title: Gonadotrophin induction of ovulation using a step-down dose regimen: single-centre clinical experience in 82 patients.
abstract: A total of 82 normogonadotrophic clomiphene-resistant anovulatory patients were treated with exogenous gonadotrophins according to a step-down dose regimen during 234 cycles. In 43 (18%) cycles co-treatment with gonadotrophin-releasing hormone analogues was applied. The initial dose was between 1.5 and 2.5 ampoules (75 IU follicle-stimulating hormone each) per day (dependent on body weight), and decreasing steps of 0.5 ampoules/day were based on sonographic findings. The overall ovulation rate was 91% (213 cycles). The median treatment period was 11 days and a total of 14 ampoules of gonadotrophin were needed. In 131 (62%) of the ovulatory cycles not more than one, and in 208 (98%) cycles not more than two, follicles > or = 16 mm were present on the day human chorionic gonadotrophin was given. A total of 37 pregnancies occurred of which two were twins and one was a triplet (multiple pregnancy rate 8%). The pregnancy rate per cycle was 17% and the cumulative pregnancy rate after 7 months was 47%. The abortion rate was 19%. There were four (1.7%) cases of mild ovarian hyperstimulation, of which none became pregnant. In conclusion, this study shows that the applied step-down regimen for gonadotrophin induction of ovulation can be a safe and effective treatment alternative for patients with clomiphene-resistant anovulation. The duration of ovarian stimulation and the amount of exogenous gonadotrophin required is limited. Pregnancy rates are comparable with those reported for step-up regimens, and a low incidence of complications (i.e. multiple gestation and ovarian hyperstimulation) was noted.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Obstetrics and Gynaecology, Dijkzigt Academic Hospital, Rotterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: van Santbrink
authors.forename: P F
authors.initials: PF
authors.lastname: Donderwinkel
authors.forename: T J
authors.initials: TJ
authors.lastname: van Dessel
authors.forename: B C
authors.initials: BC
authors.lastname: Fauser
mesh_terms: D000328:Adult; D002064:Buserelin / Q000008:administration & dosage; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D002996:Clomiphene / Q000494:pharmacology; D004351:Drug Resistance; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000097:blood; D006062:Gonadotropins / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D008596:Menotropins / Q000008:administration & dosage; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D013997:Time Factors
chemical_list: D006063:Chorionic Gonadotropin; D006062:Gonadotropins; D002996:Clomiphene; D008596:Menotropins; D005640:Follicle Stimulating Hormone; D002064:Buserelin