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

Garthwaite, Heather, Stewart, James, King, Kathryn, McGarry, Kenneth and Wilkes, Scott (2018) Ultrasound monitoring during first-cycle treatment with clomifene citrate: a national survey of compliance with NICE. Human Fertility. ISSN 1464-7273

Item Type: Article


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.

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More Information

Depositing User: Klaire Purvis-Shepherd


Item ID: 10194
Identification Number:
ISSN: 1464-7273
Official URL:

Users with ORCIDS

ORCID for Kathryn King: ORCID iD
ORCID for Kenneth McGarry: ORCID iD
ORCID for Scott Wilkes: ORCID iD

Catalogue record

Date Deposited: 23 Nov 2018 11:31
Last Modified: 18 Dec 2019 16:07


Author: Kathryn King ORCID iD
Author: Kenneth McGarry ORCID iD
Author: Scott Wilkes ORCID iD
Author: Heather Garthwaite
Author: James Stewart

University Divisions

Faculty of Technology
Faculty of Technology > School of Computer Science


Sciences > Health Sciences

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