Comparison of Clomiphene Citrate and Low Dose Recombinant FSH for Induction of Ovulation in Infertile Women with Polycystic Ovary Syndrome

Abstract

A AB BS S TTR RA AC CT T O Ob bj je ec ct ti iv ve e: : In our study, we aim to compare the treatment success and complication rates of clomiphene citrate (CC) and gonadotopins (r-FSH) using low dose step-up protocol, which are both frequently used as induction of ovulation protocols in patients with polycystic ovary syndrome (PCOS). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 138 patients with PCOS who presented at our infertility outpatient clinic and underwent ovulation induction were included in the study. Diagnosis of PCOS was reached using Rotterdam Criteria after exclusion of other etiological factors. Induction of ovulation was performed on 86 patients with CC and 52 patients with recombinant FSH (r-FSH) using low dose step-up protocol. Clomiphene citrate (n=86) was administered between the 5 th and 9 th days of the menstrual cycle with an initial dose of 50 mg/day. Ovulation induction with r-FSH (n=52) was done using low dose step-up protocol with an initial dose of 75 IU/day. R Re es su ul lt ts s: : Number of follicles was significantly higher in patients in the r-FSH group (p=0.01). The incidence of ovarian hyperstimulation syndrome (OHSS) did not differ significantly among the groups (p=0.487). Also there was no significant difference in pregnancy ratios between two groups (p=0.064). Pregnancy ratios in the r-FSH and CC groups were found to be 12.5% and 5.9%, respectively. Of the pregnant subjects in the CC groups (n=8), one had a miscarriage at 10 th gestational week; one live birth and 1 stillbirth was observed while pregnancies of the remaining 5 (62.5%) were maintained. Within the r-FSH group, where 16 subjects got pregnant, 6 live births (37.5%) and 1 stillbirth (6.3%) observed, and 2 subjects (12.5%) had first trimester abortus. 7 subjects of this group (43.8%) had their pregnancies maintained, while two of these were multiple pregnancies (one couplet and one triplet). C Co on nc cl lu us si io on n: : Clomiphene citrate should be the first line treatment in the ovulation induction of patients with PCOS due to its low costs, easier patient monitorization (oral use), and lower risk of multiple pregnancies and OHSS. On the other hand, we think that administration of r-FSH in PCOS patients using low dose step-up protocol is a safe approach. Therefore, it should be the treatment of choice in patients who do not respond to CC of maximum dosage or for 6 or more cycles. K Ke ey y W Wo or rd ds s: : Clomiphene; gonadotropins; infertility; polycystic ovary syndrome Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmamızın amacı, polikistik over sendromlu (PCOS) hastalarda ovulasyon indüksiyon protokolü olarak sıklıkla kullanılan klomifen sitrat (CC) ve düşük doz step up protokolü ile uygulanan gonadotropinlerin (r-FSH) tedavi başarısı ile komplikasyon oranları açısından karşılaştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : İnfertilite polikliniğimize başvuran ve ovulasyon indüksiyonu yapılan 138 PCOS olgusu çalışmaya dâhil edildi. PCOS tanısı diğer etyolojik faktörleri dışladıktan so...