Ovulation induction using clomiphene citrate using stair – Step regimen versus traditional regimen in polycystic ovary syndrome women – A randomized control trial

Agrawal, Kanhaiyalal; Gainder, Shalini; Dhaliwal, Lakhbir Kaur; Suri, Vanita

doi:10.4103/jhrs.jhrs_15_17

Cited by 6 publications

(1 citation statement)

References 12 publications

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“…Jones et al reported a significant increase in the number of follicles in the SSP group, with mean values of 2 in SSP and 1 in CC (4) . Agrawal et al found the highest number of follicles and the largest follicle size in the SSP group (12) . However, our results do not align with those of Pourhoseini et al, who found no significant differences between the two groups in terms of the number of medium, large, or total follicles (pvalues of 0.288 for all) (13) .…”

Section: Discussionmentioning

confidence: 95%

Traditional Clomiphene Citrate with Phytoestrogen Versus Traditional Clomiphene Citrate Versus Stair Step Protocol in Patients with Polycystic Ovaries: A Randomized Clinical Trial

2023

The Egyptian Journal of Hospital Medicine

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Introduction: Polycystic ovary syndrome (PCOS) ranks among the most prevalent endocrine disease affecting women of reproductive age. Multiple therapeutic approaches have been suggested for the management of PCOS. Anovulation is responsible for approximately 40% of female infertility cases, and a significant portion of individuals dealing with infertility are also diagnosed with polycystic ovary syndrome. Patients and methods: This was a prospective multi-center randomized clinical trial conducted from April 2022 till March 2023 involving one hundred fifty female patients with PCOS categorized into three categories, category I (traditional protocol) involved 50 subjects who received traditional clomiphene citrate (CC) 100 mg for 5 days, and category II stair-step protocol (SS) involved 50 subjects who received clomiphene citrate 50 mg for 5 days followed by 100 mg for another 5 days and phytoestrogen given for the whole 10 days. In addition, group III clomiphene + phytoestrogen (CCP) included 50 patients who received 100 mg of clomiphene citrate for 5 days and phytoestrogen for 10 days. Results: There was significantly thinner endometrium in the CC group as compared to the other two groups; the greatest endometrial thickness was in the SS protocol group, followed by the CCP group; a higher pregnancy rate and ovulation rate were in the SS protocol group, followed by the CCP group; and the lowest pregnancy rate and ovulation rate were in the CC group. Conclusions: Clomiphene, when used as an SS regimen, improves pregnancy rates without any side effects compared to traditional regimens. Adding phytoestrogens to CC is associated with improving endometrial thickness and pregnancy rates.

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Section: Discussionmentioning

confidence: 95%

Traditional Clomiphene Citrate with Phytoestrogen Versus Traditional Clomiphene Citrate Versus Stair Step Protocol in Patients with Polycystic Ovaries: A Randomized Clinical Trial

2023

The Egyptian Journal of Hospital Medicine

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The stair-step approach in treatment of anovulatory PCOS patients

Horowitz

Weissman

2020

Clin Med�Insights�Reprod�Health

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Clomiphene citrate (CC) is a widely accepted first-line treatment for anovulatory patients with polycystic ovarian syndrome (PCOS). The current practice is to prescribe CC with gradual dose increments until ovulation is achieved. Typically, progesterone withdrawal bleeding is induced between each dose increment and before the commencement of gonadotropin therapy in CC-resistant patients. It has been recently suggested that dose increments of CC can be administered once failure to induce ovulation at a certain dose has been documented, without induction of progesterone withdrawal bleeding, and this approach has been nicknamed the clomiphene-citrate stair-step (CC-SS) protocol. The same principle has been found feasible before introducing gonadotropin therapy in CC-resistant PCOS patients. Our objective was to review the world literature on the CC-SS protocol and to summarize our own experience with extending the CC-SS approach to initiation of gonadotropin therapy. Studies on CC-SS protocol ( n = 4) have found that this approach leads to a significant reduction of the time to ovulation and to an increased ovulation rate. In our own retrospective case series, 18 CC-resistant PCOS patients initiated gonadotropin stimulation without induction of progesterone withdrawal bleeding, using the chronic low-dose regimen. The time to ovulation in the study group was 54.2 ± 6.2 days, while the estimated time to ovulation calculated according to the traditional approach was approximately 110 days. The clinical pregnancy rate was 44% (8/18), and all pregnancies were singletons. One patient miscarried; hence, the live birth rate was 38.9% (7/18). In summary, the CC-SS approach and its extension to the initiation of gonadotropin therapy results in considerable reduction of the time to ovulation, and favorable ovulation rates and reproductive outcome. Large-scale confirmation of these findings by properly designed randomized controlled trials may lead to a change of practice in the treatment of anovulatory infertility in PCOS patients, allowing simplification of treatment and a shorter time to ovulation and pregnancy.

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Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with polycystic ovarian syndrome

et al. 2022

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Objectives: To compare the efficacy of letrozole (LTZ) vs clomiphene citrate (CC) for ovulation induction in patients having polycystic ovarian syndrome (PCOS). Methods: This randomized controlled trial was conducted at The Department of Obstetrics & Gynecology, Nishtar Medical University Hospital, Multan, Pakistan from January 2021 to June 2021. A total of 78 women aged 18 to 30 years, diagnosed having PCOS were enrolled. In Group-A, 39 women were given LTZ, 5mg for five days of menstrual cycle. In Group-B, 39 women were given CC, 100mg for five days of menstrual cycle. All patients underwent transvaginal scan (TVS) for the evaluation of efficacy in terms of ovulation induction. Results: Overall mean age was noted to be 25.41±2.84 years. Most of the patients, 51 (65.4%) belonged to rural area of residence. There were 52 (66.7%) patients with BMI less than 25 kg/m2. Overall, mean duration of infertility was found to be 2.62±0.74 years. Among 70 patients who completed the follow ups and analyzed regarding efficacy, in Group-A, efficacy was noted in 23 (59.0%) patients in comparison to 14 (35.9%) in Group-B (p=0.0413). Mean endometrial thickness was significantly better in Group-A versus Group-B (8.1±1.5 mm vs. 6.8±1.9 mm, p=0.0022). Conclusion: Aiming ovulation induction, letrozole in comparison to clomiphene citrate was found to have significantly better efficacy among women having anovulatory PCOS. doi: https://doi.org/10.12669/pjms.38.5.5565 How to cite this:Khakwani M, Parveen R, Yousaf S, Tareen AU. Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with polycystic ovarian syndrome. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.5565 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ovulation induction using clomiphene citrate using stair – Step regimen versus traditional regimen in polycystic ovary syndrome women – A randomized control trial

Cited by 6 publications

References 12 publications

Traditional Clomiphene Citrate with Phytoestrogen Versus Traditional Clomiphene Citrate Versus Stair Step Protocol in Patients with Polycystic Ovaries: A Randomized Clinical Trial

Traditional Clomiphene Citrate with Phytoestrogen Versus Traditional Clomiphene Citrate Versus Stair Step Protocol in Patients with Polycystic Ovaries: A Randomized Clinical Trial

The stair-step approach in treatment of anovulatory PCOS patients

Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with polycystic ovarian syndrome

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