Clomiphene citrate for women with unexplained infertility

Abstract

Ovulation induction with clomiphene citrate (CC) alone or combined with intrauterine insemination (IUI), when indicated, is an effective and relatively inexpensive first line treatment for "unexplained infertility" due to suboptimal ovulation or cervical mucus factor, and may shorten the time to pregnancy by increasing the number of preovulatory follicles. Its most effective use will be in women older than 30 years because of the age-related decrease in antral follicles and in women with suboptimal ovulation as evidenced by low preovulation estrogen levels and low progesterone levels, or a short luteal phase. Outcomes are dependent on preovulatory follicle numbers and age of the female partner. Treatment should be continued for a maximum of four cycles except in women with ovulatory dysfunction where it may be continued for up to six cycles. Pregnancy rates can be improved and the risk of multiple pregnancies reduced by ultrasound and hormone monitoring.