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Ultrasound monitoring during first-cycle treatment with clomifene citrate: a national survey of compliance with NICE

Lookup NU author(s): Dr Jane Stewart


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© 2018, © 2018 The British Fertility Society. The National Institute for Health and Care Excellence Clinical Guideline 156 advises that transvaginal ultrasonography (TVUS) should be used in the first cycle of treatment with clomifene citrate, to assess for multifollicular development and hence the risk of multiple pregnancy. This guidance is based on expert opinion rather than research evidence. We conducted a cross-sectional online and postal survey among UK-based consultant gynaecologists and fertility specialists, to explore compliance with this guideline. A total of 110 responses met the inclusion criteria. During first-cycle treatment with clomifene, 50.9% of respondents were not always using TVUS, and 21.8% never were. Clinicians who did not have immediate access to TVUS were significantly less likely to scan (p < 0.01). Other key factors influencing practice were, personal experience of the clinician, lack of an evidence base to support the guideline and a willingness to accept the risk of multiple pregnancy. Several respondents questioned the value of scanning the first cycle only and highlighted that over-response may be seen in subsequent cycles. This study confirms that there is variation in adherence to the guideline and uncertainty about the clinical need for scan monitoring. Further evidence to support or refute the guideline is required.

Publication metadata

Author(s): Garthwaite H, Stewart J, King K, McGarry K, Wilkes S

Publication type: Article

Publication status: Published

Journal: Human Fertility

Year: 2020

Volume: 23

Issue: 3

Pages: 193-199

Online publication date: 02/11/2018

Acceptance date: 31/08/2018

ISSN (print): 1464-7273

ISSN (electronic): 1742-8149

Publisher: Taylor and Francis Ltd


DOI: 10.1080/14647273.2018.1535201


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