Endocrinology: Sequential step-up and step-down dose regimen: an alternative method for ovulation induction with follicle-stimulating hormone in polycystic ovarian syndrome

Abstract

This study was designed to compare both the effectiveness and safety of two low-dose gonadotrophin regimens (step-up versus sequential step-up and step-down) for ovulation induction in polycystic ovarian syndrome (PCOS) patients. In all, 56 infertile clomiphene citrate-resistant PCOS patients were included in this prospective randomized study. A total of 38 cycles were conducted with a classic step-up protocol, whereas for 35 cycles the follicle-stimulating hormone (FSH) threshold dose was reduced by half when the leading follicle reached 14 mm in diameter (sequential protocol). Serum oestradiol, progesterone and luteinizing hormone concentrations and follicular growth rate were evaluated during the cycle. At the time of human chorionic gonadotrophin administration, cycles treated with sequential protocol exhibited significantly lower oestradiol concentrations [434 +/- 45 versus 593 +/- 67 pg/ml (mean +/- SEM)] and the number of medium-sized (14-15 mm) follicles was significantly reduced (0.3 +/- 0.1 versus 0.8 +/- 0.2) compared with cycles treated with the classic step-up protocol. Moreover, in these cycles serum luteal oestradiol concentrations were decreased significantly (350 +/- 77 versus 657 +/- 104 pg/ ml) compared with the classic step-up protocol. A sequential step-up and step-down protocol seems to be a safe and effective regimen for ovulation induction in PCOS patients. Decreasing the FSH dose following step-up follicular selection may be an alternative method to avoid multifollicular development.

Diagnosis of Polycystic Ovary Syndrome

“…(55) In women with PCOS resistant to clomiphene citrate, gonadotropin therapy with both urinary and recombinant follicle-stimulating hormone (FSH) generally results in pregnancy. (56)(57)(58)(59) In this respect, pituitary desensitization with gonadotropin-releasing hormone analog (GnRHa) in combination with FSH is superior to FSH-only treatment in PCOS patients who demonstrate premature luteinization during clomiphene citrate treatment. (60) However, women undergoing gonadotropin therapy with or without GnRHa are at a higher risk for multiple pregnancy and ovarian hyperstimulation syndrome (OHSS).…”

The impact of ovulation induction and ovarian stimulation on the risk of pregnancy-induced hypertension and on neonatal outcomes: A case/control study

“…Moreover, there might be a small proportion of women with PCOS in the 'spontaneous pregnancy' group because this group was not screened for PCOS, as a result, the observed correlations between PCOS and PIH might be rather an underestimation of the true link, and prospective epidemiological studies are needed to address this question that could have public health impact [34]. Lastly, it may be assumed that mild ovarian stimulation preferentially used in this cohort [14] as a method to avoid multi follicular development in PCOS could have minimised the over risk of PIH in this group [9,15].…”

“…In this context, we aimed to investigate retrospectively in a monocentric cohort of women with identical protocols for prenatal care the rates of PIH, gestational diabetes mellitus, caesarean section, and neonatal outcomes among singleton pregnancies conceived spontaneously or after ovulation induction or ART: (i) considering mainly the type of ovarian stimulation with a focus on the periconceptional hormonal environment assessed by the number of follicles that were produced [14,15]; (ii) considering infertility causes, and notably PCOS; and (iii) adjusting for women's characteristics [10,11].…”

Phase IV, open-label, randomized study of low-dose recombinant human follicle-stimulating hormone protocols for ovulation induction

“…However, a substantial proportion (approximately 40%) of women with WHO Group II anovulatory infertility fail to conceive following CC therapy [5]. Such patients may benefit from gonadotrophin therapy to stimulate follicle development and induce ovulation [1,4,6-9]. Ovulation induction (OI), however, may be associated with the serious complications of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy [9-11].…”