Minimal ovarian hyperstimulation for in vitro fertilization using sequential clomiphene citrate and gonadotropin with or without the addition of a gonadotropin-releasing hormone antagonist

Fertil Steril. 2002 Nov;78(5):1068-72. doi: 10.1016/s0015-0282(02)03374-5.


Objective: To compare the results of a minimal-stimulation protocol with those of a standard protocol used for IVF.

Design: Retrospective, controlled study.

Setting: University center.

Patient(s): Fifty-five patients undergoing IVF using a minimal-stimulation protocol with or without adjuvant therapy with a GnRH antagonist. A control group consisted of age- and diagnosis-matched patients undergoing a standard long GnRH agonist (GnRH-a)-gonadotropin stimulation during the same time period.

Intervention(s): Clomiphene citrate and gonadotropins, with or without the GnRH antagonist ganirelix.

Main outcome measure(s): Oocytes recovered and pregnancy rates.

Result(s): The number of oocytes retrieved was significantly lower for the minimal-stimulation regimen compared with the case of the long GnRH-a protocol (4.8 +/- 2.6 vs. 16.2 +/- 7.5, respectively). The clinical pregnancy rate per transfer, however, was not significantly different between the two regimens (37% vs. 41%, minimal stimulation vs. long GnRH-a protocol, respectively). The addition of ganirelix resulted in at least the same pregnancy outcome as compared with the case of cycles without the antagonist.

Conclusion(s): Minimal stimulation using clomiphene citrate followed by gonadotropin for IVF results in pregnancy rates equal to the standard long GnRH-a-gonadotropin protocol. The addition of ganirelix resulted in at least similar results with the advantage of eliminating the occurrence of a premature endogenous LH surge.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Clomiphene / therapeutic use*
  • Female
  • Fertilization in Vitro*
  • Gonadotropin-Releasing Hormone / agonists
  • Gonadotropin-Releasing Hormone / analogs & derivatives*
  • Gonadotropin-Releasing Hormone / antagonists & inhibitors*
  • Gonadotropin-Releasing Hormone / therapeutic use
  • Gonadotropins / therapeutic use*
  • Hormone Antagonists / therapeutic use
  • Humans
  • Oocytes
  • Ovulation Induction*
  • Pregnancy
  • Pregnancy Rate
  • Retrospective Studies
  • Tissue and Organ Harvesting


  • Gonadotropins
  • Hormone Antagonists
  • Clomiphene
  • Gonadotropin-Releasing Hormone
  • ganirelix