Sequential use of clomiphene citrate and human menopausal gonadotropin in anovulatory infertility

Background: Infertility is a complex disorder with significant medical, psychosocial and economic aspects. Infertility causes great distress to many couples, causing increased numbers of them to seek specialist fertility care. Objectives: To measure the success rate of combined clomiphene citrate and gonadotropin therapy in anovulatory infertile patients overcoming the drawbacks of clomiphene alone treatment. Materials and methods: In this observational analytical study, total of 100 anovulatory infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotropin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in present study, 46 patients became pregnant. Primary infertility was seen in 81 patients (81%) and secondary infertility in remaining 19(19%) of patients. Polycystic ovary disease (PCOD) was the commonest cause of anovulation seen in 62% of patients. Miscarriage was seen in 3 patients (3%). Multiple pregnancies were observed in 8 patients (8%). Number of patients conceived after 1 cycle was 12 (26%), 2nd cycle was 20 (43.47%), 3rd cycle was 14 (30.43%). Conclusions: Present study shows the success rate of 46% with CC-HMG combined regimen. Sequential clomiphene/ HMG regimen appears to be an effective protocol for controlled ovarian stimulation in infertile women who are resistant to clomiphene alone which has drawback of poor endometrial quality. It is easy to administer, requires less intense monitoring, fewer medications, and is cheaper without sacrificing efficacy, in other words it's a cost effective technique in the management of infertile patients.