The relationship between clomiphene citrate (CC) dosing regimens and adverse reproductive outcomes has not been fully elucidated, both with and without use of in vitro fertilisation (IVF). We aimed to study the association between cumulative CC dose and perinatal outcomes among fresh autologous IVF cycles.

Retrospective cohort study.

We included all fresh autologous IVF embryo transfer cycles performed in the US fertility clinics during 2004–2021 using CC for ovulation induction. We used robust Poisson regression models to estimate adjusted risk ratios (aRRs) and 95% CIs for associations between four categories of CC dose (

21 004 fresh autologous embryo transfer cycles using CC.

The primary outcome measures included biochemical pregnancy, clinical pregnancy, spontaneous abortion, stillbirth, live birth, multiple birth and preterm delivery.

Among fresh autologous embryo transfer cycles using CC, 21.3% used

Our findings extend previous findings on the association between CC exposure and adverse perinatal outcomes by demonstrating a dose-dependent relationship.