Clomiphene citrate priming increases sensitivity during ovarian stimulation in poor ovarian responders undergoing in vitro fertilization treatment: a retrospective cohort study

Abstract

This single-centre retrospective cohort study aimed to investigate whether a clomiphene citrate (CC) priming protocol could increase ovarian sensitivity in poor ovarian responders. It included 294 patients (374 ovarian stimulation cycles). Of these, 193 cycles were treated by a CC priming antagonist protocol (study group) and 181 by the classical flexible gonadotropin-releasing hormone antagonist protocol (control group). Stimulation data and laboratory and clinical outcomes were compared between the groups. The results showed that in the study group, total gonadotropin dosage and dosage per follicle were considerably lower, the follicle-to-oocyte index was significantly higher, and the gonadotropin duration was shorter. After adjusting for potential confounders, multivariate regression analysis showed that cumulative ongoing pregnancy remained comparable between the groups (adjusted odds ratio: 0.761, 95% confidence interval: 0.300–1.933, p = 0.566). Age, body mass index, gonadotropin dosage per follicle, and the follicle-to-oocyte index were negatively associated with the reproductive outcomes. The result of the sensitivity analysis showed that patients in the study group were administered less gonadotropin at a lower gonadotropin dosage per follicle and for a shorter duration. In conclusion, the CC priming antagonist protocol offered a convenient and patient-friendly way to increase ovarian sensitivity during ovarian stimulation in poor ovarian responders.

Keywords:

• Antagonist
• clomiphene citrate
• poor ovarian response
• ovarian stimulation
• ovarian sensitivity; in vitro fertilization

Acknowledgements

The authors thank the patients who participated in this study, as well as the embryologists, and nursing staff.

Author contributions

SL: data collection and statistical analysis; drafting of the manuscript. XL, HL, ML, and YLv: data collection and revision of the manuscript. YLi: supervision of the study, conception, and review of the manuscript. All authors performed revision of intellectual content and approved the final version of the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by 1351 Talent Training Program of Beijing Chao-Yang Hospital (CYXX-2017-20); Capital Health Development Scientific Research Project (Independent Innovation, 2020-1-2039); Beijing Health Promotion Foundation (2019-09-05); 2018 Fertility Research Program of Young and Middle-aged Physicians-China Health Promotion Foundation; 2020 Fertility Research Program of Young and Middle-aged Physicians-China Health Promotion Foundation; and Beijing Hospitals Authority Youth Programme (QML20200301).