Evidence map›Paper›PMID 39893355›Full record

ArticleJournal of assisted reproduction and genetics2025

Clomiphene citrate throughout the duration of ovarian stimulation in patients with diminished ovarian reserve: an approach to decrease costs, reduce injection burden, and prevent premature ovulation.

Rachel S Mandelbaum, Samuel Melville, Aaron Masjedi, Natasha Raj-Derouin, Intira Sriprasert, Molly M Quinn, Richard J Paulson, John G Wilcox, Joie Z Guner

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of assisted reproduction and genetics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Rachel S MandelbaumDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA. rachel.mandelbaum@med.usc.edu.ORCID http://orcid.org/0000-0001-8611-1462
Samuel MelvilleUSC Keck School of Medicine, Los Angeles, CA, USA.
Aaron MasjediDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
Natasha Raj-DerouinDepartment of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Intira SriprasertDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
Molly M QuinnDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
Richard J PaulsonDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
John G WilcoxHRC Fertility, an affiliate of Keck School of Medicine at USC, Pasadena, CA, USA.
Joie Z GunerDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeClomiphene citrate (CC) is often utilized as an adjunct in in vitro fertilization (IVF) protocols during the first 5 days of stimulation for endogenous FSH release. However, due to its antiestrogenic mechanism of action, CC may also effectively prevent the LH surge, and hence premature ovulation, if continued until the day of trigger. The objective of this study was to evaluate a "long CC" protocol, in which CC is continued throughout the entire cycle in-lieu of GnRH antagonist, and to compare IVF outcomes with a standard 5-day CC + GnRH antagonist protocol in patients with diminished ovarian reserve (DOR) undergoing IVF with high-dose gonadotropins.

methodsThis is a retrospective cohort study of all CC-based IVF cycles at a single institution between 9/2020 and 9/2022. Mild stimulation protocols were excluded. The long CC group received CC throughout the entire cycle without GnRH antagonist. The CC + GnRH antagonist group received CC for the first 5 days of stimulation followed by GnRH antagonist when the lead follicle reached 14 mm. The primary outcome was mature oocyte yield.

resultsThere were 361 cycles (77%) in the long CC group and 108 (23%) in the 5-day CC + GnRH antagonist group. Age and AMH levels were similar between the two groups. There was no significant difference in mature oocyte yield between the long CC and 5-day CC + GnRH antagonist groups (median 5 (IQR 5) vs. 4.5 (IQR 5), respectively, (P = 0.922)). MII oocytes/AFC did not differ (0.69 vs. 0.56, respectively, P = 0.16). Premature ovulation occurred in 0.3% of cycles in the long CC group vs. 3.0% of cycles in the 5-day CC + GnRH antagonist group (P = 0.019).

conclusionsIn DOR patients undergoing IVF, a long CC protocol is an effective and patient-friendly approach associated with non-inferior oocyte yield.

Indexed as

ClomipheneInfertility, FemaleOvarian ReserveOvulationOvulation InductionAdultFemaleFertility Agents, FemaleFertilization in VitroGonadotropin-Releasing HormoneHumansOocytesPregnancyPregnancy RateRetrospective StudiesClomipheneFertility Agents, FemaleGonadotropin-Releasing HormoneClomiphene citrateDiminished ovarian reserveIn vitro fertilizationPremature ovulation

Identifiers

PMID39893355
PMCPMC11950535

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.