Clomiphene Citrate and Fshhmg Protocol

This protocol used to be the preferred protocol in most IVF units prior to development of GnRH analogs. As mentioned, it was abandoned in our program as the dominant superovulatory regimen because of the high cancellation rate due to untimely LH surges and some reports of the possible adverse effect of clomiphene citrate on the endometrium. In our unit, this protocol is used only for patients who have responded well (>5 oocytes retrieved) to clomiphene citrate and HMG in the past and who did not respond well to the downregulation or boost protocols, or to patients who did not want to use GnRH agonists and who previously responded well to the combination of clomiphene citrate and FSH/HMG.

In this protocol, clomiphene citrate 100mg/day commences on day 2 of the cycle and proceeds for 5 days. HMG begins on day 3 and continues, as do the other protocols, until 1 day before the hCG injection. hCG (5000 IU in IM injections) is given when the estimated leading follicle is 18-19 mm in diameter with serum E2 levels >1800 pmol/L.

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