Quintuplets: A Rare Event Following Clomiphene Citrate Therapy

Abstract

While the effectiveness of clomiphene citrate in the treatment of oligo-ovulatory women has been demonstrated, its use in unexplained infertility remains controversial. In fact, expectant management, controlled ovarian stimulation plus intrauterine insemination and in vitro fertilization are among the possible treatments options for unexplained infertility. According to the most recent Cochrane review, clomiphene citrate was found to be no more effective than no treatment or placebo for clinical pregnancy or live birth, independent of the use of intrauterine insemination or human chorionic gonadotropin. 2 Clomiphene citrate increases the number of follicles produced per cycle and, therefore, increases the number of potential oocytes to be fertilized. Hence, ovulation induction with clomiphene citrate in unexplained infertility, which by definition includes women with ovulatory cycles, must be done very carefully because it can easily lead to multiple ovulations and multiple pregnancies. Moreover, with no clear positive impact on the live birth rate, clomiphene citrate can definitely be considered as risky, as shown in this Image of the Month. 1 Furthermore, we would like to emphasize the need for close ultrasound monitoring of the follicular response when clomiphene citrate is used in conjunction with gonadotropins. In the case mentioned, human chorionic gonadotropin was used to trigger ovulation, which most probably led to the fertilization of five oocytes. Most high order pregnancies could be averted with ultrasound monitoring which could, if needed, prompt cancellation of the cycle or conversion to rescue IVF. 3