Practice Committee of the American Society for Reproductive Medicine (2003). Use of clomiphene citrate in women. Fertility and Sterility, 80(5), 1302-1308. https://doi.org/10.1016/s0015-0282(03)01184-1
Practice Committee of the American Society for Reproductive Medicine. Use of clomiphene citrate in women. Fertil Steril. 2003;80(5):1302-1308. doi:10.1016/s0015-0282(03)01184-1
Practice Committee of the American Society for Reproductive Medicine. "Use of clomiphene citrate in women." Fertility and Sterility, vol. 80, no. 5, 2003, pp. 1302-1308.
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RRM Academy Synopsis
Clomiphene induces ovulation in 80% of selected infertile women
In 2003, a national doctors' group reviewed years of research on clomiphene, a drug used to trigger ovulation. It works well for properly selected women who do not ovulate on their own. About 8 out of 10 such women begin to ovulate on the drug. But pregnancy happens much less often per cycle than ovulation does.
Key Findings
About 8 out of 10 properly picked women start ovulating on clomiphene. Among those who respond, roughly 15 out of 100 treatment cycles led to pregnancy.
When no other fertility problems were present, about 22 out of 100 cycles led to pregnancy. That matched rates seen in fertile couples and in donor sperm cycles.
About 70 to 75 out of 100 women who began ovulating on the drug may be expected to become pregnant within six to nine treatment cycles.
For couples with no known cause of infertility, clomiphene alone led to pregnancy in about 3 to 8 out of 100 cycles. Adding insemination raised that to about 9 out of 100.
Multiple pregnancy happened in about 8 out of 100 clomiphene pregnancies, nearly all twins. A pooled analysis of eight case-control studies found no link between fertility drug use and invasive ovarian cancer.
Interpretation
This is a clinical practice guideline, drawing on studies published from 1961 onward plus years of clinical experience. The paper covers two groups: women who don't ovulate well on their own, and couples with no known cause found for their infertility. The findings support continued, larger study of ovulation induction and insemination in both groups.
RRM Context
This guideline says doctors should treat the root cause of not ovulating first, before reaching for a drug. The sequence fits the restorative reproductive medicine idea of finding a cause before treating. For couples with no known cause after a full evaluation, the paper says a drug trial may be reasonable, especially for younger couples early on. RRM clinicians have a term for that: undiagnosed infertility. Unexplained is only a placeholder until more evaluation happens.
Our editorial summary of this paper, not the article's abstract.
PMID 14607612 14607612 DOI 10.1016/s0015-0282(03)01184-1 10.1016/s0015-0282(03)01184-1 Practice Committee of the American Society for Reproductive Medicine et al. 2003, Practice Committee of the American Society for Reproductive Medicine 2003
008x12972 