Is the use of single dose gonadotropin in addition to clomiphene citrate effective in the treatment of unexplained infertility?

Approximately 15% of infertility observed in 10-15% of reproductive age couples was evaluated in the unexplained infertility group. Patients who underwent early follicular phase FSH, LH, E2, TSH, total testosterone, semen analysis, and HSG tests and whose tests were found to be normal are considered as unexplained infertility. Clomiphene citrate (CC) is a selective estrogen receptor modulator (SERM) most commonly used in therapy for ovulation induction. However, there are studies showing that clomiphene citrate has negative effects on endometrial thickness and endocervical mucus. Intrauterine insemination combined with gonadotropin therapy is recommended when controlled induction of ovulation using oral medications fails. The cost of treatment, the need for frequent monitoring, and the risk of ovarian hyperstimulation syndrome are limiting factors when using gonadotropins. The combination of oral drugs with gonadotropin has been reported to significantly reduce the cost of treatment, almost without changing the outcome. The aim of our study is to reduce the gonadotropin dosage used in the treatment of unexplained infertility, to reduce the cost and to obtain low ovarian hyperstimulation risks, to obtain a single follicle instead of the formation of many follicles, to obtain a thicker endometrial thickness by reducing the negative effect of clomiphene citrate on endometrial thickness, and to obtain higher estradiol to detect values and to obtain higher midluteal progesterone values. We divided our unexplained infertility patients into four groups, administered CC, CC+150 units of single dose Follitropin alfa, 150 units of single dose Follitropin alfa+CC, and single dose 150 units of Follitropin alfa treatments. We could not observe a statistically significant difference in the group we gave combined treatment in terms of endometrial thickness, estradiol values, progesterone values, OHSS risk and pregnancy occurrence rates according to the use of clomiphene citrate. In order to see the full effectiveness of these treatments, large-scale randomized controlled studies are needed, in which the causes of infertility are clearly distinguished, including all groups at the sa me time.