Is clomiphene citrate stair-step protocol a good alternative to gonadotrophins in clomiphene-resistant PCO patients? Prospective study

• Published in: The journal of obstetrics and gynaecology research 2016-05, Vol.42 (5), p.547-553
• Main Authors: Salaheldin AbdelHamid, Amr M., Rateb, Ahmed M., Ismail Madkour, Wael A.
• Format: Article
• Language: English
• Subjects: Adult; Clomiphene - administration & dosage; Clomiphene - adverse effects; Clomiphene - therapeutic use; clomiphene citrate resistance; clomiphene citrate stair-step protocol; Female; Fertility Agents, Female - administration & dosage; Fertility Agents, Female - adverse effects; Fertility Agents, Female - therapeutic use; Follicle Stimulating Hormone - administration & dosage; Follicle Stimulating Hormone - adverse effects; Follicle Stimulating Hormone - therapeutic use; gonadotrophin; Humans; Infertility, Female - complications; Infertility, Female - drug therapy; Ovulation - drug effects; polycystic ovary syndrome; Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - drug therapy; Pregnancy; Pregnancy Rate; Prospective Studies; Treatment Outcome; Young Adult
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.12940

Aim To compare the efficacy and safety of the clomiphene citrate (CC) stair‐step protocol with standard gonadotrophin (follicle‐stimulating hormone) treatment in clomiphene‐resistant polycystic ovary syndrome (PCOS) patients. The study was a prospective cohort study in a tertiary infertility center in Abu Dhabi, United Arab Emirates (UAE). Methods The subjects consisted of 100 PCOS CC‐resistant patients who attended between January 2014 and January 2015. Fifty received CC again but in accordance with the stair‐step protocol, and the other 50 received the standard gonadotrophin treatment used in the center in which the study was conducted. The primary outcome measure was dominant follicle achievement; the secondary outcome measures were (i) clinical pregnancy rate; (ii) time to ovulation measured from treatment initiation to sonographic confirmation of a dominant follicle in days; and (iii) adverse effect occurrence. Results There was no difference between the two treatment modalities concerning the ability to achieve a dominant follicle or the clinical pregnancy rate. The time to ovulation was significantly shorter with the CC stair‐step protocol than with gonadotrophin treatment. Ovarian hyperstimulation syndrome and ovarian cyst formation were more likely to occur with gonadotrophin treatment. Conclusion Clomiphene citrate stair‐step protocol can be offered to PCOS CC‐resistant patients as an alternative to gonadotrophin therapy with similar efficacy.