Kemmann E, Jones J R
Fertil Steril. 1983 Jun;39(6):772-9. doi: 10.1016/s0015-0282(16)47116-5.
Either to induce ovulation in anovulatory infertility patients or to enhance ovulation in patients with mild endometriosis or luteal phase inadequacy, we utilized a sequential regimen of low-dose clomiphene citrate (CC) followed by human menopausal gonadotropin (hMG) injections on alternate days; duration and dosage of menotropin therapy was individualized by using serum estradiol levels for monitoring until the time of administration of human chorionic gonadotropins. Previous therapeutic efforts without menotropins had been unsuccessful in all patients. One third of 70 treated patients conceived during 156 treatment cycles. The pregnancy rate was 44% in anovulatory patients (n = 34), and 26% in patients with ovulation dysfunction (n = 23). Pregnancy rates declined with patient's age. Four of the 23 patients that conceived had a spontaneous abortion (17%). The multiple gestation rate was 10.5%. A relative inhibition of cervical mucus development was noted and shown to be caused by CC. Hyperstimulation occurred in three patients. The discussed CC-hMG regimen approaches the effectiveness of standard hMG therapy; but compared with standard hMG therapy, it has significant economic advantages and seems to have a markedly lower rate of multiple gestation. However, like standard hMG therapy, CC-hMG therapy requires careful monitoring specifically, because hyperstimulation may occur.
为了诱导无排卵性不孕症患者排卵，或增强轻度子宫内膜异位症或黄体期缺陷患者的排卵功能，我们采用了低剂量枸橼酸氯米芬（CC）序贯方案，随后隔天注射人绝经期促性腺激素（hMG）；使用血清雌二醇水平进行监测，将促性腺激素治疗的持续时间和剂量个体化，直至注射人绒毛膜促性腺激素之时。以往未使用促性腺激素的治疗方法在所有患者中均未成功。70例接受治疗的患者中有三分之一在156个治疗周期内受孕。无排卵患者（n = 34）的妊娠率为44%，排卵功能障碍患者（n = 23）的妊娠率为26%。妊娠率随患者年龄下降。23例受孕患者中有4例发生自然流产（17%）。多胎妊娠率为10.5%。观察到宫颈黏液发育受到相对抑制，且证实是由CC引起的。3例患者发生了卵巢过度刺激综合征。所讨论的CC-hMG方案接近标准hMG治疗的有效性；但与标准hMG治疗相比，它具有显著的经济优势，且多胎妊娠率似乎明显更低。然而，与标准hMG治疗一样，CC-hMG治疗需要特别仔细的监测，因为可能会发生卵巢过度刺激综合征。
