% noted to have ovulatory dysfunction. Pregnancy rates varied significantly (P<.05) with patient age (9.3% in women <40 years vs. 2.4% in women greater than or equal to40), duration of infertility (9.0% in women with less than or equal to3 years of infertility vs. 2.2% in women with >3 years of infertility) and number of follicles produced during stimulation (9.1% in women with greater than or equal to3 follicles vs. 4.6% in women with <3 follicles). Conclusion(s): The effectiveness of the MS protocol in a general infertility population with a predominantly ovulatory status is much less than that previously reported in a younger patient population with a significant rate of ovulatory dysfunction. This protocol does not appear to lead to pregnancy rates higher than that reported for clomiphene citrate/intrauterine insemination (IUI) cycles. The clinical pregnancy rates using a minimal stimulation protocol are particularly compromised in women over 40. those with a longer duration of infertility or those who produce few follicles during stimulation. (Fertil Steril(R) 2002;77:384-6. 02002 by American Society for Reproductive Medicine.).