scholarly journals Low-dose gonadotropin induction of ovulation in anovulatory women: still needed in the age of IVF

Reproduction ◽  
2018 ◽  
Vol 156 (1) ◽  
pp. F1-F10 ◽  
Author(s):  
Davinia M White ◽  
Kate Hardy ◽  
Suzannah Lovelock ◽  
Stephen Franks
Keyword(s):  
Large Scale ◽  
Low Dose ◽  
Polycystic Ovary ◽  
Hypogonadotropic Hypogonadism ◽  
Efficacy And Safety ◽  
Oestrogen Treatment ◽  
Induction Of Ovulation ◽  
Appropriate Treatment ◽  
Physiological Approach ◽  
Dose Step

Low-dose, step-up gonadotropin is the treatment of choice for women with polycystic ovary syndrome (PCOS) who have not conceived after anti-oestrogen treatment and as an effective alternative to pulsatile GnRH in women with hypogonadotropic hypogonadism (HH). There has been, however, no large-scale, comparative study between the two groups using low-dose gonadotropins. Here, we performed a retrospective, comparative analysis, in a single clinic database, of efficacy and safety of induction of ovulation using low-dose gonadotropins in 364 women with PCOS and 80 women with HH. The rate of ovulation was high in both PCOS (83%) and HH (84%) but mono-follicular, ovulatory cycles were more prevalent in PCOS than in HH (77% vs 53%,P < 0.0001) and the proportion of cycles that were abandoned was higher in HH than in PCOS (25% vs 15%,P < 0.0001). The median threshold dose of gonadotropin required to induce ovulation was 75 IU/day in PCOS and 113 IU/day in HH (P < 0.001) and the range of doses was greater in HH women. Forty-nine percent of women with PCOS and 65% of those with HH conceived (more than 90% within 6 cycles of treatment) and had at least one pregnancy. Multiple pregnancies (all twins) occurred in only 4% of women with PCOS and 5% of those with HH. These findings emphasise the efficacy and safety of low-dose gonadotropin treatment for both clomiphene-resistant women with PCOS and those with HH. These results highlight the importance of choosing the more physiological approach of gonadotropin induction of ovulation in both groups as the most appropriate treatment, in preference to IVF.

scholarly journals Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

2008 ◽  
Vol 36 (6) ◽  
pp. 1197-1204 ◽  
Author(s):  
R Yildizhan ◽  
E Adali ◽  
A Kolusari ◽  
M Kurdoglu ◽  
B Yildizhan ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Low Dose ◽  
Polycystic Ovary ◽  
Follicle Stimulating Hormone ◽  
Obese Group ◽  
Ovary Syndrome ◽  
Infertile Women ◽  
Starting Dose ◽  
Dose Step ◽  
Stimulating Hormone

Sixty-seven infertile women with polycystic ovary syndrome (PCOS) were divided into two groups, obese and non-obese, according to their body mass index. Waist-to-hip ratio, insulin resistance, total testosterone and dehydroepiandrosterone sulphate levels were significantly elevated in obese, compared with non-obese, patients. Both groups were treated with a low-dose step-up protocol of recombinant follicle-stimulating hormone (rFSH) with a starting dose of 50 IU/day and, every third day, a 25-IU increase in the dose until the appropriate dose was achieved for each individual, up to a maximum of 175 IU/day. In the obese group only, repeat therapy commenced in the second ovulatory cycle in women who had not become pregnant, however a starting dose of 75 IU/day was then used, with incremental and maximum dose as before. The results of the starting dose of 75 IU/day rFSH were compared with the results of a 50 IU/day rFSH starting dose in the obese group. A starting dose of 50 IU/day rFSH in a low-dose step-up regimen was found to be effective, safe and well-tolerated for inducing follicular development in non-obese infertile women with PCOS. However, for obese PCOS patients, a starting dose of 75 IU/day rFSH is recommended.

scholarly journals Urinary Follicle-Stimulating Hormone for Normogonadotropic Clomiphene-Resistant Anovulatory Infertility: Prospective, Randomized Comparison between Low Dose Step-Up and Step-Down Dose Regimens1

1997 ◽  
Vol 82 (11) ◽  
pp. 3597-3602 ◽  
Author(s):  
Evert J. P. van Santbrink ◽  
Bart C. J. M. Fauser
Keyword(s):  
Low Dose ◽  
Ovarian Response ◽  
Serum Levels ◽  
Transvaginal Sonography ◽  
Normal Range ◽  
Duration Of Treatment ◽  
Induction Of Ovulation ◽  
Step Down ◽  
Late Follicular Phase ◽  
Dose Step

A low dose step-up and step-down regimen for induction of ovulation using urinary FSH was compared in a prospective randomized fashion in 37 normogonadotropic clomiphene-resistant oligo- or amenorrheic infertile women. The objectives was to assess potential differences in duration of treatment, ovarian stimulation (serum FSH levels), and response [serum estradiol (E2) levels and number and size of follicles]. Monitoring (blood sampling and transvaginal sonography) took place on the day of initiation of treatment, the first day of ovarian response as assessed by ultrasound (i.e. the first day a follicle ≥10 mm could be recognized), the day of hCG administration to induce ovulation, and 3 days thereafter. The median duration of treatment in the low dose step-up group was 18 (range, 7–41) days compared to 9 (range, 4–16) days in the step-down group (P = 0.003), and the total numbers of ampules administered were 20 (range, 7–69) and 14 (range, 7–33), respectively (P = NS). Serum FSH levels from the first day of sonographic ovarian response until the administration of hCG were constant (median increase, 2%/day) in patients receiving the low dose step-up protocol, but showed a decrease (median, 5%/day) in step-down cycles (P &lt; 0.001). Monofollicular growth, defined as not more than one follicle 16 mm or larger on the day of hCG administration, was observed in 56% of low dose step-up and 88% of step-down cycles (P = 0.04). The percentage of patients with normal range periovulatory E2 serum levels (500–1500 pmol/L) was 33% in the low dose step-up group vs. 71% in the step-down group (P = 0.03). We conclude that a step-down protocol for gonadotropin induction of ovulation exhibits a more physiological, late follicular phase FSH serum profile than a low dose step-up protocol. This results in a shorter duration of treatment, a greater number of monofollicular cycles, and more cycles with periovulatory E2 levels within the normal range in the step-down protocol.

Low-dose gonadotrophin therapy for induction of ovulation in 100 women with polycystic ovary syndrome

1991 ◽  
Vol 6 (8) ◽  
pp. 1095-1099 ◽  
Author(s):  
D. Hamilton-Fairley ◽  
D. Kiddy ◽  
H. Watson ◽  
M. Sagle ◽  
S. Franks
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Low Dose ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Induction Of Ovulation
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