Infertility: Incidence of spontaneous abortion in clomiphene pregnancies
Abstract
The purpose of this study was to determine whether the use of clomiphene results in a higher incidence of spontaneous abortion than occurs naturally in subfertile patients. Reproductive outcomes of 1744 clomiphene pregnancies were compared to outcomes of 3245 spontaneous pregnancies in a prospective study. Abortion was classified as clinical if a sac was seen on ultrasound or if it occurred after 6 gestational weeks, and as preclinical if a quantitative human chorionic gonadotrophin (HCG) was > or = 25 mIU and no sac was seen or abortion occurred earlier. The overall incidence of abortion was higher for clomiphene pregnancies (23.7%), compared with spontaneous pregnancies (20.4%) (P < 0.01). Preclinical abortions were increased by clomiphene for all ages (5.8 versus 3.9%, P < 0.01) and for age > or = 30 years (8.0 versus 4.9%, P < 0.001), but not for age < 30 years (3.7 versus 3.0%). Clinical abortions were increased by clomiphene for age < 30 years (15.9 versus 11.2%) (P < 0.01), but not for age > or = 30 years (20.1 versus 22.3%) or all ages (18.0 versus 16.4%). Clinical abortions occurred 22% less often following clomiphene compared with spontaneous pregnancies for patients with luteal insufficiency (18.3 versus 23.6%, P < 0.05). We conclude that the increase in abortion due to clomiphene is small and may be related to different causes for women aged < 30 and > or = 30 years, and also that clomiphene may decrease clinical abortions in patients with luteal insufficiency.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Clomiphene results in a 60%-85% ovulation rate and a 10%-20% pregnancy rate per cycle.
“Clomiphene results in a 60%-85% ovulation rate and a 10%-20% pregnancy rate per cycle (2)(3)(4)(5)(6)(7)(8).”
From A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women (2002) · cites this paper as [2]
Cites
Clifford, K., Rai, R., Watson, H., & Regan, L. (1994) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a138703 · Cited by 423 · see citing works
INCREASED FREQUENCY OF CHROMOSOMAL ANOMALIES IN ABORTIONS AFTER INDUCED OVULATION
Boué, J., & Boué, A. (1973) · The Lancet · doi:10.1016/s0140-6736(73)92261-7 · Cited by 108 · see citing works
Laufer, N., Pratt, B. M., DeCherney, A. H., Naftolin, F. N., Merino, M. J., & Markert, C. L. (1983) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(83)90440-4 · Cited by 71 · see citing works
Dickey, R. P., Olar, T. T., Curole, D. N., Taylor, S. N., Rye, P. H., & Matulich, E. M. (1990) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a137202 · Cited by 51 · see citing works
Self-citationDickey, R. P. (1995) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a135811 · Cited by 23 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Consensus on infertility treatment related to polycystic ovary syndrome
The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group March 2–3, 2. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.09.041 · Cited by 719 · see citing works
The Science behind 25 Years of Ovarian Stimulation for in Vitro Fertilization
Macklon, N., Stouffer, R. L., Giudice, L. C., & Fauser, B. C. J. M. (2006) · Endocrine Reviews · doi:10.1210/er.2005-0015 · Cited by 561 · see citing works
Fisher, S. A., Reid, R. L., Van Vugt, D. A., & Casper, R. F. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03241-7 · Cited by 347 · see citing works
Mitwally, M. F. M. (2003) · Human Reproduction · doi:10.1093/humrep/deg311 · Cited by 344 · see citing works
Gupta, S., Agarwal, A. K., Banerjee, J., & Álvarez, J. G. (2007) · Obstetrical & Gynecological Survey · doi:10.1097/01.ogx.0000261644.89300.df · Cited by 334 · see citing works
Clomiphene citrate—end of an era? a mini-review
Homburg, R. (2005) · Human Reproduction · doi:10.1093/humrep/dei042 · Cited by 332 · see citing works
Modern use of clomiphene citrate in induction of ovulation
Κousta, E. (1997) · Human Reproduction Update · doi:10.1093/humupd/3.4.359 · Cited by 327 · see citing works
Development, pharmacology and clinical experience with clomiphene citrate
Dickey, R. (1996) · Human Reproduction Update · doi:10.1093/humupd/2.6.483 · Cited by 226 · see citing works
Self-citationSchieve, L. A., Rasmussen, S. A., Louis, G. M. B., Schendel, D., Reynolds, M. A., & Wright, V. C. (2004) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000124571.04890.67 · Cited by 154 · see citing works
Pregnancy complications in PCOS
Homburg, R. (2006) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2006.03.009 · Cited by 140 · see citing works
Use of clomiphene citrate in infertile women: a committee opinion
(2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.05.033 · Cited by 122 · see citing works
Begum, M. R., Ferdous, J., Begum, A., & Quadir, E. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.08.044 · Cited by 109 · see citing works
Akolekar, R., Bower, S. J., Flack, N. J., Bilardo, C. M., & Nicolaides, K. H. (2011) · Prenatal Diagnosis · doi:10.1002/pd.2644 · Cited by 95 · see citing works
Chapin, R. E., Robbins, W. A., Schieve, L. A., Sweeney, A., Tabacova, S. A., & Tomashek, K. M. (2003) · Environmental Health Perspectives · doi:10.1289/ehp.6261 · Cited by 92 · see citing works
A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage
Cocksedge, K. A., Li, T.-C., Saravelos, S. H., & Metwally, M. (2008) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)60304-5 · Cited by 73 · see citing works
Amer, S. A., Li, T. C., Metwally, M., Emarh, M., & Ledger, W. L. (2008) · Human Reproduction · doi:10.1093/humrep/den325 · Cited by 73 · see citing works
Relationship of clomiphene dose and patient weight to successful treatment
Dickey, R. P., Taylor, S. N., Curole, D. N., Rye, P. H., Lu, P. Y., & Pyrzak, R. (1997) · Human Reproduction · doi:10.1093/humrep/12.3.449 · Cited by 73 · see citing works
Self-citationHan, A. R., Kim, H. O., Cha, S. W., Park, C. W., Kim, J. Y., Yang, K. M., Song, I. O., Koong, M. K., & Kang, I. S. (2011) · Daehan saengsik uihak hoeji/Clinical and experimental reproductive medicine · doi:10.5653/cerm.2011.38.2.103 · Cited by 63 · see citing works
Ray, P. B., Ray, A., & Chakraborti, P. S. (2011) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-011-2091-7 · Cited by 54 · see citing works
Use of clomiphene citrate in women
(2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.08.023 · Cited by 41 · see citing works
Clomiphene citrate in the twenty-first century
Nasseri, S., & Ledger, W. J. (2001) · Human Fertility · doi:10.1080/1464727012000199212 · Cited by 40 · see citing works
Nejad, E. S. T., Abediasl, Z., Rashidi, B. H., Nekoo, E. A., Shariat, M., & Amirchaghmaghi, E. (2008) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-008-9209-2 · Cited by 37 · see citing works
Zebrafish AC modelling: (Q)SAR models to predict developmental toxicity in zebrafish embryo
Lavado, G. J., Gadaleta, D., Toma, C., Golbamaki, A., Toropov, A. A., Toropova, A. P., Marzo, M., Baderna, D., Arning, J., & Benfenati, E. (2020) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2020.110936 · Cited by 32 · see citing works
Ott, J., Kurz, C., Nouri, K., Wirth, S., Vytiska‐Binstorfer, E., Huber, J. C., & Mayerhofer, K. (2010) · Reproductive Biology and Endocrinology · doi:10.1186/1477-7827-8-45 · Cited by 32 · see citing works
Polycystic Ovarian Syndrome and Fertility
LENTSCHER, J. A., Slocum, B., & Torrealday, S. (2020) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000595 · Cited by 31 · see citing works
Ibrahim, M. I., Moustafa, R. A., & Abdel-Azeem, A. A. (2012) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-012-2478-0 · Cited by 29 · see citing works
RetractedLi, Y., Kuang, H., Shen, W., Ma, H., Zhang, Y., Stener‐Victorin, E., Hung, E., Ng, E. H. Y., Liu, J., Kuang, H., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003934 · Cited by 26 · see citing works
Oral agents for ovulation induction – clomiphene citrate versus aromatase inhibitors
Homburg, R. (2008) · Human Fertility · doi:10.1080/14647270701689670 · Cited by 26 · see citing works
Embryo implantation failure and other reproductive defects in Ube2q1 -deficient female mice
Grzmil, P., Altmann, M. E., Adham, I. M., Engel, U., Jarry, H., Schweyer, S., Wolf, S., Mänz, J., & Engel, W. (2012) · Reproduction · doi:10.1530/rep-12-0054 · Cited by 24 · see citing works
Begum, M. R., Quadir, E., Begum, A., Begum, R. A., & Begum, M. (2006) · Journal of obstetrics and gynaecology research · doi:10.1111/j.1447-0756.2006.00434.x · Cited by 23 · see citing works
Tavaniotou, A., Albano, C., Steirteghem, A. V., & Devroey, P. (2003) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)62161-x · Cited by 21 · see citing works
Current trends in the treatment of polycystic ovary syndrome with desire for children
Checa, M. Á. (2009) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s3779 · Cited by 20 · see citing works
Use of clomiphene citrate in women
The Practice Committee of the American Society for Reproductive Medicine (2003) · Fertility and Sterility · doi:10.1016/s0015-0282(03)01184-1 · Cited by 19 · see citing works
Endometrial Evaluation Is Not Predictive for In Vitro Fertilization Treatment
Csemiczky, G., Wramsby, H., JOHANNISSON, E., & Landgren, B.-M. (1999) · Journal of Assisted Reproduction and Genetics · doi:10.1023/a:1022594729197 · Cited by 18 · see citing works
A randomized trial comparing the ovulation induction efficacy of clomiphene citrate and letrozole
Ghose, S., Gowda, M. S. S., & Angel, M. (2014) · Journal of Natural Science Biology and Medicine · doi:10.4103/0976-9668.136241 · Cited by 16 · see citing works
Is it safe to prescribe clomiphene citrate without ultrasound monitoring facilities?
Coughlan, C., Fitzgerald, J., Milne, P., & Wingfield, M. B. (2010) · Journal of Obstetrics and Gynaecology · doi:10.3109/01443611003646280 · Cited by 14 · see citing works
Clomiphene citrate: the changing landscape
Gupta, M. C., & Khanna, J. (2018) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20183011 · Cited by 13 · see citing works
Sakhavar, N., Kaveh, M., & Sadegi, K. (2014) · Europe PMC (PubMed Central) · Cited by 11 · see citing works
Pregnancy Complications in PCOS
Homburg, R. (2009) · Springer eBooks · doi:10.1007/978-0-387-09718-3_11 · Cited by 10 · see citing works
Assessment of the luteal phase in stimulated and substituted cycles.
Fatemi, H. M. (2009) · PubMed Central · Cited by 10 · see citing works
Nutu, M., Feng, Y., Egecioglu, E., Weijdegård, B., Stener‐Victorin, E., & Shao, R. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.03.039 · Cited by 9 · see citing works
Letrozole for ovulation induction
Mitwally, M. F., & Casper, R. F. (2006) · Expert Review of Obstetrics & Gynecology · doi:10.1586/17474108.1.1.15 · Cited by 6 · see citing works
Clomiphene Citrate versus Letrozole for Ovulation Induction in PCOS: A Comparative Study
Nambiar, S. S. (2018) · Journal of South Asian Federation of Obstetrics and Gynaecology · doi:10.5005/jp-journals-10006-1631 · Cited by 5 · see citing works
Chin, P. Y., Chan, H. Y., Kieffer, T. E. C., Prins, J. R., Russell, D. L., Davies, M. J., & Robertson, S. A. (2024) · Endocrinology · doi:10.1210/endocr/bqae047 · Cited by 5 · see citing works
Use of clomiphene citrate in women
(2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2004.05.008 · Cited by 5 · see citing works
Ovulation induction with clomiphene or gonadotropins
Lambalk, C. B., Huirne, J. A. F., Macklon, N., Fauser, B. C. J. M., & Homburg, R. (2005) · International Congress Series · doi:10.1016/j.ics.2005.01.009 · Cited by 4 · see citing works
Is the fertility treatment itself a risk factor for early pregnancy loss?
Torrealday, S. (2014) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000064 · Cited by 4 · see citing works
Management of Polycystic Ovary Syndrome
Yasmin, E., & Balen, A. H. (2007) · Women s Health · doi:10.2217/17455057.3.3.355 · Cited by 4 · see citing works
Roy, O., Ammankallu, S., Narayana, V. K., Kotimoole, C. N., Hebbar, S. S., Adiga, P. K., Joshi, M. B., Gowda, J., Kumar, A., Adiga, S. K., et al. (2025) · Reproductive Sciences · doi:10.1007/s43032-025-01884-w · Cited by 3 · see citing works
Clomiphene Citrate for Ovulation Induction
Dickey, R. P. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9780511547287.026 · Cited by 3 · see citing works
Self-citationNajim, H. D., Al-khfajy, W. S., Albasry, Z., & Al‐Taie, A. (2023) · International Journal of Academic Medicine · doi:10.4103/ijam.ijam_90_22 · Cited by 2 · see citing works
Hammadeh, M. E., Ertan, K., Rosenbaum, P., & Schmidt, W. (2007) · Cited by 2 · see citing works
Coughlan, C., & Ledger, W. J. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511762390.013 · Cited by 2 · see citing works
Ovulationsinduktion und ovarielle Stimulation
Griesinger, G. (2019) · Springer Reference Medizin · doi:10.1007/978-3-662-57636-6_15 · Cited by 2 · see citing works
Experience of clomiphene use in a district general hospital
Damodaran, S., Mamatha, L., Pheely, M., & Mahmood, T. A. (2010) · Journal of Obstetrics and Gynaecology · doi:10.3109/01443610903267499 · Cited by 2 · see citing works
Polycystic Ovary Syndrome: Ovulation Induction Strategies
Taha, L. E., Rizk, B. R., Ledger, W. J., Sayegh, R. A., & Awwad, J. T. (2022) · Cambridge University Press eBooks · doi:10.1017/9781316477021.016 · Cited by 1 · see citing works
Bosenge-Nguma, J.-D., O’yandjo, A. M., Djang'Eing'A, R. M., Juakali, S. K. V., Otuli, N. L., Chin, A. H. B., & Bosunga, G. K. (2024) · Cureus · doi:10.7759/cureus.63414 · Cited by 1 · see citing works
Bosenge-Nguma, J.-D., O’yandjo, A. M., Djang'Eing'A, R. M., Juakali, S. K. V., Otuli, N. L., Ntokamunda, J.-L. K., Chin, A. H. B., & Bosunga, G. K. (2024) · Contraception and Reproductive Medicine · doi:10.1186/s40834-024-00307-6 · Cited by 1 · see citing works
Pregnancy in Polycystic Ovary Syndrome
Homburg, R. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-108-6_20 · Cited by 1 · see citing works
Determination of pro-oxidant-antioxidant balance (PAB) assay in mothers with spontaneous abortion
Ghasemi, F., Kamali, A., & Shokrpour, M. (2021) · Bionatura · doi:10.21931/rb/2021.06.03.14 · Cited by 1 · see citing works
Sánchez, I. O. (2014) · BURJC Digital (King Juan Carlos University)
Mild forms of ovarian stimulation
Aboulghar, M. A., & Rizk, B. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511762390.004
Use of Metformin in Clomiphene Citrate (CC) Resistant Polycystic Ovary Syndrome (PCOS)
Begum, M. R., Banu, L. A., Rumana, R., Dewan, F., & Rouf, S. (2009) · Journal of South Asian Federation of Obstetrics and Gynaecology · doi:10.5005/jp-journals-10006-1035
Siebert, T. I. (2008) · SUNScholar (Stellenbosch University)
Effective Regimens for Ovulation Induction in Polycystic Ovary Syndrome
Tapanainen, J. S., & Morin-Papunen, L. C. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-108-6_19
Difficulties and complication of ovarian stimulation
Aboulghar, M. A., & Rizk, B. R. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511762390.012
Ovulationsinduktion und ovarielle Stimulation
Griesinger, G. (2019) · Springer Reference Medizin · doi:10.1007/978-3-662-55601-6_15-1
Griesinger, G. (2013) · Springer eBooks · doi:10.1007/978-3-642-30181-0_11
Gibson, M. (2010) · Springer eBooks · doi:10.1007/978-1-4419-1436-1_35
Oral Agents for Ovarian Stimulation
Mitwally, M. F., & Casper, R. F. (2022) · Cambridge University Press eBooks · doi:10.1017/9781316477021.004
Lecomte, P., & Lecomte, C. (2000) · EMC - Ginecología-Obstetricia · doi:10.1016/s1283-081x(00)71877-7
Homburg, R. (2014) · Springer eBooks · doi:10.1007/978-3-319-05612-8_8
Lecomte, P., & Lecomte, C. (2006) · EMC - Gynécologie · doi:10.1016/s0246-1064(00)00030-x
Oral Agents for Ovulation Induction
Narin, R. (2022) · Düzce Tıp Fakültesi Dergisi · doi:10.18678/dtfd.1185208
Roy, O., Hegde, S., Ritting, M. L., Hebbar, S. S., Gowda, J., Agarwal, J., Nair, A. S., Joshi, M. B., Kumar, A., Adiga, S. K., et al. (2026) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2026.117819
- Authors
- Dickey, R. P., Taylor, S. N., Curole, D. N., Rye, P. H., & Pyrzak, R.
- Affiliations
- Tulane University (US)
- Corresponding author
- Dickey, R. P.
- ORCID
- Dickey, R. P.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-12-01
- Volume
- 11
- Issue
- 12
- Pages
- 2623-2628
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2016380394
- Cited by
- 76
- References
- 5
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 2 · 2014: 5 · 2013: 3 · 2012: 2
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- clomiphene citrate, miscarriage, infertility, subfertility, luteal insufficiency, maternal age, pregnancy outcomes, ovulation induction
- MeSH terms
- Abortion, Spontaneous, Adult, Clomiphene, Female, Fertilization in Vitro, Follicle Stimulating Hormone, Gestational Age, Humans, Menotropins, Pregnancy, Pregnancy Outcome, Prospective Studies, Gamete Intrafallopian Transfer
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
