Comparison of a single dose of follitropin alfa administered before or after clomiphene citrate in the treatment of unexplained infertility

Objective: To evaluate the efficacy of a single 150 international unit (IU) dose of follitropin alfa (FA), administered either before or after clomiphene citrate (CC), in women with unexplained infertility. Methods: This prospective interventional study included 105 patients allocated to four groups. Group 1 received CC 100 mg/day on cycle days 3-7. Group 2 received a single 150-IU dose of FA on day 3, followed by CC on days 4-8. Group 3 received CC 100 mg/day on days 3-7, followed by a single 150-IU dose of FA on day 8. Group 4 received only a single 150-IU dose of FA on day 3. The primary outcomes were pregnancy rate (PR) and risk of ovarian hyperstimulation syndrome (OHSS), and the secondary outcome was ovulation rate (OR). Results: No ovulation was observed in the single-dose FA group. Group 1 had a PR of 11.4%, an OR of 94.3%, and an OHSS risk of 5.7%. Group 2 had a PR of 3.3%, an OR of 80.8%, and an OHSS risk of 13.3%. Group 3 had a PR of 6.7%, an OR of 92.6%, and an OHSS risk of 10%. The OR was significantly higher in the CC group than in the other groups (p=0.022). However, no significant differences were observed among groups in PR or OHSS risk (p>0.05). Conclusion: Adding a single dose of FA before or after CC did not improve treatment success in patients with unexplained infertility.