Traditional Clomiphene Citrate Administration vs. Stair-step Approach

Traditional Clomiphene Citrate Administration Versus a Stair-Step Approach: A Randomized Controlled Trial

The purpose of this study is to compare the length of time to achieve ovulation and pregnancy with a traditional protocol administration of clomiphene citrate versus a stair step administration.

Our hypothesis is by using a stair-step approach in which a period is not induced between administrations of escalating doses of clomiphene citrate, the time to ovulation and pregnancy may be reduced.

The traditional administration of clomiphene citrate for ovulation induction involves taking clomiphene citrate for 5 days. If ovulation does not occur within 14 days, a progestin pill (such as Provera) is prescribed for 10 days to induce a period (which normally occurs within 1 week of stopping the pill). Then a higher dose of clomiphene citrate will be prescribed.

The stair-step administration of clomiphene citrate for ovulation induction also involves taking clomiphene citrate for 5 days. In contrast, if ovulation does not occur within 7-9 days, a progestin pill (such as Provera) would NOT be taken to induce a period. The dose of clomiphene will then be increased. Therefore, this would do away with the 10 days of taking the progestin pill, and also do away with waiting for a period (usually 3 to 7 days) for a total of up to a 20 day difference between clomiphene citrate dosing cycles.

Inclusion Criteria:

• Ovulatory dysfunction as evidenced by mid-luteal progesterone less then 3ng/dL, non-biphasic basal body temperature charting, or menstrual history of cycles > 35 days.

• Female patients 18 to 45 years old

• Six months or greater of unprotected intercourse without pregnancy.

• Normal TSH and prolactin serum levels

• Semen analysis of male partner with > 15 million motile sperm on semen analysis.

  • NOTE: Must be willing to travel to the Oklahoma City area for treatment.

Exclusion Criteria:

• Failure to spontaneously menstruate or to menstruate following progestin administration
• Allergy or intolerance to the side effects of clomiphene citrate, hCG (human chorionic gonadotropins), or medroxyprogesterone acetate (Provera).
• Known anatomical defect affecting the uterine cavity including submucosal fibroids or endometrial polyps.
• Know tubal hydrosalpinx or risk factors for tubal obstruction
• Known liver dysfunction
• Known or suspected androgen secreting tumor, cushings disease, or adrenal hyperplasia (congenital or adult onset)
• Ovarian cyst > 20mm or endometrial lining >6 mm on trans-vaginal baseline ultrasound.
• Stage III or IV endometriosis
• Decreased ovarian reserve as evidenced by antral follicle count less than 6 by Transvaginal ultrasound or a cycle-day-3 serum FSH of > 10 uIU/ml.
• Positive HIV in either the female patient or her partner.