Clomiphene citrate versus gonadotrophins for ovulation stimulation

Clomiphene (clomiphene citrate) remains the drug of first choice in women suffering from anovulation and in ovulating women with inadequate follicular or luteal development. In ovarian stimulation for various assisted reproductive techniques, the role of clomiphene remains limited, because the use of gonadotrophins with or without gonadotrophin-releasing hormone agonists/antagonists leads to a more effective ovarian response. Some of the goals of infertility treatment in the next century are to decrease the cost of medication and treatment and to reduce the number of multiple pregnancies. In this respect, the use of clomiphene citrate appears to be worth re-evaluating. The largest series of clomiphene patients, analysed by life-table or per-cycle methods, show that clomiphene is effective for at least six cycles of treatment. However, the combination of clomiphene with gonadotrophins or gonadotrophins only appear to be more effective than clomiphene alone.