Ovulation induction with clomiphene or gonadotropins

Clomiphene citrate (CC) results in ovulatory cycles in about 75–90% of patients with PCOS and is particularly successful in the leaner, oligomenorrheic non-amenorrheic patient with only limited signs of hyperandrogenism. Of those that ovulate 60–70% conceive with 40–50% resulting in live births. Tra...

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Bibliographic Details
Published in:International Congress series 2005-04, Vol.1279, p.16-23
Main Authors: Lambalk, C.B., Huirne, J.A.F., Macklon, N.S., Fauser, B.C.J.M., Homburg, R.
Format: Article
Language:English
Subjects:
Clomiphene
Gonadotropins
Ovulation induction
PCOS
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Summary:Clomiphene citrate (CC) results in ovulatory cycles in about 75–90% of patients with PCOS and is particularly successful in the leaner, oligomenorrheic non-amenorrheic patient with only limited signs of hyperandrogenism. Of those that ovulate 60–70% conceive with 40–50% resulting in live births. Traditionally the method following unsuccessful ovulation induction with CC, either because anovulation persists or because no pregnancy occurs, is to administer gonadotropins directly. The gonadotropin step-down protocol for the PCOS patient is highly attractive from a physiological point of view. Nevertheless, practically and taking into account safety, the low-dose step-up protocol seems the first choice approach. Almost all patients become ovulatory after adequate dosages of gonadotropins with a high BMI, clomiphene resistance, higher IGF1 and FSH serum levels that indicate the need of higher doses of FSH. The overall conception rate is 50–60%. Pregnancy rates are lower in case of obesity, insulin resistance and higher age.
ISSN:0531-5131
1873-6157
DOI:10.1016/j.ics.2005.01.009