The use of clomiphene citrate and pituitary gonadotropin in successive pregnancies: The Sheffield quadruplets

The induction of ovulation followed by subsequent pregnancy in the same patient on two occasions is reported. Initially, clomiphene citrate was used, resulting in a singleton birth. The subsequent use of pituitary gonadotropin, following the failure of clomiphene, induced a multiple ovulation and a quadruplet pregnancy, which included monoamniotic twins. The hormonal values both during ovarian stimulation and throughout the subsequent pregnancies are reported. It was of interest to note that, despite the presence of four fetuses, the estriol values did not differ markedly from those observed during the singleton pregnancy. The pregnanediol values were all elevated, probably reflecting the marked increase in placental tissue.