{
    "abstract": "Clomiphene citrate (CC) is often utilized as an adjunct in in vitro fertilization (IVF) protocols during the first 5\u00a0days 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\u2009+\u2009GnRH antagonist protocol in patients with diminished ovarian reserve (DOR) undergoing IVF with high-dose gonadotropins.\nThis 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\u2009+\u2009GnRH antagonist group received CC for the first 5\u00a0days of stimulation followed by GnRH antagonist when the lead follicle reached 14\u00a0mm. The primary outcome was mature oocyte yield.\nThere were 361 cycles (77%) in the long CC group and 108 (23%) in the 5-day CC\u2009+\u2009GnRH 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\u2009+\u2009GnRH antagonist groups (median 5 (IQR 5) vs. 4.5 (IQR 5), respectively, (P\u2009=\u20090.922)). MII oocytes/AFC did not differ (0.69 vs. 0.56, respectively, P\u2009=\u20090.16). Premature ovulation occurred in 0.3% of cycles in the long CC group vs. 3.0% of cycles in the 5-day CC\u2009+\u2009GnRH antagonist group (P\u2009=\u20090.019).\nIn DOR patients undergoing IVF, a long CC protocol is an effective and patient-friendly approach associated with non-inferior oocyte yield.",
    "authors": [
        {
            "affiliation": "Division 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.\nHRC Fertility, an affiliate of Keck School of Medicine at USC, Pasadena, CA, USA. rachel.mandelbaum@med.usc.edu.",
            "firstname": "Rachel S",
            "initials": "RS",
            "lastname": "Mandelbaum"
        },
        {
            "affiliation": "USC Keck School of Medicine, Los Angeles, CA, USA.",
            "firstname": "Samuel",
            "initials": "S",
            "lastname": "Melville"
        },
        {
            "affiliation": "Division 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.",
            "firstname": "Aaron",
            "initials": "A",
            "lastname": "Masjedi"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.",
            "firstname": "Natasha",
            "initials": "N",
            "lastname": "Raj-Derouin"
        },
        {
            "affiliation": "Division 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.",
            "firstname": "Intira",
            "initials": "I",
            "lastname": "Sriprasert"
        },
        {
            "affiliation": "Division 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.\nHRC Fertility, an affiliate of Keck School of Medicine at USC, Pasadena, CA, USA.",
            "firstname": "Molly M",
            "initials": "MM",
            "lastname": "Quinn"
        },
        {
            "affiliation": "Division 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.\nHRC Fertility, an affiliate of Keck School of Medicine at USC, Pasadena, CA, USA.",
            "firstname": "Richard J",
            "initials": "RJ",
            "lastname": "Paulson"
        },
        {
            "affiliation": "HRC Fertility, an affiliate of Keck School of Medicine at USC, Pasadena, CA, USA.",
            "firstname": "John G",
            "initials": "JG",
            "lastname": "Wilcox"
        },
        {
            "affiliation": "Division 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.\nHRC Fertility, an affiliate of Keck School of Medicine at USC, Pasadena, CA, USA.",
            "firstname": "Joie Z",
            "initials": "JZ",
            "lastname": "Guner"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. The Author(s).",
    "doi": "10.1007/s10815-025-03412-w",
    "journal": "Journal of assisted reproduction and genetics",
    "keywords": [
        "Clomiphene citrate",
        "Diminished ovarian reserve",
        "In vitro fertilization",
        "Premature ovulation"
    ],
    "methods": null,
    "publication_date": "2025-02-02",
    "pubmed_id": "39893355\n7221556\n5539112\n6714446\n5653116\n3150950\n21989495\n32502769\n23152261\n15193479\n34531825\n34609115\n25956370\n24882557\n34992345\n30338234\n20236631\n9853849\n11163814\n31824419\n10689017\n17697488\n29728130\n26175889",
    "results": "There were 361 cycles (77%) in the long CC group and 108 (23%) in the 5-day CC\u2009+\u2009GnRH 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\u2009+\u2009GnRH antagonist groups (median 5 (IQR 5) vs. 4.5 (IQR 5), respectively, (P\u2009=\u20090.922)). MII oocytes/AFC did not differ (0.69 vs. 0.56, respectively, P\u2009=\u20090.16). Premature ovulation occurred in 0.3% of cycles in the long CC group vs. 3.0% of cycles in the 5-day CC\u2009+\u2009GnRH antagonist group (P\u2009=\u20090.019).",
    "title": "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.",
    "xml": "<Element 'PubmedArticle' at 0x788505614770>"
}