[Clomiphene acetate and prednisone: alternative approach for the management of patients with chronic anovulation and clomiphene treatment failure].
Chronic anovulation is a common neuroendocrine cause of infertility. Pharmacological management of such condition includes the use of clomiphen citrate (CC), which is the most utilized of the ovulation inductors. Clinical efficacy of CC provides ovulation rates of around 70%. Those patients who did not respond are candidates to receive gonadothrophin treatment, which will increase costs and the risk of ovarian hyperstimulation and multiple pregnancies. Because of that, new alternative treatments have been assayed, such as the concomitant use of dexametasone. This alternative has improved the response, but its use has been limited because the side effects of this treatment overcome their benefits. Another alternative is the use of prednisone throughout the menstrual cycle together with CC administered in pre-established days. This treatment is expected to improve the response without adding side effects. However, its clinical efficacy and clínical tolerance have not been studied. In this study we used CC and prednisone in a sample of patients diagnosed with infertility and chronic anovulation, and with previous failure to the treatment with CC. Patients were compared to a group of women with similar characteristics but who received additional cycles of CC. The group that received prednisone and CC increased their ovulation rates in 38%, compared to 8% in women that received only CC. Similarly, pregnancy rates increased 20% in the CC plus prednisone group while the group that received CC alone remained in 0 pregnancies. In the total sample, tolerance to treatment was adequate. There were no side effects associated to the use of prednisone. We conclude that the treatment with CC plus prednisone is an alternative treatment for patients in which the classical treatment with CC has failed.
Vital Reyes
V S
VS
Hospital de Ginecobstetricia 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México D. F.
Tellez Velasco
S
S
Hinojosa Cruz
J C
JC
Reyes Fuentes
A
A
D000328:Adult; D000858:Anovulation / Q000188:drug therapy*; D002908:Chronic Disease; D002996:Clomiphene / Q000627:therapeutic use*; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D008137:Longitudinal Studies; D011241:Prednisone / Q000627:therapeutic use*; D011247:Pregnancy / Q000706:statistics & numerical data; D017211:Treatment Failure
D004965:Estrogen Antagonists; D005938:Glucocorticoids; D002996:Clomiphene; D011241:Prednisone