Initial estradiol response predicts outcome of exogenous gonadotropins using a step-down dose regimen for induction of ovulation in polycystic ovary syndrome.
OBJECTIVE
To study ovarian stimulation and response patterns during a gonadotropin step-down dose regimen for induction of ovulation by applying a decremental dose regimen in polycystic ovary syndrome (PCOS) patients.


METHODS
The present prospective study involves 28 infertile clomiphene citrate-resistant PCOS patients during gonadotropin-induced cycles using a modified step-down dose regimen (and adjuvant GnRH agonist medication). Applied gonadotropin doses included initial daily doses of 150 IU IM followed by two reducing steps (37.5 IU each) based on sonographic criteria to a final daily dose of 75 IU IM.


METHODS
Anovulatory infertile women in an academic referral center.


METHODS
Daily blood withdrawal and transvaginal pelvic ultrasound.


METHODS
Serum FSH and E2 concentration and follicle growth were investigated daily during gonadotropin administration.


RESULTS
An initial 2.1-fold increase in serum FSH levels was observed followed by a subsequent decrease of 10% (median) per day for 4 days. Growth of ovarian follicles was sustained and ovulation achieved (midluteal P, 11.7 +/- 1.3 ng/mL; conversion factor to SI unit, 3.180; mean +/- SD) in 22 patients. Major variability in day 3 E2 increase (range, 67 to 866 pg/mL; conversion factor to SI unit, 3.671)--not related to differences in FSH serum concentrations and without changes in follicle number and size--suggests differences in ovarian sensitivity for FSH stimulation. A strong correlation (r = 0.82) was found between day 3 E2 increase and the chance of ovulation. Moreover, E2 levels on the day of gonadotropin dose reduction predict (r = 0.68) chances of late follicular phase E2 levels exceeding 871 pg/mL (conversion factor to SI value, 3.671).


CONCLUSIONS
These findings provide the endocrine basis for the concept of gonadotropin induction of ovulation using a step-down dose regimen. Initial E2 increase (before initiation of follicle growth) represent differences in ovarian sensitivity to gonadotropins and predict treatment outcome.
Schoot
D C
DC
Dijkzigt Academic Hospital, Rotterdam, The Netherlands.
Hop
W C
WC
de Jong
F H
FH
van Dessel
T J
TJ
Fauser
B C
BC
D002064:Buserelin / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004958:Estradiol / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008596:Menotropins / Q000627:therapeutic use; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology*; D011446:Prospective Studies
D006063:Chorionic Gonadotropin; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone; D002064:Buserelin