The effect of clomiphene citrate and menopausal gonadotropins on cervical mucus in ovulatory cycles.

OBJECTIVE

To determine the effect of clomiphene citrate (CC) and hMG on cervical mucus (CM), optimally sampled in the periovulatory period from confirmed ovulatory cycles, in the dosage range commonly employed for ovulation induction.

DESIGN

Controlled, observational.

SETTING

Infertility treatment center at a university medical center.

PATIENTS

One hundred fifty-four infertile patients undergoing 161 treatment cycles in which postcoital test was performed in a documented ovulatory cycle.

INTERVENTION

One hundred six patients received CC at dosages of 50 to 200 mg. Twenty patients received hMG at dosages of 75 to 225 IU. Thirty-seven patients sampled during spontaneous ovulatory cycles served as controls.

MAIN OUTCOME MEASURE

Cervical mucus score using standardized scoring criteria.

RESULTS

Subjects receiving CC at all dosages had significantly lower CM scores 8.6 +/- 0.5, compared with patients receiving hMG 11.0 +/- 0.6 or spontaneous cycles 12.1 +/- 0.5. The incidence of unfavorable CM (score < 10/15) was similar in patients receiving CC at dosages of 50 mg (48.1%), 100 mg (48.6%), and 150 to 200 mg (60%).

CONCLUSIONS

Cervical mucus scores are reduced in ovulatory cycles after CC administration compared with both spontaneous ovulatory cycles and in patients undergoing superovulation with hMG. The reduction in CM scores was similar at all dosages of CC studied. The lack of adverse effects on CM during hMG therapy supports a local antiestrogenic effect of CC at the level of the cervix.