Comparison of Clomiphene Citrate vs Human Menopausal Gonadotropin for controlled ovarian stimulation in infertile women with decreased ovarian reserve (DOR) - A randomised controlled trial

For women with decreased ovarian reserve, controlled ovarian stimulation is done with drugs like clomiphene citrate, letrozole and injectable HMG, and very less number of studies have been done to establish the superiority of one over the other. In this study, two drugs, clomiphene citrate and injectable HMG will be compared for evaluating the efficacy of controlled ovarian stimulation over 3 cycles in women with decreased ovarian reserve. Concealed allocation by placing in sealed envelopes will be done. Each woman will be assigned one envelope and would be categorised into group A and B .Group A will receive oral clomiphene citrate 50mg orally from day 2 to day 6 of menstrual cycle for 3 cycles. If patient does not ovulate in the first cycle then further 2 cycles will be tried with 100mg/day. Group B will receive injectable HMG i/m as a step up regimen starting from 75IU/day from day 2-5 of cycle and increasing every 4-7 days till a maximum dose of upto 225 IU. Comparison of proportion of mean number of dominant follicles formed during controlled ovulation stimulation among clomiphene citrate and injectable HMG over 3 cycles will be done. Further, biochemical pregnancy as defined by positive UPT, clinical pregnancy confirmed by ultrasound findings, OHSS, multiple pregnancy and miscarriage rates will be compared over the 3 cycles.