A new protocol for individualized hMG therapy by estrogen priming and cervical mucus monitoring.

A new protocol of estrogen-priming and cervical mucus monitoring for individualized hMG therapy was devised. Prior to treatment, the amount of cervical mucus ("a" mm3) should be determined. Then the peak value ("b" mm3) on the amount of cervical mucus resulting from the exogenous 2-day injection of 1 mg of estradiol benzoate is confirmed. After a decrease of the amount of cervical mucus is noted, daily dose of 225(1 - a/b) IU of hMG is administered until the amount of cervical mucus reaches or exceeds the "b" value. hCG is given 36 hours later than the last previous injection of hMG. This new individualized hMG therapy induced 51 ovulations (69.9%), 9 pregnancies (17.6%), and no multiple pregnancies (0%) out of 73 treated anovulatory cycles. This new protocol appears promising for prevention of multiple pregnancy due to hMG therapy, perhaps based on the mechanism of estrogen priming and individualization of both daily dose and duration of hMG administration.