Minimal stimulation achieves pregnancy rates comparable to human menopausal gonadotropins in the treatment of infertility

Objective: To examine the effectiveness of a novel clomiphene citrate (CC) and hMG combination protocol (''minimal stimulation'') for controlled ovarian hyperstimulation. Minimal stimulation consists of administering 100 mg/d CC for 5 days followed by a single dose of 150 IU hMG. The results of this analysis are compared with those of an hMG-alone protocol. In vitro fertilization-embryo transfer and donor insemination patients are excluded from this analysis. Design: Retrospective review of minimal stimulation and hMG cycles from January 1, 1989 to December 31, 1992. Setting: Tertiary care center reproductive endocrinology and infertility clinic. Patients: Two hundred thirty-two women who underwent 549 treatment cycles. Main Outcome Measures: Clinical and multiple pregnancy rates (PRs) and medication costs. Results: Sixty-one women received 106 cycles of minimal stimulation and 183 received 443 cycles of hMG. Although subject groups were not assigned randomly, multivariate analysis detected no significant differences between the treatment groups. The total ampules of hMG required differed significantly (2.0 for minimal stimulation versus 16.8 +/- 8.5 [mean +/- SD] for hMG). Pregnancy rates and multiple gestation rates were similar. Medication expense of minimal stimulation is 21% that of the hMG protocol. Conclusions: Minimal stimulation is as effective as hMG in the population examined. The comparable PRs and decreased medication costs of minimal stimulation justifies further evaluation of its role in the treatment of infertility.