title: Extended clomiphene citrate (CC) and prednisone for the treatment of chronic anovulation resistant to CC alone.
abstract: OBJECTIVE
  To evaluate effectiveness and safety of a regimen of extended clomiphene citrate (CC) and prednisone for patients who fail treatment with CC alone.
  
  
  METHODS
  Retrospective observational analysis.
  
  
  METHODS
  University-based tertiary infertility center.
  
  
  METHODS
  Twenty-four anovulatory patients who failed to ovulate after CC 150 mg administered for 5 days.
  
  
  METHODS
  Treatment consisted of CC given on cycle days 3 through 9 (extended) at a starting dose of 100 to 150 mg/d. Additionally, patients were given prednisone 5 mg orally each night throughout the cycle.
  
  
  METHODS
  Ovulation was confirmed by luteal serum P. Pregnancy was confirmed by rising hCG levels and transvaginal ultrasound.
  
  
  RESULTS
  A total of 60 cycles were available for review. Forty-four of these cycles were ovulatory (73%) and 11 patients (46%) conceived on this therapy. Logistic (two-parameter) pregnancy occurrence over time (cycles) revealed a maximum pregnancy probability of 0.66 and a cycle fecundity of 0.36. No complications of therapy were noted.
  
  
  CONCLUSIONS
  Clomiphene citrate-resistant anovulatory patients have high rates of ovulation and pregnancy after treatment with extended CC and prednisone. This therapy offers a potential reduction in cost and risk and should be considered in this group of patients before gonadotropin stimulation or surgery.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA. IVFDOC@FIONA.UMSMED.EDU
authors.forename: J D
authors.initials: JD
authors.lastname: Isaacs
authors.forename: S R
authors.initials: SR
authors.lastname: Lincoln
authors.forename: B D
authors.initials: BD
authors.lastname: Cowan
mesh_terms: D000328:Adult; D000858:Anovulation / Q000188:drug therapy*; D002908:Chronic Disease; D002996:Clomiphene / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010060:Ovulation / Q000187:drug effects / Q000502:physiology; D011241:Prednisone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D005938:Glucocorticoids; D002996:Clomiphene; D011241:Prednisone