title: The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO group II anovulatory infertile women: evidence from a large multicenter study in Spain.
abstract: OBJECTIVE
  Our goal was to investigate the safety, effectiveness, and feasibility for the practicing physician of stepwise and low-dose administration of FSH in WHO group II anovulatory infertile women.
  
  
  METHODS
  Infertile female patients (n = 234) suffering from WHO group II anovulation, and who failed to became pregnant with clomiphene citrate, were included in a multicenter, prospective, clinical study of treatment with a protocol of chronic low-dose and small incremental rises with urinary purified or highly purified FSH. Follicular development was monitored with ultrasonographic scans.
  
  
  RESULTS
  The 234 patients received a total of 534 cycles of treatment, for a mean number of 2.3 treated cycles per patient. hCG was withheld in 65 (12.2%) cyles because of no response and in 28 (5.2%) cycles because of hyperresponse. Of the remaining 441 cycles, 419 (95%) were ovulatory, and in 198 (47.3%) of these cycles a single dominant follicle developed. There were 93 pregnancies (39.7% per patient), for a cycle fecundity rate of 17.4%. Cumulative conception rate after two treated cycles was 33.5%. There were 14 (15%) pairs of twins and 10 (10.8%) spontaneous miscarriages. The prevalence of complications was low with no cases of severe OHSS. Basal LH/FSH ratio was significantly higher in the pregnant group of patients than in nonpregnant women.
  
  
  CONCLUSIONS
  Stepwise and chronic low-dose administration of FSH is a safe and effective method for treatment of WHO group II anovulatory infertility, mainly in those patients having high LH/FSH ratios.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Balasch
authors.forename: R
authors.initials: R
authors.lastname: Tur
authors.forename: P
authors.initials: P
authors.lastname: Alvarez
authors.forename: J M
authors.initials: JM
authors.lastname: Bajo
authors.forename: E
authors.initials: E
authors.lastname: Bosch
authors.forename: I
authors.initials: I
authors.lastname: Bruna
authors.forename: P
authors.initials: P
authors.lastname: Caballero
authors.forename: J
authors.initials: J
authors.lastname: Calaf
authors.forename: I
authors.initials: I
authors.lastname: Cano
authors.forename: E
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authors.lastname: Carrillo
authors.forename: J A
authors.initials: JA
authors.lastname: Duque
authors.forename: G
authors.initials: G
authors.lastname: Folguera
authors.forename: A
authors.initials: A
authors.lastname: de la Fuente
authors.forename: C
authors.initials: C
authors.lastname: Jiménez
authors.forename: G
authors.initials: G
authors.lastname: Laguens
authors.forename: E
authors.initials: E
authors.lastname: López
authors.forename: A
authors.initials: A
authors.lastname: Lozano
authors.forename: A
authors.initials: A
authors.lastname: Matarranz
authors.forename: C
authors.initials: C
authors.lastname: Moreno
authors.forename: J
authors.initials: J
authors.lastname: Nava
authors.forename: M
authors.initials: M
authors.lastname: Sanchis
authors.forename: E
authors.initials: E
authors.lastname: Temprano
authors.forename: G
authors.initials: G
authors.lastname: Ventura
authors.forename: J A
authors.initials: JA
authors.lastname: Peinado
mesh_terms: D000328:Adult; D000858:Anovulation / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D012449:Safety; D013030:Spain; D014463:Ultrasonography
chemical_list: D005640:Follicle Stimulating Hormone