Use of clomiphene to prevent premature luteinizing hormone surge during controlled ovarian hyper stimulation

Background: This study seeks to evaluate concurrent use of clomiphene to block spontaneous LH surge in controlled ovarian stimulation in patients with good ovarian reserve. Methods: Thirty five fertile donors with good antral count were stimulated from day 1 or 2 of spontaneous or withdrawal bleeds with clomiphene citrate and recombinant FSH. Transvaginal oocyte retrieval was done after 34 hours of trigger. An LH surge was defined as an LH level ≥10 mIU/ml with progesterone elevation (≥1.0 ng/ml). Fertilization and Embryo quality was assessed from day 2 onwards. Each recipient was transferred a maximum of 3 embryos and remaining were cryopreserved. Results: After an average stimulation of 8.65 days, 15.4 oocytes were retrieved per stimulation. LH surge was noted in 3 cases (9.68%) though oocyte retrieval was done in all cases. Fresh embryo transfer was done in respective recipients of all cases with an implantation rate of 61.29% and a cumulative live birth rate of 42%. Conclusions: Controlled ovarian stimulation using clomiphene and gonadotropin is a viable option to prevent LH surge without additional use of antagonist.