Ovulation induction with clomiphene or gonadotropins


Lambalk, C.B., Huirne, J.A.F., Macklon, N.S., Fauser, B.C.J.M. and Homburg, R. (2005) Ovulation induction with clomiphene or gonadotropins. In, Slager, E., Fauser, B., van Geijn, H., Brolmann, H. and Vervest, H. (eds.) Gynaecology, Obstetrics, and Reproductive Medicine in Daily Practice. Amsterdam, NL, Elsevier, 16-23. (International Congress Series, 1279). (doi:10.1016/j.ics.2005.01.009 ).

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Description/Abstract

Clomiphene citrate (CC) results in ovulatory cycles in about 75–90% of patients with PCOS and is particularly successful in the leaner, oligomenorrheic non-amenorrheic patient with only limited signs of hyperandrogenism. Of those that ovulate 60–70% conceive with 40–50% resulting in live births.

Traditionally the method following unsuccessful ovulation induction with CC, either because anovulation persists or because no pregnancy occurs, is to administer gonadotropins directly.

The gonadotropin step-down protocol for the PCOS patient is highly attractive from a physiological point of view. Nevertheless, practically and taking into account safety, the low-dose step-up protocol seems the first choice approach. Almost all patients become ovulatory after adequate dosages of gonadotropins with a high BMI, clomiphene resistance, higher IGF1 and FSH serum levels that indicate the need of higher doses of FSH. The overall conception rate is 50–60%. Pregnancy rates are lower in case of obesity, insulin resistance and higher age

Item Type: Book Section
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Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: University Structure - Pre August 2011 > School of Medicine > Developmental Origins of Health and Disease
ePrint ID: 151039
Date Deposited: 01 Jul 2010 12:01
Last Modified: 27 Mar 2014 19:10
Publisher: Elsevier
URI: http://eprints.soton.ac.uk/id/eprint/151039

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