The assessment of a cycle with clomiphene as an indicator for further treatment

A group of 15 anovulatory women was treated during one single cycle with clomiphene citrate (CC) 100 mg daily, starting on day 5 of the cycle for 5 days, (group A). Eleven ovulatory patients represent a control group (group B). Serum levels of follicular stimulating hormone (FSH) and luteinizing hormone (LH) were determined on day 5 and 9 of the cycle. Follicular growth was assessed by ultrasound from day 9 until presumed ovulation Estradiol levels and cervical mucus characteristics were measured on day 14 and progesterone assessed on day 23 of the cycle. In the clomiphene induced cycles FSH and LH values on day 9 were significantly above pretreatment levels (p < 0.001 and p < 0.0001, respectively), and above those of day 9 of the control group (p< 0.0001). In comparison to the control group under CC treatment, an excessive production of estradiol was observed (p < 0.0001) corresponding to significant increase in number of follicles (over 15 mm in diameter), p < 0.04. Inspite this elevated estradiol, the cervical score was significantly lower (p< 0.004) than in the control group. Three patients out of the 15 were characterized by a discrepancy between elevated estradiol levels and a poor mucus score. The rational of the CC assessment cycle is to identify those patients who may need an alternative treatment such as HMG/HCG or pulsatile GnRH.