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Implantation, abortion, and birth after in vitro fertilization using the natural menstrual cycle or follicular stimulation with clomiphene citrate and human menopausal gonadotropin

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Abstract

The incidence of pregnancy and abortion was analyzed in 1679 patients having embryos replaced after oocyte recovery and in vitro fertilization in order to alleviate their infertility. In these patients, 364 pregnancies were achieved and 108 abortions occurred. Patients were treated either on their natural cycle, having a spontaneous luteinizing hormone (LH) surge to induce ovalation, or after ovarian stimulation using clomiphene citrate alone or in combination with human menopausal gonadotropin (hMG). The data were assessed in relation to the numbers of embryos replaced, the follicular stimulation and ovulation induction regime used; the dose of gonadotropins and the dose of antiestrogens, and the age of the patient. The most successful treatment for the number of live births per laparoscopy was the use of clomiphene citrate in combination with human menopausal gonadotropin followed by human chorionic gonadotropin (hCG) to induce follicular maturation and ovulation. This treatment produced a significantly higher (P<0.001) number of patients with multiple embryos (86.5%). There was no significant effect on pregnancy or abortion with alow (<400-mg) or high (≥400-mg) dose of clomiphene. The total dose of gonadotropins used did not influence the incidence of pregnancy or abortion. The use of hCG with hMG induced a significant (P<0.01) positive effect on the incidence of pregnancy. The incidence of pregnancy showed a progressive decline with increasing age but there was a highly significant (P<0.01) increase in the incidence of abortion with increasing age. With increasing numbers of embryos replaced, up to three, the incidence of deliveries increased. The most successful follicular stimulation regime and the replacement of three embryos produced about 25% of the patients delivering normal healthy babies after embryo replacement.

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Author notes

  1. S. B. Fishel

    Present address: Department of Obstetrics and Gynecology, University Hospital, Queens Medical Center, NG7 2UH, Nottingham, UK

Authors and Affiliations

  1. Bourn Hall Clinic, Bourn, CB3 7TR, Cambridge, UK

    S. B. Fishel, R. G. Edwards, J. M. Purdy, P. C. Steptoe, J. Webster, J. Cohen, C. Fehilly, J. Hewitt & G. Rowland

  2. Physiological Laboratory, University of Cambridge, Downing Street, CB2 3EG, Cambridge, UK

    R. G. Edwards

  3. Department of Applied Biology, University of Cambridge, Pembroke Street, CB2 3DX, Cambridge, UK

    E. Walters

Authors
  1. S. B. Fishel
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  2. R. G. Edwards
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  3. J. M. Purdy
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  4. P. C. Steptoe
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  5. J. Webster
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  6. E. Walters
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  7. J. Cohen
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  8. C. Fehilly
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  9. J. Hewitt
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  10. G. Rowland
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Fishel, S.B., Edwards, R.G., Purdy, J.M. et al. Implantation, abortion, and birth after in vitro fertilization using the natural menstrual cycle or follicular stimulation with clomiphene citrate and human menopausal gonadotropin. J Assist Reprod Genet 2, 123–131 (1985). https://doi.org/10.1007/BF01131498

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  • DOI: https://doi.org/10.1007/BF01131498

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