In vitro fertilization and embryo transfer in infertile patients treated with clomiphene and gonadotrophins

Abstract

A technique by which 182 preovulatory eggs were obtained from women with damaged Fallopian tubes and inseminated in vitro in a modified Tyrodes solution containing .5-1.5 X 10 (6) spermatozoa/ml and equilibrated in 5% carbon dixoide 5% oxygen and 90% nitrogen is described. A schedule of 50-100 mg daily clomiphene for 5 consecutive days followed by 5000 IU human chorionic gonadotropin (HCG) administered 19-36 hours before laparoscopy yielded an average of 1 preovulatory egg per patient. A schedule of human pituitary gonadotropin (HPG) 480-620 IU daily for 5 days followed by 10000 IU HCG injected immediately after the preovulatory estrogen peak with egg collection performed 31-36 hours later yield a greater number of large ovarian follicles with an average of 4 eggs per patient. In the HPG-HCG group there was significant correlation between preovulatory estrogen excretion and size of developing follicles. Of the 182 eggs inseminated in vitro 35 underwent cleavage and 41 were apparently fertilized as judged by the presence of 2 polar bodies and/or pronuclei. 17 morphologically normal embryos ranging from the 8-cell to the morula stage of development were transferred into the uterine cavity of infertile women. No pregnancies have yet been established by this method.