Lambalk, C.B., Huirne, J.A.F., Macklon, N.S., Fauser, B.C.J.M. and Homburg, R.
Ovulation induction with clomiphene or gonadotropins
Slager, E., Fauser, B., van Geijn, H., Brolmann, H. and Vervest, H. (eds.)
Gynaecology, Obstetrics, and Reproductive Medicine in Daily Practice.
(International Congress Series, 1279).
Full text not available from this repository.
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
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