Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome: a novel protocol
Received 13 December 2007; received in revised form 2 January 2008; accepted 3 January 2008. published online 04 March 2008.
Objective
To test a novel protocol of luteal phase administration of clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS).
Design
Prospective, randomized, controlled trial.
Setting
University teaching hospital and private practice settings.
Patient(s)
The study comprised a total of 212 women (438 cycles) with PCOS.
Intervention(s)
Patients in the early CC group received 100 mg of CC daily starting the next day after finishing medroxyprogesterone acetate (MPA) for 5 days (110 patients, 227 cycles), whereas the patients in the late CC group received 100 mg of CC daily for 5 days starting on day 3 of the menses (102 patients, 211 cycles).
Main Outcome Measure(s)
Number of growing and mature follicles, serum E2 (in picograms per milliliter), serum P (in nanograms per milliliter), endometrial thickness (in millimeters), occurrence of pregnancy and miscarriage.
Result(s)
There were more ovulating patients in the early CC group (59.1% vs. 51.9%), without significant differences. The total number of follicles and the number of follicles ≥14 mm and ≥18 mm during stimulation were significantly greater in the early CC group. The endometrial thickness at the time of hCG administration was significantly greater in the early CC group (9.1 ± 0.23 vs. 8.2 ± 0.60 mm). Serum E2 and P were not significantly different between the two groups. Pregnancy occurred in 23/110 cycles in the early CC group (20.9%) and 16/102 cycles (15.7%) in the late CC group; the difference was not statistically significant. The miscarriage rate was similar in the two groups.
Conclusion(s)
Early administration of CC in patients with PCOS will lead to more follicular growth and endometrial thickness, which might result in a higher pregnancy rate (PR).
aDepartment of Obstetrics & Gynecology, Mansoura University, Mansoura, Egypt
bDepartment of Obstetrics & Gynecology, Cairo University, Cairo, Egypt
cDepartment of Clinical Pathology, Mansoura University, Mansoura, Egypt
dDepartment of Radiology, Mansoura University, Mansoura, Egypt
Reprint requests: Ahmed Badawy, M.D., M.R.C.O.G., Department of Obstetrics & Gynecology, Mansoura University Hospitals, Mansoura, Egypt (FAX: 20502303939).
A.B. has nothing to disclose. H.I. has nothing to disclose. A.M. has nothing to disclose. M.A. has nothing to disclose.
ABSTRACT